This paper provides analysis of a 3-year longitudinal ethnographic study following the gradual adaptation of an Electronic Medical Record (EMR) in a community health centre in Canada. Adopting a sociotechnical perspective, I follow the EMR and the work practices as they undergo continuous modifications and I identify changes that are brought about by the EMR. Findings from this research show essential differences between types of sociotechnical changes and their implications. I distinguish between the initial changes that occurred and their implications which I characterize as having straightforward, direct, and immediate effects; and the emergent changes and their implications which I characterize as being broader and having a deeper level of impact in the long term. Furthermore, I illustrate how some of these changes reflected realizations of the visions behind the dream of implementing an EMR; while other changes enabled new practices and illuminated issues that were invisible before. Finally, drawing upon insights from actor-network theory, I show how the EMR is becoming more than just a tool; it is participating in creating new practices and gradually transforming the medical profession.