An emergency department (ED) clinical system was developed by in-house personnel, with ED physician, nursing, registration and clerical staff input. The utilization of existing hardware and customization of the hospital's mainframe hospital information system (HIS) facilitated the implementation of a cost-effective system that meets the information access needs of a busy, state-of-the-art academic ED. The transition to automation of the ED was facilitated through the use of a comprehensive training plan and change strategies.