Electronic Health Record / Electronic Medical Record Concept and Challenges November 16, 2007

1. Electronic Health Record / Electronic Medical RecordConcept and ChallengesNovember 16, 2007

2. Most Commonly Used Definition of EHR/EMR • 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

3. Electronic Medical Record (EMR) is a building block process Technology Tools for User Interface Clinical Decision Support Tools Clinical Documentation Basic Order Entry and Results Reporting System Technology Infrastructure and the Clinical System is a major foundation block ….

4. Current State of Systems Health System Outpatient EMR Inpatient EMR

5. New state level healthcare environment can reallocate services and funding to improve health care outcomes and reduce costs Medicaid/Insurance Companies Wellness, Disease Management, Claims Analysis, PHR, Exercise Programs State Employees Insurance Fund Wellness, Disease Management, Claims Analysis, PHR, Exercise Programs HHS FDA AHRQ CDC CMS VA MHS Private Grants • Grants/Bids • CDC Biosurvelliance • NHIN 2 • Midcare Modernization Network/NHIN Physicians Health Home, Bridges to Excellence, HTS, Portal, Hosted PHR Patient Portal, PHR, Medical Home, Wellness Hospitals and Clinics NHIN 2, Relief from uninsured

6. Forces driving information transformation in provider healthcare IT System & Standard Adoption Nonpayment for Performance - Medicare’s New Reimbursement Rule Effective 10/2007 More informed consumers Enterprise analytics & integration Changing demographics Hospitals must report patient-satisfaction data for Medicare reimbursement Effective 2007 Hospital-based EMR Stark Law relief for IT Departmental automation Growing Pay4 Performance Bonus paid for each claim meeting specific quality criteria Public reporting cost and quality information Market drivers / Demographic shifts Increasing costs and changing reimbursement Maturing adoption of IT but still ISV dominated

7. Healthcare Organizations are data rich but Information poor…… • Challenges • Brittle Applications • Infrastructure complexity • Information Islands • Fragmented knowledge management • Performance and bottlenecks • Application and development silos • Rising cost of meeting business needs • Volume and complexity of data

8. Vendor Market

9. Product Life Cycles and Vendors Epic EpicCare Eclipsys SCM McKesson Horizon McKesson Paragon Cerner Millennium Siemens Soarian Meditech C/S &Magic Siemens Invision Eclipsys SunriseXA Cerner Classic 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

10. KLAS 2007 Mid-Year Category Leaders

11. Case Studies

12. Selection of Electronic Health Record • Governance • Making sure everyone that needs to be involved participates in the process • Structured and effective process • Structured process • Recognizing when it needs to be tweaked • The Decision • Commitment to make the decision

13. Decision Day #1 January 2007 Selection process included four key milestones …… Decision Days Decision Day #4 august 2007 Decision Day #3 June 2007 Decision Day #2 March 2007 Approval of Vendor Short List Selection of three vendors with solutions appropriate and suitable for CSHS Approval of Vendor Finalists Top two vendors whose solutions could potentially meet the future state needs of CSHS Approval of Vendor of Choice The solution most suitable for CSHS – believed to provide the best functionality, technical capabilities, and market leadership Finalization of Key Requirements and Guiding Principles Finalization of the solution components for a core clinical information system

14. Vendor Comparison Categories • 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 B • Technology • Evaluation based on the technical requirements identified in the process • Integration with CSHS environment (intra-operability) • 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

15. 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 Each vendor was scored according to the following scale: Comparative Scale: Note: Vendors are presented in alphabetic order throughout G R

16. Connectivity Between Inpatient and Outpatient EMR

17. Guiding Principles • Physician needs must be met • Maintaining or improving existing functionalities • Implementing process improvements to enhance the quality of care • Patient safety and quality of care will be improved • Regulatory requirements will be satisfied (e.g. JCAHO, etc.) • The revenue structure may only be positively affected • Use the applications as designed, and coordinate business practices to optimize the software

18. Thank You