I don't know about you, but I couldn't survive without the basic IT tools I use to run my day. From given--but powerful--tools like email for communication (I'm a Thunderbird fan), Web browsers for research, commerce and networking (think Plaxo and LinkedIn) and calendaring/contact management software (Palm desktop), I need them all. I'd probably be pounded into a pancake by my schedule and obligations if I didn't have access to them.  These are the types of tools deployed by your newly emerging micropractice, the one-man or one-woman show depending on modern technology.

I'm also a big fan of the conveniences provided by large companies' IT infrastructure. When I worked at a $100M data firm, I got corporate security, information management tools, shared storage, virus updates and more. Once you get used to having powerful databases available, 24/7 tech support, a Web dev team to work with you rather than a single person going it alone or as a consultant, you get hooked. And the corporate managers depend on big iron to scale their operation. Think the Cleveland or Mayo Clinic and you have the picture.

On the other hand, when you work at a smallish company (let's say, 30-50 employees), you're sort of stuck in the middle. You don't have access to high-end corporate IT perks like a large dedicated support staff. Sometimes it's one guy who's doing all the network administration and development too, or even an outsider who comes only once a week! And I can well understand why these middling size companies don't invest more in IT. They have what they need, and maybe just a bit less, but they're getting by, and they're just short of the need for costly big-enterprise IT. Now, consider the medium-sized medical group, whose name is little known but represents a legion across the U.S. That's the position they're in, too.

Such mid-sized practices (which, as it happens, are the fastest-growing practice category) certainly have computers and practice management software in place, they're probably working with billing technology in some form if it isn't integrated into the PM package, and they're generally pretty satisfied with what they've got. They're just big enough to be deathly afraid of change, as they're not as flexible as the little guys nor as well-funded as the giants.

Now, how are you going to get the practice in the middle to invest in emerging tech like EMRs and eprescribing? For one thing, let's admit this niche is the problem. General statements that smaller practices aren't adopting such technology are too vague. Second, let's make sure it's this mid-market niche that gets the first infusion of support and cash. It's funny how government programs and the like often end up supporting giants rather than smaller players.

So how are we going to push this process along? Let's roll up our sleeves and toss out some solutions. Readers, what do you think? - Anne