Microsoft, of all the companies that might consider creating a PHR, is especially problematic. Microsoft has a long history of standards abuse.

Lets consider a parallel issue to the "personal health record", personal email. I use gmail and have used yahoo mail in the past, but for this example lets pretend that I used Hotmail, a Microsoft Product. Hotmail users trust Microsoft to protect and store potentially sensitive personal email data. I currently have at least a gigabyte of personal messages on my mail account. At this rate I will have at least 100 gigs of messages assuming I die of old age. What if my wife (who will likely outlive me given that she is younger and averse to simple sugars, cholesterol, sodium and saturated fats in a way that I am not) wanted to ensure that my emails survived Microsoft's eventual demise? After inheriting my password, my wife could download everything via Hotmail's POP3 service. She could download my emails to a proprietary package like Outlook, or better yet, a GPL email application. She could transfer them to another service that she trusted, like gmail.

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HealthVault: Abusing vs Implementing Standards.