The meaningful use (MU) regulations provide incentive monies for hospitals and physicians that establish electronic health records systems (EHRs) and satisfy other criteria, such as providing new forms of ‘patient engagement’ like technologically-enabled patient-provider communications. The advantages of a wireless record-sharing are enormous – quicker diagnoses, better quality tracking, and seamless payment systems. But there are lots of steps and decisions required in setting up EHRs and developing broader data exchange systems like health information organizations/exchanges (HIOs or HIEs). Last week, the Department of Health and Human Services’ Office of the National Coordinator denied certification for two small EHRs and promised ongoing rigorous enforcement of EHRs. Those engaged in developing of EHRs and HIEs must address a range of operational and legal issues, including picking and monitoring vendors; figuring out patient consent issues, particularly with respect to sensitive psychiatric, substance abuse and other data; determining governance issues; figuring out how to finance the HIE; and assessing other potential risks, such as if the HIE fails to link a record to the right patient or the HIE is hacked or accessed by an unauthorized person. Many are studying these challenges and seeking solutions. The College of Healthcare Information Management Executives recently sent a comment letter to ONC suggesting the development of a single set of standards for certification. Based on the need, common approaches and product designs will emerge out of solutions developed in the field today by hospitals, health systems, physicians, vendors and others–sooner rather than later.