An official looking letter from the Department of Veterans Affairs arrived. “I am writing to inform you that a portable computer hard drive used by the Veterans Affairs Medical Center is missing. The hard drive included demographic information and identifiers, such as UPIN, dates of birth, state license numbers, business addresses and what may be your employer identification number.” The letter, dated May 2007, reminded me of last year’s news story: the theft of a Veterans Administration computer that contained personal data on millions of veterans and active-duty personnel.EMR Pros & consElectronic medical records have advantages and disadvantages. Yet, despite worrisome possibilities such as these, I believe the pros outweigh the cons.Access to InformationIt’s wonderful to be able to share information across specialties in our multi-specialty clinic. The chart is always available — even from home or on the road — when a special need arises, and is never lost on someone’s desk. A back-up copy nearly eliminates the potential for catastrophic loss of data as might occur with a fire or other disaster. The research possibilities associated with electronic records are limitless — including the ability to search and analyze records to assess cost and quality, as well as the potential for retrospective studies on the efficacy of treatment, assuming quantitative outcome measures are used and recorded. Facilitating Patient CareElectronic records can facilitate recording of medical encounters, reminding doctors to assess specific variables. An electronic system can help remind doctors to ask psoriasis patients about joint pain or to encourage them to join the Psoriasis Foundation. An electronic system can also remind us to follow pay-for-performance criteria. While paper systems could do similar things, they would be more cumbersome. Plus, one can track who accesses an electronic record — something much more difficult to do with a paper system. Just knowing that tracking is taking place probably deters people from inappropriately looking through another person’s records. Hedging the RisksElectronic records also take up a lot less space than the numerous paper folders in our file rooms. And, as the VA has discovered to its consternation, that does make it easier for someone to walk away with a large volume of data. Clearly, as appealing as a single national medical record system may be, it won’t be risk-free because while reducing the risk of one disaster, it increases the chance of another. Fortunately for me, the VA has given me the contact information for the big three national credit bureaus, so I can take steps to protect myself from their data loss. Steven R. Feldman, M.D., Ph.D.Chief Medical Editor