The debate over the electronic medium through which patients will view their health records has gained heat with a set of announcements by a private venture. Backers of the Health eCard, which stores patient records on a smart card the size of a credit card, are overtly citing public concern about the troubled programme to computerise the NHS in England as a reason for patients to pick smart cards rather than the official NHS web channel for access to their records.

Although both sides say they can coexist, the debate illustrates a worldwide battle of media for providing patients and clinicians with access to electronic patient records. The essential divide is over whether records are best stored on smart cards or similar computer memory devices carried by patients1 or inspected online through the internet or dedicated kiosks in, for example, general practice waiting rooms.

In general, the web is favoured in the US, where software giant Google recently followed its rival Microsoft in announcing trials of an internet based health records service. But support for health cards is strong in Europe, where several governments are issuing citizens with identity cards designed to hold medical data.

The NHS, after an early experiment with cards, …