Regional health information organizations (RHIOs) rapidly integrate and deliver patient information to clinicians from multiple independent care organizations. By providing such information, they can reduce health care costs and improve safety. Special concerns about privacy arise as these regional systems connect nationally. We should add special barriers beyond the protections of the Health Insurance Portability and Accountability Act (HIPAA) to protect against surprises at the national level. At the local level, we should remain within the HIPAA rules because the application of additional barriers to RHIO access would interfere with efficient and safe care.