For those who don't follow this stuff, last week marked the official demise of the Santa Barbara County Care Data Exchange (their website is already down -- there's some background here). The Santa Barbara project was a pioneering effort launched by (among others) David Brailer, the first and former head of the Office of the National Coordinator for Health IT.
The project struggled for many years with a variety of issues, but never did go live. After 8 years and over $10 million, the project leaders finally called it quits. A report in Government Health IT cites legal and technical costs associated with privacy protection as the final straw (see Privacy, funding doubts shutter Calif. RHIO). In a presentation given to the eHI Connecting Communities coalition (subscription only), one of the project's leaders emphasized that technology was not the issue, and that lack of a detailed and viable business plan undermined the project's long-term prospects.
I think there will be many lessons and cautionary tales coming out of this pioneering effort -- they'll probably dribble out over time. Sad to say but this could be the first of many "RHIOs" that throw in the towel for lack of a real business model.