That Was Then This Is Now….. Healthcare IT and Operations in the Era of Healthcare Reform One System’s Journey 1

UMass Memorial Health Care 7 Hospital System Clinical Partner to UMass Medical School 13,500 employees 3,000 registered nurses Approximately 1,600 physicians 1,111 beds $1.4b in Annual Revenue ~60,000 discharges ~1,000,000 outpatient visits

UMass Memorial Health Care 7 Hospital System Clinical Partner to UMass Medical School 13,500 employees 3,000 registered nurses Approximately 1,600 physicians 1,111 beds $1.4b in Annual Revenue ~60,000 inpatients ~1,000,000 outpatients

UMass Memorial Health Care 7 Hospital System Clinical Partner to UMass Medical School 13,500 employees 3,000 registered nurses Approximately 1,600 physicians 1,111 beds $1.4b in Annual Revenue ~60,000 inpatients ~1,000,000 outpatients

UMass Memorial Health Care 7 Hospital System Clinical Partner to UMass Medical School 13,500 employees 3,000 registered nurses Approximately 1,600 physicians 1,111 beds $1.4b in Annual Revenue ~60,000 inpatients ~1,000,000 outpatients

UMass Memorial Health Care 7 Hospital System Clinical Partner to UMass Medical School 13,500 employees 3,000 registered nurses Approximately 1,600 physicians 1,111 beds $1.4b in Annual Revenue ~60,000 inpatients ~1,000,000 outpatients

UMass Memorial Health Care 7 Hospital System Clinical Partner to UMass Medical School 13,500 employees 3,000 registered nurses Approximately 1,600 physicians 1,111 beds $1.4b in Annual Revenue ~60,000 inpatients ~1,000,000 outpatients

Meditech Siemens Soarian Allscripts / IDX University Memorial Hahnemann Community Medical Group Clinton Hospital HealthAlliance Hospital Wing Memorial Hospital Medical Group Marlborough Hospital Private Medical Practice A Private Medical Practice C Private Medical Practice B Current Information Systems Evolved Historically Affiliated Hospital

History Period of underfunding IT ( ) – Aging infrastructure, reliability challenges – Paper-based system Significant bright spots – Electronic ICU across all hospitals – One community hospital has lead EMR efforts – Commitment to ambulatory EMR in 2007 – Recognized quality leader in numerous areas – Excellent operational statistics (through shear effort) Recognition of need to modernize IT systems 9

Challenging Environmental Factors Declining Reimbursement Universal Coverage State and National IT Requirements - HITECH Payment Reform – Bundled payment – Accountable Care Organizations (ACO’s) – Quality & Outcomes Coordination of Care Redefinition of Relationships – Competitor vs Partner Privacy and Security Issues 10

Cost Shifting vs Cost Reduction 11 Kilday Presentation at HFMA Enterprise Performance Management Meeting February 12, 2010

Health Alliance Clinton Wing Marlborough Private Medical Practices UMMMC Providers PATIENT CENTERED Safety Quality Service excellence Distributed care Right service Right place Right time Clinically Efficient Operationally Efficient Interoperability of information PATIENT CENTERED Safety Quality Service excellence Distributed care Right service Right place Right time Clinically Efficient Operationally Efficient Interoperability of information The Patient Other Services In-Home Hospice PT / OT The Vision CMG 12 Providers

IT Systems Overhaul Advantages – Senior leadership & board commitment – Learn from experiences of the “pioneers” – Financial commitment Disadvantages – Time pressures – Culture – Financial reality – Breadth of effort (inside system & across community) 13

University Memorial Hahnemann Community Medical Group Clinton Hospital HealthAlliance Hospital Wing Memorial Hospital Medical Group Marlborough Hospital Private Medical Practice A Private Medical Practice C Private Medical Practice B Existing Bright Spots Siemens Soarian Allscripts / IDX

University Memorial Hahnemann Community Medical Group Clinton Hospital HealthAlliance Hospital Wing Memorial Hospital Medical Group Marlborough Hospital Private Medical Practice A Private Medical Practice C Private Medical Practice B The Future Includes More - Allscripts Siemens Soarian Allscripts / IDX Allscripts / Soarian Scheduling (pilot) Allscripts MyWay

University Memorial Hahnemann Community Medical Group Clinton Hospital HealthAlliance Hospital Wing Memorial Hospital Medical Group Marlborough Hospital Private Medical Practice A Private Medical Practice C Private Medical Practice B The Future Includes More - Siemens Soarian Siemens Soarian Allscripts / IDX Allscripts / Soarian Scheduling (pilot) Allscripts MyWay

Private Medical Practice A Siemens Soarian Allscripts / IDX University Memorial Hahnemann Community Medical Group Clinton Hospital HealthAlliance Hospital Wing Memorial Hospital Marlborough Hospital Initiate & dbMotion Private Medical Practice C Private Medical Practice B Medical Group Allscripts / Soarian Scheduling (pilot) Allscripts MyWay Initiate & dbMotion Tie Everything Together

Approach Focus on operations, not IT Selection process (priority of selection criteria) – First: Execution and delivery of operational results – Second: Total cost of ownership (7 year focus) – Third: Feature/function Contracting – Operational improvements built into contracts – Deliver results, not software Detailed cost/benefit analysis – Internal and External costs – Benefits tied to delivery of operational improvements 18

Total Cost of Ownership Both Implementation and Post-Live 19

Total Cost of Ownership Both Implementation and Post-Live 20

Total Cost of Ownership Both Implementation and Post-Live 21

Total Cost of Ownership Both Implementation and Post-Live 22

Focus on Benefits Realization 23

Focus on Benefits Realization 24

Focus on Benefits Realization 25

Focus on Benefits Realization 26

Implementation Timeline 27

Enter HITECH…….. 28

Focus on Ultimate Goal Structure  Process  Outcomes 29

Incentive $ - Penalties $$$ 30 Glaser Presentation at HFMA Enterprise Performance Management Meeting February 12, 2010

How does this affect our timeline? 31

How does this affect our timeline? Do it fast, but do it right….. 32 After reading most of the regulations and just finishing a conference call with the VHA on the subject I would offer the following thought. Installing an EHR just to get stimulus dollars will turn out to make as much sense as having children just to get a tax break. R. Hal Baker, MD, FACP VP & CIO WellSpan Health 45 Monument Rd. York, PA

HIE - Vision for Connected Healthcare Enable high-quality, patient-centric care by making all relevant information about a patient available at the point-of-care, irrespective of organization, geography or care setting.

Connected Healthcare Solution Stack Value Scope of Information Sharing EMR at the point of care Connect organizations Uniquely identify patients and providers Aggregate and harmonize Seamless access

Traditional Approach to Sharing Data – Central Repository dbMotion Clinical Repository & Portal Enterprise Master Patient Index UMass Memorial Health Care External Organization Local Applications Send data to UMass Memorial so we can put it in our systems in case it’s needed We store, aggregate and use the data Data, information, or service provided back to external organization

Challenge – What Data to Share? 36 UMass Memorial Health Care Independent Medical Group Independent Medical Group Shared Patients

Wing Memorial Hospital Hospital UMass Memorial Medical Center MarlboroughHospitalMarlboroughHospital ClintonHospitalClintonHospital Health Alliance Hospital Hospital OutsideOrganizationOutsideOrganization John Smith 123 Main Street Anywhere USA G: U: 1234 M: M7766 C: H: 7765A W: D O: John Smith 123 Main Street Anywhere USA G: U: 1234 M: M7766 C: H: 7765A W: D O: The Patient Hub Enterprise Master Person Index Enterprise Master Person Index CommunityMedicalGroupCommunityMedicalGroup

UMass Memorial Health Care Community Allscripts MyWay Ambulatory EMR Community Portal Acute and Ambulatory EMR Initiate EMPI Allscripts Enterprise Any other EMR Private Medical Group or IPA Affiliated Hospital Organization Independent Physicians Community EMPI Meditech Soarian Wing Meditech UMass Memorial Healthcare Many locations, providers, 1 connection

What we need to offer For Providers with an EMR Data Delivery – their data about their patients – selected UMMHC data about their patients – delivered and place in their EMR as desired Access to everything when they want it – portal access Bi-directional orders and results – order communication across EMR’s

What we need to offer For Providers without an EMR Allscripts MyWay Different EMR than Allscripts Enterprise used by UMMHC – specifically designed for the smaller practice (< 5 physicians) Offered by Allscripts as UMMHC’s preferred EMR for private physicians – per month subscription fee with no upfront setup or implementation fees – full EMR, integrated practice management, ePrescribing, electronic claims submission – includes three days of additional on-site training, one day of customization, and full interoperability with UMMHC

Summary – Keys to the Future Cost Reduction Variability Reduction Information Sharing – “Connected Healthcare” Strategic Partnerships 41

Summary – Keys to the Future Cost Reduction Variability Reduction Information Sharing – “Connected Healthcare” Strategic Partnerships 42

Thank You. Questions?