Centricity TM Solutions for Enterprise Imaging Roadmap Bill Stoval & Chris Burt (UPMC) May 2015

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Agenda 3 1.Centricity Solutions for Enterprise Imaging Roadmap (20 min) Innovation: Imaging Relevant Clinical Context (20 min) 3.Q&A (20 min)

Centricity TM Solutions for Enterprise Imaging Centricity Solutions for Enterprise Imaging Omnyx TM Pathology Suite Omnyx TM IDP Acute Imaging Suite Ambulatory Imaging Suite Women’s Health Imaging Suite Oncology Imaging Suite Centricity Cardio Enterprise Centricity Clinical Archive Centricity Universal Viewer AW – Advanced Visualization Centricity Universal Viewer AW – Advanced Visualization Centricity Radiology Workflow Centricity 360 TM Centricity Women’s Health Workflow Centricity Oncology Workflow Centricity Cardio Workflow Centricity Solutions for Enterprise Imaging Centricity Cardio Enterprise is comprised of Centricity Cardio Imaging and Centricity Cardio Workflow. Centricity Clinical Archive includes the following product components: Centricity Enterprise Archive, Universal Viewer ZFP, Caradigm eHIE, Centricity Clinical Gateway, NextGate MatchMetrix EMPI, PACSGEAR PacsSCAN™ Omnyx™ products are for in vitro diagnostic use for specific clinical applications, and are intended for research use only on other applications. Omnyx is a trademark of Omnyx, LLC. 4

Imaging is now an enterprise-level priority Specialist Best of breed tools Department Integrated solution Enterprise Cross enterprise tools Community Collaboration suite Coordinated care demands moving from stand-alone silos of data to integrated, user friendly workflows 5

The four key components for enterprise imaging All of these elements are required to truly deliver collaborative care Visualization ArchivingCollaboration Workflow 6

Enterprise Imaging Roadmap 1 Outcomes That Matter Help Improve Efficiency HELIMED DIAGNOSTIC IMAGING 1 SPEED PREP TIME  50 % Roadmap Priorities 3 TODAY Planned 2015Planned Cross-enterprise reporting Workflow controls Mobile Modality (apps 3 & 4) Breast ultrasound workflow Relevant clinical context Imaging Desktop Mobile Modality (+wound care) UV Cardiology support UV with AW 3.2 (6 more apps) Admin console Diagnostic UV Web & ZFP Cross-enterprise display 3D Breast imaging workflow UV with AW3.0 (5 embedded apps) Patient alerts Enhance Quality Care WALDVIERTEL SINGLE PATIENT JACKET ALL PRIORS LONDON HEALTH SCIENCES CENTRE 2 SILOS OF IMAGING DATA CONSOLIDATED ARCHIVE $2M  storage costs 3%  duplicate exams UNIVERSITY OF PITTSBURGH MEDICAL CENTER SILOS OF PATIENT DATA RELEVANT CLINICAL CONTEXT CLINICAL INSIGHT 1- Case Study - Helimed Diagnostic Imaging Case study, March Results may vary and do not constitute a representation, warranty or performance guarantee. 2 - Case Study – Southwest Ontario Diagnostic Network, Results may vary and do not constitute a representation, warranty or performance guarantee. 3- Any descriptions of future functionality reflect current product direction, are for informational purposes only and do not constitute a commitment to provide specific functionality. Timing and availability are subject to change and applicable regulatory approvals. 7

Christopher Burt Vice President, Product Development University of Pittsburgh Medical Center (UPMC) Technology Development Center 8 University of Pittsburgh Medical Center (UPMC) is a collaboration partner of GEHC and as a result, has a financial interest in the development and commercialization of certain GEHC next generation imaging products.

University of Pittsburgh Medical Center (UPMC) & Centricity Solutions for Enterprise Imaging 9 Next generation imaging redefines the Enterprise Imaging space by providing solutions that enable physicians to provide patient centric care contextualized to the patient’s specific clinical condition visualized in a way that is most relevant to the providers clinical specialty and needs.

The EMR conundrum 10 “We read a chest X-ray in seconds, we don’t have time to dig in a chart. We need boiled down information that we can find in 10 seconds. It needs to be fast, it needs to be filtered, and it needs to be tailored to what we are doing. The chest radiologist cares about some things that the bone radiologist does not.” Source: Diagnostic Imaging.com, ‘Why the PACS workflow isn’t working’ by Liza Haar. January See more at: Cree M. Gaskin, MD, University of Virginia Health

Next generation contextualization 11 Imaging Related Clinical Context (IRCC) Identifies relevant aspects of the imaging exam in conjunction with the clinical context extracted from data contained within the EMR to provide the Radiologist with the set of information related to the patients disease state, progression, and past medical history which is visualized in a way that suits the specific radiologist’s workflow needs.

The moving target of “Clinical Context” 12 OrientReport Interpret Reason for Exam We cannot simply provide radiologists with Imaging Related Clinical Context once at the start of their workflow and assume that the same content will suffice until the report is finalized. We must be able to flexibly retrieve and display information as radiologists’ needs change, from exam to exam and within an exam.

The moving target of “Clinical Context” 13 OrientReport Interpret What information can we retrieve to help CLARIFY the reason for the exam, and provide a hypothesis for a diagnosis? Reason for Exam

The moving target of “Clinical Context” 14 OrientReport Interpret What other information in the record supports the initial hypothesis? ….. And if we discover that our first guess is wrong, can we COURSE CORRECT? Reason for Exam

The moving target of “Clinical Context” 15 OrientReport Interpret If there are CRITICAL or incidental findings, can we locate supporting facts quickly? Reason for Exam

The moving target of “Clinical Context” 16 OrientReport Interpret If we are interrupted, can we return to the original thought and CONCLUDE the diagnosis? Reason for Exam

Context to Orient 17 What clinical question is the ordering physician looking to answer by ordering this exam? Identify notes & other communication authored by the physician who ordered the exam Within these notes, identify sections where the physician: Documents the intent to order the current study Mentions the same modality / body region Mentions reason for exam & related history Identify prior radiology reports that mention the need for follow-up.

Context to Interpret 18 What are the patient’s underlying conditions and the documentation that supports them? Answering this question requires knowing several things: Environmental context of exam (Inpatient vs. Outpatient vs. ED) The probable affected area of the diagnosis – How many different body regions might provide evidence to support the diagnosis? Disease category (Trauma, Vascular, Infection, Neoplasm, Metabolic…) The patient’s current phase of treatment at the point of the exam (Screening, Follow-Up, Pre/Post Surgery…)

Context to Report 19 How do we structure reports so that we are generating information that comes full circle when the patient returns for another exam? Workflow driven reports for Lung Cancer Screening and other lesion tracking use cases Direct import to the report of key information (contrast, radiation dosage…) as well as summarized patient history using NLP. Capture and track follow-up recommendations to close the loop on the outcome of care.

Title or Job Number | XX Month 201X 20 Source: Patient data not from actual patient.

Title or Job Number | XX Month 201X 21 Visual based on a visualization by Cool Hunting (2014) Source: Patient data not from actual patient.

2015 Game Plan Solution Quality: Product & service excellence 2 2 Collaboration: Share images and insights with providers in and outside of the care delivery network 3 3 Innovation: Innovations across specialty areas to make enterprises more effective

Questions? 23