Georgetown University Selection of Electronic Health Record Presented by: Suniti Ponkshe June 14,2007

1. Georgetown University Selection of Electronic Health RecordPresented by: Suniti Ponkshe June 14,2007

2. Healthcare Challenges • Everyone believes that American healthcare system needs a major reform because it has many challenges that are hard to resolve: • Cost • US spends around 14% of gross domestic product on healthcare (estimated to rise up to 20% by 2010) — other advanced nations spend an average of 8% • Quality/Value • The Commonwealth Fund study indicates that Americans spend more but receive less value • Deaths due to medical error and other problems are equivalent of a World Trade Center disaster every week for over 18 months, or the crash of two fully loaded 747 aircraft every day of the year.

3. Healthcare Challenges • Everyone believes that American healthcare system needs a major reform because it has many challenges that are hard to resolve: • Access • “Access” refers to the ease with which people can obtain the care they need • Access problems are caused by lack of coverage from insurance, high co-payments, lack of providers in certain areas, etc. • Effectiveness • Even though some experts say that the benefits outweigh the cost in such areas as heart disease and low-weight newborns — others argue that there is a lot of waste in the heath care system, which results in ineffective service

4. Healthcare Challenges – Potential Solution • There are no easy answers to solve healthcare issues, but —use of Healthcare Information Technology (HIT) is one such solution • Improving quality with the use of HIT – connecting quality with better use of technology • Pay for performance – quality improvement in care delivery • CMS pay-for-performance program • Bridges to excellence • Evalue8 • Insurance companies – Blue Cross Blue Shield plans • Measuring quality and outcomes is not possible without use of technology

5. Nine Technology Trends Nine significant technology trends for 2006: • Disaster Preparedness • Disease Management • Electronic Medical Records • E-Prescribing • National Standards • Pay for Performance • Personal Health Records • Regional Health Information Organization • Wireless Security * Healthcare Informatics February 2006 Issue

6. Nine Technology Trends Nine significant technology trends for 2007: • Disease Management (2) • Enterprise Master Patient Indexes • Electronic Medical Records (3) • Pay for Performance (6) • Personal Digital Assistants • Personal Health Records (7) • Telehealth • Storage • Vendor Consolidation * Healthcare Informatics February 2007 Issue

7. Healthcare CIO Trends Healthcare Information and Management Systems Society (HIMSS) 2006 Leadership Survey of healthcare CIO’s listed eight key priorities: • Reduce Medication Errors / Promote Patient Safety (1) • Implement an EMR (7) • Connect IT at Hospital and Remote Locations (6) • Process/Workflow Design (5) • Implement Wireless Systems (4) • Replace/Upgrade Inpatient clinical Systems (3) • Upgrade Network Infrastructure • Design/Implement IT Strategic Plan www.himss.org/2006survey/docs/healthcare_cio_key_trends.pdf

8. Most Commonly Used Definition of EHR • Electronic Health Record (EHR) • “a secure, real-time, point-of-care, patient-centric information resource for clinicians. • The EHR aids the clinicians’ decision-making by providing access to patient health record information when they need it and incorporates evidence-based decision support. • The EHR automates and streamlines the clinicians’ workflow, ensuring all clinical information is communicated and ameliorates delays in response that result in delays or gaps in care. • The EHR also supports the collection of data for uses other than clinical care, such as billing, quality management, outcomes reporting, and public health disease surveillance and reporting.” Source: http://www.himss.org/content/files/ehrattributes070703.pdf

9. Electronic Health Record (EHR) is a building block process and the Clinical System is a major foundation block ….

10. Technology Tools for User Interface Clinical Decision Support Tools Clinical Documentation Basic Order Entry and Results Reporting System Technology Infrastructure

11. DRAFT Overview of Major Systems & Implementation Status Pharmacy/ Medication Safety Clinical Decision Support Physician Clinical Practice Medication Order Entry & Formulary Mgmt SMS Medication Dispensing Pyxis Med/IV Charting Physician Order Entry Credentialing MSO Results Review SMS Patient Locator/ Patient Lists SMS Data Warehouse Home Grown Decision Support TQ/T2 Report Writer Data Warehouse Drug Database Micromedix Dosing Mgmt SMS Drug Interactions SMS PDA Support Outcomes Measurement / Comparative Data Med AI Core Information Management Components CMAR User Interface/ Portal CareNet GL/AP Peoplesoft Standard CDM/ Master File SMS Health Information Management Enterprise Patient Access SoftMed Chart Management Transcription/ Dictation Medquist (Outside Vendor Order Entry SMS Clinical Data Repository CareNet Patient Accounting SMS/Affinity/Keane Admission/ Registration SMS Enterprise Schedluling HBOC Eligibility Verification HDX Result SMS SMS Document Imaging InterQual Support for LOC Common Medical Vocabularies ICD-9/ CPT4 HR/Payroll Peoplesoft Kronos Wincoder Abstracting Enterprise Master Person Index (MPI) SMS EAD Security Tools Novell Request for Authorization SoftMed MRN Management and Merge WincoderCoding Support SoftMed Electronic Signature Longitudinal Clinical Data SMS LCR Rules Engine SMS Integration Tools E-Link Clinical Documentation SMS Patient Assessment/ Tracking SMS I &O Vital Signs Flowsheets SMS Departmental/ Support Services Supply Chain Lab Sunquest Radiology Quadris Cardiology MUSE Cath Lab Catalyst Blood Bank Sunquest Patient Supply Charges SMS & Par Excellence Materials Mgmt Peoplesoft Care Plans SMS Emergency Department EmSTAT Task Lists SMS Pathology CoPath Sr. Living Clinicals Accu-Med SMS Kardex Respiratory Mediserve & I-Stat OB GE QS Contract Management VCM Home Health Allegheny Surgery Surgi-Server Omni-Server Patient Assessment SMS Non-MD orders SMS Sr. Living Financials Keane Home Health McKesson/HBOC Maximum Utilization Moderate Utilization Purchased – Not Implemented In Progress

12. Clinical Systems Vendor Landscape has Changed ……. • Vendors are becoming full service providers -- through acquisitions and some system building • Vendors are migrating to an “open system” platform, i.e., ability to interface with other systems easily • Health systems are leveraging technology to support and meet their quality strategic plan such as Patient Safety, saving lives and reliable information • Some health systems are adopting “Best of Breed” approaches with appropriate boundaries – supporting Cedars’ quality strategic goal of meeting user needs and adding value • Academic Medical Centers, who once had home build culture, are now opting for vendor systems

13. Product Life Cycles Epic EpicCare Eclipsys SCM McKesson Horizon Cerner Millennium McKesson Paragon Siemens Soarian Meditech C/S &Magic Siemens Invision Cerner Classic Eclipsys SunriseXA Eclipsys 7000 GE Centricity Enterprise Competitive Strong new client sales. Relatively heavy investment in enhancements Declining Declining investment in enhancements Few new client sales New Pilot sites completed New sales accelerating High investment in development Pre- Release Major development underway Pilot sites being installed Sunset Little investment in support No new client sales

14. Electronic Health Record • Vendor Market • Hundreds of vendors • Too competitive • Diminishing market sector lines • Selecting EHR • Structured process • Criteria • Impact on the workflow • Right purchasing option

15. System Selection Methodology Understand Current State Identify Vendor Short List Conduct Vendor Evaluation Define Future State Vision Conduct Decision Day 2 Conduct Decision Day 3 Identify System Capability Gaps Contract Negotiations Develop RFQ Conduct Decision Day 1 Preliminary Implementation Planning Prepare Clinical Benefits

16. Key Steps……. Documented items during Future State sessions Sorted and categorized items by Process, Themes and Assumptions Analyzed list to develop CIS requirements and key questions Feb 2 and Feb 20 Review requirements with Care Delivery Team & Steering Committee March 9 Develop RFQ, vendor scripts, and refine requirements

17. We are here today ……. Steering Committee Approved Guiding Principles and Key Requirements Developed Comparative Vendor Analysis and Summary of Alternatives Care Delivery and Physician Advisory Teams Review Vendor Analysis Steering Committee Select 2 or 3 vendors for demonstrations and other evaluation steps Conduct vendor demonstrations, site visits, corporate visits, and reference calls Summarize analysis for Decision Day #3

18. Overwhelmingly recognized as the leader – second to none. Generally recognized as a leader - could be tied with one other. Considered equivalent to others – tied with two or more. Needs improvement – More than three other vendors considered materially better. Not generally available – may be building it but doesn’t have it today. Comparative Approach This is an example Comparative Scale: Each vendor was scored according to the scale

19. Request for Quote (RFQ) Provided background information regarding company, references, implementation strategies, cost estimates Etc. Each vendor is evaluated based primarily on software demonstrations, with some focus on RFQ responses. Software Demonstrations Summarized the functional usability of the application against the future state vision using scripts.

20. Vendor Comparison • Functionality • Evaluation based on the key requirements1 from future state sessions • Clinical Documentation • Orders Management • Medication Management • Pharmacy • Clinical Decision Support • Results Review • Usability • Health Analytics • 1 Key Requirements are in Attachment A • Technology • Evaluation based on the technical requirements identified in the process • Integration with CSHS environment (interoperability) • Scalability • Speed and Reliability • Company • Evaluation based on market intelligence and experiences • Vendor Vision • Company Viability • Ability to Execute • Customer Service Focus • Vendor Culture and Goals alignment with CSHS

21. Thank You Suniti Ponkshe Associate Partner IBM Healthlink Solutions sponkshe@us.ibm.com Phone: 703.903.9685