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A unified patient medical record offers hope for better care and reduced costs without deteriorating the confidentiality of patient information. However, two kinds of confidentiality concerns--patients' desire to preserve privacy and vendors' desire to limit knowledge of their systems and control the data in them--impede the full exploitation of medical records for better patient care. We should be using patient records both to detect health IT problems and for epidemiological research. In neither case should we decide that the importance of secrecy, whether asserted by companies or patients, completely trumps the use of health data for research. In particular, corporate secrecy should be limited when information is necessary for treatment and research. We need to balance public health against risks to both patient concerns and commercialization.