A report in Health Data Management describes how Kaiser Permanente has implemented a comprehensive health information system, including an electronic medical record. The project took twice as long as projected and cost more than twice as much, partly due to scope creep and likely also to the usual problems with large IT projects. (HDM article) One of the biggest areas of unanticipated cost was the loss of productivity due to training and implementation efforts. A number of valuable lessons can be learned from Kaiser’s experience and perhaps the most important is that anyone who things achieving wider use of health information technology in our diverse health system is going to be quick or easy is very, very wrong. It is likely to take much longer and be much more expensive than even the experts currently anticipate.