Electronic health records (EHR) hold promise in improving the quality and efficiency of health care, yet the health care system remains years behind other industries with respect to the adoption of information technology (IT). Stakeholders in the medical community, including government and tertiary hospitals, have emphasized the urgent need to adopt IT systems. This paper reviews the current research and development efforts related to EHR in Korea, which have been supported by the government since December 2005, on the basis of the following core EHR components: EHR architectures that incorporate an external, implementation-independent view of a complete EHR; EHR functionality for defining tasks that an EHR system should perform; semantic ontology for developing standard vocabularies at the national level; EHR messaging standards for exchanging data; and clinical decision support systems for improving patient safety. Recent international work on EHR systems and the underlying trends are described, and suitable directions for research and development are suggested under relevant subtopics. Advances in the relevant areas will greatly facilitate our ability to achieve interoperability and promote patient safety. However, EHR systems will perform optimally only if we improve our understanding of the political, structural, and technical foundations for EHR, and reach consensus via collaborations between all the stakeholders in the health care system.