This paper discussed on the importance of management system of paperless electronic medical record and pointed out that we would encountered lots of problems during the construction of paperless electronic medical record management system including authenticity， legal effect， similarity，safety， mistakes and missing of medical records. This paper analyzed these problems and proposed corre-sponding countermeasures including developing safety management system， whole-process monitoring of medical record quality， enhancing archive management， developing backup and recovery mechanisms， improving secrecy and authorization system， promoting borrowing management， performing copy system， strengthening electronic signature management， implementing unique number management and enhanc-ing overall quality of personnel