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The Boston Electronic Medical Record Collaborative is working to develop a system that will use the World Wide Web to transfer computer-based patient information to clinicians in emergency departments. Maintaining adequate confidentiality of these records while still facilitating patient care is paramount to this effort. This paper describes an explicit protocol that would make it possible to electronically identify patients and providers, secure permission for release of records, and track information that is transmitted. It is hoped that other, similar efforts now underway will be able to use and build on this model. Comment on this proposal is invited from all parties with an interest in confidentiality. The system will be used only with 'scrubbed' data--data from which all identifiers have been removed--until it is generally agreed that the confidentiality methods proposed here are appropriate and sufficient., The Boston Electronic Medical Record Collaborative has designed a protocol that must be met by any security technology to be used in the transfer of patient records over the Internet or World Wide Web. The potential benefits of being able to instantly transmit a patient's medical records as needed to a hospital emergency department are considerable, if patient confidentiality is protected. The protocol sets requirements for access, patient consent, authentication and other aspects of confidentiality balanced against the need for instant information.

Development of a comprehensive medical information system may improve the quality of health care in the US. Management of patient information has always been an important concern in the practice of medicine. A research article examined the use of computer-based patient records by primary care physicians in the Netherlands. Over 25% of Dutch primary care physicians have introduced computer-based records to their practices. Management of patient records in the US has often been fragmented with no comprehensive system for storage and retrieval of information. Many of the information systems introduced in the US have focused more on administrative tasks than on patient care. Four criteria may need to be met for development of a successful patient information system in the US. These include increased physician interaction with the system, introduction of a standardized vocabulary, more support by professional groups and better use of government funding.