March 11, 2010

Paul W. Brient, President & CEO

Health Information Exchangeand

Meaningful Use at the Hospital Level

Agenda

PatientKeeper Overview

HIE and Meaningful Use

HIE Case Studies– Healthy Ocala

– HealthCare Partners (HCP)

Perspectives on Making HIE Successful in Puerto Rico

HIE and CPOE demonstration

PatientKeeper

Experience and Success– 11 years of experience developing applications and

integrating data for physicians

– 2 U.S. Patents• Synchronization across multiple

disparate systems• Physician Charge Capture

– Large, diverse customer base across all settings of care (Health Systems, AMCs, HIEs, Community Hospitals, Large & Small Physician Practices)

Stable and Growing

– More than 17,000 active users every day• Expected to double over the next 12 months

– More than 400 hospitals

– Offices in Boston and Chicago

AcademicMedical Centers

Brigham & Women’sGeorgetownH. Lee Moffitt Cancer Center (USF)Mass General Mt. Sinai – NYNorth Shore-LIJOhio State UniversitySUNY StonybrookTulaneUCSDVCU

National Health Systems

Adventist EastCHICHRISTUS HealthHCAHMALifepointTenet

Regional Community Hospital Systems

BayCare (FL)Bassett Health System (NY)Iowa Health System (IA)Mayo Health (MN)Memorial Health System (FL)Memorial Health System (IL)Norton (KY) Oakwood Health System (MI)Ochsner Community Hospitals (LA)St. Vincent's Catholic Medical Ctr (NY)

Stand-Alone Community Hospitals

Berger Health (OH)BroMenn (IL)Hardin (KY)Halifax (FL)Mercy (Cedar Rapids, IA)Morris (IL)Opelousas General (LA)

RHIO/HIE Healthy OCALA Health Care Partners

Long Term Care/Rehab

Hebrew Senior Life (MA)Masonicare (CT)

Multi-FacilityHospitalist Groups

Community HospitalistsExecutive Health Resources (PA)HealthCare Partners (CA)Inpatient Physicians Network

Group Practices Athens Pulmonary & Allergy (GA)Atlanta Gastroenterology (GA)Carson Tahoe Psychiatry (NV)Charter Health (MA)Digestive Health Specialists (WA)Florida Cardiothoracic Surgery (FL)Highland Family Practice (NC)Midwest Heart (IL)Pulmonary Medical Assoc (CA)Tucson Pulmonology (AZ)

We Have The Privilege of Working With A Wide Variety of HealthCare Delivery Organizations

And Have Extensive Integration Experience and ExpertiseHIS Practice

ManagementAmbulatory

EMRPACS/Imaging/

VideoReference Labs

& Pharmacy

Cerner ClassicCerner MillenniumChildren’s Hospital EMREclipsys SunriseEclipsys Sunrise XAEpicGE/IDX Carecast HCS MedicsMcKesson StarMcKesson SeriesMcKesson HorizonMEDITECH MagicMEDITECH C/SPartners BICS/LMRSiemens MedSeries 4Siemens InvisionSiemens SorianQuadramed

A4ADSAthenaBillWorkeClinicalWorksEpicGE Centricity POGE/IDX FlowcastGE/IDX GroupcastGreenwayHealthPackKeaneMEDITECH LSSMEDITECH MPMMedical ManagerMisysNextGenSage IntergySiemens InvisionTimeTrade

A4AllscriptseClinicalWorksEpicGreenwayGE Centricity EMRMEDITECH/LSSMisysNextGenPartners LMRQuestWellogic Consult

ChartOneGE QS Fetal MonitoringImageCube/CannonPACSDR PACSIatricsMyFreePACSStentor PACSSony IR ICU Camera (SNC-RZ25N)GE PACS

RxHubQuestSureScripts

DEPARTMENTAL SYSTEMS

Lab Radiology/Path/Micro Pharmacy Transcription

LabStatMEDITECH Mock LabsMISYSSnQSoftLabQuestLabCorp

CoPathGE/IDX ImagecastNoviusSoftPath

MedicsMediwareRxTFC

ArrendaleAssistmedDoc-In-A-RowEDISMedquist/DictaphoneQuadris/Dolbey

Agenda

PatientKeeper Overview

HIE and Meaningful Use

HIE Case Studies– Healthy Ocala

– HealthCare Partners (HCP)

Perspectives on Making HIE Successful in Puerto Rico

HIE and CPOE demonstration

The HITECH Act and Meaningful Use Is Driving The “Last Mile” of HealthCare Automation

Physicians must install EMR systems and start sharing data Hospitals must exchange information with hospitals, providers,

and patients

Hospitals are required to implement the last of the physician automation functionality

– Physician Order Entry (CPOE)

– Physician Documentation

--- AND ---

Organizations will have to achieve significant adoption/use of the system in three years

HealthCare Information Exchange Isn’t A New Concept

CHIN - Community Health Information Network

RHIO - Regional Health Information Organizations

HIE - Health Information Exchange

And Now

HealthCare Information Exchange Has Been A Key Part of HealthCare Reform

“Among the many problems facing health care today is

the inefficient sharing of a patient's medical information.

This inefficiency can lead to inaccurate diagnosis,

inappropriate treatment, and more frequently duplicated

testing. The total cost to US health care because of

these problems is significant. For that reason, several

of the health care reform proposals offered today

include a requirement for a regional database.”

This Was Written Over 15 Years Ago

“Among the many problems facing health care today is

the inefficient sharing of a patient's medical information.

This inefficiency can lead to inaccurate diagnosis,

inappropriate treatment, and more frequently duplicated

testing. The total cost to US health care because of

these problems is significant. For that reason, several

of the health care reform proposals offered today

include a requirement for a regional database.”

―Wakerly, Ralph. (October 25, 1993). Info networks to be integral in reform. Modern Healthcare, 54-56.

CHIN and RHIO Initiatives Struggled

Over 500 CHIN projects nationwide in 1995– Few got past the planning phase

– Funded by National Telecommunications and Information Administration and HRSA Rural Health Telemedicine Grants

– Many driven by Regional Bell Operating Companies (RBOCs)

About 165 RHIOs established by 2006– Only 26 “fully operational” and actually exchanging

clinical information

– None had demonstrated a sustainable business model

– The most celebrated (The Santa Barbara County (Calif.) Care Data Exchange) shut down in March 2007

Source: Scientific Technologies Corporation 2001, eHealth Initiative 2006

Common Themes… Most ran out of money or energy before they got into

operation

Of those that were able exchange healthcare data, many had to shut down or change what they were doing

– Very low physician use or physician endorsement

– No significant impact on healthcare costs

There were a lot of challenges– Few standards

– Largely paper-based physician practices

– No clear mandate

– No “off the shelf” software

We Have Taken A Unique Approach To Health Information Exchange & Meaningful Use

Providing both the Health Information Exchange AND the applications necessary to meet Meaningful Use Requirements and ensure physicians actually use the data being exchanged

Health Information Exchange + Physician Workflow

Applications

SuccessfulHIE Deployment

AndAchievement of Meaningful Use

=

PatientKeeper Offers A Full-Featured HIE Infrastructure

And A Complete Set of Physician Applications

PatientKeeper Physician Workflow Applications

Access Patient Information Anytime-Anywhere

Physician Portal NoteWriter Charge Capture

Mobile Clinical Results Sign-Out Charge Analytics

CPOE Forms P4P: PQRI

Ambulatory Order Entry Provider Directory

Medication History eSignature

ePrescription

Clinical Suite Documentation &Communication Suite Financial Suite

To Create A Single Environment To Support Your Physicians

Agenda

PatientKeeper Overview

HIE and Meaningful Use

HIE Case Studies– Healthy Ocala

– HealthCare Partners (HCP)

Perspectives on Making HIE Successful in Puerto Rico

HIE and CPOE demonstration

Case Study: Healthy Ocala RHIO

A health information exchange serving Marion County, Florida– In the process of expanding to 9 other counties in Central and North

Florida

A model for a self-sustaining RHIO with broad community participation

Utilize PatientKeeper as their health information exchange infrastructure and for physician workflow applications

– Tightly integrated with WorldDoc Personal Health Record

– Tightly integrated with ambulatory EMRs including Greenway

We Offer Healthy Ocala Members Multiple Ways To Enroll

Patients “opt-in” to Healthy Ocala Health Information Exchange

– Self-service through WorldDoc PHR and passed through to PatientKeeper

– Enrolled at Physicians office using PatientKeeper

– Enrolled as part of Prestige 55

PatientKeeper creates a complete longitudinal medical record for all enrolled patients with data from hospitals, physician practices, reference labs, imaging centers, LTC facilities, home care providers, and using patient-reported data from the PHR

Healthy Ocala Infrastructure

Physicians

Ocala RegionalMedical Center

West MarionCommunity Hospital

Munroe RegionalMedical Center

Patients

PatientKeeper System

PhysicianOffices

Case Study: HealthCare Partners

HCP uses PatientKeeper to exchange discharge summaries, patient demographics, and discrete clinical information from over 25 hospitals with their practice EMRs

HCP Hospitalists enter post-discharge orders into the PatientKeeper system

– These orders are routed to the relevant practice’s EMR and to HCP Care Managers to ensure continuity of care/handoff as patients are transitioned back to their PCP’s care

Healthcare Partners Infrastructure

San Fernando Valley

Pasadena/San Gabriel Valley San Dimas Hospital

(McKesson Star)

Verdugo Hills Hospital(Siemens Medseries4)

Methodist Hospital(McKesson Star)

San Gabriel Valley Medical Center(Siemens Medseries4)

Huntington Hospital(MEDITECH Client Server)

Foothill Presbyterian Hospital(MEDITECH Magic)

Los Angeles

South Bay

Long Beach

Glendale Memorial Hospital & Health Center(McKesson Star)

Beverly Hospital(MEDITECH Magic)

California Hospital Medical Center(Siemens Medseries4)

Good Samaritan Hospital(MEDITECH Client Server)

Monterey Park Hospital(Self-Developed)

Torrance Memorial Medical Center(Stockell InsightCS)

Long Beach Memorial Medical Center(Keane Patcom Plus)

St. Mary Medical Center(McKesson Star)

Allscripts EMRGE Centricity Business

Mission Community Hospital (McKesson Paragon)

Providence Holy Cross Medical Center (Eclipsys 7000)

West Hills Hospital and Medical Center(MEDITECH Magic)

Valley Presbyterian Hospital(McKesson Precision 2000)

PatientKeeperApplication

Server

Keys To Making Health Information Exchange Work Keep costs low by making this an integral part of the overall

healthcare IT infrastructure– The “Other” HITECH initiatives

• Physician (EMR)• Hospital (Order Entry, Physician Documentation)

– Physician workflow improvements– Personal Health Records (PHR)– Care Management (UR, Case Management, Disease Management)– Downtime Capabilities

Make workflow for physicians as seamless as possible– Physicians should not have to “go somewhere else” to access external information

Enable physicians to drive changes in care delivery– Publish summary data with process metrics and outcome metrics– Encourage research around what is most effective in Puerto Rico– Incorporate learnings into workflow systems (EMR, CPOE)– This must be physician driven to the extent possible

Agenda

PatientKeeper Overview

HIE and Meaningful Use

HIE Case Studies– Healthy Ocala

– HealthCare Partners (HCP)

Perspectives on Making HIE Successful in Puerto Rico

HIE and CPOE demonstration

There Is An Opportunity To Create An Island-Wide Health Information Exchange

SSS MMM MCS Humana

Auxilio Mutuo Hospital

CardiovascularCenter of

Puerto Rico

HospitalBuen Samartino

Hospital EpiscopalSan Lucas

MetroPavia Health

University of Puerto Rico Hospital

CommunityHealth Centers(333’s)

HealthPlans

PhysicianOffices

Ancillary LabsSAIL

RxPharmacyQIPRO

Puerto Rico Exchange

This System Can Be Built Incrementally

1. Begin importing data from your hospitals – One HIS system at a time

– Make the data available to physician practices via a web browser and smartphones

2. Deploy EMRs to your physician practices– HITECH funds will make this self-funding for physicians

3. Import data from reference labs

4. Import data from each EMR-enabled physician practices

5. Implement island-wide PHR (Personal Health Record)

6. Push data back to each EMR-enabled physician practice

7. Deploy CPOE and Physician Documentation

8. Start developing and implementing quality improvement programs

Puerto Rico Has A Unique Opportunity To Use HIE To Understand and Impact HealthCare Delivery

Puerto Rico is a fairly closed system

Of sufficient scale to be meaningful but not so big/complex that change is impossible

With significant potential for cooperation and collaboration across the healthcare continuum

– Payers

– Care Management

– Hospitals

– Physicians

Agenda

PatientKeeper Overview

HIE and Meaningful Use

HIE Case Studies– Healthy Ocala

– HealthCare Partners (HCP)

Perspectives on Making HIE Successful in Puerto Rico

HIE and CPOE demonstration