Here's the good news: Seventy-seven percent of free-standing physician practices have an ambulatory electronic medical record system installed, and a robust 90 percent of hospital-owned providers are up and running with EMRs.

Compared to where we were just a few short years ago, that's impressive progress.

The not-so-good news? Stage 2 meaningful use numbers still continue to lag expectations. Through Aug. 1, just 1,898 eligible professionals had attested – an elite subset of the 537,600 physicians and practices that have signed up to be for the MU program. Still, at least the momentum is moving in the right direction, however haltingly.

Of those success stories, it's a safe bet that the overwhelming majority are affiliated with hospitals, which offer critical financial, technical and logistical help.

That distinction between hospital-owned and free-standing practices is an interesting one, as illustrated by some data points in HIMSS Analytics' 6th annual "Ambulatory PM & EHR Study," published in August.

Asked about the chief motivators for their ambulatory EMR investments, most providers said meaningful use was a critical catalyst, of course, and cited efficiency (38 percent) and quality (19 percent) as big reasons for their purchases.

"This was particularly true for free standing organizations as almost half with defined purchase plans are relying upon the (EMR) to increase practice efficiencies," according to the report. "Hospital owned facilities tend to be a bit more focused on quality of care and sharing data with other facilities."

Asked by HIMSS Analytics about the barriers to purchasing EMRs, practices of both types report that ARRA helped to defray the biggest – cost – and now the large majority (73 percent) say they don't have plans to buy because they've already got one that's certified for meaningful use.

But 9 percent of providers report that cost is still a prohibitive barrier to implementation – and another 5 percent say they're not willing or able to invest in an EMR because "retirement is right around the corner."

Both tethered and non-tethered practices are making use of certified EHRs, according to the report, and while the top five vendors for both segments include familiar names like Allscripts, Cerner and eClinicalWorks, the biggest slice of the pie for tethered practices belongs to Epic.

Epic serves barely 6 percent of independent providers, however: tops for that market segment is Vitera/Greenway, reflecting a combined client base following those companies' $644 million merger this past November. 

And while "the ambulatory market owned by single-hospital systems is clearly skewed towards Epic's favor," the report shows, "the vendor space in the free standing category is relatively fragmented with many smaller and regional players."

That's especially true when when it comes to the specialists, points out HIMSS Analytics Executive Vice President John Hoyt. "Ophthalmology, gastroenterology, all these really special systems. I don't think they're certified. And frankly I don't think they need to be."

(Interestingly, the number of certified ambulatory systems is on the rise; ONC data shows 958 such products as of Feb. 27 – that number had increased to 1,000 by Aug. 22.)