The next-generation system from Amicore—founded in 2001 by Microsoft Corp., IBM and Pfizer Inc.—employs Microsoft's .Net tools, is designed specifically for the Tablet PC, and combines functions for both practice and clinical management into one database. The current rollout is for the clinical side, with the practice side coming early next year.

The key advantage is ease of use, said Ray Desrochers, vice president of development for Amicore. The product is a combination of a client-side server and an application service provider. While "headless" servers physically store information at physician offices, periodic updates and regular backups are controlled remotely by Amicore.

"That's a very familiar solution," said Manuel Lowenhaupt, a physician and national practice leader for clinical transformation at CapGemini Health. "The typical physician office has no interest in maintaining any hardware and has no infrastructure to support IT."

Lowenhaupt also is seeing an increase in systems that integrate claims processing and patient visits. "I'm seeing more and more of the successful solutions embracing both the clinical and business aspects of the office. Wouldn't it be nice when I was submitting a claim, if I could easily attach the clinical documentation of support?"

However, the vision of a product often lags behind execution, he said, so small physician practices should interview others about the vendors they use. Even if those practices are not using the vendor's latest product, such queries can still be valuable.

He said that in a recent analysis, the cost of acquiring a fully functioning EMR (electronic medical records) system for an ambulatory system was $75,000 per physician, and maintenance would be around $30,000 per physician per year including devices. However, he said, low-cost systems could be a tenth of that.

Excluding hardware, a group of 20 physicians should be able to get the system running for $7,000 to $10,000 per physician per year, said Amicore's Desrochers, adding that ballpark pricing is difficult because the number of front-office staff per physician as well as software configurations vary widely. Currently, about 1,200 physicians are using the product.

Amicore's president, Rich Noffsinger, declined to discuss any projections for future sales, saying only that he had high expectations.

Noffsinger said that his company had very consciously gone after the small-group market because that would reach the majority of physicians. "You can't have a meaningful impact on the marketplace if you ignore that big group. So we made sure [the product's] cost was very low and easy to support."

Small physician offices have been reluctant to adopt health care IT.

Desrochers said the software is both intuitive and highly customizable, modeled on the Outlook interface. For example, individual physicians can select the order in which information is entered into the system based on the way they prefer to conduct patient interviews.

Like other EMR systems, Amicore's can communicate with systems for payers (using ANSI standards) and laboratories (using HL-7). Desrochers said Amicore's alliance with Microsoft means it can react to changes in standards more quickly than other companies.

For example, Amicore uses Microsoft's BizTalk 2004 with health accelerators, an HL-7 accelerator and a HIPAA accelerator. So "the exchange comes out of the box without tons and tons of hand-coding." Other companies with EMR offerings, such as NextGen and Greenway, also use BizTalk.

Still, Desrochers said Amicore's parents give it a special advantage. "Client/server solutions don't have the ability to quickly adapt to changing standards. We have built from the ground up a program that has a lot of flexibility from a data exchange system. We knew that those standards would be important going forward."