Electronic health records (EHRs) have the potential to increase the quality and decrease the cost of cancer care. These twin goals can only be met by a fully functional oncology EHR, which includes at a minimum: searchable data repositories, clinical decision support (CDS), the ability to electronically order chemotherapeutic medications, and the ability to interface with patients via a patient portal. Such fully functional EHRs not only offer patients the best potential for high-quality care, they enable retrospective analysis to answer a wide variety of comparative effectiveness and quality improvement questions. The significant barriers of cost, time pressures, aversion to CDS, and interoperability will need to be overcome if EHRs are to be meaningfully used by the majority of oncologists.