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Three major approaches to sharing healthcare information electronically exist: message-based sharing, data warehousing, and common architecture. Message-based approaches allow institutions to share information, even if they have different storage systems. Data warehouses, as the name suggests, are repositories information that can be accessed by providers, and common architecture involves an integrated architecture storage system that links providers. A common domain-specific EHCR data model is regarded as ideal as it is commonly accessible and thus least likely to result in medical errors due to incomplete information. However, the implementation of this model has proven difficult in the U.S. (Grimson, Grimson & Hasslebring 2000: 50).

The European Union nations are already embarking upon an even more ambitious initiative in the form of total unity of all nations' databases, although this too has proved elusive, given an inability to agree upon specific models. For example, "the Good European Health Record concentrated on providing a comprehensive model that captures all the rich ethico-legal semantics of the EHCR, while the W3-EMRS placed more emphasis on the ability to share records securely between institutions and agreeing on a common data set for the shared record" (Grimson, Grimson & Hasslebring 2000: 50). Much of the article involves discussing the different applications and advantages of specific approaches and software systems. Ultimately, this is frustrating given that the conclusion of the article is that while the technological implementation will be determined by developments in the non-healthcare markets of business and IT, the methods by which healthcare data will be structured must be determined by pressures and demands of the healthcare community itself in a united fashion. Uncertainty about the value of a truly united system of records and reconciling different security needs for different contexts has made such universal agreement a challenge.

Many of the concerns of the article have grown outdated, such as its tentative discussion of how the World Wide Web can be useful in information-sharing. A more comprehensive discussion of the need for discussion between healthcare entities in the industry and across borders about the most effective way to implement ER and to share data in a secure manner, and the cultural reasons for why such dialogue has not occurred, would have been more useful and ultimately made the article less dated. A specific comparison of how different systems can work in action, rather than just a theoretical discussion of the software architecture would also have made a more persuasive case for the superiority of different systems over others.