There is a spectrum of physician readiness regarding Internet technology acceptance. Some influencing factors include; physician's work and home access, perceived quality of usability, the amount of the individual physician's browser and email experience. Physician engagement in the use of technology has been a very staged and gradual process. It has taken some 8+ years (in our organization) to accomplish the current primary care adoption rate of the EMR (> 70% of total), portal and email usage (don't have definitive measures on these yet). We see ourselves as progressive, but relatively early in our physician e-culture journey. Within this spectrum there are physicians of all ages who embrace technology and are willing to expend the energy to learn "how to" get stuff done. Others, do not have the tolerance, or are at a point in their professional working lives that they do not desire to expend such time on transitioning their respective work flow and clinical practice. That is by the way a key phrase to focus upon "work flow!"

Key learnings regarding physician web based technology engagement:

• Influential peers make a difference
• Measurable, improved clinical outcomes speak volumes
• Financial incentives can play a part
• Reproducible time effectiveness drives change
• Motivated, enthusiastic office staff essential
• Temporary, focused, additional support resources a must
• Effective governance structure must be in place to achieve large numbers