The authors also describe at length their efforts to improve clinical quality with their EMR. This is, after all, the fundamental goal. And here again, we see the challenges. EMR systems generally are not sold out of the box with numerous preloaded clinical templates, order sets, or decision support rules. Vendors, after all, primarily employ software developers, not clinicians or expert consensus groups. Therefore, configuring EMR tools to help improve care is often a “phase 2” effort that occurs after a practice has survived the initial operational transition to the EMR.