To drive health information exchange (HIE), community and state efforts were federally funded to broadly engage providers in exchanging data in ways that improve patient care. After federal funding ended, a national survey of community and state HIE efforts was conducted. 106 operational HIE efforts engaged more than one third of all US providers in 2014. However, this number is down from 119 in 2012, and represents the first decline observed since the tracking of these efforts began in 2006. Only half of operational efforts reported being financially viable, and all efforts reported a variety of barriers to continuation.