It's interesting to look at the access and referrer logs for the docnotes website.  Rererrer logs tell me who has linked to docnotes .. access logs tell me who has visited .. and often .. from where.

Where do people come from?
Most often … it's either "unknown" meaning they typed in the link or used a bookmark on in the browser … or from a search engine.
Other referrers are the medical weblogs .. or
Where are people logged in from?
It's usually possible to determine the domain from which a user is coming from.  So if a user is on AOL .. I can tell .. or AT&T .. or MSN.   More interesting is when the domain is from a health related webiste.  Today's interesing login is from Medfusion.  It's a company that offers several services to physician practices. They do their programming in ColdFusion, which is good .. and they seem to offer services to practices including online lab result reporting, online scheduling (for patient appointments) and online bill payment.  It's not clear, though, how they interact with the myriad practice management systems.  There is no mention of interfaces on the website.  This is important to know.  INdeed, the reason that we're moving out of relayhelath is because we don't want to have several separate data repositories.  We want out patient information to live in ONE place.  So we're building our own simple (yeh .. coldfusion, of course) replacement for RelayHealth.  It's going to run as a webservice on our external server.  The internal server will poll the exteral server every few minutes.  If there are new messages, The external server responds with the (encrypted) data, and the internal server will post the messages to our internal messaging system.

So it's not clear to me what the role of Medfusion will be.  No mention on their website of pricing.  Id be surprised if it's cheap.  Build vs buy?  I'll continue to build.