The emerging COVID-19 pandemic has become a once-in-a-century challenge that has impacted society profoundly and has disrupted almost every facet of life for people around the world. The demands on the infrastructure of health information technology (Health IT) are numerous, as we learn to use the tools we have created to address the issues we are facing now. In most areas where work-from-home and social distancing have become prevalent, and especially in areas where shelter-in-place orders have been issued, the nature of ambulatory care has dramatically changed. Some practices, such as non-trauma orthopedics, are unable to find operating room availability, and their practices have ground to a halt. The result of this has been a dramatic and sudden decrease in office volume – 5 or 6 virtual visits in a day, plus one or two in-person visits, in the place where a practice used to be 20 visits per provider per day, is not economically sustainable, especially for small and independent practices.