This report summarizes more than a decade of experiences with implementing computer-based testing across a 4-year medical curriculum. Practical considerations are given to the fields incorporated within an item database and their use in the creation and analysis of examinations, security issues in the delivery and integrity of examinations, curricular integration, use of examination log files, effectiveness and timeliness of reports, and the potential for educational research. The solutions to many complicated issues have practical relevance and interest to the community of educators who are considering the adoption of this technology for assessment.