US regional health information organizations or health information exchanges have received widespread scrutiny because their persistent efforts often display disappointing results. This case study is based on a literature review of one of the earliest and most comprehensive health information exchange initiatives in North America, the Santa Barbara County Care Data Exchange. This project was proposed in 1998, commenced in 1999 and terminated operations on December 31, 2006. The project was ultimately unsuccessful. However, numerous lessons were learned, a greater foundation of knowledge is emerging and opportunities exist to gain further knowledge from this failed project.

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