So there I was, sitting in the doctor's office chatting about my medical history when it hit me like a ton of bricks: this guy is listening to me. He's making eye contact, asking pertinent questions and seemingly absorbing the details about my (relative) health.

"Where can I call you tomorrow when we get the lab results from your blood test?" he asked as he took a little black book out of his shirt pocket to jot down my phone number. There wasn't a point during the 30-plus-minute appointment where he started typing on a laptop or tablet PC. He was focused on the exam and me.

Regular readers of this blog will recall that I'm in the market for a new primary care doc. My visit with this new one on Monday went well enough that I plan to see him again—in three months, in fact, for a follow-up appointment since he adjusted the dosage on one of my medications. But one thing gives me pause before fully committing to a long-term relationship: the office is still entirely paper-based.

It's a two-person practice—my doc and his wife. He's extremely reluctant to install an electronic health record for several reasons, but in particular he doesn't believe the benefits outweigh the considerable costs. Not even the promise of federal incentive money or support from one of Chicago's big city hospitals are enough to off set his immediate out-of-pocket expenses. Plus, he's just not convinced of the efficiency argument.

His views aren't all that different from practitioners who responded to a Medical Group Management Association survey last year. Nearly 70 percent of respondents felt EHRs would decrease their productivity anywhere from 1 to 10 percent. When I pressed my doc a bit further, suggesting that there are indeed benefits to such things as information exchange, he said he could just as easily pick up a phone. What about clinical decision support tools? He's not sold. His peers are worried as well: 44 percent told MGMA that implementing clinical decision support as required under meaningful use would be difficult or very difficult.

There are clearly major hurdles to getting private practice docs to adopt EHRs. According to the most recent data from the CDC's National Center for Health Statistics, 50 percent of office-based physicians use an EMR of any type, 24 percent have a basic system and just 10 percent have a fully functional system. Hoping to accelerate physician adoption, the AMA earlier this week unveiled an an online tutorial to help docs "choose, purchase and implement the best technology systems for their practice."

Will something like the AMA's initiative help? In mind, the larger question is what's the tipping point for adoption? At what point do private practice doctors decide it is worth the investment? Is it the looming Medicare penalties? Will they be at a competitive disadvantage? Ideally, I'd like for my primary care doctor to have the capability to electronically exchange files with my asthma/allergy doctor, whose office is entirely electronic. I'd like for him to get instant access to digital images at the hospital and if I were to ever start a PHR, I'd be happy to give him access in order to import information. But is being digital a deal breaker? Not at this point, so long as I continue to have a good patient experience and clinical care isn't compromised.

What do you think is the tipping point? Email your thoughts to