The case for electronic health records seems undeniable. They've proven to boost physician efficiency and productivity. Prices for fully functional EHR software continue to decline. Sweeten that with today's affordable hardware, and financing is less of an issue. Yet, with all the arrows pointing to EHR adoption, resistance still exists. This hesitation can partly be blamed on implementation.

Perhaps a bitter colleague who bought an EHR told you about the dreaded words found only in the contract's fine print: staff training courses . . . initial changeover support rates . . . paper record conversion fees . . . the list goes on.

So the EHR fairy tale is clouded not only with extra dollar signs but the imagined chaos of converting from paper to electronic charts. You're looking into a tablet PC like a deer in headlights, unable to pull up a med list. Your staff is running around like headless chickens trying to send you electronic messages. Patients feel like they're the unfortunate guinea pigs in a medical records experiment.

Don't let your imagination get the best of you, though. Once you choose the EHR that's right for you, implementation doesn't have to be difficult. That's what I discovered when I converted to an EHR in 2004. I had just joined my father's solo practice, and our staff was so computer-challenged that most of them didn't know how to use a mouse. Yet we made the switch without a trainer from our EHR vendor. Here are some lessons from our experience of going from paper-weighted to paperless.

Play with it. Don't shut down your practice for a week and spend thousands of dollars having someone intensively train you and your staff on all the functions of the EHR; most of them will be forgotten in a week. I was in a practice that did this, and I learned more from fiddling with the program for an hour than I did after viewing hundreds of PowerPoint slides. Most tasks for the EHR are no more complicated than checking e-mail. Software demos and free or inexpensive tutorials allow you to set your own pace.

Start out and work in. It's a simple guideline that promotes seamless change. First, automate tasks outside of the exam room, such as scheduling and interoffice communication, then gradually phase in point-of-care charting. There's no reason to "go live" on a certain morning and abruptly abandon your paper charts. You'll only frustrate yourself and confuse your staff.

This incremental approach also lets you ease into buying hardware. In many practices, the existing hardware is more than adequate at the beginning. It's unrealistic to foresee your medical staff's preference for tablet PCs, laptops, exam-room workstations, or pocket PCs. Take your time, evaluate the situation, and make purchases as you go. There's no hurry.

Make scheduling your first baby step. Begin by teaching your staff to use the EHR's scheduling module for follow-ups and new-patient visits. This gets employees familiar with the look and feel of their new system and how it "thinks." Then they can move existing appointments from your old scheduling software to the EHR.

Next, move to interoffice messaging. Electronic messages are a fantastic replacement for all the handwritten notes that doctors and staff exchange. Think about the patient who calls to renew a prescription. Instead of a staffer slapping a sticky note on the patient's chart, she can send you an electronic message, and you can zap a reply right back. Eventually staffers can even attach the patient's electronic record to the message instead of pulling the paper chart.