For more than 40 years, various health services researchers have noted the many distortions in the American healthcare economy that produce massive information assymetries and almost near opacity in the medical services delivery market. This paper comments on the potential of health information exchanges (HIE) to address many of these deeply embedded structural issues. Although hundreds of HIEs are emerging across the nation and the value of moving to a fully interoperable digital healthcare system has been widely recognized, the economic sustainability of HIEs remains a vexing matter While most of these organizations rely on a transaction- or production efficiency-based model, the authors conclude this model has economic limits and their future viability may rest upon HIEs becoming public utility infomediaries. As infomediaries that create value-not just in new exchange efficiencies but by establishing new system-wide feedback loops-HIEs may yield entirely new levels of value to many types of markets interested in better managing their portfolios of risk.