Most physicians have little time or inclination to comparison shop for EHR systems and are ill-equipped to deal with the technology problems likely to crop up when implementing them. "We can't assume every small practice will be able to [install EHRs] on their own," says Farzad Mostashari, an assistant commissioner in the New York City Department of Health who has helped oversee the city's EHR program. "The most effective implementations have been community wide," says Bates. "On their own, people pick too many different programs and make it difficult to exchange information."

In a letter sent to the White House and to Congress last week, a number of physicians and health-care administrators from across the country, including Halamka and Mostashari, urged the incorporation of community-level guidance into the bill. Legislators appeared to have listened, designating funding for regional health-care IT centers that will provide technical and other assistance to area providers. The bill includes funding--via competitive grants--for regional centers that would help relieve this burden by providing best-practice guidelines and technical assistance.

The letter cited two successful examples of community-based deployments: New York's primary-care information project and the Massachusetts eHealth Collaborative. The New York project, launched in 2007, is an effort to bring EHRs to primary-care providers even in the poorest parts of the city. The program provides technical training and support, and will also assess both the economic and health benefits of going digital. "The experience in [Massachusetts and New York] has been nearly 100 percent successful adoption of EHR implementation in the practices that participated," says Harvard Medical School's Halamka.

Community-based efforts are also important to adequately address privacy issues, one of the biggest concerns that have cropped up in response to EHRs."Small practices have no experience with security features," says Mostashari. "We have a privacy lawyer who helps develop privacy practices so providers can take steps to reduce their risk."

He emphasizes that while electronic health records carry some risk--data on thousands of people could be inadvertently or purposely released--there are also benefits, such as being able to audit who accessed a particular chart.

Companies that sell EHRs are already gearing up for the expanding market. "We intend to aggressively ramp up our business," says Girish Kumar Navani, president and cofounder of eClinicalWorks, a Massachusetts-based technology firm that supplied software and support to both the Massachusetts and New York EHR projects. "We're planning to open an office in California and will hire a lot of people there as well."