Physicians in small practices are concerned about financial barriers.1 Collectively, through their professional association, they would benefit from economies of scale. The American Psychiatric Association has, for example, 36 000 members,3 of which 30%, or 10 000, may be in small practices.

Physicians in small practices are concerned about future obsolescence.1 With the market share delivered by the medical specialty society, the vendor would be able to stay in business and to continue to improve its EHR. Furthermore,...]]> 2011-12-10T07:38:52-08:00 info:doi/10.1136/amiajnl-2011-000593 hwp:master-id:amiajnl;amiajnl-2011-000593 American Medical Informatics Association 2012-01-01 Correspondence 19 1 143 143 http://jamia.bmj.com/cgi/content/short/18/5/726?rss=1 In their report ‘Electronic health records in small physician practices: availability, use, and perceived benefits’, Rao et al correctly point out many of the challenges these small practices face when adopting electronic health records (EHR).1 As part of New York City's Primary Care Information Project, we have deployed EHRs to over 2550 providers in NYC, including over 400 small physician practices. In order to get to a point where these providers feel comfortable using the EHR fully, after implementation they often need intensive technical assistance (eg, workflow redesign, quality improvement support, EHR customization and configuration, revenue cycle management, and ongoing training on EHR features and functionality). We have found that this support, often costing $12 000–$16 000 per provider, is necessary to help small practice providers meaningfully use their EHRs, and early evaluation of our work has found that small practice providers that receive our assistance have improved usage...]]> 2011-08-16T13:07:37-07:00 info:doi/10.1136/amiajnl-2011-000427 hwp:master-id:amiajnl;amiajnl-2011-000427 American Medical Informatics Association 2011-09-01 Correspondence 18 5 726 726