Medicare and Medicaid meaningful use incentives are anticipated to create demand for products and services that enable HIE among eligible providers. This demand for health information exchange will likely be met by an increased supply of marketed products and services to enable HIE, resulting in a competitive marketplace for HIE services. States/state designated entities (SDEs) are to include private sector stakeholders in their State HIE Program and will need to hold stakeholders accountable for their contributions to the development and universal adoption of HIE. For example, a state could rely on HIT vendors to develop and operate state level network services for HIE and for health plans to provide incentives to clinicians and hospitals for HIE.