Currently, 90% of the provider staff and 100% of the employees have fully adopted EMR at 12 months from the “go-live” date. Our goal is to move the balance of the providers by 18 months from “go-live.” Prior to “go-live,” scanning criteria used to transition existing paper charts to EMR were established and agreed upon by the clinical team. The practice used 2 years’ worth of previous data as a starting point and included items such as the initial consultation, initial polysomnogram, and pertinent radiology reports beyond the 2-year mark. Initially, 1½ full-time equivalents (FTEs) of support staff per location were assigned to the scanning and importing function. Scanning began nearly 3 months prior to “go-live” and continues daily. With improved efficiency, it is accomplished within 10 h per week per practice site. During active “go-live,” provider office appointments were reduced by 50% during the first 30 days, and by 25% in the second 30 days. The majority of providers successfully returned to their routine office schedules within 90 days of “go-live.” Work flow continues to improve in clinical triage, medication management, preauthorizations, clinical orders, disease-specific template design, and medical-file management, and in the widespread use of real-time communication among providers, staff, and patients with flags, phone notes, scanned documents, and e-faxing. Interoperability remains one of our greatest challenges among the several hospitals, diagnostic facilities, and sleep laboratories in which we practice. Finding universal solutions that work within the confines of an institutional infrastructure remains an unresolved dilemma. We are hopeful that government pressure to comply with accepted standards will help in this regard.