Many smaller physician billing companies today are challenged to upgrade to a more enhanced practice management system that includes EMR in order to retain their client base. Obstacles include the large up front financial investment, the specialized personnel to support EMR, and the resources to transition their current clientele to a new system. Billing companies are also challenged to differentiate themselves from other billing companies and not be viewed as a “commodity” as well as being continuously challenged to lower their fees in a competitive market.