This guide is designed to help ministries of health, implementers and others involved in establishing eHealth architecture and health system project teams get started with health information exchange. Over the past few years we have observed that some implementers choose to start their journey by working in a specific OpenHIE component like a facility registry. Other implementers may choose to start with a health exchange project that allows for sharing of health data. While a third group started at a more foundational level like doing an eHealth Architecture or blueprint project. Each of these starting points has benefits and challenges. Ultimately, the components, the data exchange projects and the architecture are needed to benefit fully from health information exchange and none of these pathways is mutually exclusive. The path toward data exchange is a multi-faceted journey that will take time.