We write in response to Rind and colleagues' article on maintaining the confidentiality of electronic medical records shared over the Internet [1]. Although the proposed policy has some excellent features, we believe it also contains the following flaws.

First, no explicit procedure is provided for informing all patients that they may object to the electronic transmission of their records between institutions. Second, it is not clear how clinicians will obtain information about the existence of a patient's records at other institutions and whether this will be done in a way that does not violate patient confidentiality. Third, it is not clear whether the patient will have control over what information is transmitted. Will the patient's entire record be transmitted? This issue is critical in view of the fact that the record becomes part of the permanent record of the recipient institution.

Fourth, nothing is said about who may have access to the record in the recipient institution after the emergency has passed. Fifth, the process of assuring a recipient institution that a patient has given consent for the transmission of his or her records is inadequate. Finally, the policy does not address any of the issues related to the electronic transmission of patient records between geographically separate entities that belong to the same corporate network. One of the paradoxes of the current U.S. health care structure is that the transmission of electronic patient records without consent between entities with corporate links is permissible. But the patient is less concerned with corporate relationships than with just who will see what.

We believe that the proposed policy needs to be strengthened.