Healthcare Market Drivers

1. Georgetown University Selection of Electronic Health RecordPresented by: Suniti Ponkshe September 22, 2010

2. Three broad drivers for healthcare transformation: costcontainment, greater collaboration and improved quality of care • Rising healthcare costs and economic pressures are increasingly constraining access and quality • Tax shortfall • Rise in unemployment • Lack of transparency • Dramatic increase in uninsured population and uncompensated care • Value-driven healthcare will drive optimization and require proactive collaboration among all stakeholders • Governments, Payers and Providers shifting focus beyond acute care to Wellness, Prevention and Chronic Disease management • Increasing demand for improved quality and outcomes measurement “The stars are aligned for historic transformation in Healthcare” ……. And it did ……….. Healthcare Market Drivers

3. “The stars were aligned for historic transformation in Healthcare” ……. And we began our journey ……….. American Recovery and Reinvestment Act The Health Information Technology for Economic and Clinical Health (HITECH) Act The Patient Protection and Affordable Care Act Healthcare Journey

4. American Recovery and Reinvestment Act (ARRA) • ARRA 8 • The Health Information Technology for Economic and Clinical Health (HITECH) Act • Adoption of Interoperable Health IT • ONC Authority • Medicare and Medicaid Incentives • The Patient Protection and Affordable Care Act (PPACA) • Many Implications for Health IT • Center for Innovation • Service Delivery Models – Accountable Care Organization; Medical Home • Payment Models – Shared Savings; Risk Adjusted Payments Provisions

5. The HITECH Vision • Improved Individual and Population Health Outcomes • Increased Transparency and Efficiency • Improved Ability to Study and Improve Care Delivery Data Meaningful Use of Certified EHRs Adoption of EHRs Exchange of Health Information • Regional extension centers • Workforce training • State grants for health information exchange • Standards and certification framework • Privacy and security framework Medicare and Medicaid Incentives and Penalties Research to Enhance Health Information Technology

6. EHR Adoption in Physician Office Practices 100 25 80 20 60 15 40 10 20 5 0 0 Level of EHR Function Size of Practice > 50 physicians Basic System 13% 50% Percentage Percentage Fully Functional 1 - 3physicians 4% 9% DesRoches., N Engl J Med 2008 6

7. Stage 3 Stage 2 Stage 1 Conceptual Approach to Meaningful Use

8. Nine Significant Technology Trends for 2010: • Clinical Informatics • Computerized Provider Order Entry (CPOE) • Data Infrastructure • HITECH • Privacy • Reimbursement Reform • Smart Phones • Telemedicine 2010 Technology Trends * Healthcare Informatics February 2010 Issue

9. Healthcare Information and Management Systems Society (HIMSS) 2010 Leadership Survey Key Priorities: • Meeting Meaningful Use Criteria • Focus on Clinical Systems • Leveraging Information • Optimizing Current Systems • Focus on Ambulatory Systems • Patient-Centric Solutions • Interoperability Between In-house Systems • Integration with Medical Devices www.himss.org/2010survey Healthcare CIO Trends

10. 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.” Most Commonly Used Definition of EHR

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

12. Vendors are becoming full service providers -- through acquisitions and some system building • Payers are getting into product offering • 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 quality strategic goal and meeting user needs while adding value • Lines between inpatient and ambulatory vendors are diminishing Clinical Systems Vendor Landscape has Changed …….

13. 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 Product Life Cycles

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

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

16. Decision-making Process Vision Decision Three areas pivotal to the Process are ……

17. Vision • Best of Breed, Best of suites, others • Ownership • Analytics • Others Vision Requires Review of Key Strategies

18. Decision-making Process Selection process needs broad support, collaboration and consensus

19. Clinical System Selection (CSS) Executive Steering Team CCS Care Delivery Advisory Team CSS Physician Advisory Team CCS Technology Task Force CCS Communication Task Force Project Governance Needs to Involve all Constituents ….

20. Establish Goals and Key Requirements Decision Day Facilitate Future State Sessions Develop Comparative Vendor Analysis Create Short List Decision Day Conduct Vendor Demonstrations Select Finalists Decision Day An Effective Process is Needed With Milestones Conduct Additional Evaluation of Vendors Select Vendor of Choice & Begin Contracting Decision Day

21. Company • Evaluation based on market intelligence and experiences • Vendor Vision • Company Viability • Ability to Execute • Customer Service Focus • Vendor Culture and Goals alignment with the client • Technology • Evaluation based on the technical requirements identified in the process • Integration with Current environment (interoperability) • Scalability • Privacy & Security • Speed and Reliability • Functionality • Evaluation based on the key requirements from future state sessions • Meaningful Use Criteria • Five Priority areas • ACOs • Medication Home • Pharmacy • Clinical Decision Support • Results Review • Usability • Health Analytics Vendor Comparison Criteria

22. 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 Scale: List of Vendors Comparative Approach Each vendor was scored according to the scale

23. Vendor Usability Vendor 1 Vendor 3 Vendor 2

24. Suniti Ponkshe Partner Accenture Suniti.ponkshe@accenture.com Phone: 703.903.9685 Mobile: 703.966.6689 Thank You

25. Overview of Major Systems & Implementation Status DRAFT 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