Sales Proposal for Prospect New content: slides 2-9 Original content: slides 10-18

Optimizing Emergency Department Outcomes

The Swinging Pendulum in Health IT 2010 Meaningful Use Technology adoption Enterprise vendors Single architecture 2016 Value-based care Technology optimization Specialty vendors Flexible architecture EHR Incentive Programs: Where We Go Next (CMS, January 2016) Reward providers for the outcomes technology helps them achieve with patients Allow providers the flexibility to customize HIT to their needs Level the technology playing field Prioritize interoperability and implement standards that focus on real-world use

Increased Focus on Interoperability “We are deadly serious about interoperability... the focus will move away from rewarding providers for the use of technology and towards the outcome they achieve with their patients.” Andy Slavitt, CMS, January 11, 2016 Current State: Interface Patient demographics and basic medical information available in a data repository Information available to providers weeks or months post-encounter Future State: Interoperability Critical, relevant clinical data from EHRs available in all other EHRs through the use of open APIs Information available to providers in real-time, at the point of care

“We only succeed if we bring the ideas behind the big legislation successfully to the kitchen table of the American family and the exam room of their physicians.” - CMS, January 2016 Ability for providers to choose the tools that will help them provide the best care T-System’s clinically-driven emergency care toolset with 100% physician adoption that improves patient outcomes Real-time interoperability that provides clinical data at the point of care Integrate T-System’s emergency physician software with Epic ASAP through Epic’s open API’s

Becoming Partners and Industry Leaders Enterprise vendors, including Epic, have responded to CMS’s call for open APIs but there are few (if any) successful proof points. CLIENT and Together, we can prove that clinical information exchange in real-time at the point of care can be a reality – one that will provide physicians with the tools and data they need to improve patient outcomes.

T-System’s EV for Physicians: Improving Outcomes in Emergency Medicine “As the most expensive employee in the ED, I spend 40% of my time on data entry. What a business model.” Epic physician user, March 2016 T-System’s EV for Physicians: Improving Outcomes in Emergency Medicine Visual layout and clinical content designed to trigger cognitive forcing Developed by emergency physicians, for emergency physicians Industry standard for chief complaint-based emergency medicine documentation Intuitive and fast user interface; ultra short learning curve Patent pending, non-interruptive feedback prevents unspecified ICD-10 codes Mimics clinical thought and behavior patterns

Proposal: Onsite Workflow Evaluation Performed by experts with extensive clinical and leadership backgrounds in emergency care, T-System’s onsite workflow evaluation is designed to help hospitals provide compassionate emergency care and high performance long-term. Onsite Workflow Evaluation Work with client’s operational effectiveness team to understand current objectives and future goals. Deep dive into operations, processes and interactions, including those affected by ancillary departments. Understand the ease of use with current systems Analyze current clinical workflow Analyze key performance indicators Analyze soft skills important to patient experience Ensure proposed integration will augment Epic’s value and preserve important data

Onsite Workflow Evaluation: Outcomes Deliver targeted performance and interoperability recommendations Deliver successful T-System and Epic integration Provide assessment of current operations, workflow and processes as well as targeted operational improvement recommendations and support to implement those recommendations. Propose plan for interoperability of T- System’s emergency physician software and Epic ASAP based on client’s operations, workflow and processes Discuss opportunities to partner with the current operational effectiveness team. Leverage open API’s from Epic to integrate T-System’s EV for Physicians emergency physician software with Epic ASAP Evaluate additional integration opportunities by partnering with client and Epic to further develop API capabilities Enhance T-System solution to utilize additional API capabilities from Epic

Software and Services Proposal Electronic Emergency Department Documentation Integration and Performance Assessment

Why would you even think about using an ED tool when you have Epic? If you did, how would it work (possibly)?

T-Sytem/ASAP Integration Proposal: API-based Integration of T-System’s emergency physician documentation content and workflow with Epic ASAP Outcome: Decreased physician documentation time, increased documentation accuracy and completeness and improved physician satisfaction with ASAP

T-System Content and Workflow Developed over 20 years by ED physicians for ED physicians; mimics ED clinical thought and behavior patterns Industry standard for chief-complaint based template content Intuitive and fast UI; ultra short learning curve Cognitive forcing drives high quality care and documentation Non-interruptive feedback ensures documentation completeness and guides ICD-10 documentation avoiding unspecified codes

Next Steps Onsite evaluation of current workflow Ensure proposed integration augments ASAP’s value, avoid degradation in department productivity or enterprise data Create collaborative integration proposal based on system capabilities and value proposition Additional opportunity exists for value-add integration Work in partnership with client and Epic to further develop API capabilities Enhance T-System electronic product to utilize additional current EPIC API capabilities

T-System Services Philosophy Services are aligned with our products to promote sustainable operational efficiencies. While many Emergency Departments are similar, no two are exactly alike. Our services provide a customized approach based on individual needs. We believe that nothing is more important than patient care and patient experience. Our goal is to ensure the right processes, skills and tools are in place so that your providers, nurses and others are able to focus on the patient.

T-System Performance Assessment Performed by experts with extensive clinical and leadership backgrounds in episodic care. Deep dive into Emergency Department operations, processes and interactions including those affected by ancillary departments. Analysis and assessment designed to optimize emergency department performance. Improves key performance indicators through targeted operational improvement recommendations and support to implement recommendations.

Performance Assessment Anticipated Approach Propose beginning with the following priorities: Conduct a one day onsite visit to assess and analyze current workflow and processes. Review and analyze key performance indicators. Understand the ease of use with current systems in the ED. Assess and analyze current soft skills in the ED important to patient experience. Understand the work being done by the current operational effectiveness team in place at facility.

Performance Assessment: Post One Day Visit Meet with key leadership to review findings related to the onsite visit. Review what is working well. Review areas for improvement. Review opportunities to partner with the current operational effectiveness team. Review T-System recommendations and determine the timeline for implementation of necessary improvements.