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It’s been more than two decades since President Bill Clinton signed the Health Insurance Portability and Accountability Act into law in 1996. Since then, the rule has arguably become far more synonymous with its privacy provisions than the health plan flexibility for which it’s named.

And 20 years later, its rules – made all the more complex by the rise of health information technology and the electronic data exchange it enables – continue to confuse patients and providers alike, according to the American Health Information Management Association.

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