HIOs that are designed, implemented, and used to support value-added care processes and longitudinal care can enable clinical transformation. But ensuring provider and patient participation and trust in HIE is central to the long term success of HIE. Patients understand the value that comes from their providers having access to information that enables a timely diagnosis, improved coordination of care, and more efficient delivery quality care. However, patients also are aware of the potential misuse of their health information. The protection of privacy, as part of the mission of the HIO, makes it clear to all stakeholders that the clinical or administrative value of HIE and the protection of health information are irrevocably linked by all participants. A clear statement of privacy and security principles and information about privacy and security policies, communicated in terms that patients understand and available in multiple mediums to facilitate patient access, will underscore the importance of patient privacy and the patient-centeredness of HIE.