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Electronic health records (EHR) offer clear efficiency, productivity, and safety benefits to health care organizations, medical personnel, and patients. Implementing an EHR modernization program throughout the Department of Veterans Affairs (VA) health care system proved to be a huge challenge, given the size and scope of VA facilities, the interoperability requirements within multiple, interconnected systems, and the complexity of change management while maintaining the quality of care for America's veterans. This case study provides an overview of change management processes within large organizations, using the implementation of the Veterans Health Administration's Electronic Health Record Modernization (EHRM) project as a management challenge. The case includes a description of the Department of Veterans Affairs and its health care system, describing previous electronic health record systems. Despite the attempts to innovate, VHA patients and providers often struggled to locate critical health information. But the initial EHRM test rollouts revealed that even the most systematic planning and implementation could result in surprises.