1. Mark OHerlihy Director of Healthcare Europe, Middle East & Africa Perceptive Software 'Using Information to Drive Integrated Care' "Healthcare Content in Context" © 2012 Perceptive Software. All rights reserved.

2. Presentation Focus © 2012 Perceptive Software, LLC. All rights reserved. ECM Enterprise Content Management VNA Vendor Neutral Archive, Enterprise Clinical Content Management Interoperability The ability to share information between systems, internally or externally Data Liquidity Delivering useful, relevant data to each stakeholder, users or applications VNA + ECM: Build a Foundation for Data Liquidity

3. Healthcare Today Content Challenges Manage, Store, Access Archived, existing and new Store Efficiently, Access on Demand

4. Healthcare Today Content Challenges Manage, Store, Access Archived, existing and new Store Efficiently, Access on Demand Process Challenges Manual Unmanaged Processes Business and clinical inefficiencies Discover, Design, Execute, Improve

5. Healthcare Today Content Challenges Manage, Store, Access Archived, existing and new Store Efficiently, Access on Demand Application Challenges Proprietary, inflexible systems Access and functionality limitations Eliminate Silos, Deliver in EMR context Process Challenges Manual Unmanaged Processes Business and clinical inefficiencies Discover, Design, Execute, Improve

6. Your Enterprise Environment © 2012 Perceptive Software, LLC. All rights reserved. + EMR Process Strengths Clinical Pathways, CPOE, Clinical Messaging + EMR Content Strengths Physician/nurse populated data, Nursing assessments, MD Documentation EMR -Processes outside of EMR Chemo Treatment Plan Management Provider Credentialing -Content outside of EMR Photos, paper documents, Correspondence, Faxes, Radiology Dictation and Imaging, Pathology Other Clinical Systems Radiology, Cardiology, Lab, HIM Unified Content Platform; Eliminate content silos Optimize your EMR Complete the patient record Enterprise non-clinical Systems ERP, HR, Revenue Cycle, Registration / Admissions ERP REG HR LAB RIS HIM All content Any source Any purpose In context

7. ECM + VNA Build a Foundation for Data Liquidity © 2012 Perceptive Software, LLC. All rights reserved.

8. VNA: Definitions VNA, PNA, PEA, ANP, UCA, CCF, UCP – WHAT! So what is it? VNA & ECM Combined Market Response What is a Vendor Neutral Archive

9. Acronyms VNA – Vendor Neutral Archive (Industry) PNA – PACS Neutral Archive (Mike Gray) PEA – PACS Enterprise Archive (Industry) ANP – Archive Neutral PACS (Paul Chang) UCA – Universal Clinical Archive (Dell) CCF – Clinical Content Foundation (Dr. Rasu Shrestha - UPMC) UCP – Universal Clinical Platform (Acuo)

10. What is a VNA? Platform that provides long-term, disaster recovery, lifecycle management Ability to easily share medical (data) by communicating with different PACS Central repository for medical imaging data and other patient data based on open architecture for multiple departments of multiple hospitals. Accepts data irrespective of the originating PACS or other viewing, acquisition and workflow management system Makes originating sources changeable without having to change the data formats or interface of the archive. 1 1 InMedica Research – Data Storage – Vendor Neutral Architecture – 2012 Edition

11. Platform – much more than an archive, a platform enables Open architecture – based on standards or standards based interfaces Accept data irrespective – source and format should blur and become unimportant Sharing – data becomes liquid Originating source(s) changeable – customer has choice and control to change data sources and consumers VNA – Key Points

12. VNA – Key Point Interoperability Delivers Data Liquidity – Useful, Relevant Data to Each Stakeholder, User or Application

13. Market Research VNA and ECM Combine – Market Response IMS Research – Lexmark Acquires Acuo Technologies – InMedicas View - http://www.imsresearch.com/blog/Healthcare_Data_Man agement_Intelligence_Service_Monthly_Analysis_Feb_2 013/33 http://www.imsresearch.com/blog/Healthcare_Data_Man agement_Intelligence_Service_Monthly_Analysis_Feb_2 013/33 ImagingBiz - The VNA Revealed: Understanding Its Role in a Health-delivery system - http://www.imagingbiz.com/articles/radinformatics/the- vna-revealed-understanding-its-role-in-a-health-delivery- system http://www.imagingbiz.com/articles/radinformatics/the- vna-revealed-understanding-its-role-in-a-health-delivery- system Applied Radiology - Enterprise vendor neutral archive: Guide to riding the bandwagon - http://www.appliedradiology.com/Issues/2013/02/Articles /Enterprise-vendor-neutral-archive--Guide-to-riding-the- bandwagon.aspx http://www.appliedradiology.com/Issues/2013/02/Articles /Enterprise-vendor-neutral-archive--Guide-to-riding-the- bandwagon.aspx Gartner – Lexmarks Acquisition of Acuo Technologies Heralds a new ECM Focus for HDOs - http://www.gartner.com/technology/reprints.do?id=1- 1E1KL8D&ct=130211&st=sg http://www.gartner.com/technology/reprints.do?id=1- 1E1KL8D&ct=130211&st=sg

14. IMS Research – Rise of the Middleware © 2012 Perceptive Software. All rights reserved. It highlights the potential for VNAs to help drive hospitals towards cross- enterprise data integration. However, it also shows the potential limitations of VNAs to do so on their own. It signals a trend towards integration of third-party systems to bring together major hospital IT systems – something we are calling The Rise of the Middleware (see third section). It begs the question – what is next for VNAs?

15. Radinformatics – Need for Interoperability © 2012 Perceptive Software. All rights reserved. Hospitals arent the only ones consolidating, as evidenced by Lexmark Internationals recent acquisition of Acuo Technologiesa trend that Shoemaker also views as a natural progression. …especially as VNAs begin to move out of the radiology/cardiology space. There is a large need for interoperability between enterprise content- management systems and clinical systems to provide a complete record of structured and unstructured content to the EMR systems.

16. Applied Radiology – Not all VNAs are created equal © 2012 Perceptive Software. All rights reserved. Not all VNA solutions are created equal, however, and as each of these categories continues to evolve, the story keeps on getting better for all of us. Enterprise content management (ECM) firms bridging with VNAs seems to be the next logical evolution, and this makes for perfect sense in terms of a broader strategy to manage all content across the healthcare enterprise. Across the board, there is a push for greater degrees of maturity around content management in healthcare, and my prediction is for continued innovation in this area.

17. Gartner – New ECM Focus for HCOs © 2012 Perceptive Software. All rights reserved. View ECM as an enterprise wide information infrastructure that will support multiple business and clinical applications and workflows. Create a content ecosystem that puts the user (the patient, clinician or employee) at the center. Resist installing stand-alone ECM components such as document management and imaging (DMI), Web content management, and digital asset management applications. Consolidate content repositories and develop exit strategies for departmental content applications that are not considered critical and can be addressed by an ECM solution.

18. Creating a New Reality in Healthcare Completing The Patient Record © 2012 Perceptive Software, LLC. All rights reserved.

19. ? ? ? ? ? ? ? ? ? Challenges of EMR/EHR Integration Typical EMR/EHR Installation Missing health content = incomplete picture of patient healthcare experience Disparate departmental systems and clinical data silos Cardiology PACS Other clinical content RIS/HIS/eMPI Radiology PACS Unstructured content in digital and paper formats, in standalone servers, physical file cabinets and desk drawers, sent by courier and carried by patients

20. Unified Content Platform ECM Cardiology PACS Radiology PACSSpecialty PACS Cloud SAN NAS Enterprise Content Strategy Liberated data – to capture, manage and access in context EMR

21. Semantic searching of multiple data elements from a single view Pretrieve patient clinical content Analytics of unstructured content Eliminate information silos Deliver in Context © 2012 Perceptive Software. All rights reserved.

22. Content-based medical record © 2011 Perceptive Software, LLC. All rights reserved.

23. Healthcare Vision © 2012 Perceptive Software. All rights reserved. EMR NHS #: 200803768 Core System (EMR)Device OutputDICOMExternal ContentTraditional Content A powerful healthcare solution that drives both cost efficiencies and better patient care through a single, enterprise-wide and content-based medical record that is accessible via any electronic medical record (EMR) system Integration with patient data from EMR Clinical content intermingled with ECM in results grid

24. Unified Healthcare Content Platform VNA vendor neutral archive ECM enterprise content management Content-Based Medical Record all content, any source, any purpose, in context of the patient record Radiology PACS, Cardiology PACS, RIS/HIS/eMPI, other clinical content Scanned documents, reports, notes, photos, videos, wave forms, other content SAN CAS/Cloud NAS CAS/Cloud NAS

25. Questions? Mark OHerlihy Director of Healthcare Europe, Middle East & Africa Perceptive Software © 2012 Perceptive Software. All rights reserved.