For much of the world, truly productive and functional Electronic Health Record Systems (EHRs) remain an elusive goal of the future. Opportunities abound from the visibility provided by the availability of Health Information Technology funding in the U.S. and other countries of the world. Now is the time to seize the initiative to move from the past to the future to design HIT systems that meet the specific needs of each nation of the world in a way that is obtainable and affordable, and that provides an immediate return on investment. We need to move from an electronic system based on the paper-system to an empowering system based on available technology. We need to recognize that the EHR is not just for data storage but needs to become an intelligent, active partner with the healthcare provider and the patient to enhance health. This paper describes the current state of EHRs and addresses challenges for moving into the future.