The determination of the governing entity often is dependent on the type of organizations that form it and their beliefs about the HIE being a public good or a profit-making opportunity. When the HIE is organized by a government or non-profit entity, it is often formed as a public good. When the entity is formed by organizations that are for-profit, it is seen less as a public good and more as a means to improve the revenue for the stakeholder organizations. HIEs formed by a combination of public and private (both for-profit and not-for-profit) entities are deemed a public good, and therefore are non-profit entities.

In addition to whether an HIE is set up as a for-profit or not-for-profit/non-profit entity, HIE initiatives primarily are administered in one of two ways, state-run HIEs and community-based HIEs. The following sections describe each type of entity currently in place across the country.