Many years ago I learned the remarkable uses of carbon paper. A carbon came with my lab, so I filed one and gave one to the patient. Regarding notes, I leaned to write my note on a clipboard with a sheet of carbon paper behind. I could then give the entire carbon to the patient (rarely) or the lower portion with the diagnosis and recommendations (usually) to the patient. For more complex discussions of recommendations. I picked up a clipboard with stationary over a carbon set, and just wrote them out as I spoke, and then gave the patient the top sheet and filed the carbon.

Simple, cheap, no electricity, encryption, password, backup server, service contract, software updates, or legacy data conversion required.

I still believe that the only major advantage of EMR for the actual practice is in big practices where you save the expense of filing and retrieving charts. For the small office the only advantage of any import is the anticipated future opportunity to the government and insurance companies of violating the autonomy and privacy of patients and physicians for their own purposes.