This is the final evaluation report of the State Health Information Exchange Cooperative Agreement Program. The State HIE program was created to enable rapid development of health information exchange across the nation. The evaluation found that there is no one-size-fits-all solution with exchange. Development and use of health information exchange is predicated on the state and local environments. There is now more health information exchange capacity in the nation, as well as a path forward toward greater data use for both exchange and interoperability. .