Converting from CoumaCare to DAWN-AC V7

1. Teresa Hodgkins Pharm.D. Director of Anticoagulation Center Desert Medical Group/Oasis IPA Palm Springs, California Converting from CoumaCare to DAWN-AC V7

2. Knox-Keene licensed medical plan (full-risk) established 1981 80,000+ lives (20,000 seniors) 100+ primary care physicians �Coumadin Clinic� established 1996

4. Prior to DAWN-AC Closed enrollment capped at 650 pts Primary Care Physician responsible for new warfarin patients Resultant physician dissatisfaction High reliance on paper-based system �Lost� patient information Various lists maintained by 2 clerical personnel Each patient contacted by phone for lab results and instructions

5. How we used CoumaCare�. Utilized by the anticoagulation service for many years Performed scheduling and some sorting of data Information was compiled in a �running dialog� format Had concurrent paper process

6. Conversion Process Only active patient data from CoumaCare was converted and placed into DAWN-AC by DAWN-AC programmers Resultant data was reviewed for accuracy and appropriateness by DMG/Oasis clinicians Adjustments/refinements were performed Overall process took months to coordinate

7. February 2006 Go Live! Most of the clinic staff had very little training on DAWN-AC prior to the Go Live date Brenda Nicol arrived to assist in the process By the end of day 2 we had a functional system used by all staff members

8. Utility of the List View Incredible flexibility Can be easily customized to your process Allows patient data to be sorted in many different ways Now we manage the data instead of allowing the data to manage us!

9. Now we can sort patients by� Physician/Laboratory/Pharmacy Specific insurance type Acute care hospitalization with details Enrollment in special programs such as intense case management, living and aging well for frail elderly, and patients receiving home health services

10. Letters and DAWN-mailer� Allow us to easily generate documents Fax via computer to a multitude of entities Save to patient file Virtually a paperless process Results/missed lab letters to patients Enrollment forms and patient summary reports to physicians Laboratory orders Any document we wish to create as the need arises�

11. Dosage Calculator� Greatly assists in determining doses for patients Not a substitute for clinician but does aid the clinician Greater efficiency has allowed for more time to be spent on patient education and assessment

12. After Conversion to DAWN-AC Enrollment opened Marketing to PCPs for referrals Development of paperless process Stable patients receive letters with results and instructions Job functionality redesigned for clinical efficiencies

13. Today� Since Go Live, we have added over 600 new patients (in 6 months) Total patient load is rapidly approaching 1000 We evaluate approximately 450 PT/INR results per week Stable patients now receive letters for instruction

14. Results� Physician satisfaction much improved. They are able to focus efforts on other aspects of patient care. Patient satisfaction with service remarkable (100 patients surveyed-100 rated overall satisfaction either very satisfied or extremely satisfied) Anticoagulation Center Director named Manager of the Year!

15. Future Goals� Use DAWN-AC to better measure and demonstrate the quality of our service Participate in benchmarking program Apply the clinical model for the anticoagulation service to other aspects of disease management for the patients of DMG/Oasis IPA (The door is open�)

16. Thank You�