 It is remote out here in upcountry Maui, but far away doesn't mean far behind. Dr. Masturiani, for instance, was among the first to implement and maintain an electronic medical record system in Hawaii. This is where our server is kept. We back up our e-clinical works program every day and then do a thorough backup, a much larger backup once a month as well. We use a DAT system that's integrated into our server, and basically it's just popping in a DAT tape. Every day the program runs at 11 o'clock at night, and then we check it to make sure it was completed in the morning. Dr. Masturiani is his own IT officer, and he trained all of his staff over the past two and a half years on the EMR system. His team is young and dynamic, actually using paper, seems out of place around here. Whenever we need information, it's a lot simpler. We just type it up, pop it up, print it out, fax it up. It's two snaps compared to looking through a paper chart, trying to figure out what everything says on it, can't read half the writing on it. So, I probably wouldn't want to go back to it. This is probably the best way to go. It does everything. Every staff member has a workstation to enter patient data as it is generated. Masturiani collaborates with a physician assistant at the nurse practitioner. His team is involved in the ongoing refinement of the system, and today the office can claim to be one of the most efficiently run in Hawaii. Once I'm done with my exam, I can go to her chart and create her chart under a template. I go in, I click a generic template that we've created that's viral syndrome. I hit that, I merge the plate, it then has a physical exam already charted for me, and I only change any of the abnormals from that basic template. So, my charting is cut down to about a third of the time while I'm with the patient. All the practitioners that I have grew up with the program, and as it became more useful to us, we fine-tuned it so that it fits our practice well. They were part of that process. So, the templates have been set up with their input. The addition of the alert systems that we use were talked about with them. We meet once a month and review any problems we're having with the program or with office flow, and so they've been a part of that actually. When Masturiani and his staff took over the practice in 2004, the e-clinical work software had just been installed. Since then, the Comtree Dock has never stopped pushing it to the next level. Well, one of the many aspects we enjoy about the e-clinic works program is the ability to use modules to interact with patients instead of large machines. Instead of using an EKG machine, for example, we have a small module made by iMark that allows us to plug directly using a USB cable into our computer system, and then our cardiac leads are attached to the patient in normal fashion. The data is downloaded in real time directly into the system and can be saved and faxed and used just like a normal EKG would be. The family doctor is using the EMR to manage preventative care and his chronically ill patients. E-clinical works allows him to keep track of annual exams and will alert his staff to initiate necessary treatments. This patient, particularly now, is due for colonoscopy. She hasn't had a DEXA scan. The mammogram and PE and pap smear all do. I can also look at the immunizations and see if she's had her yearly immunization for influenza, if she's up to date with her tetanus, or if she might be in need of a pneumavax. Those are all set up as preconditions for certain patient groups. Mastriani never leaves his office with a stack of charts under his arm and he usually gets out before sunset. He may just be a country doc, but his level of EMR utilization outperforms most city physicians in Hawaii.