This article describes the initial and ongoing efforts of our pulmonary medicine practice to deploy an electronic medical records (EMR) system. Key factors in the vendor selection and implementation process included (1) identification and commitment to long-term goals for EMR; (2) dedicated resources, including both physician and nonphysician champions to lead the design and implementation teams; and (3) ample patience and time allotted to achieve the desired results: a fully functional system that enhances quality, improves operational efficiency, and reduces costs. An EMR scorecard including multiple system attributes was designed to facilitate vendor comparisons. Perseverance, patience, and compromise were necessary to overcome the challenge of changing the behavior of providers and support staff. We have accomplished improvements in workflow automation and reductions in staff hours, office supplies, file space, and transcription costs. Our system lacks pulmonary-specific templates and prompts for work flow and clinical decision making. We have directed internal resources and outsourced professional support to design these features as our practice strives to enhance our quality of care with pulmonary disease management that conforms to national guidelines.