This March 2014 report from the General Accountability Office (GAO) is critical of the U.S. Department of Health and Human Services (HHS) strategy to support nationwide health information exchange and interoperability. Among the continuing barriers to health information exchange identified in the report are insufficient health data exchange standards, concerns about how privacy rules can vary among states, difficulties in matching patients to their records, and costs associated with exchanging data, including the costs of electronic health records themselves. The report noted that the August 2013 Office of National Coordinator for Health Information Technology (ONC) and Centers for Medicare and Medicaid Services (CMS) strategy to advance health information exchange only described principles to guide health information exchange, but did not include any specific actions, priorities, and milestones. That ONC-CMS strategy document itself acknowledged that “gaps and challenges still remain for the widespread use of interoperable systems and HIE across providers, settings of care, consumers and patients, and payers. Both providers and their vendors do not yet have a business imperative to electronically share person-level health information across providers and settings of care that exceeds the cost of doing so.” The GAO report called for specific actions, priorities, and milestones to be established by the ONC, CMS, and HHS as a whole, to make more progress on supporting health information exchange (and to be consistent with strategies for effective governmental planning and implementation of programs. In its written response, HHS concurred with the GAO report’s recommendations.