re: When EHR Critics Jump To Bad Conclusions
I did not read the original report you refer to. But, it sounds to me like irresponsible reporting on the part of the study authors who may (or may not) have an agenda against health IT.
As you mentioned, larger organizations have the scale to best utilize health IT for increasing quality of outcomes and reducing costs. Patients at that level of care often have more serious problems and are seeing multiple providers within the organization. On the other hand, many of the smaller clinics are seeing patients for the first time and therefore have no basis (health IT data) to review. Their costs are, therefore, what they are.
Down the road, when health IT can flow appropriately from one institution/doc to the next, it will become more apparent how having that data at the next stop along the way will increase quality of care, reduce redundant tests, and lower costs overall.