Little is known about electronic medical record (EMR) use in small dialysis organizations (SDOs). The objective was to determine the prevalence of EMRs in SDOs in the United States. A random sample telephone survey of SDOs was conducted in October, 2008. Approximately 60.7% of the facilities was found to be using an EMR, but only 33.5% had comprehensive systems that recorded medications, tests, and clinical notes. While 75.3% of the respondents indicated they were satisfied or very satisfied with their EMRs, just over one-third of those said they were planning to upgrade or replace their current systems.