Health information exchanges (HIEs) offer potential data sources for public health agencies to improve chronic disease surveillance; however, public health has not yet capitalized on these data. This study identified barriers that public health departments participating in the Health Information Network of South Texas face regarding HIE and community-level surveillance of chronic diseases. This study focused on 2 health departments participating in the Health Information Network of South Texas. We administered a survey to inventory the technology infrastructure of health departments and conducted semistructured interviews of the local, state, and national officials. We identified 3 barriers to using HIE for disease surveillance: insufficient skilled staff, variation in how laws are interpreted, and lack of a coordinated public health information technology strategy. We provide 4 recommendations for policy and practice: personnel capacity development, interorganizational informatics collaboration, interim approaches to clarifying the legality of bidirectional HIE until overarching legislation is enacted, and development of an enterprise architecture plan.