These findings help fill a gap in knowledge about what type of HIE use occurs for children and under what conditions. Healthcare professionals, advocates and the government believe HIE has the potential to transform healthcare and children may benefit greatly from the improved information sharing. However, the simple existence of these systems is not likely to be sufficient and assuming use will automatically follow existence is unfounded. HIE systems must be applied to the delivery of care and the improvement of patient health. The improved use of HIE to avoid duplication and improve coordination of care for pediatric patients will be increasingly important as health reform moves to extend coverage to nearly all children.