The odds seemed stacked against a new health information exchange in Michigan as it began operating in what had become a precarious business climate. Unsustainable HIEs in District of Columbia, Kansas City and Kingsport, Tenn., were shutting down. An eHealth Initiative report counted just 18 HIEs among hundreds in existence that broke even on operations without depending on grant money.

A $548 million federal grant program was rushing financial reinforcements to the rescue of HIEs, but none of that money was destined for fledgling Michigan Health Connect, which had been hatched in 2009 by three competing health systems in the western Lower Peninsula and went into operation by 2011.

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