Interoperable electronic medical records (EMRs) have the potential to produce better health outcomes while improving the efficiency of care delivery and reducing its costs. Implementation will require massive changes at all levels. In many instances, the costs of implementation could fall on one group, while savings will accrue to some other group. A successful transition strategy identifies a series of steps, where each step pays its own way, at the level of the local groups directly affected, and lays the foundation for the next step. Such a strategy implies an era in which large groups will likely play a critical role.