Objectives The use of electronic medical record (EMR) systems is an identified competency for psychologists. However, limited information is available regarding EMR use in behavior health settings and in clinical training for psychologists. We wanted to assess current EMR use in psychology training clinics, describe adoption and implementation processes and compare perceived concerns across the diffusion of EMR systems in these clinics. In addition, we explored system features/functions used and perceptions of training needs and impact. Methods This paper reports a survey of Clinic Directors within psychology training programs, whose clinics were members of the Association of Psychology Training Clinics (APTC). Using current theoretical frameworks, an online survey was developed and administered to Clinic Training Directors, with a return rate of 41%. Results Findings suggested ongoing diffusion of EMR systems across these clinics and identified differences in concerns associated with EMR status. Those clinics which adopted or were planning to adopt had lower concerns than clinics not planning to adopt for Cost, Time to Document, Interaction with Patients, Implementation Time, and Computer Challenges. Adopters had least concern about IT Support. Clinic Directors׳ responses to qualitative questions indicated benefits relating to clinic efficiencies, providing training to students, and improving documentation. Only a few clinics had progressed to considering how EMR use could enhance patient care. Conclusion The paper discusses diffusion of EMR across these clinics, limitations in current use as well as future directions.