There has been a huge adoption gap of health information technology in small primary care physician offices in the U.S. that is poorly understood. Usability barriers, cost, and time factors may all contribute. Poor office workflow efficiency has anecdotally been reported to complicate efforts, and the Center for Medicare and Medicaid Services developed the Doctors Office Quality Information Technology toolkit to address this issue. The CMMS Office Systems Survey reviewed the use of this tool, but that data is not yet published. Recently, to help reengineer the electronic health record (EHR) and implement it in a more provider- supportive fashion, ergonomics has been applied to health information technology. This capstone will review the implementation of HIT in small primary care physician offices, failures of HIT implementation in the literature, and propose an ergonomic paradigm based on human factors engineering to develop more usable, useful, and safer approaches to the implementation of EHR into primary care practices.