Electronic medical record (EMR) systems are broadly advocated, yet implementations are often more difficult than anticipated and sometimes fail. The myriad problems faced when changing medical records from paper (or mixed paper/electronic) to a new EMR include several areas that, while important, receive less attention in medical informatics literature. Examples are attention to the complexities of clinical document life history, the accuracy of EMR user attributes, and the transition of responsibilities of medical record committees during EMR implementation. We'll discuss these and other EMR implementation issues, using examples drawn from the UW Medicine ORCA project.