We consider the practical aspects of justifying, planning, implementing, and budgeting for an electronic medical record. Examples include the decision about integrating versus replacing old systems, the timing of implementation for each clinical area, preparation for installing computerized order entry, a discussion about how to implement physician progress notes, and a discussion about how electronic nursing systems interact with the EMR. Integration of other systems such as PACS and EKGs are discussed. Wireless integration and telemedicine also are addressed, as well as backup, redundant systems and budgeting. The reader will gain a full understanding of the scope of the problems involved in implementing an EMR, and will have a step-by-step description of how to approach the task.