Some HIE organizations (HIO) may act as a service provider. Like a telephone company, they offer various services at different prices. Your relationship is limited to picking the best contract for the best service at the best price. If you want something better or cheaper, you change providers - in other words, the service is a commodity. Like your phone company, they don't expect or even want you to seek a seat on their board.
Currently (summer 2014), this is not a common exchange service offering for public health. This is because HIE connections for health departments are not yet very standardized, and existing public health exchange services can be both limited and complicated from either a technology or a pricing perspective. However, as more exchange services become nationally standardized and integrated into certified EHR products, these relationships may become more common. Health departments investing in EHR systems may find some HIE services, like Direct messaging, currently offered through their EHR vendor, and thus may already have options to choose from.
More often, there will be a significant up-front business investment in the form of time, money and maybe technical modifications to implement HIE. The fiscally responsible health officer should ascertain whether the return on investment (ROI) - in money or in public health capacity - is worthwhile.
Such calculations are not always straightforward. In addition to calculating the costs and benefits of the exchange services arrangement, one must also consider the risk that the HIO in which you invest fails to produce the expected benefits, or to survive. On the other hand, your stockholding may give you influence and potential participation in the governance of the HIO.
Your value to the organization is more than financial. Because your participation may influence others' participation and funding, and because your department may bring unique information to the exchange, you might be able to negotiate when it comes to prices and services.
Finally, you may to enter a strategic relationship with an HIO, creating an ongoing affiliation for transformative change in the community. In other words, you may conclude that the health of the entire community could benefit from HIE services, and thus your involvement is about more than just your agency's ROI. At this level, the public health department is not only an investor, but becomes a strategic leader in the exchange.
Available relationship opportunities will change depending on who offers services in your jurisdiction, which services are needed by the health department, and the health department's capabilities. There is no "one right answer." The environment for HIE will likely continue to change rapidly over the coming years, and so will the need for regular reassessments of such decisions.