Countries are moving forward to develop databases from electronic health records for monitoring and research. Twenty-two of twenty-five countries report a national plan or policy to implement electronic health records and 20 report starting its implementation. Eighteen national plans include the secondary use of the data. Thirteen countries are using data from electronic record systems to monitor public health, eleven countries to conduct health research and nine countries to monitor patient safety. Barriers to creating and analysing databases from electronic health records reported by countries include concerns with current legislative frameworks, particularly as they apply to data privacy protection (16 countries); problems with the quality of data within EHRs (14 countries); and resource constraints to database creation (nine countries) and to the de-identification of data to protect privacy (seven countries). Data quality concerns include a lack of clinical terminology standards; improper coding; missing data; and variable quality across health care providers.This chapter reports findings from the 2011/12 OECD study of 25 countries regarding current uses of electronic records in physician offices and hospitals; national plans to implement electronic health record systems; implementation of national systems; the development of minimum datasets; the use of structure and terminology standards to code data; the status and technical challenges of database creation from electronic health records; and current uses of data from electronic health records including public health, patient safety and health system performance monitoring.