Development of a national health exchange has been the focus of governments in many countries as a means of delivering quality health care at affordable cost. In deployment of a national health exchange, an important facilitator is the adoption and usage of Electronic Medical Record (EMR) systems by primary health care providers such as small clinics, and secondary/tertiary providers such as speciality clinics and hospitals. However, in-spite of expected benefits to physicians, adoption and usage are found to be low, even in some advanced countries. Adoption levels also vary widely across countries. In this research we used the theoretical lens of TPB to conduct four case studies of small clinics in Malaysia to explore their intent to adopt EMR systems. Based on our findings, we develop a theoretical understanding of the small clinics intent towards EMR adoption and propose that the theory of planned behavior (TPB) when integrated with institutional theory serves to provide better explanation of adoption of new technology in situations of low visibility of the technology, as is generally observed in developing countries. The findings have implications for researchers interested in health-care technology diffusion.