In today's managed healthcare environment two issues are at the forefront of concern: patient safety and patient confidentiality. Both of these share a common element in their relationship with medical and pharmaceutical health data. Patient safety depends upon access to this information, and yet ironically, medical and pharmaceutical records are now more difficult to access. This article looks at a case study of patients in Appalachia and how various issues influence patient safety, information that is needed and how to use these resources to reduce medical risk, especially in pharmaceutical therapies of the elderly.