ABSTRACT
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 526
In 2009, the United States government enacted the Health Information Technology for Eco-
nomic and Clinical Health Act (HITECH) that includes an incentive program totaling up to $27
billion for the adoption and meaningful use of Electronic Health Records (EHRs). Health informa-
tion exchanges have emerged to facilitate the meaningful use of health information by sharing and
exchanging somewhat disparate and distributed EHRs. According to HITECH, the meaningful use
of EHRs can help “improve care coordination, reduce disparities, engage patients and their fami-
lies, and improve population and public health” [12]. Such meaningful use can only be achieved
through carefully controlled sharing and exchanging of personal health information and complying
with existing regulations such as the Health Insurance Portability and Accountability Act (HIPAA),
otherwise the privacy of patients may be severely damaged. In the United States, 75% of patients
have expressed concerns about uninformed sharing of their health information [44], possibly due to
the frequent data breaches in medical institutions [27].