There is a significant Electronic Health Record (EHR) adoption gap between large and small provider practices. The state of Maryland, while not found as having the lowest percentage of providers with an EHR meeting basic system criteria, was one of eight states that was well below the national average. The purpose of this project was to develop evidence based guidelines for implementation of best practices for small size (less than five providers) Primary Care Providers (PCP) to optimize adoption of EHRs to support the National Quality Strategy’s three broad aims. This quality improvement (QI) project used the Technology Acceptance Model (TAM) to guide the development of Evidence Based Guidelines for EHR Adoption in PCPs. The sample size was a panel of eleven experts for round one and ten experts for round two, using the Delphi technique. Evidence Based Guidelines for EHR Adoption in PCPs were developed based on the literature and best practices. The guidelines were then submitted for review by an expert panel via the Delphi technique through two rounds of iterative surveys. Results were a consensus of greater than 51% agreement for all guidelines. The Evidence Based Guidelines for EHR Adoption in PCPs seeks to translate best evidence into practice and will assist to standardize EHR adoption best practices for small size (less than five providers) PCPs. Future plans include submission for publication of the guidelines to the Agency for Healthcare Research and Quality (AHRQ) National Guideline Clearinghouse and presentations to global healthcare information technology organizations to ensure dissemination.