Motivation – Electronic medical records (EMR) have been hailed for their potential benefits. As EMR technology begins to be implemented, this research investigates its impact on emergency medicine. Research approach – 150 hours of naturalistic observations of emergency physicians in two Midwestern hospitals were performed. Findings – Results suggest that for EMR benefits to emerge, results must be easily distributed and located, data entry formats must support both input and later review, formatting must reveal changes over time for quantitative data, and records must support administrative and logistic functions. Research limitations – We cannot quantify the prevalence or cost of the current limitations in EMR. Originality/Value – This research is a first investigation of the impact of EMR systems on NDM in the field. Based on preliminary analyses, implications for (re)design of EMR systems are provided. Take-away message – To support practitioners, EMR systems must be grounded in a better understanding of the basic functions emergency physicians need to satisfy.