In 2015, $3.2 trillion was spent in the US and the Center for Medicare and Medicaid is projecting that spending will grow at an average rate of 5.6% a year in the next decade. Researchers have found that organizations with higher IT maturity tend to show better operational and financial performance. While there have been multiple studies on HIT in hospitals and large practices, there have been few studies that have directly examined HITs in Small Physician Practices (SPP). The purpose of this study is to explore maturity of HIT use using multiple case study methodology to observe how SPP have matured through their use of HIT. Hence, the goal of this study is to answer the following question: How is the IT maturity of use different for small physician practices? To answer this question, we conducted multiple case studies with five SPP. This study developed a modified IT Value Hierarchy and highlights the importance of both IT security and inter-organizational integration on these healthcare organizations.