Two trends have transformed the medical record from simple physician's office notes to complex records. First, medical care became much more technologically complex. Patients will see specialists for different problems so there is no longer a single physician who oversees all their care. There are also many more non- physician care providers such as physical therapists and laboratory personnel who participate in patient care. Medical records are the vehicle for communication between these different members of the medical care team and the medical record is, at least in theory, the common storehouse for all of the information about the patient's care and condition. These medical care team members must have access to the medical record to care for the patient and to record what they have done and observed. Records, or copies of the records, must move between different providers and institutions if the patient is to receive quality care.

Second, the growth of medical insurance and government paid care, such as Medicare and Medicaid, fundamentally changed the relationship between patients and medical care providers. Patients select physicians based on their health plan, and often change physicians when the health plans change. Many patients have no family physician and seek care as needed from emergency room physicians and ambulatory care clinics, seldom seeing the same physician twice. Medical records provide the only continuity to their care and these patients suffer because their records are not readily available. This has led to calls for national databanks for medical records so that a patient's medical information will be available wherever that patient seeks care.

Medical insurance inserts a third party into medical care because the insurer wants to know what care it is paying for and whether it was necessary. Very private medical information must be sent to the insurer if the patient wants the care paid for, and few patients can afford to pay for care without submitting the claims for payment. Private insurance is usually provided by employers, which leads to conflicts if the employee's medical information is shared with other employees or managers. The government paid programs monitor the care provided as closely as the private companies. At times the government will audit medical care providers to make sure they are complying with Medicare or Medicaid rules. The auditors will examine hundreds or thousands of medical records, with full access to all patient information.