Purpose: The purpose of this paper is to explore physician sensemaking and readiness to implement electronic medical records (EMR) as a first step to finding strategies that enhance EMR adoption behaviors. Design/methodology/approach: The case study approach provides a detailed analysis of individuals within an organizational unit. Using a theoretical lens of sensemaking and readiness for change gives a framework for triangulated inquiry. Findings: Findings reveal that physicians' key sensemaking factors are alignment, expectations, symbols (i.e. voice activation technology), outside influences, emotional arousal, trust, faith, forced implementation, controlled influence, and clarification of identity. These factors collectively describe how physician derive meaning through innovation. Research limitations/implications: The findings elucidate physicians as autonomous learners utilizing innovative thought processes to prepare for EMR implementation. Physicians used innovation in EMR implementation as a method of controlled influence to clarify their identity as efficient, competent professionals who demand performance excellence. Practical implications: These findings have implications for EMR implementation strategies and future research in innovation and EMR adoption behaviors. Originality/value: This study provides needed information about how physicians grasp EMR technology in the practice of medicine and how it impacts their readiness to use EMR. Much is known about the barriers, difficulties, and benefits of EMR, but little is know about how physicians construct meaning from the use of this new technology. (Contains 1 table and 5 figures.)