In 2004, the federal government set an ambitious goal of ensuring that most Americans have electronic health records within 10 years and the presence of a widespread clinical information exchange capability will greatly facilitate this goal. Through HEAL NY, New York State is currently awarding millions of dollars in grants to support health information technology initiatives across the state through regional clinical information exchanges. The financial success of these initiatives is expected to result from improvements in health care quality and efficiency. However, whether these initiatives will be cost saving, as experts assert, and what the return-on-investments of these initiatives will be are unknown. Answering these questions will provide critical information to the nation as we progress towards a national health information network. We will conduct a multi-center financial evaluation of regional clinical information exchanges. The results of the financial evaluations proposed in this study will provide a framework and standardized methodology including metrics for financial evaluations of regional health information organizations and return-on-investment analyses from the perspectives of providers and payers. We will consider the financial effects as driven by changes in quality, safety, and efficiency.