Background - As many health care practitioners, health information management professionals, and health lawyers know, balancing patients’ privacy interests with the need to access accurate, up-to-date medical information can be challenging. Over the decade and a half since the passage of HIPAA, though, most have learned to maneuver within the mandates of the Privacy Rule while navigating its intersection with more restrictive state laws. Health care providers have implemented policies and procedures that safeguard patients’ health information—in compliance with federal and state requirements—while ensuring appropriate and timely access to medical records for permissible purposes, such as for treatment, payment, peer review, quality, public health, and law enforcement. Substance abuse records, however, are subject to more restrictive federal requirements related to disclosure and have remained particularly vexing to assess and incorporate into today’s modern health care environment. This is especially true as health care providers have sought to improve and enhance the interoperability of electronic health records, not only in response to the Affordable Care Act’s meaningful use and health information exchange (“HIE”) mandates, but also in response to the development of alternative payor models, innovative and collaborative care programs, and provider consolidation.