Eric Q. Reynolds Vice-President Atlas Medical Corporation Healthcare EMR Emergence and Laboratory EMR Strategies for 2009

Eric Q. Reynolds Currently ATLAS Medical VP of Sales and Marketing Twenty (gulp) years in laboratory industry Survived a gauntlet of positions Toxicologist Client Services System Deployments and Training Field Team Management Sales and Account Management Joined ATLAS Medical in Fall of 2007

Webinar Agenda EMR Definition What an EMR Does The Role of the EMR in Outpatient Clinics vs. Hospitals EMR Facts and Industry Trends EMR Market Adoption Physician EMR Adoption Government Gets Involved (Stark, CCHIT, and HITECH) Physician EMR Requirements for Lab Orders and Results Lab/EMR Integration vs. “one off” Interfacing Benefits to Lab/EMR Integration

Outpatient EMR Definition PMS (Practice Management System) for Administrative Use Registration Scheduling Billing May be included as part of the EMR or a stand alone product > 90% adoption nationally * EMR (Electronic Medical Record) for Clinical Use Patient charts Medications, Conditions, Allergies Results (Laboratory, ECG, Radiology) 17% adoption nationally ** * Source: Physicians Practice, “IT Enhancement: Time, at Last, for an Upgrade?” author Shirley Grace, February 2007 ** Source: The New England Journal of Medicine, “Electronic Health Records in Ambulatory Care - A National Survey of Physicians” July 3, 2008

What Does an Outpatient EMR Do? Electronic Medical Record What was paper, isn’t Anytime access to patient’s charts Clinical workflow mgmt. Clinical assessment Disease management Interfaces to/from: Labs Radiology ECG/Cath Other EMRs Outcomes Reporting

EMR: Outpatient vs. Hospital EMR Clinical Outpatient Clinic Hospital or IDN HIS Administrative CDR Clinical PMS Administrative Registration Scheduling Billing Registration Scheduling Billing ADT Patient Charts Meds, problems, allergies Results (Labs, ECG,Rad) Enterprise wide repository Generally labs and documents

EMR Industry Facts and Trends Currently over 350 EMRs are available in North America 32 new EMR vendors have been certified over the past 12 months Quest and LCA investing significant $$ in EMR interfacing and have a head start over hospitals 2009 Health Information Technology for Economic and Clinical Health Act (“HITECH”) will spur significant increases in EMR utilization in the outpatient setting Significant challenges will be placed on independent laboratories and hospital laboratories to integrate with all manner of outpatient EMR systems

EMR Vendor Snapshot Top 10 EMR Vendors (smaller 1-10 Physician practices) (largest growth sector): NextGen AllscriptsMisys (Merger Completed 10/08) (Allscripts purchased A4 Health in 2006) McKesson (puchase Practice Partner 2/07) (PMSI name change to Practice Partner in 2006) e-MDs e-ClinicalWorks iMedica Sage Emdeon Intergy EMR (WebMD) GE Centricity Medinotes

EMR Market Adoption EMR Penetration # Docs % total E2009E2010E2011E Solo181,500339,07510,39111,89813,62315,60717,89820, , ,00026,84032,75440,00048,91159,89973, ,000109,02011,09513,64216,76320,59225,29531, ,50077,8169,69112,02114,92118,51222,92928, ,500710,20312,85516,12920,06324,60029,56734,982 Total penetration58,11470,87286,444105,370128,222155,588188,477 Total # Docs550, %12.9%15.7%19.2%23.3%28.3%34.3% Source: CDC, Health Affairs, AC Group, MGMA, SFG Research. Compiled: Susquehanna Financial Group investor report on Allscripts, published 3/22/07

Physician EMR Adoption Profile Investment (time, tools, etc, …) EMR Implementation Timeline Minimal workflow impact Populates chart with clinical data; lab results and transcription usually via scanned documents Chart review from home Phone notes Virtual “to do” list Office efficiencies Script legibility Interaction checks Formulary compliance Face sheet documentation E&M Compliance Billing efficiencies Disease management CPOE requirement Complete EMR workflow View and Sign Office Communication Medication Management Full Encounter Documentation Lab Results are required in 90% of EMR go-lives Lab Orders are adopted when general orders are adopted Orders

2006 – Uncle Sam Gets Involved In August 2006, the Department of Health and Human Services (HHS) published rules that provide an exception under the physician self-referral prohibition law (Stark), as well as safe harbor under the anti-kickback act (AKA), for the donation of interoperable EHR technology to physicians and other health care practitioners or entities. In August 2006, the Department of Health and Human Services (HHS) published rules that provide an exception under the physician self-referral prohibition law (Stark), as well as safe harbor under the anti-kickback act (AKA), for the donation of interoperable EHR technology to physicians and other health care practitioners or entities. EHR software is “deemed to be interoperable if a certifying body recognized by the Secretary has certified the software no more than 12 months prior to the date it is provided to the physician/recipient.” EHR software is “deemed to be interoperable if a certifying body recognized by the Secretary has certified the software no more than 12 months prior to the date it is provided to the physician/recipient.” CCHIT is an officially recognized certifying body CCHIT = Certification Committee for Healthcare Information Technology CCHIT is an officially recognized certifying body CCHIT = Certification Committee for Healthcare Information Technology

CCHIT Certification Chronology CCHIT interoperability requirements that impact laboratory Currently it’s a Low Bar, 32 EMR vendors have been certified 2007 Receive General Text Reports Display normal versus abnormal results Display flow sheets Provider results notification Order lab diagnostic tests Associate a diagnosis with a test Test specific AOE prompts Transmit the lab order – ONLY ON PAPER Group, or panel ordering 2007 Receive General Text Reports Display normal versus abnormal results Display flow sheets Provider results notification Order lab diagnostic tests Associate a diagnosis with a test Test specific AOE prompts Transmit the lab order – ONLY ON PAPER Group, or panel ordering 2008 Receive Microbiology lab results Capture co-signatures for orders Associated Images with result 2008 Receive Microbiology lab results Capture co-signatures for orders Associated Images with result 2009 Transmit the Lab Test Order Electronically 2009 Transmit the Lab Test Order Electronically Still Missing Today: Electronic Orders Auto-update of Orders Rules based Routing Still Missing Today: Electronic Orders Auto-update of Orders Rules based Routing

HITECH Begins in 2009 CCHIT expected to be go forward certification body for healthcare IT $19 billion in incentives and funding $17 billion in physician incentives $2 billion in HHS “discretionary funds” Aims to dramatically drive interoperability standards across healthcare IT 90% physician EMR adoption by 2020?* *2009 Congressional Budget Office

What Physicians Want for Lab All orders originate from within the physician’s EMR Must be easy to use! Want the fewest “clicks” to order and view lab Dynamically update physicians’ ordering information Make it part of physicians’ normal EMR workflow All results returned to physicians’ EMR and matched to their patients’ record (IP/OP/OR) Inform the ordering provider of pending results

EMR Integration Physician Office Perception: EMRLIS

Integration…Not the Other “I” Word Integration vs. “One-off” Interfacing: Eliminates costly burden of building, maintaining and supporting “one off” interfaces from hospital IT dept. Eliminates incomplete lab orders: ex) missing clinical, billing, and business information Test and result codes correctly mapped and updated Automatic standardized laboratory requisition and label printing Order routing based on insurance plan Enables EMR to accept unsolicited and/or partial results

Benefits of EMR Integration Platform Improve customer service and client satisfaction Make it easier for your customers to order within their EMR Consolidates inpatient, outpatient, outreach results Perform test and bill correctly the first time, avoid calling for missing clinical and billing information Creates another exit barrier with physician Increase revenue, improve efficiency, reduce operational costs Decrease billing and clinical errors Eliminate data entry at the lab and PSC Reduce costly data correction/retrieval activities Reduce medical necessity denials and write-offs

Healthcare EMR Emergence and Laboratory EMR Strategies for 2009 Thank You! Questions?