Presentation by Dr. C. Martin Harris of Cleveland Clinic. Dr. Harris came to Milwaukee on October 9th to provide the information in this presentation.

1. EMR Use in the Age of Healthcare Reform C. Martin Harris, M.D. Chief Information Officer, Cleveland Clinic Executive Director, eCleveland Clinic

3. American Reinvestment and Recovery Act HIT Directives Definition of Meaningful Use Standards Definition Measures Definition Framework (HIT Adoption, Quality Management, and Interoperability) Secretary, Health and Human Services HIT Policy Committee HIT Standards Committee

6. e Analytics and Research : Research Standardization Dr. Connect : Improved Communication; Improved Care My Practice : Electronic Medical Record System My Practice ● Community eHealth Services Virtual Visit : Patient/Physician Interaction Globally My Consult : Your First Choice for a Second Opinion My Chart : Your Personal Health Connection My Monitoring : Ongoing Condition Reporting from Home Providers Patients My Practice : Electronic Medical Record System

7. My Practice Electronic Medical Record Patients Front Desk Nurses Physicians Schedulers Residents Researchers Physicians = 6,004 Residents / Fellows = 850 Pharmacists = 364 Other End Users = 38,608 Patients in the EMR = 5,707,792 Prescriptions = 42,472,788 Orders = 126,649,261 Encounters = 24,174,250 Total Results = 484,072,179 Cleveland Clinic User and Encounter Statistics (Through August, 2009)

10. Results

11. On-Line Documentation

12. Computerized Physician Order Entry

13. Drug Interaction Alert DRUGS: COUMADIN TABLET 2 MG PO ZOLOFT 50 MG PO SIGNIFICANCE LEVEL. Very High Can override and accept the interaction

14. Age, Gender, and Diagnosis Specific Health Maintenance Alerts

15. e Analytics and Research : Research Standardization Dr. Connect : Improved Communication; Improved Care My Practice : Electronic Medical Record System My Practice ● Community eHealth Services Virtual Visit : Patient/Physician Interaction Globally My Consult : Your First Choice for a Second Opinion My Chart : Your Personal Health Connection My Monitoring : Ongoing Condition Reporting from Home Providers Patients My Chart : Your Personal Health Connection

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21. e Analytics and Research : Research Standardization Dr. Connect : Improved Communication; Improved Care My Practice : Electronic Medical Record System My Practice ● Community eHealth Services Virtual Visit : Patient/Physician Interaction Globally My Consult : Your First Choice for a Second Opinion My Chart : Your Personal Health Connection My Monitoring : Ongoing Condition Reporting from Home Providers Patients My Monitoring : Ongoing Condition Reporting from Home

22. eEnabled Chronic Care Management Model

23. eEnabled Chronic Care Management Model Connectivity

24. My Practice: Physician Results View , , , , , Patient’s Blood Pressure Measures from Home

25. eEnabled Chronic Care Management Model Connectivity My Chart

26. Dear Patient, I recommend the following: Begin spironolactone 25mg once daily. I sent this as a secure ePrescription to your preferred pharmacy. Stop Norvasc (amlodipine), but do not discard. Decrease potassium to 20mEq once daily Stop by the lab for blood potassium test 2-3 weeks after making these changes. Message me if you have additional questions.

27. e Analytics and Research : Research Standardization Dr. Connect : Improved Communication; Improved Care My Practice : Electronic Medical Record System My Practice ● Community eHealth Services Virtual Visit : Patient/Physician Interaction Globally My Consult : Your First Choice for a Second Opinion My Chart : Your Personal Health Connection My Monitoring : Ongoing Condition Reporting from Home Providers Patients My Practice ● Community

29. 1. Independent Physician’s Office 2. Independent commercial pharmacy, labs, and patient at home 3. Cleveland Clinic Ambulatory sites 4. Cleveland Clinic Inpatient Meaningful Use Operating Model

30. Process to Achieve Meaningful Use Operating Model Objectives “ The ultimate vision is one in which all patients are fully engaged in their healthcare, providers have real-time access to all medical information and tools to help ensure the quality and safety of the care provided while also affording improved access and elimination of health care disparities.” “ Meaningful Use: A Definition” Recommendations from the Meaningful Use Workgroup to the Health IT Policy Committee June 16, 2009