For starters, I am curious as to what costs, if any, were sunk costs?  Are they suggesting that even the variable costs were too high?

What does this say about the EHR ROI for ambulatory care?  I think it could be saying three things.

1.  Perhaps it shows that there is some lower threshold in terms of the number of physicians in a practice needed to show a positive ROI
2.  Perhaps in these economic conditions it makes more sense to use a managed services approach for ambulatory EHR
3.  Perhaps this is a strong argument for purchasing a wrap-around EHR service