All systems go down at some point.

So John Glaser, CIO of Partners Healthcare, wasn't particularly worried when the electronic medical record (EMR) system used by more than 6,000 doctors and nurses affiliated with Partners started experiencing brief outages in late July. After all, since the start of 2004 the EMR system had experienced anywhere from two to six short disruptions a month—slowdowns or outages lasting from a couple of minutes to several hours. Inconvenient, yes, but not the end of the world. There was no reason to suggest that this was any different.

But the disruptions got worse—the outages occurring with greater frequency. The automated alerts Glaser receives when his systems are strained poured in. Doctors called and e-mailed with complaints. Partners administrators let him know that a lot of people were irritated. In every crisis there is a point at which the notion that this is just a bad week gives way to the recognition that you are treading on thin ice.

By early August, Glaser says, "we realized we were in trouble."

Between then and mid-September, Partners' EMR system slowed or shut down 25 times, often for hours at a time. Each disruption affected every doctor on the system; they could not gain access to their patients' medical records, and at times clinics were forced to turn patients away untreated. The IS department faced heat on all sides—from the doctors whose work was disrupted and from Partners' administration who feared a medical mutiny over the EMR system.

Dr. Mark Eisenberg, a doctor at Partners' Charlestown Healthcare Center, couldn't access his patients' medical records for 45 minutes during one of these slowdowns. "It is a real problem if we have no record to look at when we see a patient," Eisenberg says. "There are real concerns about care if you can't see lab results or what medications someone is taking."

Partners is Boston's largest hospital group. The organization includes two of the city's major academic hospitals—Massachusetts General (MGH) and Brigham and Women's—as well as smaller community hospitals, clinics and even individual doctors' offices. The two hospitals have been among the earliest adopters of medical information systems. Some of their doctors have been using the electronic medical records for 15 years, and the overall adoption rate is about 70 percent within Massachusetts General and Brigham and Women's hospitals. The rest of the community lags far behind, however. Excluding the large hospitals, the adoption rate for the rest of the Partners network is only 10 percent. One of Partners' top goals over the past two years has been to bring on board these users, a group of approximately 2,000, who are mostly physicians in private practices affiliated with one or more of the hospitals in the Partners system.