© Copyright IBM Corporation 2007 Electronic Health Record / Electronic Medical Record Concept and Challenges November 16, 2007

© Copyright IBM Corporation 2007 Most Commonly Used Definition of EHR/EMR Electronic Health Record (EHR) “ a secure, real-time, point-of-care, patient-centric information resource for clinicians.  The EHR aids the clinicians’ decision-making by providing access to patient health record information when they need it and incorporates evidence-based decision support.  The EHR automates and streamlines the clinicians’ workflow, ensuring all clinical information is communicated and ameliorates delays in response that result in delays or gaps in care.  The EHR also supports the collection of data for uses other than clinical care, such as billing, quality management, outcomes reporting, and public health disease surveillance and reporting.” Source:

© Copyright IBM Corporation 2007 Technology Infrastructure Basic Order Entry and Results Reporting System Clinical Documentation Clinical Decision Support Tools Technology Tools for User Interface Electronic Medical Record (EMR) is a building block process and the Clinical System is a major foundation block ….

© Copyright IBM Corporation 2007 Current State of Systems Outpatient EMR Health System Inpatient EMR

© Copyright IBM Corporation 2007 New state level healthcare environment can reallocate services and funding to improve health care outcomes and reduce costs HHS FDA AHRQ CDC CMS VA MHS Private Grants Grants/Bids CDC Biosurvelliance NHIN 2 Midcare Modernization Medicaid/Insurance Companies Wellness, Disease Management, Claims Analysis, PHR, Exercise Programs State Employees Insurance Fund Wellness, Disease Management, Claims Analysis, PHR, Exercise Programs Hospitals and Clinics NHIN 2, Relief from uninsured Patient Portal, PHR, Medical Home, Wellness Physicians Health Home, Bridges to Excellence, HTS, Portal, Hosted PHR Network/NHIN

© Copyright IBM Corporation 2007 Forces driving information transformation in provider healthcare Increasing costs and changing reimbursement Maturing adoption of IT but still ISV dominated Market drivers / Demographic shifts Public reporting cost and quality information More informed consumers Changing demographics Stark Law relief for IT IT System & Standard Adoption Hospitals must report patient-satisfaction data for Medicare reimbursement Effective 2007 Growing Pay4 Performance Bonus paid for each claim meeting specific quality criteria Nonpayment for Performance - Medicare’s New Reimbursement Rule Effective 10/2007 Departmental automation Hospital-based EMR Enterprise analytics & integration

© Copyright IBM Corporation 2007 Healthcare Organizations are data rich but Information poor…… Challenges Brittle Applications Infrastructure complexity Information Islands Fragmented knowledge management Performance and bottlenecks Application and development silos Rising cost of meeting business needs Volume and complexity of data

© Copyright IBM Corporation 2007 Vendor Market

© Copyright IBM Corporation 2007 Product Life Cycles and Vendors Eclipsys 7000 New Pilot sites completed New sales accelerating High investment in development Sunset Little investment in support No new client sales Declining Declining investment in enhancements Few new client sales Competitive Strong new client sales. Relatively heavy investment in enhancements Pre- Release Major development underway Pilot sites being installed Cerner Classic Siemens Soarian Siemens Invision Meditech C/S &Magic Cerner Millennium Eclipsys SCM Epic EpicCare Eclipsys SunriseXA GE Centricity Enterprise McKesson Horizon McKesson Paragon

© Copyright IBM Corporation 2007 KLAS 2007 Mid-Year Category Leaders

© Copyright IBM Corporation 2007 Case Studies

© Copyright IBM Corporation 2007 Selection of Electronic Health Record  Governance Making sure everyone that needs to be involved participates in the process  Structured and effective process Structured process Recognizing when it needs to be tweaked  The Decision Commitment to make the decision

© Copyright IBM Corporation 2007 Selection process included four key milestones …… Decision Days Finalization of Key Requirements and Guiding Principles Finalization of the solution components for a core clinical information system Approval of Vendor Short List Selection of three vendors with solutions appropriate and suitable for CSHS Approval of Vendor Finalists Top two vendors whose solutions could potentially meet the future state needs of CSHS Approval of Vendor of Choice The solution most suitable for CSHS – believed to provide the best functionality, technical capabilities, and market leadership Decision Day #1 January 2007 Decision Day #2 March 2007 Decision Day #3 June 2007 Decision Day #4 august 2007

© Copyright IBM Corporation 2007 Vendor Comparison Categories Functionality Evaluation based on the key requirements 1 from future state sessions  Clinical Documentation  Orders Management  Medication Management  Pharmacy  Clinical Decision Support  Results Review  Usability  Health Analytics 1 Key Requirements are in Attachment BFunctionality Evaluation based on the key requirements 1 from future state sessions  Clinical Documentation  Orders Management  Medication Management  Pharmacy  Clinical Decision Support  Results Review  Usability  Health Analytics 1 Key Requirements are in Attachment BTechnology Evaluation based on the technical requirements identified in the process  Integration with CSHS environment (intra-operability)  Scalability  Speed and ReliabilityTechnology Evaluation based on the technical requirements identified in the process  Integration with CSHS environment (intra-operability)  Scalability  Speed and ReliabilityCompany Evaluation based on market intelligence and experiences  Vendor Vision  Company Viability  Ability to Execute  Customer Service Focus  Vendor Culture and Goals alignment with CSHSCompany Evaluation based on market intelligence and experiences  Vendor Vision  Company Viability  Ability to Execute  Customer Service Focus  Vendor Culture and Goals alignment with CSHS

© Copyright IBM Corporation 2007 Comparative Approach Overwhelmingly recognized as the leader – second to none. Generally recognized as a leader - could be tied with one other. Considered equivalent to others – tied with two or more. Needs improvement – More than three other vendors considered materially better. Not generally available – may be building it but doesn’t have it today. Comparative Scale: Each vendor was scored according to the following scale: Note: Vendors are presented in alphabetic order throughout G R

© Copyright IBM Corporation 2007 Connectivity Between Inpatient and Outpatient EMR

© Copyright IBM Corporation 2007 Guiding Principles  Physician needs must be met - Maintaining or improving existing functionalities - Implementing process improvements to enhance the quality of care  Patient safety and quality of care will be improved  Regulatory requirements will be satisfied (e.g. JCAHO, etc.)  The revenue structure may only be positively affected  Use the applications as designed, and coordinate business practices to optimize the software

© Copyright IBM Corporation 2007 Thank You