This section focuses on the legal protection of personal medical information in the clinical setting and research settings. When this personal medical information also has public health significance, these laws and regulations have exceptions that allow the sharing and use of the information to protect the public health and to maintain vital statistics records. Since most clinical research depends on the use of the patient's existing medical treatment records, it is key to understand the legal protections for those records before introducing the special rules for research. The legal protections for medical records and the regulations governing their use in research are in the process of dramatic change. What was once a system of paper records governed by a mishmash of state laws and very limited overall federal control is moving to an electronic world regulated by federal law. The key legal change has been regulations authorized by the Health Insurance Portability and Accountability Act HIPAA of 1996 (HIPAA) .