Point of Care (PoC) Technology Planning

1. Point of Care (PoC) Technology Planning Prepared for Cardinal Health

2. External Hospital Pressures • Patient safety – JCAHO, Leapfrog, etc. • Publicly available outcomes data • Adoption of mandated nurse to patient ratios • Continued nursing shortage and skill gaps • Patient satisfaction – Press Gainey scores • Evolving technologies and new vendors • EMR/EHR adoption pressures

3. Resulting Health Care Trends • Most patient flow bottlenecks occur in critical care areas – ICU and telemetry – ED overcrowding and ambulance diversions continue • Patient monitoring and ventilators are moving to general care units to off-load critical care areas • New care delivery strategies – variable acuity units, house-wide monitoring, medical emergency teams • Renovation and building trends – private rooms, decentralized nursing stations, “universal rooms”

4. Technology Evolution • Medical devices and IT systems are blurring • Device data integration with EMRs • Central station proliferation (telemetry, pumps, ventilators) • Alarm notification systems • Increasing PoC software adoption (meds admin, EMR, CPOE, etc.) • Proliferation of PoC computing devices • RFID adoption (patient, staff, asset tracking)

5. Changes at the Point of Care • Enterprise solutions are needed for what was once considered stand-alone • Various medical devices integrated with information systems (e.g., EMR, remote care) • House-wide access to surveillance and therapy delivery data – management and alarms • Wireless communications with phones, nurse call, and medical devices

6. What’s Your Situation? • How many different nurse call systems do you have? • How many individual medical device networks are installed? • How many vendors provide your monitors, pumps and ventilators? • How many central stations will you have on nursing units in 5 years? • How many point of care computing devices do your nurses really need? How many will they accept? • What would it cost to “upgrade” all your nurse call, patient monitoring and IV pumps to support connectivity and IT integration?

7. IT Project mgt Nursing Mission-critical infrastructure Staffing models Care delivery methods PoC computing devices Admissions criteria Policies & procedures Enterprise solutions Nursing unit design Biomeds Medical Staff Patient safety Access to resources Device evaluations Administration Patient satisfaction Direct clinical support Outcomes Productive environment Patient satisfaction Bed utilization Clinical arms race Organizational Silos Point of Care

8. Communications Phones Pagers PDAs Computers on wheels Overhead pages Nurse call Medical Devices Tasks Patient care PoC diagnostics Patient assessments Ventilators Patient monitors Alarms Meds administration IV pumps Telemetry packs Documentation Spot vital signs monitors Coordinating care Patient education The Point of Care

9. Communications Phones Pagers PDAs Variable workload by patient Direct care vs. facilitating care Open nursing positions Nursing skill levels Interrupt-driven environment Direct care sometimes lags Delays in care delivery Tasks poorly aligned with devices, and information systems Computers on wheels Overhead pages Disparate alarms Different alarm annunciation Different alarm classifications Alarms at device or central station Alarm fatigue Failure to rescue No single vendor solution Vendor standardization difficult to achieve Nurse call Medical Devices Two-way phone tag Unheard calls or pages Delayed or undelivered pages Proliferation of devices Noise and confusion Unreliable communications Delays in care delivery Patient safety impact Tasks Patient care PoC diagnostics Patient assessments Ventilators Patient monitors Alarms Meds administration IV pumps Telemetry packs Documentation Spot vital signs monitors Coordinating care Patient education

10. Point Solution Limitations • Vendor’s PoC solutions fail to cross vendor and device categories – they only solve part of the problem • Unnecessary and expensive upgrades • Proprietary tech that creates lock-in through high changing costs • Proliferation of computing devices at point of care

11. Emergin Integration Suite • A foundational integration platform that drives process improvement – standardization, interoperability and automation • Open, vendor-neutral, device independent • Orchestrates over 200 best-of-breed systems using plug-and-play technology • Modular and scalable, begin with a single system and add service components incrementally • Zero-Defect Communications

12. Enterprise Architecture Infrastructure Systems Point-of-Care Systems Information Systems Building Systems EMR Adapter Adapter Adapter Staff Directory Dashboards Enterprise Service Bus Emergin Orchestrator Client Patient Directory Adapter Location Services Communication Systems Universal Assignments White Board Command Center Patient Safety Indicators Quality Metrics

13. Available Adapters A4 Health Systems Adaptive Aeroscout Alcatel Amtelco Aarmark Ascom BMC Canamex Cardinal Health Care Technology Cerner Cingular Cisco Comtech Wireless Datascope Draeger Medical Dukane Eclipsys Ekahau ELO EXI Frontrange GE Healthcare GE Security Get Well Network Hewlett Packard Hill-Rom Home Free Johnson Controls Life Line McKesson Meditech Microsoft Motorola Multitone NEC Nextel Notifier Nortel Note Page PCSC Philips Medical Picis Premise Premise Radianse Rauland RF Technologies SBC SDC Siemens Skytel SimplexGrinnell Spacelabs SpectraLink Sprint Startel Surguard Swisslog Symbol TAC Americas Tektone Teletracking TMA Systems TOA Tyco USA Mobility Varatronics Vasona VeriChip Verizon Versus VisionLink Visiplex Vocera Waveware Wescom West-Call XTend Zetron

14. Performance Management PatientSafetyOfficer Nursing Leadership IT/Communications IT/Communication QoS Reports provide the following to monitor IT Quality of Service: System Malfunctions Total Successes/Failures Per Vendor Total Messages Per System Type Total Messages Per Carrier Total Messages Per Recipient A Patient Safety Officer can review a root cause analysis transcript of activity to trace errors and omissions to the second: Alarm Set Delivered to Communication System Delivered to Communication Device Delivered to Recipient Read by Recipient Acknowledged by Recipient Alarm Reset Nursing Reports provide the following to evaluate staff-patient ratios and nurse vigilance: Total Alarms Per Vendor Total Alerts Per Vendor Alarms Per Location Alarms Per Sensitivity

15. Operational Efficiencies • A Service-Oriented Architecture unites departments and drives teamwork across the healthcare enterprise • Leverages and extends the life of legacy system investments • Drives standardization & interoperability across multiple silos • Enables healthcare organizations the flexibility to pick-and-choose any combination of disparate technologies; enables best-of-breed selections • Produces score cards that monitor progress of event activity and dashboards the measure operational performance

16. Staff Productivity • Creates teamwork by enabling communications across multi-disciplinary departments • Automatically populates patient and staff directories; no more manual data entry • Standardize the way that clinicians enter staff assignments; perform this task globally, not locally • Location services - • Quickly and efficiently find objects and people

17. Failure Mode & Effects Analysis • Proactively identifies system malfunctions and alerts supervisors to take immediate action • Reduces, if not eliminates, human mistakes by proactively monitoring common errors and omissions • Helps healthcare organizations move away from timely and anecdotal investigations; produces a root cause analysis transcript that can quickly and efficiently identify errors • Adds checks and balances to identify patient and staff location during a critical alarm situation • Can assist in reducing mortality rates by adding the necessary ‘safety net’ required for improved patient safety

18. Cardinal Alaris Gateway Dashboards Emergin Orchestrator Client Point-of-Care System Communication Systems Communication Systems Enterprise Service Bus Alarms Management Server Point-of-Care System Communication Systems EMR Staff Directory Patient Directory Location Services

19. Gateway Features • Pump alarms transmitted from Alaris to Emergin • Pump, Syringe, PCA • Occlusion, PCA-pause, Air-in-line, etc. • Monitoring alarms supported • SpO2, EtCO2 • EtCO2 – no breath, disposable disconnected, etc.

20. Gateway Benefits • Improved Communications • Faster Response Times • Improved Workflow • “Root Cause” Analyses

21. Return on Investment Summary Quantitative ROI • Leverage existing technologies -- not ‘rip-and-replace’ • Enterprise workflow automation -- assignments, management reports, communication systems • Nurse Productivity Gains – 51% improvement in completing patient tasks, $37,700 per care unit per year (see U of Maryland study) • Patient Safety – root cause analysis transcripts for adverse events, including sentinel events/ supervisory alerts • Patient Satisfaction – raise scores by improving response time • Staff Satisfaction/Retention – improve the clinical processes to reduce workload Qualitative ROI

22. Some Key Questions • How long does a root cause analysis take now? • How can you maximize communications for disaster readiness? • What facilities alerts need to be managed? How is that done today?

23. Tim Gee Principal tim@medicalconnectivity.com www.medicalconnectivity.com www.cardinal.com www.emergin.com