When CIOs debate the difficulty of installing electronic medical records, they inevitably point to Kaiser Permanente. The $40 billion healthcare organization has been deploying electronic medical records (EMR) in various pockets of its provider and insurance network for more than a decade and decided to link them all into one companywide system. System outages, physician rebellion, privacy issues Kaiser has dealt with it all. CIO Phil Fasano, who joined Kaiser in 2006, talks about weathering the ups and downs. \n\nQ: You weren't there at the start of Kaiser's many e-health projects. How did you reset those that may have been off-track? \nTo read more on this topic, see: Booster Shot.\n\n\n\nA: The challenges were well written about and had to do with reliability in IT, timing, budget and our progress.\n\nQ: So, a little bit of everything was causing trouble?\n\nA: You learn things as you go along. The organization has gone through some significant learning about what was required of IT to make this a success. I spent my first six months with physician leadership and got a deep understanding of what an integrated system means, what it means to be a physician at Kaiser Permanente and a patient at Kaiser Permanente. Once you implement an EMR, it becomes core to delivering care. If the system is unavailable for an hour, that just can't be. We made major investments in data centers, servers, networksin the hundreds of millions of dollars. \n\nQ: How should healthcare CIOs plan EMR projects to qualify for stimulus funds? \n\nA: They tend to take two to five years. There's a lot to do. Think about why you need a medical record, and have that be your primary driver, not the incentive money. Physicians have to be onboard. They're the ones who will get meaningful use out of it. It's more than just [IT] keeping them aware. Physician leadership has to be involved. Physicians listen best to other physicians. \n\nDo you Tweet. Follow me on Twitter @knash99. Follow everything from CIO Magazine @CIOMagazine.