This week the Clinton/Frist (or should it be Frist/Clinton) legislation got on breakfast time TV, and Brailer’s office announced that it was going to be starting the first few pilots towards interoperability with some $60m available. A more ambitious $4bn bill was introduced too, although that won’t go anywhere unless someone adds the words "Terror" or "Iraq" to the title. But while all the fuss is about interoperability of data transfer, there is a whole set of players who need data to become electronic before it can be made "interoperable". While the larger medical groups and hospitals are rapidly getting on the EMR adoption curve, it’s a much slower process among the small practices that account for 75% of America’s doctors and patients — most of their information is stuck in paper. Other countries solved this problem the old fashioned way — the government paid for doctors to get EMRs in their offices. Before we get too worked up about interoperability and RHIOs, a bigger national push to get smaller practices using clinical information technology might be a better idea.