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
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