1. Clinician Mindset: Where are the docs heads in all this? June 18, 2010 Ryan Bosch MD FACP MBA Chief Medical Information Officer Inova Health System

2. Questions that are prevalent…about EMR’s? How much money is this going to cost me? How do I do this? Can I do this? Who can help me with this process? I cannot afford to make a bad decision… How long will it take? What about my subspecialty or specific professional needs…what are my peers saying? What is my long term practice goals? …remain independent or consider larger practice setting?

3. Money –This is “dinner” money…most small practices do not have excess capital set aside for this type of upfront investment –Cost estimates: (2-3 clinician practice)  Hardware $30,000, Software $30,000, Implementation $30,000 Consulting  This is after you make your vendor selection which takes TIME/money  Get what you pay for…$150-1000/mo per clinician (2-12,000/year license maintenance –Areas for cost savings, but require savvy consumer Know How Reluctance to ask for help….not sure who to ask or to Trust Uncoverings of the workflow of how the practice runs (personal) Money and Know How…

4. Avoiding the mistakes of others… Who can help me…peers, local IT techs, hospital systems, large consulting groups? What are the mistakes of others…but more importantly how do they apply to me?...what are my goals? Start with the “man in the mirror” (or woman) Define goals of the practice and expectations of the EMR Who is really going to be the user? Must lead by example to promote user ship in office For less sophisticated system undisciplined workflow creates a real mess real quick that is hard to fix

5. Traditional Apprehensions/Change Management EMR’s cannot support my subspecialty. I cannot type/too many clicks. Can I really get to e-prescribe, order entry, and HIE in time to get the HITECH incentives…are they really going to pay us…things change I am too close to retiring to get the value out of this Maybe I should join a large practice? I do not have any IT experience…my current paper system works …why do I have to change?

6. Clinician Mindset Summary Most know that EMR’s are still minimally implemented and when used…used only superficially as dictate/Scan “Watchful waiting”…wanting assurances This is a philosophical issue…what does the man in the mirror think and how can he/she be incented to overcome this large hurdle? When to transform? When is “someday” going to be here? 15% and 85% rule. Soon it will all be electronic. Most Agree. Where, how, and in what way can I get trusted help? Individual decision…waiting for the inflection point!