The extended length of time needed to plan, select, configure, implement, refine, and, finally, achieve effective use of an EMR remains one of the most important reasons for the limited availability of these systems for physicians in the United States. In a 2002 study,7 The Ohio State University reported a 7-year time period from the completion of EMR strategic planning to complete installation. Of course, this length of time may be considerably less in a smaller health-care setting; however, the importance of this report is that, irrespective of the size of the organization, the implementation of an EMR takes vision, planning, and institutional perseverance, which is a rare commodity in American health care today. By the term institutional perseverance, I mean that once organizations have decided to adopt an EMR, there must be a commitment to continued, focused, and innovative leadership in continuing the project over a period of years. The time in office of senior managers in American hospitals today, in particular the chief information officers, suggests that there may be several senior leaders within a health system before an EMR is completely implemented and effectively becomes part of the culture of an organization. However, experience has shown that expecting current leadership to be in place for the completion of an EMR project is a key element in achieving success.