OBJECTIVES To document the presence and functioning of different practice systems in a small sample of medical groups in Minnesota and to examine the relationship between the presence of practice systems and prior adoption of an electronic medical record (EMR). STUDY DESIGN Descriptive study of the frequency of practice systems in 11 medical groups. METHODS We recruited 11 medical groups for the study. Four groups had an EMR; the other groups used paper medical records, often supplemented by electronic ordering or data systems. Using an on-site audit team, we validated the presence of practice systems organized under 8 categories. RESULTS All of the medical groups had implemented a substantial number of practice systems for care management of patients with chronic conditions. Although the medical groups with an EMR tended to have more comprehensive practice systems in place, the medical groups without an EMR also had most of the practice systems. CONCLUSIONS Although required in some functions, an EMR may not be necessary in facilitating practice systems that support consistent management of patients with chronic illness. Approaches are needed that will encourage the implementation of practice systems in medical groups with and without an EMR.