Microsoft has unveiled HealthVault, a program that allows consumers to keep their health records online. Google has plans in the works to do a similar program, and the web is full of offerings designed to give consumers more information about healthcare. But central to the issue of making electronic health records work is creating systems on a widespread basis that can talk to each other. Work around integration issues is ongoing, but there are four major challenges facing efforts to create a meaningful electronic medical records program in the United States.

1. The landscape of electronic medical information is fragmented.

First, there is the issue of the types of records themselves: Electronic medical records (EMRs, which are also called electronic health records or EHRs) are the health care provider records of patient information and treatment, and include such things as doctor’s notes, blood test results and so on. By contrast, the term personal health records (also called PHRs) can be anything from a health plan supplied history of what tests a patient received (but not necessarily the results) to a mother’s tracking of a her family’s treatments, illnesses, and forays into fitness. It’s the area of electronic medical records that has received the lion’s share of attention from proponents of an improved way of treating healthcare data, while focusing little attention on the patient’s piece in all of this.

“While we’re seeing more and more movement to connect disparate parts of health care system to facilitate medical delivery, the effort to enable consumers to connect with health information is very immature,” says Janet Marchibroda, CEO and founder of the eHealth Initiative, a nonprofit group that seeks to use IT to improve healthcare.

Generally, health care information is thought of in disparate buckets: health care provider, health plan, and patient. “Nirvana, the one we’re all shooting towards is an electronic health record that our doctors have access to and we also have access to as we navigate our own health care,” she says. “Conceptually it requires having info about us in a patient-centric way. I have these allergies, I take these drugs.” She says that ideally consent to see what information would lie at the determination of the patient. “We haven’t figured all this out yet but you’re seeing change in the marketplace.”