EHR Implementation and AdoptionAmbulatory EHR

at MaineGeneral Medical CenterTuesday September 9, 2008AHRQ Annual Conference

WE HAVE A SUCCESSFUL AMBULATORY EHR IMPLEMENTATION IN RURAL MAINE

Funded by AHRQHIT Implementation Grant Number: UC1 HS15337Grant Title: Improving HIT Implementation in a Rural Health System September, 2004 – March, 2008

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

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

MaineGeneral

0% 50% 100%

Patients

Doctors

Practices

Square Miles

Rural Counties

Hospitals

Integrated Delivery …

70,000

100

30

11,000

5

2

1

70,000

156

82

Participating

It’s about Sharing

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

One PatientOne Chart

Ancillaries

Primary Care

Specialty

Patient

A Short History of a Long Project

05

1015202530354045

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010C

umul

ativ

e e-

Prac

tices

RFP

Touchworks

7 Pilot Sites

AHRQ Grant

1st Ext Pract

Tracking the Conversion

A Good Problem List is a Disease Registry

Structured Data is Key to Clinical Reporting

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.

Cost

AccessQuality&Safety

Needs

WantsCommunity Individual

It’s About A Better Value for the Healthcare Dollar

It’s Not About EMR

Mixed Quality Measures

Near 100% ePrescribing• 25,000 e-Prescriptions per Month

– 1,400 Schedule II prescriptions – 2,400 Schedule III to V

Error Rates

Panel Size

Visit Volume

Revenue and Expense

Little Difference in Hospitalization

Cost

AccessQuality&Safety

Needs

WantsCommunityIndividual

•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

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

Questions?

Thanks