When people in healthcare talk about the promise of digital medical records, they often point to Kaiser Permanente. Yet when Kaiser has to deal with other healthcare groups, it confronts the same problems as the rest of the profession. For instance, it has a large clinic in Denver that works closely with two non-Kaiser hospitals. A few years ago, those hospitals decided to buy an EHR system. "We thought they should choose Epic. They said, 'We don't think we should.' " says Jack Cochran, a plastic surgeon who is executive director of the Permanente Federation, which oversees Kaiser's physicians. Sure enough, when the hospitals installed their software, Kaiser couldn't communicate with them electronically. Thankfully, the hospitals had fax machines.