For many security-conscious executives, the next big frontier will be health information exchanges. "HIEs are the biggest access and security challenge moving forward," says Bill Spooner, senior vice president and CIO at San Diego-based Sharp Healthcare. "The usefulness of the HIE will depend on how well we work through it. We want to be absolutely secure in getting patient consent for sharing their information, and at the same time, make sure their information is available."

It's an issue being raised across the country. The University of Pittsburgh Medical Center recently launched a data exchange with several area hospitals. Access to information will be based on having a prior relationship with the patient, says John Houston, vice president privacy and information security. "You want to make sure that not just anyone can query the HIE," he says. "Members will be contractually committed to doing the right thing. But the members will need to enforce appropriate conduct." Technology can only go so far in preserving patients' rights, he says. "The HIE is based on trust."

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