The design of electronic medical record (EMR) software has a strong impact on user acceptance. To keep up with the growing complexity of activities performed today in Neonatal Intensive Care Units a well-designed EMR must provide an overall vision of all up-to-date information concerning the patient, both machine generated and clinical diagnostics, and be equipped with and computerized physician order entry (CPOE) system. The diffusion of new technological innovations in critical care environments can have unintended consequences, including changes in workflow, staff roles, and patient outcomes. We rely on the pros and cons of a 10-year successful implementation of an electronic medical record in a third level neonatal care unit, initially dedicated exclusively to neonatal intensive care, then extended to intermediate care and finally reaching the nursery.