A pilot study at the Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK, examined the use of the Standard Generalized Markup Language (SGML) for electronic patient records. Seven hundred patients had their text records encoded in SGML and 14 of these patients had legacy, laboratory and other data included. Records were incorporated in a commercial SGML database to demonstrate in-context searching. A commercial SGML browser allowed rapid access to clinical events in large records. A study of comparative file sizes between formats was performed. The acceptability of electronic records was assessed with clinicians. Specifications for the system are discussed and the relationship with traditional technologies explained. SGML represents a suitable format for the manipulation and publication of electronic patient records.