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

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# Public standards and patients' control: how to keep electronic medical records accessible but private {#article-title-2} 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.2 In this article we propose two doctrines and six desirable characteristics to guide the development of online medical record systems. We describe how such systems could be developed and used clinically. #### Summary points Electronic medical record systems should be designed so that they can exchange all their stored data according to public standards Giving patients control over permissions to view their record—as well as creation, collation, annotation, modification, dissemination, use, and deletion of the record—is key to ensuring patients' access to their own medical information while protecting their privacy Many existing electronic medical record systems fragment medical records by adopting incompatible means of acquiring, processing, storing, and communicating data Record systems should be able to accept data (historical, radiological, laboratory, etc) from multiple sources including physician's offices, hospital computer systems, laboratories, and patients' personal computers Consumers are managing bank accounts, investments, and purchases on line, and many turn to the web for gathering information about medical conditions; they will expect this level of control to be extended to online medical portfolios # Medical information: access and privacy {#article-title-3} No single institution can hope to encompass a patient's entire record. Ideally, it should be possible to create or assemble …