The transition from paper medical records to electronic medical records (EMRs) started in the 1960s, spearheaded by often-forgotten leaders including Larry Weed (University of Vermont) and Octo Barnett (Harvard, Massachusetts General Hospital), whose successes occurred in spite of poor support from the available technology and, in some cases, their organizations. Proponents have identified the ability of EMRs to improve health care and lower costs. Accordingly, national initiatives have begun in the United Kingdom, the Netherlands, and the United States. With few exceptions, politics, technology, and medical practice have challenged larger implementations. California Kaiser Healthcare's EMR was far more expensive and complex than projected, and national implementations in the United Kingdom and Netherlands have been difficult. The evolution of EMRs has significantly transformed the skill sets required for medical records professionals, and this textbook teaches the basic skills needed to understand the engineering required for this technology.