January 2020. The regulatory environment surrounding health information exchange (HIE) is complex, and includes variations in state policies regarding patient consent for data exchange. We analyzed 2016 national hospital data and found that hospitals in states with opt-in consent policies were more likely to report regulatory barriers to health information exchange, compared to hospitals in opt-out consent states. However, this was concentrated among less technologically equipped hospitals. We found no relationship between consent policies and the actual amount of HIE in which a hospital engaged, suggesting that burdens brought on by opt-in policies may fall disproportionately on less technologically advanced hospitals. This may further exacerbate the digital divide in hospital technology adoption.