The rate limiting step in a primary care out patient only office is the nursing role. If you envision the EHR, e-faxes, telephone, schedule, scanner, dual monitored desktop being commanded by one fabulous nurse to care and comfort over 1000+ patients on a daily basis, think of Dawn.
I would much rather think of the nursing position, not in the negative but in the positive, not a rate limiting step but rather an exponentially effective facilitator.
If given the correct technological edge, the nurse will become your best ally fending off inefficiencies, regulations, and despondency. She will not only educate and integrate the patients into your portal system immediately, but will followup to ensure the portal is working effectively and meaningfully for each and every patient with one.
She will co-manage the shared inbox of both the EHR/portal-efaxing applications to expedite and improve care with her physician so that a streamlined efficient operation can better handle all of the new technology coming down the pike. As patients desire to try new ways of interacting she will be ready, and better yet get her doc ahead of the curve.
As you can tell I am a bit partial to my nurse but without her, I would still be struggling in the paper world.