ent view of our health or treatment situation, especially at a time of urgent need. Moreover, doctors’ famously indecipherable handwriting can itself pose potential perils.

Fortunately, there is an emerging digital alternative to analog record keeping—the electronic medical record (EMR), sometimes referred to as PHR (personal health record), PMR ( personal medical record), or even EHR ( electronic health record). No matter what it’s called, the EMR promises to be a digital portfolio of our medical records, from health history to test results to images, all accessible and updatable from anywhere at any time as needed.

In principle, an EMR offers benefits to patients, doctors, and insurers (both private and public). Since most patients lack access to their doctors’ charts, the status quo results in a fire-wall between us and our own medical information. In contrast, with the right software, patients could securely view their own EMR from anywhere, potentially helping them be better informed participants in their own healthcare, especially when communicating with medical professionals.

For doctors EMRs provide administrative benefits; for example, office staff are freed from manually managing paperwork, allowing them to focus on more important tasks. Plus, storing large volumes of paper charts takes up costly real estate; with EMRs stored “in the cloud” records management becomes much less cumbersome and potentially cheaper.

Administrative efficiency is nice, but the more significant benefit to doctors is that EMRs promise to improve their ability to provide care.

With instant access to comprehensive patient data, decisions can be based on a more complete picture of a patient’s condition. Additionally, the software that stores and manages EMRs can apply program logic to help guide diagnoses or even catch errors; for example, if a doctor prescribes a drug contraindicated with another by type or dose, the EMR could signal whether further review is warranted, potentially catching dangerous mistakes. Prescribing the wrong medication—an often touchy subject in medical circles—was addressed in a 2006 report by the Institute of Medicine, which stated that more than 1. 5 million Americans per year are harmed by “errors in prescribing, dispensing and taking medications.” Electronic health records could go a long way toward reducing such mistakes.

Closely related to digital records are electronic prescriptions, or “ e-prescriptions.” As with paper charts, patients easily forget or lose the scribbles they carry from doctor to pharmacist; moreover, at least some percentage of medication errors are the direct result of errors in reading or entering prescription information. These problems could essentially disappear with e-prescriptions sent directly from a doctor’s office to a pharmacy, yet as of 2008 only about 6 percent of U.S. doctors used e-prescriptions, despite the fact that more than 70 percent of pharmacies—including all major chains—accept them. To further accelerate e-prescribing, the Medicare Improvements for Patients and Providers Act of 2008 includes bonuses to be paid by Medicare to doctors using e-prescriptions.

Pushing medical providers to go digital attracts political support; U.S. politicians from both the left and right, including President Barack Obama and former House Speaker Newt Gingrich, have publicly given theirs. Indeed, the Veterans Administration uses an EMR system called Vist A to serve four million patients, making it the largest single medical provider and EMR user in the U.S. However, when it comes to enlisting medical providers, EMR-adoption details must still be worked out, along with the other aspects of health informatics. We might call such details “the three Ps”: privacy, payment, and protocols.

Privacy in Practice

In our digital culture of unsolicited marketing, data breaches, and identity theft, news headlines regularly remind us about the risk of storing digital information. Our health information is at once an especially personal and intimate account that must be shared to some degree for us to receive proper medical care. It can also make a tempting target for identity thieves and other snoops.

How personal medical data might be exploited runs the gamut. For example, prescription data may be sold to marketers, a practice currently allowed by U.S. law when data is “ de-identified,” or personally identifying information is removed. But studies suggest de-identification does not always achieve anonymity, even when following requirements. Pharmacies like Walgreens and CVS Caremark buy and sell prescription data, theoretically bound by privacy laws that require it to be de-identified before it can be distributed. But no law prevents com-