Robert Kolodner, the National Coordinator of Health Information Technology, dropped a small bombshell last month when he reported that only 4 percent of practices with one or two doctors had EHRs (Health IT News, Sept. 25, 2007). Vendors, meanwhile, have estimated that the EHR penetration rate in practices of three or fewer doctors is 5-10 percent. If it's true, as various reports suggest, that between 10 and 20 percent of the physician universe is EHR-enabled, then the digital divide between large and small practices is greater than ever.

According to a recent study by the Center for Studying Health System Change, about a third of U.S. physicians work in practices of one or two doctors. But some specialties have taken up EHRs much faster than others. For example, 37 percent of family physicians who belong to the AAFP—many of whom are in small practices—say they have EHRs (InfoTech Bulletin, "More family physicians adopt EHRs," July 27, 2007).