In "Ryba's 16 rules of effective HIE" published in Government Health IT, I recently wrote about what I believe to be the rules that can be used to define an HIE that is reusable across all use cases. I don't get into what technical implementation it supports or even what type of healthcare information is being exchanged. However, if your HIE complies with these rules, I believe you have a "fully effective" HIE. That said, if it does not, it may or may not be adequately effective for where the world is today. The point is, these rules are what I think exchanges, public or private, should comply with, or at least should be able to comply with, from a functional perspective. How soon you will need to meet all of them will probably be determined by market forces or government mandates in your area.
While I left technology out of the rules, if you follow any of my previous writings, you know I of course believe that a services oriented architecture and enterprise service bus best applies to the rules primarily due to its inherent focus on resuability and abstraction. So, if you are building your HIE using an ESB, I think you are probably heading in the right direction.
If you haven't yet met all the rules, you probably are not alone. The rules are what I think we aspire to. They are based on mostly where we are but to a greater degree where we are going.
To answer my title question, our HIE is effective and is mostly compliant to the rules, but like all HIEs, we still have work to do. Abstraction is an area that seems to always need continual maturity for both syntactical interoperability to transform between transports and schemas and semantic interoperability to translate terminology between different vocabularies. Syntactical interoperability allows one to know what the other is saying; semantic interoperability allows them to understand what you mean. This is never-ending work since new standards emerge or version on a regular basis. The abstraction rule is where myself and my staff spend a lot of our time. We see it as a big part of the technical solution value of HIE the noun.