Public standards and patients' control: how to keep electronic medical records accessible but private Commentary: Open approaches to electronic patient records Commentary: A patient's viewpoint

A patient's medical records are generally fragmented across multiple treatment sites, posing an obstacle to clinical care, research, and public health efforts. 1 Electronic medical records and the internet provide a technical infrastructure on which to build longitudinal medical records that can be integrated across sites of care. Choices about the structure and ownership of these records will have profound impact on the accessibility and privacy of patient information. Already, alarming trends are apparent as proprietary online medical record systems are developed and deployed. The technology promising to unify the currently disparate pieces of a patient's medical record may actually threaten the accessibility of the information and compromise patients' privacy. We describe how such systems could be developed and used clinically.