An increasing number of hospitals are implementing electronic medical records and other information technology (IT), and national policy is focused on fostering expansion of these systems. In September 2004, a 100-bed acute care hospital in a rural community was awarded a grant to implement and evaluate an integrated hospital IT system. The evaluation used qualitative and quantitative methods, including examining data on patient outcomes, conducting surveys of staff, and interviewing leaders and staff about the implementation process. In the end, the hospital suffered a number of setbacks during the implementation that could provide lessons to other hospitals. The hospital was hindered by a lack of clinical leadership, staff skepticism, turnover in the executive team, an overly aggressive schedule, and a vendor whose products were not ready on time. The IT implementation was associated with a large increase in patient care errors, including medication errors, procedure errors, and patient falls. These patient errors might have been averted if the launch of the IT system had been better planned and implemented. The experience of this hospital exemplifies difficulties that can be encountered when implementing IT systems. IT implementation must have unbending support from the top level of management, strong clinical leadership, a proactive internal marketing campaign, a timeline and implementation approach that allow for learning and change, and a good IT partner. Careful planning and thoughtful perseverance are required to ensure a successful IT implementation that benefits patients.