As mentioned above, HIOs are required to comply with state privacy regulations. When HIOs operate across state lines (or exchange health information with HIOs in other states), compliance with state laws can be tricky. Efforts are ongoing by several states to harmonize their laws to reduce variations in requirements, but this work is in an early phase of development.

The HIPSC report on the harmonization of state privacy laws contains links to roadmaps from states as they move toward the implementation of HIE⁴.

In addition, the ONC offers information on resources that can assist HIEs that are trying to address challenges to exchanging health data across state lines. The State Health Policy Consortium, funded by ONC and managed by RTI, is open to multi-state groups that are trying to resolve privacy and security policy issues to enable exchange of health information across states.