Decisions with respect to advanced clinical information systems that ultimately will form an electronic health record (EHR) system are being made almost exclusively by some IT departments or the vendor, rather than more appropriately by end-user stakeholders. There are myriad examples of issues that arise when an EHR is viewed only as an IT project. These range from issues impacting direct patient care to risk management and many issues in between. The dilemma in many cases is that it is difficult to engage end-users -- it is much easier for IT or the vendor to simply make the decisions. As a result, the EHR becomes an IT project by default -- and often, the resulting initiative neither attends to the need to plan change nor helps users adapt to change. An EHR is not a small project, so leadership should also appreciate that it will take time for IT and end-users to help each other in achieving these goals.