The news from this study that the larger the practice, the higher the EHR adoption rate is probably not news.  That is what most people would assume to be the case and what we've been seeing for a couple of years now.  But it is always good to have data, even if they confirm the obvious.  People in San Diego watch the weather in January, even though every day is the same.

Two reasons for this trend are obvious.

First, pricing realities simply work against small practices.  We've priced deals on multiple software platforms for practices of every size.  We priced them years ago when we had no clue as to what we were doing and we price them now with tons of implementations in our rearview mirror.  The results are always the same...total cost of ownership on a per physician basis is nearly impossible to justify for a solo provider, still breathtakingly steep for two docs, getting there for three, and then at four, the cost per physician curve flattens out to the point that four physicians is not that different from ten, on a per provider basis.

This is reality. Period.  Certain EHR vendors are attempting to dodge this reality, but they are doing so by simply punting the implementation work to the practice and severely limiting the configuration options necessary to really make the software work for the practice.

Two, as a rule bigger practices simply have better talent and leadership for the journey. Whether the talent is in-house or hired from the outside, they can get clinical consultants and project managers and better trainers and more to make it work.  They also generally have the right leadership for the change effort because they have had to address the leadership issue already.  The physician and administrative leadership that makes a big group work comes in handy when implementing such a transformative technology.

Making it as a small practice looks tougher and tougher.