EHR Implementation and Adoption

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

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Dan Mingle, MD, MS

• 14 years - Clinical Rural Family Practice
• 5 years - Residency Faculty
• Residency Assistant Medical Director
• 2003 Graduate Dartmouths Center for Evaluative
  Clinical Sciences
• IT Project Director
• PI, IT Implementation Grant
• Director, MGH Ambulatory Clinical Informatics
• Healthcare Informatics Innovator Award, 2008

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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 QA

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MaineGeneral
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Its about Sharing
Patient

• Med List
• Allergy List
• Problem List
• Results
• Notes
• Care Plans
• Reminders
• Communication

One Patient
One Chart
Primary Care
Specialty
Ancillaries
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A Short History of a Long Project
1st Ext Pract
Touchworks
7 Pilot Sites
RFP
AHRQ Grant
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Tracking the Conversion
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A Good Problem List is a Disease Registry
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Structured Data is Key to Clinical Reporting
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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.

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Its Not About EMR
Its About A Better Value for the Healthcare
Dollar
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Mixed Quality Measures
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Near 100 ePrescribing

• 25,000 e-Prescriptions per Month
• 1,400 Schedule II prescriptions
• 2,400 Schedule III to V

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Error Rates
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Panel Size
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Visit Volume
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Revenue and Expense
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Little Difference in Hospitalization
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In Summary

• Equivocal improvements in Quality
• Significant improvement in Safety
• No change in Access
• No attributable changes in cost or revenue
• Dr. Perspective
• Pt. Perspective

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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

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Thanks

• Questions?