1. EHR Implementation and Adoption Ambulatory EHR at MaineGeneral Medical Center Tuesday September 9, 2008 AHRQ Annual Conference

2. WE HAVE A SUCCESSFUL AMBULATORY EHR IMPLEMENTATION IN RURAL MAINE Funded by AHRQ HIT Implementation Grant Number: UC1 HS15337 Grant Title: Improving HIT Implementation in a Rural Health System September, 2004 – March, 2008

3. Dan Mingle, MD, MS 14 years - Clinical Rural Family Practice 5 years - Residency Faculty –Residency Assistant Medical Director 2003 Graduate Dartmouth’s Center for Evaluative Clinical Sciences IT Project Director PI, IT Implementation Grant Director, MGH Ambulatory Clinical Informatics Healthcare Informatics’ Innovator Award, 2008

4. In my 15 minutes I told you we were successful I will Describe –Project –Timeline –Utilization data Whirlwind tour of the ROI data that proves we failed. Reiterate that we were successful Fight about it in Q&A

5. MaineGeneral

6. It’s about Sharing Med List Allergy List Problem List Results Notes Care Plans Reminders Communication One Patient One Chart Ancillaries Primary Care Specialty Patient

7. A Short History of a Long Project RFP Touchworks 7 Pilot Sites AHRQ Grant 1 st Ext Pract

8. Tracking the Conversion

9. A Good Problem List is a Disease Registry

10. Structured Data is Key to Clinical Reporting

11. User Satisfaction I rarely experience errors in the EMR. I rarely lose any of my work in the EMR. Overall, the speed and reliability of the EMR meets my needs. The EMR is about as fast as other MaineGeneral systems. The EMR support team and website is there when I need it.

12. Cost Access Quality & Safety Needs Wants CommunityIndividual It’s About A Better Value for the Healthcare Dollar It’s Not About EMR

13. Mixed Quality Measures

14. Near 100% ePrescribing 25,000 e-Prescriptions per Month –1,400 Schedule II prescriptions –2,400 Schedule III to V

15. Error Rates

16. Panel Size

17. Visit Volume

18. Revenue and Expense

19. Little Difference in Hospitalization

20. Cost Access Quality & Safety Needs Wants CommunityIndividual Equivocal improvements in Quality Significant improvement in Safety No change in Access No attributable changes in cost or revenue Dr. Perspective Pt. Perspective In Summary

21. Sustainable success 30 practices 100 Doctors 30 Residents and Fellows 12 practices in the implementation queue 70 more to go Tasks –850,000 –For 47,000 patients –To 550 users –17 / patient; 1500 / user Appointments –185,000 –For 48,000 patients –With 190 Providers –4/patient; 960/provider Prescriptions –221,000 –For 36,000 Patients –By 170 Providers –6 /patient; 1900 / provider 1344 EMR Help tickets

22. Questions? Thanks