The Future of Health Information Technology Necessary Evil or Blessing in Disguise

1. The Future of Health Information TechnologyNecessary Evil or Blessing in Disguise Mark R. Anderson, FHIMSS, CPHIMS AC Group, Inc.

2. Mark Anderson, FHIMSS, CPHIMSSHealthcare IT Futurist • 34+ Years In Healthcare IT • IDN Expertise • CIO Position at Three Multi Facility Regional IDN’s • Executive Team Member at 5 Different IDN’s • Worked In 158 Hospitals and 21 Payer Organizations • Physician Expertise • Managed 50 Physician Practices in the Late 1980’s • Former CIO of a 2,300+ physician (500+ Practices) IPA • Currently Conducting EHR Searches for > 100 Practices • National Speaker on EHR - > 380 sessions since 2001 • Negotiated more than 100 EHR contracts • Installed over $1B in technologies since 1972

3. Disclosure • Speaking at numerous professional associations and at vendor meetings (over 100/Year) • White Papers on the use of technology • Serve on numerous conference boards • EHR Search and Selections (> 100 Practices) • DOQ-IT and CMS EHR Selection Tool • NO Revenue from any vendor based on any Sales or increase in Revenues

4. Why is this session important • In 2006, the healthcare industry saw an explosion in interest in the ambulatory EHR marketplace • Partially driven by quality indicators, P4P, and a relaxing in the Stark law that prohibited hospitals from funding community EHR initiatives.    • What does this mean for the average Physician Practice?

5. Topics • How will EHR initiatives are changing the way practices look technology decisions? • What is the government’s involvement in EHRs? • How are hospitals leveraging EHR projects to increase physician bonding? • How with EHR affect your revenue stream? • Why do systems fail? • How the EHR vendors are rated and why many will not survive?

6. Vision “Technology is simply a catalyst that will empower providers to drive meaningful changes in care.” “ People love progress … but hate change”

7. What issues are physicians interested in? • Maintain or improve Quality • More timely and accurate payments from carriers. • Save time and money. • Allow them to see more patients per day. • More productive organization's. • Provide information about their organization's. Page No: 7

8. The Thing About the Future…

9. …You Hate Getting It Wrong!

10. And Big Surprises Aren’t Much Better!

11. With Only the Past for a Compass…Who will guide you?

12. Patterns Must Lead to ActionSuccess = Teamwork

13. The Digital Medical Office of the Future

14. Update patient demographics • Scan Insurance cards/ • Scan Driver’s license • Sign consent forms • Take patient picture • Collect Co-pay • Create Encounter • Document PFSH • Document ROS • Take Vitals Check-in • Receive Appointment Request • Schedule/Reschedule Appointments • Perform eligibility check Refer in Pre-exam Appointment Scheduling C C D The EHR Process Refer out C C R Charge Codes Check-out Exam • Review PFSH/ROS/Vitals/ Diagnostic Reports • Perform Physical Exam • Document Assessment • Order Rx/Diagnostic Procedures/Treatment Procedures • Provide Patient Education • Schedule follow-up appointment • Perform referral authorization • Obtain Referral appointment • Collect payments Post Exam • Perform Treatment Procedures • Draw specimen for Diagnostic Procedures • Fax/Transmit Rx and Diagnostic Orders Billing Page No: 14

15. Information Overload

16. % who already have implemented EHR Applications

17. What is the government’s involvement in EHRs? • Free EHR - Vista • Congress – What till 2009 • Personal Health Record Initiatives • Setting Standards – CCHIT • CMS and P4P • Setting Guidelines - HIE • Relaxation in Stark Law

18. Enabling Responsive Local Patient Care Patient Demographics Patient Insurance Medications Allergies Health Maint Alerts Lab Results Dictated Reports Vital Signs DX and CPT codes Patient’s Home CCD Data Physician at Home Wireless Access Point Wireless Access Point Wireless Access Point EMR/PM Application Wireless Tablet EMR/PM Application Wireless Tablet Wireless Tablet EMR/PM Application Practice 1 Practice 2 Practice 3

19. Ancillary Departments Hospitals Employers Physicians HIE Technology is best positioned to lead the way to a connected care community HomecareProviders Retail Pharmacy Payers & PBMs Patients Connecting PhysiciansDelivers the Connected Community In-patient Clinical & Physician Portal Physician Office Solutions Broad CommunityConnectivity

20. It shouldn't take a brain surgeon to design one patient centric community EHR

21. Offering Physicians Choices A Flexible and Modular Path to EMR • Level 3 • Practice • Support • Fully functional EMR • CDS • KBS • $700-$1,000 • Level 2 • Practice Support • EMR Light • Charge capture • Hlth Maint Plan • Referral Management • $500-$700 • Level 1 • Practice Support • eRX • Orders • Results • $55-$100 • Clinical Access • Physician Portal • Results Viewing • Messaging and Alerts • $50-$70 • Results • Printing • Auto-route to the office • Auto-print to the office • $30-$50 EHR/Interoperability Page No: 21

22. Physician Bonding ER has access to extensive information about patients (prior Meds, allergies, lab results, chronic issues, health maintenance alerts) Single source Enterprise Wide documentation Nursing, PT, OT, Dietary, Social Workers Reduce errors by up to 78% Nursing has access to prior patient clinical information in a summary format and detailed data by date 35% of nursing documentation is auto generated Physician Order Entry adoption based on best practices No change in registration, scheduling, and billing Auto generation of HPI and Discharge Summary 98% reduction in HPI and Discharge Transcription Costs Hospital Benefits Page No: 22

23. Hospital Sponsorship Help with cost (Relaxation in the Stark Law) One system for all charting One system for orders Reduce charting while in the hospital by 73% Auto Charge Capture for physician office visits Hospital Lab results delivered 87% faster Access to hospital data from home (with security) Physician Benefits Page No: 23

24. Benefits to the Physician • Clinical Integration • Reduce operating cost > 8% • Improve Revenue Capture > 3% • Lower costs = 40% reduction • Monthly fixed costs with local support • Pay-for-performance - $5K-10K • Interfaces to all sources • Data exchange between Primary Care, Specialists, and Hospitals • Contract terms and conditions • P4P Page No: 24

25. Clinician time savings of between 19% and 26% of non direct pt. care time MA/Nurse time savings of between 20% and 28% of daily activities Medical Record cost reduction of between 64% to 74% Transportation cost reduction of between 80% and 92% Paper cost reduction of between 61% and 68% Transcription costs reduction of between 73% and 87% Billing costs reduction of between 6% and 12% Potential Business Benefits Page No: 25

26. Charge capture and coding costs reduction of between 84% and 90% Reception costs reduction of between 10% and 14% Lab handling costs reduction of between 61% and 70% Rx handling costs reduction of between 57% and 64% Scheduling costs reduction of between 6% and 12% EOB Posting costs reduction of between 61% and 68% Collection costs reduction of between 4% and 8% QA Reporting costs reduction of between 46% and 60% ER costs decrease by 31% since the ED physicians has access to prior clinical records and results. Potential Business Benefits Page No: 26

27. Answer questions one time Centralized Patient Record Reduced potential errors Improved clinical quality and outcomes Reduced unnecessary tests by 73% Reduce costs by reducing waste in the clinical process ER has access to data at the point of care Benefit to the patient Page No: 27

28. Why systems FAIL! Page No: 28

29. EHR Failure rate • Through 2007, the EHR failure rate continues to increase. • When asked, “1 year of EHR installation, are you seeing 80% of your patients using the EHR for charting, ROS, HPI, Evaluation, coding, orders and results reporting”. • 73% of the physicians (3,245) indicated that no, they were NOT using the EHR for 80% of their patients. • 18% replaced or were not using EHR • Why, are 73% of the physicians NOT fully utilizing the EHR after 1 year? • So why are there so many failures? Page No: 29

30. Why do Implementations Fail? • Poor planning • Unrealistic expectations • Lack of physician and provider support • Flawed selection process • Mismanagement of workflow and staffing changes • Poor Contract Terms • Workflow redesign - COT Page No: 30

31. Organizational and Clinical Transformation

32. Delivery Model – Levels of Value Delivery Transform:Maximum Value Realization Implement:EMR Process Change Install:EMR Usage Page No: 32

33. Roles & Responsibilities Page No: 33

34. What are Practices Purchasing Source: AC Group annual survey of buying patterns

35. When will Physicians Purchase Source: AC Group annual survey of buying patterns

36. When will Physicians Purchase Implementation Gap Source: AC Group annual survey of buying patterns

37. Who will be purchasing% of sales by Service AC Group annual survey of buying patterns

38. How the EHR vendors are rated and why many will not survive? • Too many vendors to count • Too many vendor promising the world • Too many failures • How do you tell them apart? • What are you looking for? • How do you evaluate them?

39. Market Change over time Over 380 vendors claiming to sell EHRs Selecting the wrong vendor could cost you over $50K per provider

40. EMR/EHR Selection Tool • AC Group conducted extensive evaluation of the EHR marketplace • 9th report • Completed in October 2007 • Included over 3,000 functional questions • 48 categories of functionality • 26 subcategories of charting functionality • 114 Vendors have participated

41. EMR/EHR Selection Tool • Charting Vendors • EMR Light Vendors • EMR Vendors • EHR Vendors • CHR Vendors • Combined PMS/EHR • FQHC • Mental Health

42. EHR Functionality Only PMS – EHR Functionality Only End-User Satisfaction KLAS AAFP AC Group AC Group Product Evaluations Total Company Rating • Company Stability • Revenues • CCHIT • Total Ambulatory Revenues • Client Base • Technology

43. Certification Commission for Healthcare Information Technology • CCHIT is the recognized certification authority for electronic health records and their networks, and an independent, voluntary, private-sector initiative. • The mission is to accelerate the adoption of health information technology by creating an efficient, credible and sustainable product certification program. Page No: 43

44. CCHIT Certified EHR VendorsCertification is good for 3 years – but!!!!! 2006 Certified vendors will need to renew again in 2007 As of Feb 1, 2008 only 13 vendors have passed the 2007 CCHIT Page No: 44

45. Top EMR/EHR Vendor ApplicationsPractices with > 100 Physicians GE does not want their ranking published Based on 2,750 Functional Questions Divided Between 46 Categories

46. Top EMR/EHR Vendor ApplicationsPractices with 20 to 99 Physicians Based on 2,750 Functional Questions Divided Between 46 Categories

47. Top EMR/EHR Vendor ApplicationsPractices with 6 to 19 Physicians GE does not want their ranking published Based on 2,750 Functional Questions Divided Between 46 Categories

48. Top EMR/EHR Vendor ApplicationsPractices with 1 to 5 Physicians GE does not want their ranking published Based on 2,750 Functional Questions Divided Between 46 Categories

49. Bottom Line • What does it take to thrive?

50. BOTTOM LINE • Physicians need help when it comes to technology • Physicians need local support • Physicians need help with contracts and pricing • The community needs to share data • 80% of the data is in the office • Lets empower the physician