Most of the practices that we advise and that are using some form of EHR are struggling to make their adoption successful. The struggles range from the minor troubles such as workflow disruptions and input irritations that drive staff nuts, to the “what have we done to ourselves” sentiment. There is a common theme among these practices, and that is that every one of them made major missteps key areas of the project before the first piece of software was ever installed. They were not adequately prepared, and as one physician recently shared with me, his practice has been “harmed” by their EHR efforts.