I ran into a friend recently who is an IT muckity-muck for a big health system in a 2.5 system town.  Everyone decided that signing up for (and funding) the public utility HIE that was envisioned by people who actually do not have to compete in the market place did not make sense.  Everyone decided to go their own way, pursuing (and funding) their own private HIEs that would let them realize value from connecting with their physician networks.

Each retreated to their own corner and, surprise, the two big players independently picked the exact same HIE vendor.  (Some dude in that market is getting a big commission check, making the President's Club, and going to Hawaii).

So, should they now collaborate?  It would be pretty easy.

There is still that little issue of competition and using unique connectivity with a physician network to create advantage and win.