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Implementation of an electronic medical record (EMR) system is a complex process with broad implications. In a Midwestern hospital perinatal setting, EMR implementation involved several critical steps: strategic planning and project goal setting; project structure and governance; system requirements analysis; vendor selection and contract negotiation; and EMR training. No difference in patient care activities and communications among clinicians was found between pre- and post-EMR implementation; however, nurses’ perceptions of EMR were more negative afterward. Lessons learned and implications are provided.