September, 2005What IHE Delivers 1 Mike Schmidt, Carl Zeiss Meditec IHE Eye Care Webinar Business Overview of IHE Eye Care June 6-7, 2006

2 Defining Networking: What it is and isn’t… Networking isn’t just IT technology (but it relies on it) Networking is a market need for improved workflow Networking involves interoperability with 3 rd -party products  Requires use of appropriate standards Networking is data flow beyond “the box”

3 Networking as Practice Workflow Electronic medical records (EMR / EHR) vs. paper records  Scheduled workflow  Automatic demographics  Automatic billing Emphasis on electronic workflow between different office functions Front office functions  Patient registration / patient scheduling / order placing Clinical functions  Procedure scheduling  Acquisition / Analysis  Professional reporting Back office functions  Charge processing

4 Networking as Modality Workflow Digital instrument records vs. film or paper Emphasis on electronic workflow for storage and review of modality data Clinical function of acquisition & analysis Classic example: digital photography vs. film Includes future multi-modality clinical management systems

5 Networking as Full Electronic Workflow Practice workflow and modality workflow Between different office functions For storage and review of modality data The vision of networking is full electronic workflow, eliminating the need for paper, film, or removable media to transfer information, and having all the data available, anytime, anywhere.

6 Networking Early Adopters Retinal specialists Large clinics Networking is a key enabling technology for these customers

7 US Government Policy Goal to increase efficiency of healthcare administration Policy to encourage development of nationwide electronic healthcare records Funding for government healthcare facilities to implement EHR Strong participation by government agencies in industry standards efforts Government healthcare facilities require networking solutions VistA Office project funded by US government

8 EMR Market - US “Networking as Practice Workflow” Everybody has an electronic billing system EMR adoption is the key  17% EMR penetration in US ophthalmology in 2005  Estimated 50% adoption by 2010 Fragmented market – many vendors  Anticipate consolidation

9 Image Management System Market “Networking as Modality Workflow” Mature fundus imaging market  1200 to 1800 retinal specialists in US  Widespread use of image management systems Growth in non-mydriatic fundus imaging market Early adoption of multi-modality storage / viewing  Early ad-hoc solutions don’t use standards  PACS technology will dominate when IHE is adopted

10 Shifting Instrument Functions to the Network

11 Context of Networking Instruments: Ophthalmic IT Products

12 Order Processing

13 Networking Market Segments Small practice Large clinicHospital Patient Registration PMS HIS Order PlacerPMS HIS Order FillerEMR Image Management EMR or IMS IMSIMS or PACS

14 The Office of the Present Industry networking standards are lacking Interoperability of devices is limited Will describe in terms of 3 legacy networking solutions

15 Instrument Networking via Server

16 Instrument Networking Advantage No removable media Review on PC Limitation Single modality solution Not Addressed Patient or order data flow to the instrument Data flow for an electronic record or charge processing

17 Simple Instrument / EMR Integration

18 Simple Instrument / EMR Integration Advantage Data flow for an electronic record and charge processing Limitation Requires PC next to instrument Ineffective solution for legacy records Not Addressed Patient or order data flow to the instrument

19 Simple Review Software / EMR Integration

20 Simple Review Software / EMR Integration Advantage Patient selection workflow for review Limitation No patient or order data flows to the instrument EMR database vs. modality database Not Addressed Patient or order data flow to the instrument

21 Vision of Office of the Future Networking will use industry standards (IHE / DICOM / HL7) Will look like offices of the present in other medical specialties  Radiology  Cardiology  Patient Care (adopting IHE now) Customers will expect plug-and-play  If it doesn’t work, will want to return it The future is here  Concept demonstrated at AAO 2005 IHE Eye Care Showcase  Full electronic workflow at AAO 2006 IHE Eye Care Showcase

22 IHE Networking – Full Electronic Workflow

23 Business Summary Standards are a pre-requisite for multi- vendor interoperability Standards will fuel the transition to fully electronic offices within the next 5 years The EMR market will continue on its recent growth phase The ophthalmic PACS market will soon begin its growth phase