ehealth Connecticut Regional Extension Center

Transcription

1 ehealth Connecticut Regional Extension Center c/o Mr. Steve Ruth August 18, 2010 ehealth Connecticut Page 1

2 August 2010 eclinicalworks is ready to join forces with ehealth Connecticut Regional Extension Center and Regional Extension Centers (REC) throughout the country as they begin to offer technical assistance, guidance, and information to support and accelerate health care providers efforts to become meaningful users of Electronic Health Records (EHRs). Below is a brief introduction to eclinicalworks and the ways in which eclinicalworks can assist ehealth Connecticut as it begins to identify and share best practices for EHR adoption, assist practices and providers optimize electronic medical records (EMR) to improve patient outcomes, streamline workflow, and reduce cost, and offer ongoing support to providers who adopt EMR technology in the State of Connecticut. eclinicalworks Overview eclinicalworks is a privately held and profitable leader in ambulatory clinical solutions. Revenue for 2008 was $85 million and 2009 revenues were $112 million. The company s unified Electronic Medical Records (EMR) and Practice Management (PM) system is a CCHIT 2011 certified ambulatory solution that manages patient flow from check-in to check-out and streamlines processes regardless of practice size, specialty and number of locations. Its solutions extend beyond practice boundaries, building inter-connected communities of users and patients. eclinicalworks Experience eclinicalworks has the most community-wide deployment experience of any EMR vendor Fast, cost-effective, and PROVEN implementation strategy Scalable, web-based architecture suitable for practices, groups, and enterprises or all sizes and specialties Features developed to support FQHC/CHC/RHC clients UDS reports, sliding fee schedules, split billing Clients include one of the largest public health projects in the country the New York City Department of Health and Mental Hygiene s Primary Care Information Project (PCIP), with more than 2,000+ providers live in 350+ practices; the Massachusetts ehealth Collaborative; Central Georgia Health Network; Memorial Hermann Healthcare System; and Norman Physician Hospital Organization eclinicalworks - has an established customer base of more than 40,000 providers and 120,000+ medical professionals across all 50 states has a record of success with thousands of implementations in the 1 9 provider market has grown organically over the past 10 years; 40 profitable quarters; 40% growth in revenue in 2009 has more than 1,000 employees dedicated to one, unified product suite, the highest employee-toproduct ratio in the industry has the largest number of SaaS deployed practices in the industry (3,000+ practices) is an award-winning solution, highly rated by independent industry groups for meeting functionality and cost expectations Support for Workforce Development Co-location of resources as needed to support the REC s initial efforts Training of qualified REC personnel or members of the local workforce to support and sustain local adoption of EMRs Community Outreach Focus Groups Product Demonstrations Joint marketing and product literature Joint web presence Videos, tutorials, and documentation Innovative Training Programs On-site training on all aspects of EMR/PM use Free Webinars Free on-line assessment tool for Meaningful Use Meaningful Use Guarantee for Eligible Professionals eclinicalworks meets the Stage 1 requirements for Meaningful Use as defined by ONC ehealth Connecticut Page 2

3 The HIMSS Davies Award Three eclinicalworks customers have received the HIMSS Davies Award in 2008 and This award, which honors excellence in implementation of electronic health records, was presented to eclinicalworks clients in the Community Health Organization category. The Patient-Centric Medical Home Ninth Street Internal Medicine, located in Philadelphia, PA, is one of the first practices in the US to received the highest level recognition as a Patient-Centered Medical Home from the National Committee for Quality Assurance (NCQA). Salvatore Volpe MD PC is the first solo practice in New York State to receive Level 3 recognition by NCQA. NCQA s Physician Recognition programs identify physicians who deliver superior care using evidence-based standards. The Physician Practice Connection Patient-Centered Medical Home (PPC â -PCMH ) is designed to identify practices that systemically provide superlative preventive and chronic care management across patient populations. So, is eclinicalworks the sensation that it claims to be? The answer from today s providers is definitely yes. Functionality, cost, and ease of use are the primary reasons why customers have purchased eclinicalworks. Overall, 93 percent of customers stated that the EMR functionality met or exceeded their expectations and 97 percent stated that the overall cost of adoption met expectations. The healthcare industry is evolving rapidly, resulting in both opportunities and challenges. eclinicalworks views a collaboration with ehealth Connecticut as an opportunity to educate physicians about the clinical and practical benefits of EMR adoption. ecw is ready to meet the challenges of wide-scale EMR adoption with rapid deployment strategies, scalable, secure, and reliable technology, innovative training models, and the experience to make community implementations a reality. The eclinicalworks team looks forward to discussing how eclinicalworks can assist the ehealth Connecticut Regional Extension Center fulfill its mission of facilitating the meaningful adoption of EMRs in practices throughout Connecticut. Sincerely, Milind Shah Director, Business Development Regional Extension Centers Ext milind.shah@eclinicalworks.com ehealth Connecticut Page 3

4 TRANSMITTAL LETTER August 17, 2010 In accordance with the minimum requirements for responding to the ehealthconnecticut Request for Proposal dated July 26, 2010, eclinicalworks agrees to the following: eclinicalworks agrees to meet the standards for EHR certification criteria being established by ONC. Prior to the finalization of certification standards, eclinicalworks will attest to the fact that it intends to apply for, and meet the standards. Once the standards are finalized, eclinicalworks understands that it has six (6) months to achieve certification. eclinicalworks is willing to have submitted information posted on the ehealthconnecticut REC website and understands that it is responsible for regularly reviewing its information and submitting written revisions of that information as required. eclinicalworks is willing to provide web-based, on-line demonstrations of its products. Exhibit Listing Exhibit A ecw Price Proposal Exhibit B ecw Sample Contract Exhibit C EMR Overview Exhibit D Practice Management Overview Exhibit E Revenue Cycle Optimization (RCO) Exhibit F Electronic Health exchange (eehx) Exhibit G ecw Optional Products Exhibit H Third Party Products Exhibit I SaaS Overview Exhibit J Hardware Specifications Exhibit K Implementation Overview Exhibit L Training Overview Exhibit M Data Migration Overview Exhibit N Professional Services Exhibit O Workflow Design Exhibit P Template Customization Exhibit Q Customer Support A folder of Exhibit documents is included with the Proposal Package This proposal contains confidential information that is the property of eclinicalworks. In consideration of the receipt of this document, recipient agrees not to reproduce or make this information available in any manner to persons outside the group directly responsible for evaluation of its contents, except as may be required by applicable public access law, regulation, or both. Please note that all screen shots provided in this response were created using fictitious patient data. ehealth Connecticut Page 4

5 VENDOR PROFILE Name eclinicalworks Any Previous Names N/A Address (Headquarters) 112 Turnpike Road Westborough, MA Main Telephone Number (508) Website Corporate Status (Publicly Traded, Privately held Privately Held, For Profit, Not for Profit) PARENT COMPANY Name N/A Address Telephone Number CONTACT PERSON Name Mr. Milind Shah Title Director, Business Development, Regional Extension Centers Address 112 Turnpike Road Westborough, MA Telephone Number (508) Ext Address: MARKET DATA 1. Number of years as EHR vendor Ten (10) 2. Total customer sites live and in 7,000 sites, 40,000 providers live process to go live In Process: 805 projects in various stages of implementation a. Nationally 7,000 sites, 40,000 providers live nationally b. Connecticut 126 sites 3. Breakdown of sites by number of providers (Solo, 2-5, 6-9, >10) 4. Provide the number of installed sites by specialty and size eclinicalworks does not report client installed base by number of sites by specialty and size. ehealth Connecticut Page 5

6 a. Provide the names and contact information for 3 CT reference sites. See References Table below How Many De-Installations in last 36 months? 7. Please describe your relationship(s) with other ONC funded REC s 8. Additional Comments on Market Data Questions In the past 10 years, there have been 104 de-installs of the system, less than 1.1% of the ecw installed base. The most common reason practices leave eclinicalworks is because the provider has retired or the practice merges with a group that has a legacy EMR in place. eclinicalworks has responded to numerous RFIs and RFPs from Regional Extension Centers throughout the country; has been asked to provide product demonstrations and additional information to many RECs; and has been selected as a preferred EMR vendor by several Regional Extension Centers. eclinicalworks currently occupies approximately 20% of the small practice market space and is rapidly gaining traction in the FQHC/CHC arena as well. ecw has invested significantly in developing features that are unique to the FQHC markets, such as UDS reporting capability, sliding fee schedules, and providerbased billing capability. ecw is a commercially available, off-the-shelf unified EMR/PM solution that is scalable to any number of providers, users, and site locations. Its web-based technology allows a SaaS delivery of the application - practices require less investment in hardware and on-site IT staff and realize a high return on investment. ecw is a flexible, intuitive, and user friendly application that can be easily customized to meet the unique needs of almost every practice. Customization can be done by the user without the need for ecw intervention. ehealth Connecticut Page 6

7 PRODUCT INFORMATION 1. Product name and version # eclinicalworks Version When is your next version release? Q4 of Is your product a Client Server, ASP or Hosted model? Describe each offering. The eclinicalworks EMR/PM unified system can be delivered in an "On Premises" model as well as in a "Software as a Service" (SaaS), fully hosted model. eclinicalworks has nine co-location datacenters throughout the country, with more than 3,000 practices hosted in these datacenters. ecw has the largest hosted client base of any EMR vendor. ecw offers several licensing options that include: Subscription license with ecw hosting Hybrid license (client owns the upfront license and ecw hosts the application) Upfront license with client hosting Subscription license with client hosting eclinicalworks offers several "bundled" packages that contain various combinations of eclinicalworks options, such as Patient Portal, eclinicalmobile, eclinicalmessenger, etc. Refer to Exhibit A, eclinicalworks Pricing Proposal and Exhibit B, Sample Contract. Hardware pricing is provided by Dell. 4. Are Clinical Components Integrated? Yes a. If yes, list integrated components (e.g. The eclinicalworks EMR components include but are not limited to: e-prescribing, lab, etc) Clinical documentation CPOE orders, results Prescribing (erx provided by interface to Surescripts Vitals Clinical Decision Support System Document management Refer to Exhibit C, EMR Overview. b. If no, list non-integrated components N/A 5. Are Practice Management Yes components integrated? a. If yes, list all components. The eclinicalworks Practice Management components include but are not limited to: Master Patient Index demographic capture Patient Registration Scheduling Practice Demographic capture providers, staff, resources, locations, etc. Charge capture Claim creation, scrub, submittal, reconciliation Accounts Receivable management ehealth Connecticut Page 7

8 Collection management Refer to Exhibit D, Practice Management Overview. b. If no, list non-integrated components N/A 6. Do you offer a Revenue Cycle Yes, eclinicalworks has a Revenue Cycle Optimization service. Management or Billing Service for your clients? a. If yes, please describe Refer to Exhibit E, RCO Overview 7. Describe your patient portal offerings ecw s Patient Portal features a streamlined user interface for both and plans, if any. patients and physicians while providing extensive functionality. The web-based Patient Portal lets patients communicate with their doctor easily and securely over the Internet. The Patient Portal is the key to preventative healthcare as well as a communication tool. Patients can: Securely communicate with their practice and provider View their Personal Health Record entire record or elements only View lab and imaging results (as authorized by the practice) Schedule appointments with their provider Request appointments and view date and time of future appointments Request a prescription refill from a pre-populated list of currently refillable medications Complete forms and questionnaires on-line, streamlining the registration and history intake process Request referrals, tests, and imaging on-line Obtain patient education materials View current and past account statements Providers can: Securely communicate with patients Use Questionnaire Wizard to create custom questionnaires for patient completion from their home Upload questionnaires to speed the patient registration process and obtain reliable, patient-reported data New Patient Registration and Patient Pre-Registration Medical, Family, Social, Surgical, Allergy, and Immunization History Post lab and imaging results to the portal Send reminder notices for appointments, procedures, procedure prep, etc. Configure Personal Health Record in accordance with practice specifications Post and upload patient consent forms Obtain requests for authorized refills Obtain requests for referrals, tests, and imaging Send appropriate patient education materials directly to the patient ehealth Connecticut Page 8

9 CERTIFICATION 1. Is the product CCHIT certified? Yes 2. Version, Year and Type Comprehensive, CCHIT 2011, Ambulatory (Comprehensive or Modular) of and Child Health CCHIT Certification 3. List any other current or planned Certifications Plans for future industry certification include ONC certification. See below for details (Meaningful Use section, Question 2). MEANINGFUL USE 1. Do you offer a Meaningful Use Guarantee? a. If yes, describe the level of financial risk you will share with provider customers. 2. Describe your plans and timelines to become Meaningful Use Certified by ONC? Yes If an eligible professional is unable to qualify for reimbursement for meaningful use of the EMR due to a deficiency in the eclinicalworks application, the maintenance and support contract fees will be waived until the issue is resolved. eclinicalworks is well positioned to be certified as an EHR by an authorized ONC-authorized Testing and Certification Body (ONC-ATB). As of this writing, ecw is analyzing the final ruling from the ONC, Standards and Certification Criteria for Electronic Health Records, to prepare for this certification. Through a separate ruling published on June 18, 2010, organizations that desire to become an ONC-ATB are actively preparing and submitting applications to ONC. There is speculation that there will be approved ONC-ATBs by the end of the summer (2010) and certified EHR vendors by the end of The eclinicalworks Product Development, Certification, and Meaningful Use Education Teams are all working together to ensure that ecw is ready for this certification. eclinicalworks will be educating our customers along the way for meaningfully using the product features that will be certified as required by the rulings. ehealth Connecticut Page 9

10 ecw is committed to delivering an ambulatory EMR solution that provides the tools required for eligible professionals to become meaningful users of its technology and qualify for the CMS reimbursements under the American Reinvestment and Recovery Act. eclinicalworks currently meets the Stage 1 meaningful use requirements as defined by ONC. The eclinicalworks website ( has information on ARRA and meaningful use, a webcast, a meaningful use resource center and more. eclinicalworks and the American Recovery and Reinvestment Act and the HITECH Act As it is defined today, eclinicalworks provides the tools necessary for physicians to meet the requirements for Stage 1 meaningful use. Specific functionalities of eclinicalworks that enable compliance today and well into the future include: Integrated code tables (ICD, CPT) that associate the appropriate code with diagnoses and treatments at the point of care Flexible SOAP Note with templates facilitate timely, legible, and complete documentation Inter-operability - CPOE through HL7 interfaces for laboratory and imaging orders and results, eprescribing through Surescripts, integrated real-time allergy and interaction checking at the time of prescribing Registry Reporting for population management and reporting re-calls, appointment reminders, patient-specific reports, chronic care reports, quality measure reports, de-identified statistical reports Patient-centric medical home model of patient care across the continuum of care Peer-to-Peer (P2P) or Electronic Health exchange (eehx) for the secure exchange of clinical information, communication, and referral data between providers Ability to submit data to immunization and disease registries HIPAA compliant ehealth Connecticut Page 10

11 HEALTH INFORMATION EXCHANGE 1. Describe your HIE capabilities and experience with HIE implementations. The eclinicalworks Solution successfully interfaces with RHIOs and HIEs throughout the nation, providing the vehicle by which organizations enter the National Health Information Network (NHIN); has been chosen by a number of hospital-affiliated groups and Independent Physician Associations (IPAs) as they position themselves to participate in RHIO s in their area; and is in the process of implementing electronic health exchanges for enterpriseclass clients. eclinicalworks has successfully implemented a health exchange for the Massachusetts ehealth Collaborative (MAeHC) and is in implementation with several other regional and statewide health exchange initiatives and RHIO s, including Central Georgia Health Network, the Hudson Valley RHIO, and several RHIOs in New York State, including the NY Statewide Health Information Network (SHIN-NY), the Brooklyn Health Information Exchange (BHIX), Long Island Patient Information Exchange (LIPIX), and the Healthcare Information Xchange of New York (HIXNY). Below are several of the many provider networks who have chosen eclinicalworks in addition to those groups listed above: 2. What HIE connections and interfaces if any are included with your product. o New York City Department of Health & Mental Hygiene o Continuum Health Partners o Hendricks Regional Health Medical Group, Indiana o Central Oregon Electronic Medical Records (COEMR) o InterMed, P.A., and PrimeCare, Maine o Sisters of Charity of Leavenworth Health System (SCLHS) eclinicalworks has the Electronic Health exchange (eehx) product that allows interoperability between eclinicalworks and a RHIO or health information exchange of choice. Refer to Exhibit F, eehx. ehealthconnecticut HIE technical specifications are found on the ehealthconnecticut website at After reviewing, please comment on your ability to commit to meeting these requirements and in what timeframes. Please be sure to include specific responses regarding patient registration and query (PIX/PDQ) transactions, XDS transactions including Continuity of Care Documents, and BPPC: eclinicalworks can meet the requirements as specified in DSS Pilot Site Technical Requirements. We are currently testing most of these transaction with different RHIO s in New York and are capable of implementing the Alpha Pilot Implementation in the standard timeline of 8 to 12 weeks. Specific details regarding patient registration and query (PIX/PDQ) transactions: ecw supports Patient Identity feed [ITI -8, 9, 10] HL7v2 and [ITI-44, 45, 46] (currently in testing phase with various HIE s in the NY region - Brooklyn Health Exchange (BHIX), Bronx Health Exchange, and VITL). XDS transactions: ecw supports most XDS-B transactions [ITI-41,42,43,18] (also in testing phase) Continuity of Care Documents: C32 HITSP version 2.5. ecw is currently not using the SNOMED coding system but other coding systems such as ICD, CPT, LOINC, NCPDP are used and a proprietary terminology cross-walk is in place - Electronic Community-wide ID (ecwid) which can be easily converted to SNOMED or Medcin if required BPPC: ecw supports XACML document for consent for NY state RHIO s ehealth Connecticut Page 11

12 PRICING AND RELATED SERVICES 1. Are you willing to have us publish your pricing on our website? 2. Describe your software pricing in detail, including all components for which a practice may be charged. Yes Exhibit A, eclinicalworks Price Proposal presents three (3) price packages from which to choose. License models include: 1. SaaS subscription, hosted by ecw 2. SaaS hybrid client owns the licenses, hosted by ecw 3. Up Front client owns the licenses and hosts the application 4. Subscription client pays a monthly subscription fee and hosts the application Items that are offered in the three bundled packages: Refer to Exhibit A, ecw Price Proposal. Refer to Exhibit G, ecw Optional Products. Refer to Exhibit H, Third Party Products. 3. Are you able to offer a discount for customers of the ehealthconnecticut REC? Yes. The discount is reflected in the Pricing Proposal, Exhibit A. ehealth Connecticut Page 12

13 a. If yes, please describe The pricing provided in Exhibit A, ecw Price Proposal reflects a significant discount on the SaaS (hosted) model of the eclinicalworks EMR/PM unified system. This discount is being offered to every Regional Extension Center throughout the country in support of the aggressive implementation goals set forth by ONC for adoption of electronic medical records. The SaaS model of ecw is a secure and reliable method of application delivery that allows practices to implement the eclinicalworks solution with a minimal investment in hardware infrastructure and virtually eliminates the need for the practice to have an on-site IT staff or utilize the ongoing services of an IT consultant. Refer to Exhibit I, SaaS Overview. Refer to Exhibit A, ecw Price Proposal. 4. Do you bundle or arrange for any other related services such as hardware, network, and ISP purchasing and support? a. If yes, please describe all such relationships and services Yes; eclinicalworks has a business relationship with Dell for the procurement, installation, test, and maintenance of hardware and network equipment. eclinicalworks can provide hardware, hardware installation, and hardware maintenance services through its business relationship with Dell Computer. Please note that eclinicalworks is hardware neutral, performs well on most industry standard hardware platforms, and clients are under no obligation to purchase hardware from Dell. ehealth Connecticut Page 13

14 IMPLEMENTATION TRAINING SUPPORT 1. Briefly describe your Implementation Overview: Implementation Plan. Address issues such as on-site versus website training, 1. The Implementation Process begins when eclinicalworks workflow analysis, existing data receives the signed contract from the client. At that time, an conversion, who is trained, and eclinicalworks Project Team will be assigned to your account and software and template customization the ecw Project Manager will contact you to begin planning the implementation in detail. Issues to consider at this time are: workflow analysis, IT requirements, interface requirements, data migration, system architecture, training, and Go-Live. Special requirements and custom features are discussed in detail at this time as well. 2. A Project Plan is developed and provided to the practice team for review and approval. The proposed Project Implementation Schedule is reviewed and discussed, and various roll-out approaches are evaluated. 3. The Training Plan is customized to fit the Project Timeline and the implementation strategy that is agreed upon. 4. On-site workflow analyses are done by members of the ecw Project Team to understand the current clinical workflows, assess IT needs (hardware/devices/interfaces, etc.), and recommend strategies for smoothly transitioning to a paperless EHR. 5. A variety of activities are now occurring: data migration, practice hardware deployment, design documentation is finalized, network checks are performed, the application is installed, interfaces are defined and installed, and user training sessions are occurring. 6. Go-Live with ecw 7. Post-Implementation Support is determined based on specific needs of the practice users and issues that have surfaced during the Go-Live period. 8. For weeks post Go Live, the account is handled by a Strategic Account Manager who coordinates every facet of customer support required. Once the practice is fully operational on eclinicalworks, the Strategic Account Manager will transition the client to ecw customer support. 9. Customer support is available Monday-Friday, 7:00 AM - 9:00 PM, EST, excluding holidays. 10. On-line support at the Customer Care Portal ( is available 24 hours a day. Refer to Exhibit K, Implementation Overview. Additional details: Training: ecw provides on-site training to all system users. On-site training is a combination of classroom lecture, workbook, and handson at individual workstations. ecw offers a variety of classes including Super User, Train-the-Trainer, Advanced ebo Reporting, booster classes, etc. Free webinars on a wide variety of topics are scheduled on a monthly basis and clients can sign up at the Customer Care Portal. Refer to Exhibit L, Training Overview. ehealth Connecticut Page 14

15 Data Migration: ecw can provide data migration services from a legacy EMR. Refer to Exhibit M, Data Migration Overview. Workflow Analysis and Design: A certain amount of workflow analysis is performed by the ecw Project Manager at the beginning of the implementation. ecw offers additional Business Analyst services at an additional charge. Refer to Exhibit N, Professional Services. Refer to Exhibit O, Workflow Design. 2. Provide the normal length of implementation by practice size (solo, 2-5, 6-9, >10) 3. Describe your ongoing support post implementation. Templates and customization: ecw comes pre-loaded with hundreds of templates that are easily customizable by authorized users without the need for IT or vendor intervention. Training on template customization and application customization is provided. Refer to Exhibit P, Template Customization. The standard length of time for an eclinicalworks implementation is weeks for a practice of 1-10 providers. Post Go Live Support: The eclinicalworks Project Manager does a knowledge transfer to an assigned Strategic Account Manager (S.A.M.) as the date for Go Live approaches. The Project Manager, Strategic Account Manager, trainers, and the entire ecw Project Team are available during all phases of the project to lend assistance, escalate and resolve questions or issues, and provide guidance based on knowledge gained from their experience with many implementations. The S.A.M. is the main point of contact for the practice as they become comfortable with eclinicalworks or need additional assistance for a period of approx. 12 weeks post Go Live, prior to being transitioned to standard ecw Support. Standard Support: Telephone Support: M F 7:00 AM 9:00 PM EST (excluding holidays) Live Chat for common How To questions: M F 9:00 AM 6:00 PM EST (excluding holidays) 24 x 7 x 365 Support: Customer Care Portal at: -- The Portal is monitored by a highly qualified staff of ecw Technical Support personnel who will respond the each ticket logged within the timeframes noted in Exhibit, Customer Support. Refer to Exhibit Q, Customer Support. 4. Describe your training and support pricing structure. Training: $1,000 per day per trainer + round trip airfare Support: $600 per year per provider ehealth Connecticut Page 15

16 OTHER ISSUES 1. Do you utilize other companies or services in the process of bringing a process through the implementation and go live process? 2. What is your current wait time to begin an installation in Connecticut? No, all implementation activity is performed by eclinicalworks employees. eclinicalworks can begin implementing providers in Connecticut immediately. 3. Are you willing to help sponsor Yes. ehealthct REC promotional activities and conferences? a. If yes, describe ecw will work with ehealth Connecticut in the following ways: Community Outreach and Lead Generation Reference Sites calls and site visits Physician demonstrations live demonstrations and webinars Community Extension Events showcase the product, demonstrations, literature, etc. Partner web presence if desired Co-branded marketing literature 4. Any other information you would like to provide? eclinicalworks is an affordable, unified EMR/PM solution that can be implemented on time and within budget. ecw prices licenses by provider rather than user - all system users receive a license, but only providers are charged for the license. Database licenses are included as part of the application license fee. ecw has the largest SaaS client base of any EMR vendor, allowing the practice to invest less in hardware and IT staff, maximizing their ROI. ecw has a proven week implementation strategy that helps practices become meaningful users of the ecw technology, increases office efficiency, and improves patient outcomes ehealth Connecticut Page 16