Of all the individual ideas for healthcare reform proposed by President Obama, the notion of transitioning to a fully electronic process for the maintenance of medical records would seem to be the most obvious. It also seems like one of the easier things to accomplish, given the other, more ambitious reforms on the agenda. After all, its clear that the technology for such complex electronic record keeping already exists and is currently in use by other industries. Yet nearly two decades after the beginning of the information revolution, while the technology has grown exponentially there has been little will to apply it to medical record keeping. President Obama was not the first inhabitant of the White House to suggest that enormous savings could be captured through the application of information science and Internet technology to replace old, paper based data management. Maximizing efficiency is one, legitimate way the insurance industry could keep the climbing costs of healthcare down without cutting service levels. Presidents G.W. Bush and Bill Clinton also supported moving in this direction. So what are the obstacles? Among the roadblocks to adoption of widespread Electronic Medical Records or EMRs in the US are such issues as: Interoperability – the ability (or inability) of disparate computer systems to “speak” with one another. Doctors’ offices, hospitals, labs, insurers, public health institutions, etc. Privacy – developing protocols for transfer of data among the numerous providers in a way that protects personal information (partially addressed in HIPAA) Legacy Data Capture – the logistics involved in scanning and entering existing patients’ medical histories into the system to avoid discarding valuable, historical, medical perspective Change Management – the process of fostering adoption of new technologies and practices across entire enterprise level industries is challenging Other obstacles to adoption include: cost of implementation, unclear standards across all programs, problematic legal issues (digital signatures and data preservation procedures etc.). Everyone seems to agree that implementing EMRs in the US is a worthy goal. Yet, as with so many goals worth achieving, this one is easier said than done.