Pharmacy Track – Day 1

1. Fall Clinical Conference & Customer Business Meeting Pharmacy Track – Day 1

2. HEALTH ENTERPRISES PHARMACY SERVICES HERx REMOTE PHARMACY

3. Pharmacy • Off-site fully managed 340B program • 340B implementation and audit consulting • 24/7 real time remote order entry • Lab • Core • Reference • Mobile Services • MRI • Stereotactic Breast Biopsy • Digital Mammography Imaging • Echo/Ultrasound • Lithotripsy • Bone Densitometry Health Enterprises Overview

4. Enhance patient safety • Orders are reviewed on a real-time basis • Cost effectively expand flexibility and options in pharmacy staffing • Free up on-site staff for other critical functions and projects • Improve support for formulary and clinical initiatives Why Remote Pharmacy?

5. Reduce expenses associated with overtime and recruiting • Provide cost-effective method for achieving compliance with Joint Commission regulations • Meet the increasing standards of med safety and demand for pharmacist review • Minimize increasing labor costs Why Remote Pharmacy?

6. Remote Order Entry and Order Verification • Supplemental Remote Staffing • Clinical Services • Renal Dosing • Pharmacokinetics • Pediatric Dosing • IV compatibility/dilution information Current Services Offered by HERx

7. Address medication related questions from physicians and nurses via telephone • Visual Verification • Patient’s home medications • Medications removed from pharmacy • IV product preparation by nursing Current Services Offered by HERx

8. Health Enterprises Remote Pharmacy Service

9. Meditech • Cerner • Paragon • CPSI • Centriq Electronic Medical Records that HERx currently supports:

10. Written orders are received from hospital via eFax • Pharmacist maintains a secure Citrix connection to all hospitals • Pharmacist constantly reviews CPOE order queues and verifies physician and nurse entered orders • Nursing staff and physicians are contacted via telephone with any questions related to the medication orders Remote Pharmacy Process

11. Doc-q-Ment • Web based, secure • eFax queue for written orders or nurse communications • Documentation of orders entered, interventions, handoff report to on-site staff, basic reports • reference materialsfor staff Applications Utilized by HERx

12. qPM • provides secure Citrix connections to all hospitals • single point to log into all hospitals for our pharmacists • provides IT support for hospital connections • Telax • Cloud-based contact center • Allows for robust reporting, routing of calls, transfers between pharmacists, caller ID • Lync • Used by HERx pharmacists to communicate with each other during shifts Applications Utilized by HERx

13. Report generated by Doc-q-Ment at the end of each coverage period and faxed to the hospital • Contains numbers of orders processed, broken down by CPOE orders and written orders • All interventions performed are listed • Any clinical information that needs to be relayed to the on-site staff is included • Any information about products that need to be obtained for patients is included • Any operational issues encountered during the shift are included Handoff Communications

14. Handoff Report

15. Best Practices • Policies and Procedures • Protocols • Formulary • EMR utilization Collaboration Among HERx Hospitals

16. 14 pharmacists on staff, including Executive Director, Manager, 4 full time pharmacists, 8 part time/per diem pharmacists • Average of 19 years experience across the team • All have at least 3 years recent hospital pharmacy experience • Team includes • Clinical Coordinator for 400 bed hospital • IT Pharmacist for a 750 bed academic medical center • Several former Directors of Pharmacy HERxTeam

17. Per Diem pharmacists required to work minimum number of hours each week • Team and individual training prior to each go-live • Periodic reviews and re-training for each hospital or EMR that we work with • Quarterly or biannual visits from HERx management to meet with pharmacy and nursing staff to discuss opportunities for improvement Team Competency

18. Serve as a single point of contact at HERx for the hospital • Assigned based on EMR in place at the hospital • Lead pharmacists serve as the expert on that hospital for the rest of the HERx team • On-site visits at implementation and as needed • Develop reference materials for initial training and new processes • Responsible for relaying new processes/procedures to the HERx team HERx Lead Pharmacists

19. KPIs

20. Remote pharmacist costs generally XX% lower than hiring additional on-site staff or expanding pharmacy hours • HERx charges by the hour • Based on hospital size and anticipated order volume • No hidden charges as there can be with “per line” or “per click” models • No implementation costs Cost

21. Thank you for your time and attention today. If you have any questions concerning remote order verification operations or other Health Enterprises’ pharmacy offerings please see my contact information below. Thank you! Aaron Lott, Pharm.D.Executive Director, Pharmacy Services Health Enterprises, LLC 5825 Dry Creek Lane NE Cedar Rapids, IA 52402 Phone: (319) 310-0612Fax: (319) 368-3626 Email: alott@healthenterprises.org Website: www.healthenterprises.org Acknowledgment to Kelly Kolker as a content contributor for this prentation. Questions

22. PharmacyRoundtable &Idea Sharing Session

23. Evening Event:Meet outside the Conference Center at 5:30 pm for a hayride to the venue Remember to check out of your room before the Thursday General Sessions.