I recently attended a plenary session with an Audacious Inquiry Colleague, Edmond Magny, for the NOVA RHIO. The NOVA RHIO group has been formally meeting for the past 18 months discussing approaches to health information exchange in the Northern Virginia area and a strategy to address the inherent challenges in this kind of effort.We attended the session to get a better grasp on where in the process the NOVA group is, to understand the current participants and stakeholders at the table and to understand the current funding realities. The session began (as most do) with a 30 minute meet and greet for the attendees. This latest group had grown considerably larger (according to those with prior attendance) and signaled progress in moving the group to action. Towards the end of the meeting I spoke with Jane Woods, former Virginia Secretary of Health and member of the NOVA RHIO group, on some of the challenges she has been facing and her goals for the state of Virginia. Her understanding of the healthcare problem and her passionate belief that health information technology could play a large role in solving that problem were energizing. On many subsequent calls with Ms. Woods I have been impressed with her ability to pull the right groups together to quickly work towards a common goal around an actual health information exchange (HIE) project, no small feat for anyone who is familiar with the challenges and failed efforts. Audacious Inquiry has been travelling the country, meeting with RHIO and HIE vendor executives and developing strategy for our clients on strategic approaches to health information exchange. I think a key lesson from that initial meeting, working with Ms. Woods and from our study of other efforts, is that just having a workable strategy is insufficient. A long-term commitment and a passion and belief in the solution, while maintaining the ability to modify and adapt your approach as the landscape changes, is critical to a successful approach to health information exchange. The NOVA RHIO effort, like many others around the country, is in its infancy. The coming months and years will prove challenging, but the early direction is a promising one.