Hi Amy - if your practice doesn't participate with Medicare/Medicaid, then there *currently* is no mandatory need to adopt an EMR. Even if you do participate with Medicare/Medicaid, some docs may be willing to deal with the Medicare reimbursement penalties (that don't start until 2015) instead of taking on the costs and changes associated with implementing an EMR. Penalties will be 1% of annual Medicare reimbursement each year and increase 1% point each year there after up to a 5% cap.
However, I suspect (if it isn't already happening) that surrounding hospitals, private insurance carriers, clearinghouses, etc will start to put some pressure on docs to implement an EMR as they see cost-saving benefits from it as well.
For those practices set on holding out as long as possible, I wrote an article that explains why that may not be a bad choice over at ProfitableUse.com:
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