As the delivery of healthcare by an increasing number of service providers becomes more complex, there is an increasing need for patients to understand their treatment plans and to compare them with what they should expect to receive. Changes in society mean that patients may now have the opportunity and desire to view their electronic health record and share it with others electronically. This is the basis of the paradigm shift in healthcare. But patients, clinicians and managers need to consider how to do this safely and responsibly. There are a number of challenges that need to be overcome including informing patients and empowering them, understanding the financial model to support this as well as the change management and data protection issues, understanding how information is recorded in the record, producing tools to encourage patients to be active participants, reducing the digital divide, enabling easy identification of high-quality information, producing a framework for enabling safe sharing of information, understanding the role of a local care record development board which helps to manage the change, enabling semantic interoperability in a global market and understanding how we can assess its success. This heralds a new era of 'real-time digital medicine'.