Douglas A. Propp, MD, MS, FACEP, FACPE, Medical Director/Department Chair, Emergency Dept. and Medical Director Clinical Informatics, Advocate Lutheran General Hospital. Dr. Propp describes guiding principles and tactics for “non-incremental culture change” to occur in the context of ED automation. Measured results in satisfaction, safety, quality and efficiency are discussed, as well as unexpected challenges, unexpected benefits, and the roadmap to sustainability.