{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T07:39:46Z","timestamp":1771054786377,"version":"3.50.1"},"reference-count":65,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2017,11,2]],"date-time":"2017-11-02T00:00:00Z","timestamp":1509580800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/academic.oup.com\/journals\/pages\/about_us\/legal\/notices"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Research on the implementation of health information exchange (HIE) organizations has identified both positive and negative effects of laws relating to governance, incentives, mandates, sustainability, stakeholder participation, patient engagement, privacy, confidentiality, and security. We fill a substantial research gap by describing whether comprehensive state and territorial HIE legal frameworks address identified legal facilitators and barriers.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>We used the Westlaw database to identify state and territorial laws relating to HIEs in effect on June 7, 2016 (53 jurisdictions). We blind-coded all laws and addressed coding discrepancies in peer-review meetings. We recorded a consensus code for each law in a master database. We compared 20 HIE legal attributes with identified barriers to and enablers of HIE activity in the literature.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Forty-two states, the District of Columbia, and 2 territories have laws relating to HIEs. On average, jurisdictions address 8.32 of the 20 criteria selected in statutes and regulations. Twenty jurisdictions unambiguously address \u22645 criteria in statutes and regulations. None of the significant legal criteria are unambiguously addressed in &amp;gt;60% of the 53 jurisdictions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Laws can be barriers to or enablers of HIEs. However, jurisdictions are not addressing many significant issues identified by researchers. Consequently, there is a substantial risk that existing legal frameworks are not adequately supporting HIEs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The current evidence base is insufficient for comparative assessments or impact rankings of the various factors. However, the detailed Centers for Disease Control and Prevention dataset of HIE laws could enable investigations into the types of laws that promote or impede HIEs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocx122","type":"journal-article","created":{"date-parts":[[2017,10,13]],"date-time":"2017-10-13T19:13:28Z","timestamp":1507922008000},"page":"635-644","source":"Crossref","is-referenced-by-count":19,"title":["Falling short: how state laws can address health information exchange barriers and enablers"],"prefix":"10.1093","volume":"25","author":[{"given":"Cason D","family":"Schmit","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah A","family":"Wetter","sequence":"additional","affiliation":[{"name":"Sandra Day O\u2019Connor College of Law, Arizona State University, Phoenix, AZ, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bita A","family":"Kash","sequence":"additional","affiliation":[{"name":"Center for Health Organization Transformation, Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2017,11,2]]},"reference":[{"key":"2020110612223576500_ocx122-B1","volume-title":"Principles and Strategy for Accelerating Health Information Exchange (HIE)","author":"Office of the National Coordinator for Health Information Technology","year":"2013"},{"key":"2020110612223576500_ocx122-B2","doi-asserted-by":"crossref","DOI":"10.23970\/AHRQEPCERTA220","volume-title":"Health Information Exchange","author":"Hersh","year":"2015"},{"key":"2020110612223576500_ocx122-B3","volume-title":"Precision Medicine Initiative","author":"The White House"},{"key":"2020110612223576500_ocx122-B4","doi-asserted-by":"crossref","first-page":"4268","DOI":"10.1200\/JCO.2010.28.5478","article-title":"Rapid-learning system for cancer care","volume":"28","author":"Abernethy","year":"2010","journal-title":"J Clin Oncol."},{"key":"2020110612223576500_ocx122-B5","volume-title":"ONC Data Brief 24: Health Information Exchange among U.S. Non-federal Acute Care Hospitals: 2008-2014","author":"Swain","year":"2015"},{"key":"2020110612223576500_ocx122-B6","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.1377\/hlthaff.2014.0445","article-title":"Despite substantial progress in EHR adoption, health information exchange and patient engagement remain low in office settings","volume":"33","author":"Furukawa","year":"2014","journal-title":"Health Aff (Millwood)."},{"key":"2020110612223576500_ocx122-B7","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1111\/1468-0009.12180","article-title":"Differing strategies to meet information-sharing needs: publicly supported community health information exchanges versus health systems\u2019 enterprise health information exchanges","volume":"94","author":"Vest","year":"2016","journal-title":"Milbank Q."},{"key":"2020110612223576500_ocx122-B8","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.ijmedinf.2017.05.012","article-title":"Review of successful hospital readmission reduction strategies and the role of health information exchange","volume":"104","author":"Kash","year":"2017","journal-title":"Int J Med Inform."},{"key":"2020110612223576500_ocx122-B9","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1177\/0033354917722994","article-title":"Transitioning from paper to digital: state statutory and regulatory frameworks for health information technology","volume":"132","author":"Schmit","year":"2017","journal-title":"Public Health Rep."},{"key":"2020110612223576500_ocx122-B10","first-page":"117","article-title":"Privacy and public health in the information age: electronic health records and the Minnesota health records act","volume":"10","author":"Bomash","year":"2008","journal-title":"Minnesota J Law Sci Technol."},{"key":"2020110612223576500_ocx122-B11","first-page":"374","article-title":"Electronic health records: how the United States can learn from the French dossier medical personnel","volume":"30","author":"Grady","year":"2012","journal-title":"Wisconsin Int Law J."},{"key":"2020110612223576500_ocx122-B12","first-page":"133","article-title":"To HIPAA, a son: assessing the technical, conceptual, and legal frameworks for patient safety information","volume":"12","author":"Terry","year":"2005","journal-title":"Widener Law Rev."},{"key":"2020110612223576500_ocx122-B13","first-page":"4","article-title":"A guide to federal and state incentives for health care technology implementation","volume":"46","author":"Johnson","year":"2013","journal-title":"Md Bar J."},{"key":"2020110612223576500_ocx122-B14","volume-title":"Summary of Selected Federal Laws and Regulations Addressing Confidentiality, Privacy and Security","author":"of the National Coordinator for Health Information Technology","year":"2010"},{"key":"2020110612223576500_ocx122-B15","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1056\/NEJMp1700736","article-title":"The common rule, updated","volume":"376","author":"Menikoff","year":"2017","journal-title":"N Engl J Med."},{"key":"2020110612223576500_ocx122-B16","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1111\/jlme.12215","article-title":"The Role of Law in Supporting Secondary Uses of Electronic Health Information","volume":"43","author":"Ramanathan","year":"2015","journal-title":"J Law, Med Ethics."},{"key":"2020110612223576500_ocx122-B17","volume-title":"Nationwide Privacy and Security Framework For Electronic Exchange of Individually Identifiable Health Information I. Preamble to the Nationwide Privacy and Security Framework for Electronic Exchange of Individually Identifiable Health Information","author":"Office of the National Coordinator for Health Information Technology","year":"2008"},{"key":"2020110612223576500_ocx122-B18","volume-title":"Health Information Security and Privacy Collaboration HSPLC Roadmap: Analytical Framework and Collaborative Recommendations","author":"Harmonizing State Privacy Law Collaborative","year":"2009"},{"key":"2020110612223576500_ocx122-B19","volume-title":"Update to October 9, 2007 Report on State Privacy & Security Laws Related to Electronic Health Records and Electronic Health Information Exchange","author":"Harmonizing State Privacy Law Collaborative","year":"2008"},{"key":"2020110612223576500_ocx122-B20","doi-asserted-by":"crossref","DOI":"10.4337\/9781782545644","volume-title":"Innovative Governance Models for Emerging Technologies","author":"Marchant","year":"2013"},{"key":"2020110612223576500_ocx122-B21","first-page":"665","article-title":"The regulation of inchoate technologies","volume":"47","author":"Gervais","year":"2010","journal-title":"Houst Law Rev."},{"key":"2020110612223576500_ocx122-B22","first-page":"1","article-title":"Cultivating chaos: state responses to releases of genetically modified organisms","volume":"9","author":"Ludlow","year":"2004","journal-title":"Deakin Law Rev."},{"key":"2020110612223576500_ocx122-B23","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1080\/17579961.2009.11428365","article-title":"Regulating emerging technologies","volume":"1","author":"Mandel","year":"2009","journal-title":"Law, Innov Technol."},{"key":"2020110612223576500_ocx122-B24","doi-asserted-by":"crossref","first-page":"e127","DOI":"10.1016\/j.ijmedinf.2011.01.012","article-title":"Collaboration in electronic medical evidence development: a case study of the Social Security Administration\u2019s MEGAHIT System","volume":"80","author":"Feldman","year":"2011","journal-title":"Int J Med Inform."},{"key":"2020110612223576500_ocx122-B25","doi-asserted-by":"crossref","first-page":"e19","DOI":"10.2196\/medinform.3455","article-title":"Health information exchange implementation: lessons learned and critical success factors from a case study","volume":"2","author":"Feldman","year":"2014","journal-title":"JMIR Med Inform."},{"key":"2020110612223576500_ocx122-B26","volume-title":"Evaluation of the State Health Information Exchange Cooperative Agreement Program: Case Study Synthesis: Experiences from Five States in Enabling HIE","author":"Dullabh","year":"2013"},{"key":"2020110612223576500_ocx122-B27","first-page":"613","article-title":"Large scale health information exchange: implementation experiences from five states","volume":"192","author":"Dullabh","year":"2013","journal-title":"Stud Health Technol Inform."},{"key":"2020110612223576500_ocx122-B28","doi-asserted-by":"crossref","first-page":"9987","DOI":"10.1007\/s10916-013-9987-7","article-title":"Challenges, alternatives, and paths to sustainability for health information exchange efforts","volume":"37","author":"Vest","year":"2013","journal-title":"J Med Syst."},{"key":"2020110612223576500_ocx122-B29","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1287\/mnsc.2015.2194","article-title":"The impact of privacy regulation and technology incentives: the case of health information exchanges","volume":"62","author":"Adjerid","year":"2016","journal-title":"Manage Sci."},{"key":"2020110612223576500_ocx122-B30","volume-title":"Trends in Individuals\u2019 Perceptions regarding Privacy and Security of Medical Records and Exchange of Health Information: 2012-2014","author":"Patel","year":"2016"},{"key":"2020110612223576500_ocx122-B31","first-page":"48","article-title":"Impact of health disclosure laws on health information exchanges","volume":"2011","author":"Adjerid","year":"2011","journal-title":"AMIA Annu Symp Proc."},{"key":"2020110612223576500_ocx122-B32","volume-title":"FINAL REPORT Key Challenges to Enabling Health Information Exchange and How States Can Help","author":"Dullabh","year":"2014"},{"key":"2020110612223576500_ocx122-B33","volume-title":"Evaluation of the State Health Information Exchange Cooperative Agreement Program Experiences from Wisconsin in Enabling Health Information Exchange (HIE) Case Study Report: Experiences from Wisconsin in Enabling Health Information Exchange (HIE)","author":"NORC","year":"2012"},{"key":"2020110612223576500_ocx122-B34","volume-title":"Report to Congress, April 2015 \u2013 Report on Health Information Blocking","author":"Office of the National Coordinator for Health Information Technology","year":"2015"},{"key":"2020110612223576500_ocx122-B35","doi-asserted-by":"crossref","first-page":"302","DOI":"10.14236\/jhi.v22i2.135","article-title":"Health care provider perceptions of a query-based health information exchange: barriers and benefits","volume":"22","author":"Cochran","year":"2015","journal-title":"J Innov Heal Inform."},{"key":"2020110612223576500_ocx122-B36","volume-title":"Evaluation of the State Health Information Exchange Cooperative Agreement Program. Case Study Report: Experiences from Texas in Enabling Health Information Exchange (HIE)","author":"NORC","year":"2012"},{"key":"2020110612223576500_ocx122-B37","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1136\/amiajnl-2011-000394","article-title":"The financial impact of health information exchange on emergency department care","volume":"19","author":"Frisse","year":"2012","journal-title":"J Am Med Inform Assoc."},{"key":"2020110612223576500_ocx122-B38","doi-asserted-by":"crossref","first-page":"ocv068","DOI":"10.1093\/jamia\/ocv068","article-title":"An Empirical analysis of the financial benefits of health information exchange in emergency departments","volume":"22","author":"Yaraghi","year":"2015","journal-title":"J Am Med Inform Assoc."},{"key":"2020110612223576500_ocx122-B39","doi-asserted-by":"crossref","first-page":"e39","DOI":"10.2196\/medinform.5215","article-title":"Outcomes from health information exchange: systematic review and future research needs","volume":"3","author":"Hersh","year":"2015","journal-title":"JMIR Med Inform."},{"key":"2020110612223576500_ocx122-B40","volume-title":"Evaluation of the State Health Information Exchange Cooperative Agreement Program. Case Study Report: Experiences from Nebraska in Enabling Health Information Exchange (HIE)","author":"NORC","year":"2012"},{"key":"2020110612223576500_ocx122-B41","volume-title":"The State HIE Program Four Years Later: Key Findings on Grantees\u2019 Experiences from a Six-State Review","author":"Dullabh","year":"2014"},{"key":"2020110612223576500_ocx122-B42","volume-title":"Evaluation of the State Health Information Exchange Cooperative Agreement Program Experiences from Maine in Enabling Health Information Exchange (HIE)","author":"NORC","year":"2012"},{"key":"2020110612223576500_ocx122-B43","first-page":"333","article-title":"Hidden value: how indirect benefits of health information exchange further promote sustainability","volume":"5","author":"Tzeel","year":"2012","journal-title":"Am Heal Drug Benefits."},{"key":"2020110612223576500_ocx122-B44","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1093\/jamia\/ocv072","article-title":"Assessing payer perspectives on health information exchange","volume":"23","author":"Cross","year":"2016","journal-title":"J Am Med Inform Assoc."},{"key":"2020110612223576500_ocx122-B45","first-page":"1158","article-title":"Improve synergy between health information exchange and electronic health records to increase rates of continuously insured patients","volume":"3","author":"Gold","year":"2015","journal-title":"EGEMS (Washington, DC)."},{"key":"2020110612223576500_ocx122-B46","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijmedinf.2015.12.005","article-title":"Health information exchanges: unfulfilled promise as a data source for clinical research","volume":"87","author":"Parker","year":"2016","journal-title":"Int J Med Inform."},{"key":"2020110612223576500_ocx122-B47","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/2001-1326-2-10","article-title":"Rapid, responsive, relevant (R3) research: a call for a rapid learning health research enterprise","volume":"2","author":"Riley","year":"2013","journal-title":"Clin Transl Med."},{"key":"2020110612223576500_ocx122-B48","first-page":"643","article-title":"Clinical decision-support systems","volume-title":"Biomedical Informatics","author":"Musen"},{"key":"2020110612223576500_ocx122-B49","first-page":"438","article-title":"Which components of health information technology will drive financial value? Am J Manag Care","volume":"18","author":"Kern","journal-title":"2012"},{"key":"2020110612223576500_ocx122-B50","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1136\/amiajnl-2013-002073","article-title":"Sociotechnical challenges to developing technologies for patient access to health information exchange data","volume":"21","author":"Ancker","year":"2014","journal-title":"J Am Med Inform Assoc."},{"key":"2020110612223576500_ocx122-B51","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1215\/03616878-3665931","article-title":"Policy surveillance: a vital public health practice comes of age","volume":"41","author":"Burris","year":"2016","journal-title":"J Health Polit Policy Law."},{"key":"2020110612223576500_ocx122-B52","first-page":"237","article-title":"Measuring statutory law and regulations for empirical research","volume-title":"Public Health Law Research: Theory and Methods","author":"Anderson"},{"key":"2020110612223576500_ocx122-B53","first-page":"135","article-title":"The Department of Veterans Affairs, Department of Defense, and Kaiser Permanente Nationwide Health Information Network exchange in San Diego: patient selection, consent, and identity matching","volume":"2011","author":"Bouhaddou","year":"2011","journal-title":"AMIA Annu Symp Proc."},{"key":"2020110612223576500_ocx122-B54","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/j.ijmedinf.2014.04.005","article-title":"The Department of Veterans Affairs\u2019 (VA) implementation of the Virtual Lifetime Electronic Record (VLER): findings and lessons learned from Health Information Exchange at 12 sites","volume":"83","author":"Byrne","year":"2014","journal-title":"Int J Med Inform."},{"key":"2020110612223576500_ocx122-B55","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1136\/jamia.2010.006502","article-title":"Physicians\u2019 opinions of a health information exchange","volume":"18","author":"Hincapie","year":"2011","journal-title":"J Am Med Inform Assoc."},{"key":"2020110612223576500_ocx122-B56","volume-title":"Evolution of State Health Information Exchange: A Study of Vision, Strategy, and Progress","author":"Rosenfeld","year":"2006"},{"key":"2020110612223576500_ocx122-B57","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1001\/archinternmed.2010.54","article-title":"Health information exchange: participation by Minnesota primary care practices","volume":"170","author":"Fontaine","year":"2010","journal-title":"Arch Intern Med."},{"key":"2020110612223576500_ocx122-B58","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.hjdsi.2013.12.005","article-title":"Health information exchange among U.S. hospitals: who\u2019s in, who\u2019s out, and why?","volume":"2","author":"Adler-Milstein","year":"2014","journal-title":"Healthcare."},{"key":"2020110612223576500_ocx122-B59","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1377\/hlthaff.28.2.435","article-title":"Engaging patients for health information exchange","volume":"28","author":"Tripathi","year":"2009","journal-title":"Health Aff (Millwood)."},{"key":"2020110612223576500_ocx122-B60","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/S0378-7206(98)00099-8","article-title":"Information technology for collaborative advantage in healthcare revisited","volume":"35","author":"Pouloudi","year":"1999","journal-title":"Inf Manag."},{"key":"2020110612223576500_ocx122-B61","doi-asserted-by":"crossref","first-page":"1486","DOI":"10.1377\/hlthaff.2013.0124","article-title":"Operational health information exchanges show substantial growth, but long-term funding remains a concern","volume":"32","author":"Adler-Milstein","year":"2013","journal-title":"Health Aff (Millwood)."},{"key":"2020110612223576500_ocx122-B62","volume-title":"Nationwide Health Information Network (NHIN) Trial Implementations Task 9 Deliverable: Jurisdiction-Specific Business Plan","author":"Overhage","year":"2009"},{"key":"2020110612223576500_ocx122-B63","first-page":"1e","article-title":"Health information exchange: metrics to address quality of care and return on investment","volume":"9","author":"Khurshid","year":"2012","journal-title":"Perspect Heal Inf Manag."},{"key":"2020110612223576500_ocx122-B64","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1186\/1472-6947-13-121","article-title":"Measuring the impact of a health information exchange intervention on provider-based notifiable disease reporting using mixed methods: a study protocol","volume":"13","author":"Dixon","year":"2013","journal-title":"BMC Med Inform Decis Mak."},{"key":"2020110612223576500_ocx122-B65","volume-title":"Measuring Nationwide Progress: Interoperability and Exchange of Health Information","author":"Vanesco, Measurement Community of Practice","year":"2015"}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/25\/6\/635\/34149997\/ocx122.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/25\/6\/635\/34149997\/ocx122.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,6]],"date-time":"2020-11-06T17:23:13Z","timestamp":1604683393000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/25\/6\/635\/4587931"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,2]]},"references-count":65,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2017,11,2]]},"published-print":{"date-parts":[[2018,6,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocx122","relation":{},"ISSN":["1067-5027","1527-974X"],"issn-type":[{"value":"1067-5027","type":"print"},{"value":"1527-974X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2018,6]]},"published":{"date-parts":[[2017,11,2]]}}}