The study presented in this paper analyzes the workflow and implementation of electronic health record (EHR) systems in small physician primary care offices. We characterize these offices in terms of workflow, sources of time delay, and barriers to the support of the entire workflow through the use of EHR systems through an primary care exemplar office. The variety and complexity of interactions, a major the impediment to adoption, will benefit from standards-based information interchange facilities to provide a virtual patient record that overlies the fragmented records of the patient in the different healthcare facilities. This would be a step towards helping the small physician get the benefit of network economics.