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Centricity Physician Office 2005 User Summit EMR General Session Dave Henriksen General Manager, CPO Agenda GE Healthcare Introduction - David Henriksen, General Manager Clinical Content Update - Susan Thomas, MD, Medical Director Government and Industry Initiatives Update - Marianne Braunstein, Marketing Manager Centricity Physician Office Roadmap Update - Kathleen Brooks, EMR Product Manager 1/ GE / Business Brief Agenda • Centricity Physician Office Organization Update • Clinical Leadership • EMR 2005 – Early Adopter Program • Digital Communities 2/ GE / Physician Office Organization Functional Summary • Engineering 134 • Support 75 • Implementation 46 + 33 contracted • Sales/Marketing 53 • RTS Total 14 332 3/ GE / Significant Investment Focus on Development Revenue Growth Development FTE’s $ Million 120 120 100 100 80 80 134 60 40 87 54% Increase! 14% 60 40 64 73 2004 2005 20 20 0 0 2004 2005 Integrated Financials User Interface Clinical Content and Workflows Decision Support Interoperability eRX Clinical Leadership 4/ GE / NCQA Certification: •FIRST EMR in the Industry! •Diabetes Physician Recognition Program •Commitment to Quality •Pay for Performance Medical Quality Improvement Consortium Membership = 50% Growth in ‘05 Database = 60 % Growth in ‘05 87 Members 4.4 Million Patients 3,288 Physicians 30 Million Office Visits 35 States 326,580,576 Observations 8 Big Birds (100+ MDs) QI Reports (June ’05) 66% Growth Sessions: 100 Hours: 50 Clinical Studies 30 sponsored studies/year 9 Academic Studies/year $3.5M commercial grants in 2005 5/ GE / Introducing the Newly Released Centricity Physician Office Primary Care Kit (PCK) New in 2005 ! • Six-Sigma project by our ITPS and Engineering teams • Dozens of forms, letters, handouts, clinical lists • Created over the years with input from Clinicians • Embedded intelligence • Free to new users and IB EMR 2005 and EAP Early Adopter Program 6/ GE / EMR 2005 Images, Illustrations, & Annotations Medications Growth Charts Problems •Enhanced Allergies & Adverse Reactions •Desktop Document Management •Clinical Accuracy •CPO PM/EMR Integration The Value of EAP (Early Adopter Program) Our 2005 EAP Sites: • Carilion Health System • Central Maine Healthcare • Children’s Health System – UAB* • Community Health Network • Erickson Retirement* • Evans Medical Group* • Joseph Perkinson* • Wake Internal Medicine • Goal of EAP is to ensure readiness of new release • Validation feedback provided on new and changed features • Usability and performance of application verified • Accuracy and completeness of documentation improved • Upgrade process verified first on test servers, then in production • 3 sites now live on EMR 2005 Pilot Version* 7/ GE / Digital Communities Province of Ontario Ontario Only 24,000 Physicians 8,000 subsidy eligible 13 vendors 1 ASP provider – Aliant $150 million $60+$20 million 8/ GE / Thank You! Clinical Content 9/ GE / Centricity Physician Office 2005 User Summit Clinical Content Roadmap Susan Thomas, MD, FAAFP Medical Director Centricity Physician Office 10 / GE / Providing Clinical Content For the EMR Paths to Richer Clinical Content Quality Reporting Clinical Systems Links Encounter Forms Decision Support EMR Instrument Interfaces Knowledge Links 11 / GE / Paths to Richer Clinical Content GE Encounter Forms Forms! • Creative and flexible encounter forms, letters, handouts, clinical lists • Backbone of standard forms • Build on these with disease management and specialty content • Embedded intelligence Paths to Richer Clinical Content When was last eye exam? Labs are Due!! Decision Support Tools Decision Support • Enhanced Protocol Kits • Evidence Based Reminders • Intelligent Forms 12 / GE / Paths to Richer Clinical Content WEB BASED CONTENT LINKS MedscapeTM from WebMD iConsultTM from Elsevier PIERTM from ACP Clinical Evidence TM from BMJ UpToDateTM Inc ZynxTM Health Inc eMedicineTM Clinical Knowledge Base • Joslin Diabetes Center • Bright FuturesTM from AAP • • • • • • • Knowledge Links! Paths to Richer Clinical Content Centricity Perinatal Centricity Laboratory Clinical Interfaces • Inpatient Perinatal • Cardiac ClinicalEchocardiography • PACS Imaging Systems! • Laboratory Order Interfaces • OB Ultrasound • Intellidose Chemotherapy Administration 13 / GE / Paths to Richer Clinical Content Adherence R ate Post-MI Patients on Beta Blocker 85% 80% 75% 70% 65% MQIC Benchmark Encounter Forms Protocols & Guidelines Quality Disease Inquiries Reporting! Registries Production Reports Clinic MQIC/Quality Improvement Tools to Improve Quality & Outcomes Individual Patient Provider Panel Broader Populations First step on the Clinical Content Roadmap 14 / GE / Introducing the Centricity Physician Office Primary Care Kit • Six-Sigma project by GE’s Field Support and Engineering teams • 49 Encounter Forms, • Letters, handouts, clinical lists • Created over the years with the help of Clinicians • Embedded intelligence • Free to all users through the KnoweldgeBank Free to All users! PCK: Well Child Form Series 15 / GE / PCK: Adult Comprehensive PCK: Lab Result Letter Form 16 / GE / PCK: Childhood Immunizations PCK: Flexible Sigmoidoscopy 17 / GE / PCK: Phone Notes and Refills Let’s work together ***** [email protected] 18 / GE / Government and Industry Initiatives NHIN: The Framework In July 2004, Dr. Brailer delivers, “The Decade of Health Information Technology: Framework for Strategic Action” Goal 1: Inform Clinical Practice (“get EHRs adopted”) • Strategy 1. Incentivize EHR adoption • Strategy 2. Reduce risk of EHR investment • Strategy 3. Promote EHR diffusion in rural/underserved areas Goal 2: Interconnect Clinicians • Strategy 1. Foster regional collaborations • Strategy 2. Develop a national health information network • Strategy 3. Coordinate federal health information systems Goal 3: Personalize Care • Strategy 1. Encourage use of Personal Health Records • Strategy 2. Enhance informed consumer choice • Strategy 3. Promote use of telehealth systems Goal 4: Improve Population Health • Strategy 1. Unify public health surveillance architectures • Strategy 2. Streamline quality and health status monitoring • Strategy 3. Accelerate research and dissemination of evidence Key Actions • Establish a Health Information Technology Leadership Panel • Support private sector certification of HIT products • Fund community health information exchange demonstrations • Plan the formation of a private interoperability consortium • Require standards to facilitate electronic prescribing • Establish a Medicare beneficiary portal • Share clinical research data through a secure infrastructure • Make a commitment to standards 19 / GE / Govt & Ind Initiatives: “The Community” Jun ‘05 Jul ‘05 Aug ‘05 Sept ‘05 Oct ‘05 Nov ‘05 Dec ‘05 Jan ‘06 Feb ‘06 Mar ‘06 Most Americans have their medical informatio n in an 2009EHR 2014 AHIC “The Community” Members • In response to Brailer’s “Framework for Strategic Action” Framework call-toaction “Establish a Health Information Technology Leadership Panel” with the objective to help achieve the 2014 goal • Total of 17 members including the chair, Sec. Leavitt: – 8 federal – 8 private – 1 position open for an IT vendor Æ to Intel • Breakthroughs identified: – Consumer empowerment (e.g., PHRs) – Health improvement (e.g., eRx, chronic disease management) – Public health protection (e.g., biosurveillance) Govt & Ind Initiatives: ONC RFPs Jun ‘05 Jul ‘05 Aug ‘05 Sept ‘05 Oct ‘05 Nov ‘05 Dec ‘05 Jan ‘06 Feb ‘06 Mar ‘06 2009 2014 3 of the 4 ONC RFP Awards: Stds, Cert, Sec/Priv Oct Oct6, 6,2005 2005 For Foraatotal totalofof$17.5m $17.5m •• Standards StandardsHarmonization Harmonization ANSI ANSItotoform formHealth HealthInformation InformationTechnology TechnologyStandards StandardsPanel Panel(HITSP) (HITSP) $3.3m $3.3m •• Certification Certification(of (ofEHRs) EHRs) CCHIT CCHIT $2.7m $2.7m “Production” “Production”certification certificationofofEHRs EHRsininMarch March2006 2006 •• Security Security&&Privacy Privacy(federal (federalor orstate statelaws lawsprecedence) precedence) Research ResearchTriangle TriangleInstitute Institutetotoform formThe TheHealth HealthInformation InformationSecurity Securityand andPrivacy Privacy Collaboration Collaboration $11.5m $11.5m 20 / GE / Govt & Ind Initiatives: ONC RFPs Jun ‘05 Jul ‘05 Aug ‘05 Sept ‘05 Oct ‘05 Nov ‘05 Dec ‘05 Jan ‘06 Feb ‘06 Mar ‘06 2009 2014 Last of the 4 ONC RFPs: NHIN Real World Demos Govt & Ind Initiatives: NHIN Demo’s Nov Nov10, 10,2005 2005 For a For atotal totalofof$18.6m $18.6m • • Accenture Accenture(Apelon, (Apelon,Cisco, Cisco,CGI-AMS, CGI-AMS,Creative CreativeComputing ComputingSolutions, Solutions,eTech eTechSecurity SecurityPro, Pro,Intellithought, Intellithought, Lucent LucentGlow, Glow,Oakland OaklandConsulting ConsultingGroup, Group,Oracle, Oracle,and andQuovadx) Quovadx) –– Eastern Kentucky Regional Health Community (Kentucky) Eastern Kentucky Regional Health Community (Kentucky) –– CareSpark CareSpark(Tennessee) (Tennessee) –– West WestVirginia VirginiaeHealth eHealthInitiative Initiative(West (WestVirginia) Virginia) • • CSC CSC(Browsersoft, (Browsersoft,Business BusinessNetworks NetworksInternational, International,Center Centerfor forInformation InformationTechnology TechnologyLeadership, Leadership, Connecting Connectingfor forHealth, Health,DB DBConsulting ConsultingGroup, Group,eHealth eHealthInitiative, Initiative,Electronic ElectronicHealth HealthRecord RecordVendors Vendors Association, Association,Microsfot, Microsfot,Regenstrief RegenstriefInstitute, Institute,SiloSmashers, SiloSmashers,and andSun SunMicrosystems) Microsystems) –– Indiana IndianaHealth HealthInformation InformationExchange Exchange(Indiana) (Indiana) –– MA-SHARE MA-SHARE(Massachusetts) (Massachusetts) –– Mendocino HRE (California) Mendocino HRE (California) • • IBM IBM(Argosy, (Argosy,Business BusinessInnovation, Innovation,Cisco, Cisco,HMS HMSTechnologies, Technologies,IDL IDLSolutions, Solutions,Ingenium, Ingenium,and andVICCS) VICCS) –– Taconic TaconicHealth HealthInformation InformationNetwork Networkand andCommunity Community(New (NewYork) York) –– North Carolina Healthcare Information and Communications Alliance (Research Triangle, North Carolina Healthcare Information and Communications Alliance (Research Triangle, North NorthCarolina) Carolina) –– North NorthCarolina CarolinaHealthcare HealthcareInformation Informationand andCommunications CommunicationsAlliance Alliance(Rockingham (RockinghamCounty, County, North NorthCarolina) Carolina) • • Northrop NorthropGrumman Grumman(Air (AirCommander, Commander,Axolotl, Axolotl,Client/Server Client/ServerSoftware SoftwareSolutions, Solutions,First FirstConsulting ConsultingGroup, Group, SphereCom SphereComEnterprises, Enterprises,WebMD) WebMD) –– Santa Cruz RHIO (California) Santa Cruz RHIO (California) –– HealthBridge HealthBridge(Cincinnati, (Cincinnati,OH) OH) –– University UniversityHospitals HospitalsHealth HealthSystem System(Cleveland, (Cleveland,OH) OH) 21 / GE / AHRQ State Demos in HIT ($25M eHI 2005 HIEs (+$2M) Hurricane affected Gulf states NHIN Demos Sample of RHIOs AK WA ME MT ND VT MI MN OR WI ID NH MA CT NY SD MI RI WY PA IA NE NV IL CA UT NJ MD OH DE IN WV VA CO KS MO KY NC TN OK AZ SC AR NM MS AL GA LA TX HI FL Govt & Ind Initiatives: DOQ-IT Jun ‘05 Jul ‘05 Aug ‘05 Sept ‘05 Oct ‘05 Nov ‘05 Dec ‘05 Jan ‘06 Feb ‘06 Mar ‘06 2009 2014 DOQ-IT: CMS 8th SOW th •• Going Goingnational nationalwith withthe the77thScope ScopeofofWork, Work,DOQ-IT DOQ-ITspecial specialstudies studies program limited to AR, CA, MA, UT program limited to AR, CA, MA, UT •• 5911 5911practices practices(5% (5%ofof“primary “primarycare”) care”)inineach eachstate state •• Final Finalgoal goalisistotosupport supportquality quality •• Export Exportofofkey keymeasures measureson onchronic chronicdiseases diseasestotoaadata datawarehouse warehouse •• Marketing to and working with QIOs (DOQ-IT University) Marketing to and working with QIOs (DOQ-IT University) 22 / GE / Govt & Ind Initiatives: Stark / AKS Jun ‘05 2003: MMA Jul ‘05 Aug ‘05 Sept ‘05 Oct ‘05 Nov ‘05 Dec ‘05 Most Americans have their medical information in an EHR Jan ‘06 Feb ‘06 Mar ‘06 Rx Drug Program effective eRx: Stark & AKS Relaxtion 2009 2014 eRx uniform stds compliance Govt & Ind Initiatives: eRx Proposed Stark / AKS Available to: • hospitals for their medical staffs Relaxation • group practices to physician members • PDP sponsors and MA organizations 1) eRx exception / safe harbor • MMA of 2003 mandate for HHS 2) EHR exception / safe harbor “pre-interoperability” • Authority given to HHS in Stark and AKS for additional exceptions / safe harbor 3) EHR exception / safe harbor “post-interoperability” • May include billing and scheduling software as long as core functionality includes EHR • • • • • • All must comply with the eRx standards Necessary and used solely Cannot donate IT technology already exists (donatee must certify) Donatee cannot divest existing technology Value caps Without regard for volume and value 23 / GE / Govt & Ind Initiatives: eRx Jun ‘05 Jul ‘05 Aug ‘05 Sept ‘05 2003: MMA Oct ‘05 Stark & AKS NPRM Nov ‘05 Dec ‘05 eRx Most Americans have their medical information in an EHR Jan ‘06 Feb ‘06 Mar ‘06 Rx Drug Program effective 2009 2014 eRx uniform stds compliance Foundation standards: •NCPDP SCRIPT Version 5.0 for transactions between prescribers and dispensers for new prescriptions, refill requests and response, prescription change request and response, prescription cancellation request and response, and related messaging and administrative transactions. •ASC X12N 270/271, Version 4010 and addenda, for eligibility and benefits queries and responses between prescribers and Part D sponsors. •NCPDP Telecommunication Standard, Version 5.1, and supporting NCPDP Batch Standard, Version 1.1, for eligibility queries between dispensers and Part D sponsors Initial standards: •Formulary and benefits, patient instructions, prior authorization messages and clinical drug terminology (RxNorm), medication history, NPI GE’s Involvement John Schaeffler GEHC’s representative to U.S. Congress and govt agencies Jackie Studer GEHC’s counsel for legislative activities (e.g., Stark) Francois de Brantes Bridges to Excellence, The Leapfrog Group, eHealth Initiative Charles Parisot HITSP, IHE, HL7, ASTM John Moehrke CCHIT, IHE, HL7, ASTM Hugh Zettel EHRVA, HIMSS, ONC CSC NHIN Demo RFP, CCHIT, Katrina Relief, Legislation Tom Ricciardi Outcomes research, P4P, RHIOs Susan Thomas, MD HIMSS, CCR Acceleration Group, CCHIT, AAFP Marianne Braunstein eHI, HIMSS, CCHIT, RHIOs, DOQ-IT, Legistlation, Katrina efforts 24 / GE / Road Map Market Drivers & Priorities 25 / GE / Dynamic & Complex Environment… EMR Product Roadmap Drivers… Customer Enhancement Requests Interfaces Certification Interoperability DOQ-IT Centricity EMR Clinical Content Pay for Performance Decision Support NHIN Support ePrescribing Integrated Financials Outcomes System Architecture User Interface Refresh Centricity Physician Office Priorities Interoperability Clinical Leadership Integrated Financials 26 / GE / CPO-EMR Initiatives for 2006/2007 Customer Requests – Better reporting, Alerts, FH/SH tab on Chart Summary, Medical necessity checking w/ABN, Clinical Update “icon” Interoperability – Support RHIO initiatives, Inpatient connectivity, Interfaces, CCR/CDA Support ePrescribing – New Rx, Refills, Formulary and eligibility support, RX Hub, Sure Scripts Clinical Content and Decision Support – moving beyond the paper chart to providing decision support Federal Initiatives – RHIO(NHIN), CCHIT Certification, AHRQ, QIO, DOQ-IT, P4P User Interface and System Architecture – update screens and tools, on going product development goals Current Programs – 2005 & 2006 27 / GE / 2005/2006 – New Product Introductions Mobile Handheld Charge Capture ¾ Fully Integrated ¾ Centricity Schedule on PDA ¾ Patient Demographics on PDA ¾ Mobile Charge Capture ¾ CPT and ICD-9 Codes available n drop down list ¾ Sync with Centricity ¾ Import External Charges ¾ Confirmation of Imported Charges November 2005 EMR 2005 EMR Release ¾ Images Illustrations & annotations ¾ Medications Enhancements ¾ Growth Charts ¾ Problems ¾ Enhanced Allergies & adverse reactions ¾ Desktop Document Management ¾ Clinical Accuracy ¾ Preparation for PM-EMR integration ¾ Support of multiple DB instances on a single server December 2005 CPO-2006 Integrate PM and EMR ¾ Unified SQL Database for both PM and EMR ¾ Platform rationalizations ¾ Unified Scheduling and Administration ¾ Collection enhancements for PM ¾ Updated User Interface 3rd Quarter 2006 Save time, automate the billing process, and recapture lost revenue • Centricity Mobile is Fully Integrated with the Centricity Physician Office Practice Management System • Provides Access to Patient Lists, Demographics & Schedules on the PDA • Increase Revenue • Eliminating Lost and/or Never Recorded Charges • Reduce Lag Time • Real-time Code Edits 28 / GE / Fully Integrated Patient Lists, Demographics, & Schedules on the PDA EMR 2005 Features / Functionality Images, Illustrations, & Annotations Workflow designed for capturing digital images Images saved into database Ability to add illustration templates Simple annotation on images or illustrations Medications Medication monographs Drug dosing calculator Drug interaction checking earlier Brand medically necessary (by state) Monthly medication updates Growth Charts Problems Problem list views with dimming Problem reactivation Duplicate problem notice End date improvements (i.e., minor diagnoses) Enhanced Allergies & Adverse Reactions Desktop Document Management Views Teams Out-of-office support Multi-document routing Clinical Accuracy Required fields on encounter forms Redesigned panic high/low indicators Custom flowsheet observation labels Pediatric age improvements Units support JCAHO’s “Do Not Use List” CPO PM/EMR Integration MIK error handling Insurance & contact management Appt matching 29 / GE / CPO 2006 Description Target Market EMR Port to MS SQL 2005 Integration of User Model/SSO Installation Patient Information Administration & Set-up Scheduling & Appointments Application Look & Feel Billing and orders Combined EMR/PM Customers Small – Medium Size Doctor office SQL Database – lower cost Appeals to office with minimal IT support Collections Enhancements CPO Roadmap The future… 30 / GE / Clinical Content Foundation Charting Excellence Primary Care Kit Patient Education GE Six Sigma Content ¾ Primary Care Kit ¾ New Encounter Form Sets ¾ Flex Sig Form, EKG Form, more ¾ Vaccine management ¾ New Letters and Handouts Completed November 2005 Next Step Evidence Based Guidelines Knowledge Base Links Instrument Interfaces GE Clinical Content ¾ “Backbone” content – elements of a SOAP note ¾ Chronic Disease Mgmt ¾ Web Enabled Knowledge ¾ Building Blocks for the future 2006 Building the Future Enhanced Decision Support Embedded Knowledge Collect and Implement Best Practices Quality & Efficiency ¾ Commitment to further development & excellence ¾ Continue to Enhance Decision Support tools ¾ 3rd party clinical interfaces 2007 Interoperability… the key to the The future… Today future • Multiple versions of •HL7 HL7and v2.3 ASTM, Interfaces NCDPD, DICOM, X12 EMR Link New Interface Logi Engine c Tool •• 130 different Faster Interface development interfaces have been written • ASP Support •• Has a great Morebeen flexibility tool • Ability to support •RHIO Limited for future growth • In-patient/Out-patient •interoperability Limited to one HL7 • Device Integration format IHE Profiles •• Ready for a change support • DOQ-ITtomeasures new Standards 31 / GE / CCHIT Certification for EMR What is it? CCHIT (The Certification Commission for Health Information Technology) is a industry group formed to develop certification standards for the many EMR vendors. The mission of CCHIT is to accelerate the adoption of robust, interoperable HIT throughout the US healthcare system, by creating an efficient, credible, sustainable mechanism for the certification of HIT products. As a leader in EMR… GE Commitment • Commit to unmet requirements: We will support… 9Documentation of Medication Administration 9 Track Chronicity Levels 9 Orders Updates – view by like types (all Radiology, all labs, etc) 9 Record Advanced Directive Reviews Centricity EMR 9 Support Structured documentation of Medication, dose, time,route, site, lot #, Manufacture and User ID 9 Electronic Transmission of prescriptions and renewals 9 Track state license, DEA, UPIN & NPI numbers ePrescribing Transmissions via Sure Scripts for Retail Pharmacies • Kryptiq will offer in 1st quarter 2006 • Ability to electronically transmit to participating pharmacies in EMR Meds window for new and renewal Rx • Error management provided • Implementation only Transmissions via RX HUB for Mail Order Pharmacies Centricity EMR Meeting customer needs Support MMA & CCHIT requirements • GE will develop interface to RX HUB for 2007 availability • Ability to electronically transmit to participating pharmacies in EMR Meds window • Will support Formularies and Eligibility • New Renewals workflow and tab Will id M d hi t 32 / GE / You asked… All future EMR releases will contain enhancement requests provided by the Users! 2007 Customer Enhancement Requests from “Speaking with a Single Voice” session at 2004 Summit • Add new patient chart tab for Family History/Social History • Medication Export • Care Alerts/Reminders • Enhance Refill Form – part of ePrescribing Updating Tools… staying current Legend PM PM Specific Specific Shared Shared EMR EMRSpecific Specific Licensing && Security SecurityFramework Framework Licensing Financial Financial Transaction Transaction Mgmt Mgmt Billing, Billing, A/R, A/R, Collections Collections Balance Balance Forward Forward • Service oriented Architecture Desktop Desktop Documents Messaging Hosted Scheduling Payment Payment Entry Entry Patient Patient Information Information EDI EDI Management Management Scheduling Scheduling EDI EDI Plug-Ins Plug-Ins Reports Reports Chart Chart Chart Review & Update Documentation (Text & Forms) Decision Support (Protocols, Int Checking, E&M Advisor) Orders (Charges) Administration Administration Common UI Shell Service Service Wrappers Wrappers Service Service Wrappers Wrappers Service Service Wrappers Wrappers Business Business Logic Logic Business Business Logic Logic Business Business Logic Logic ADO.NET ADO.NET Data Data Access Access Layer Layer Internet Information Server (Web/Application Server) Terminology Terminology Application && Server Server Installers Installers Application (Single Common Common installer installer for for all) all) (Single Refreshing the User Interface • Work flow improvements Updating the • Seamless Clinical Content Architecture PM Data CPO Database Shared Data Insite Insite IIII (Monitoring (Monitoring && Supportability) Supportability) CPO Users EMR Data (Single Shared Database Server) HL7 HL7 (Integration) (Integration) Engine Engine (CPO SSO) Active Directory (User Database) Clinical Tools (Formulary Editor, Form Editor) 33 / GE / Mobile Roadmap Vision TODAY FUTURE • Integration with Centricity PM • Integration with Centricity EMR • Patient List • Clinical Summary and Clinical Results on PDA • Demographics • Schedule • ePrescribing • Charge Capture • Dictation EMR Roadmap 2005 2007 2006 Interoperability EMR 2005 CPO 2006 New Interface Engine Standards Clinical Content Decision Support Form Development EMR ePrescribing Electronic RX-Hub Enhancements GE Clinical Content Primary Care Kit User requests User Interface Architecture update CPO 2007/EMR 2007 SureScripts ePrescribing Mobile Charge Capture Mobile – EMR for Clinical Summary and results & ePrescribing 34 / GE / Thank You! 35 / GE /