For a person's health care information to be readily available electronically (or conversely secured from access) across multiple health care systems, a number of technical and policy issues must be addressed. Beside the usual issues of defining a common standard for the representation of a computationally complex health care record, there is the even more complex issue of managing person identity and rules and choices regarding information disclosure across institutional and political boundaries. The United States Department of Veterans Affairs (VA) and Department of Defense (DOD) have evolved several solutions and policies that address many of the issues involved for such identity management (GCPR - Government Computer Patient Record; FHIE - Federal Health Information Exchange; BHIE - Bi-directional Health Information Exchange; CHDR - Clinical Data Repository/Health Data Repository). The departments use a "federated model" for Master Person Indexes (MPIs) with pre-established policies and rules for exchanging and matching identity information. Persons' records can be automatically matched across the departments based on predefined traits or can be selected individually for matching or exclusion from sharing identity information. Details of the policies, processes and political issues will be described and discussed. - Cameron Schlehuber - USA