When he was reelected in 2004, President George W. Bush set a target date of 2014 for the completion of a national electronic medical records network. But it’s anyone’s guess if that deadline will be met, says Peter Waegemann, CEO of the Medical Records Institute, the Boston-based organization he founded to help promote the use of information technology in healthcare. President Bill Clinton had called for this to be done by 2004, if anyone’s counting.

Google’s efforts to popularize web-based personal health records come as the U.S. government finally seems to be getting serious about pushing a nationwide electronic health record network that would connect doctors, hospitals, insurers, patients, and other players.

The government-led Nationwide Health Information Network seeks not to impose one system, but rather encourage a patchwork of systems or “network of networks” that could be stitched together once standards have been agreed upon. The money would come mostly from the providers themselves, which could be an obstacle. Installing an electronic records system initially could cost $44,000 on average per physician, according to a September 2005 study in Health Affairs. The feds, however, will kick in some incentives. One example: Medicare in June announced a $150-million grant to help 1,200 small physician practices in 12 cities across the country switch from paper to electronic records.

All the players will ultimately have to agree on standards and systems that work and are interoperable—a task that won’t be easy either, says Dr. Robert M. Wachter, chief of the medical service at the University of California, San Francisco. “There are good computer systems and there are bad computer systems,” says Wachter, who is a member of Google Health’s advisory council. “They only get better when you get real doctors, nurses, and others feeding back into the system so you know what the bugs are.” Getting all of America’s hospitals, doctors officers, pharmacies, patients, and others wired could end up costing as much as $276 billion over 10 years, according to a January 2005 study in Health Affairs. But the same study forecasts annual savings as high as $78 billion a year from a reduction in administrative work, redundant medical tests, and the length of hospital stays, among other savings.

Wachter warns the national undertaking is vastly more challenging than linking together the hundreds of banks in the United States, so that a consumer can withdraw money at Wells Fargo, say, even if she banks at Citibank. In healthcare, there are close to 1 million different doctors offices, clinics, hospitals and other enterprises, all with different terminology, codes, and standards, he says. Do doctors write a condition down as dyspnea or shortness of breath? Do they use kilograms or pounds? “All of these have to be agreed upon so information can be shared seamlessly,” he says. “Computerization of healthcare is much harder than the computerization of Safeway or the air traffic control system.”

Google appears to be positioning itself for a role in the process as it’s creating an open system and sharing its programming interface, which will be able to interconnect with a variety proprietary systems. This way, Google Health users can import data from their pharmacies, labs, and clinics, all of which may be on separate systems, and send it to their new doctors, who may be on other systems. Google Health users, however, will remain in control of when and if their data is shared. “So we really want data to be able to flow in and out based on the patients’ wishes and we want it to be up to the consumer to decide what systems are most useful to them,” says Dr. Roni Zeiger, Google Health’s product manager who is also an urgent-care physician.

Waegemann says he is encouraged that companies like Google are taking this problem on. “Whenever the government is involved, it has not been very positive,” he says. The British government has spent billions on an electronic medical records system, but it has bombed, he says, largely because “the system they have put in front of the doctors is one they don’t like,” says Waegemann. That’s certainly not a prescription for success.