1. EMR Naomi Newhouse CNM MS TPMG CNM Chair CHCF Fellow Director Central Valley CNM Project Director Central Valley CNM Project

2. Barriers to EMR adoption Cost Cost Coordination Coordination collaboration collaboration

3. Misalignment of Incentives Payers and Purchases Win, Doctors Lose (Inpatient vs Outpatient) Payers and Purchases Win, Doctors Lose (Inpatient vs Outpatient) EMR-The Hospitals Largest Capitol Investment EMR-The Hospitals Largest Capitol Investment

4. security

5. Privacy matters Sharing Data Essential Sharing Data Essential Who has Access to What Who has Access to What Unique Patient Identifiers Unique Patient Identifiers Securing Remote Access Securing Remote Access

6. Emr/MD resistance Too Expensive Too Expensive Takes Too Much Time Takes Too Much Time Not Secure Not Secure Expensive to Maintain Expensive to Maintain Stability-Still an Issue.. Stability-Still an Issue..

7. Reaching Them where they live Docs Work in Office Settings and Admit to Hospitals They Don’t Own. Docs Work in Office Settings and Admit to Hospitals They Don’t Own. Incentives for Training and Use-Stark Laws Exception Please..$$, CMEs, Preferred Providers List, etc. Incentives for Training and Use-Stark Laws Exception Please..$$, CMEs, Preferred Providers List, etc.

8. Incentives Profitability and Funding are Strong Incentives…British NHS, Australia's National Funding Profitability and Funding are Strong Incentives…British NHS, Australia's National Funding Two Bills Before the Senate- Total of 5 1/2 million, a Strong Predictor of Gov Commitment. Two Bills Before the Senate- Total of 5 1/2 million, a Strong Predictor of Gov Commitment.

9. Overall Implementation Prediction SLOW

10. Making mandates work Provider Input to Vendor Design..HUGE Provider Input to Vendor Design..HUGE Provider’s Training Providers Provider’s Training Providers Adequate Time to Adjust Adequate Time to Adjust Rewards, $$ Bonus Happy Users Rewards, $$ Bonus Happy Users

11. Research opportunities Evidence supporting improved care.. Evidence supporting improved care.. Voice Recognition … immature market, decrease power to process, time to train, increase accuracy and privacy.. Voice Recognition … immature market, decrease power to process, time to train, increase accuracy and privacy..

12. Down the line Emr central Emr central