She says small practices should look for help from their regional IT extension centers, or even consider some sort of joint venture or cooperative with a larger healthcare entity.
"To the extent that that is palatable to a practice there is a lot of advantage to working with a larger organization that can bring down the cost and help with a lot of the other changes that need to go along with EHR adoption to make it easier on small practices," she says. "This is not to say it is not doable for small practices. But it's a much harder road and going into it with that awareness and taking the time to figure out the best approach is what I would spend my time doing."
While she considers herself an advocate for EHR, Adler-Milstein says she is fearful that the findings in the study will be used by critics to call the movement a failure.
"The real struggle we are in now is around how these systems were sold—as a magic wand and not as a tool," she says. "They are not a magic wand. You don't put them in and the next day you see higher-quality lower-cost care. The reality is there is a lot of hard work that has to go into seeing the benefits. In small practices they need help and support to do that hard work."
"For me it's nice to have evidence to point to what we need to do differently to realize the benefits. And I hope that is the attitude that others will share—which is we need to figure out how to do this right."