The answer remains elusive. A number of factors create barriers to consumer engagement and consumer mediated HIE, including the paternalistic nature of medicine, the current structure of health insurance plans, the indirect nature of third-party payment, technology-related challenges, and factors related to behavioral economics (why individuals act in certain ways). Each of these categories is discussed in some detail in Appendix A. Still, it is important that health information organizations (HIOs) and policymakers continue to chip away at the barriers, as consumer engagement is ultimately part of the long-term solution to many of the problems plaguing modern healthcare. This report considers these challenges specifically as they relate to HIE and offers some concrete, near-term recommendations for beginning to overcome them.