1. Prof. Steven H. Shaha, PhD, DBA Centre for Public Policy & Administration KLAS Research CLINICAL SYSTEMS APPLICATIONS AND RELATED TECHNOLOGY: TODAY AND INTO THE FUTURE For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

2. PROF. STEVEN H. SHAHA, PHD, DBA PROFESSOR, CENTER FOR PUBLIC POLICY & ADMINISTRATION DIRECTOR, KLAS PERFORMANCE INSIGHTS, KLAS RESEARCH 100+ peer-reviewed publications, 200+ peer-reviewed presentations, 2 books Advisory and consulting work for 10 governments in Asia, Australia and Europe including France, Spain, Switzerland, Netherlands, Singapore and Malaysia Advisory and consulting to over 50 non-healthcare organizations, including Disney, Ritz-Carlton, Coca-Cola, New Line Cinema, IBM, AT&T, Time Warner, Kodak, Johnson & Johnson, Marriott, U.S. Dept of Defense Employment history includes: Coca-Cola, RAND Corporation, UCLA Medical Center, Intermountain Health Care, Gartner Group, Inst Integrated Outcomes, Allscripts Professor or Lecturer or at 14 professional academies and graduate schools, e.g. Harvard, Columbia, Cornell, UCLA, MIT, UMass Academic Appointments (current): Center for Public Policy and Admin, Harvard (lecturer), Zayed Univ (UAE), University of Utah Education: PhD, Research Methods & Applied Statistics DBA, Business Administration (PhD) MA, MEd, BS Disclosures & Bio For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

3. THE EPR-ENABLED POSSIBILITIES For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

4. Improved Stroke Outcomes Impact of Stroke Outcomes Toolkit: Comparative Quality with versus without Stroke Care Best Practices Impact of EMR/EHR with Intelligent Order Sets and Advanced CDS For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

5. Improved Stroke Outcomes Stroke Care Best Practices CPOE w/ alerts alone Impact of EMR/EHR with Intelligent Order Sets and Advanced CDS http://cwhonors.org/viewCaseStudy2010.asp?NominationID=186&Username=shssos, accessed 5-apr-13 For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

6. Without With CDS-rich Order Set Improved Stroke Outcomes Impact of EMR/EHR with Intelligent Order Sets and Advanced CDS With CDS-rich Order Set 40.5% Greater Clinical Excellence Stroke Care Best Practices CPOE w/ alerts alone For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543 http://cwhonors.org/viewCaseStudy2010.asp?NominationID=186&Username=shssos, accessed 5-apr-13

7. Improved Stroke Outcomes Financial Impact Length of Stay 16.0% fewer (p<.001) 11.4% lower (p<.05) Readmissions in 31 Days Discharge Patterns 35.7 % fewer (p<.001) 9.4% more (p<.001) 21.4% fewer (p<.001) 12.7% lower (p<.05) 7.5% lower 0.35 fewer days avg. (p<.001) 7.5% lower 0.35 fewer days avg. (p<.001) Estimated savings of £140k-340k annualized With CDS-rich Order Set CPOE w/ alerts alone http://cwhonors.org/viewCaseStudy2010.asp?NominationID=186&Username=shssos, accessed 5-apr-13 For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

8. 16.0% fewer (p<.001) Discharge Patterns Improved Stroke Outcomes Continue after Discharged 9.4% more (p<.001) 21.4% fewer (p<.001) With CDS-rich Order Set CPOE w/ alerts alone http://cwhonors.org/viewCaseStudy2010.asp?NominationID=186&Username=shssos, accessed 5-apr-13 For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

9. Length of Stay Readmissions in 31 Days 7.7 % fewer (p<.001) Better Outcomes after Discharge Admissions to Skilled Nursing Facilities 4.1 % shorter (p<.001) Additional Efficiencies Capacity for 130 additional admissions with NO staffing increases Additional Efficiencies Capacity for 130 additional admissions with NO staffing increases With CDS-rich Order Set CPOE w/ alerts alone http://cwhonors.org/viewCaseStudy2010.asp?NominationID=186&Username=shssos, accessed 5-apr-13 For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

10. EPR REALITIES: “NOT EVERYONE CAN…” Good News Quest for Interoperability and Integration Focus on Implementation Excellence Importance of Local Uniquenesses Challenges Quest for Interoperability and Integration Implementation Challenges Local Uniquenesses Conflicting Priorities For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

11. RESEARCH MODEL 3,000+ Provider surveys and calls annually Scores on 25-item Survey Provider Narratives and Quotes Comparatives by Vendor, Market, Product Type For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

12. COVERAGE LIST For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

13. COMPARATIVE VENDOR PERFORMANCE For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

14. Vendor A Vendor B Vendor C Vendor D Vendor E Vendor F Vendor G Vendor H Vendor I EMR Product Name A EMR Product Name B EMR Product Name C EMR Product Name D EMR Product Name E EMR Product Name F EMR Product Name G EMR Product Name H EMR Product Name I For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543 COMPARATIVE VENDOR PERFORMANCE

15. EUROPE … For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

16. Vendor A Vendor B Vendor C Vendor A Vendor B Vendor C For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

17. AN INTRIGUING PATTERN … Variability in scores among top vendors? Variability between economies? Deeper search led to …. For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

18. SATISFACTION: IT VS. CLINICIANS For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

19. WHERE ARE THE DIFFERENCES? For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

20. MEAN RATINGS FOR EMERGENCY SYSTEMS 53.4% Higher Enterprise Niche For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

21. USABILITY STUDY For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

22. Vendor A Vendor B Vendor C Vendor D Vendor E Vendor F For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

23. TWO APPROACHES Model A –Less Prescriptive with Adaptability & Customizability –Implement & Adjust –Users versus Application that adapts Model B More Prescriptive versus Adaptability & Customizability Implement & Minimally Adjust Application versus User that adapts For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

24. COMPARATIVE USABILITY For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

25. COMPARATIVE TIME TO CLINICIAN AS EXPERT For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

26. COMPARATIVE TIME TO CLINICIAN AS EXPERT

27. PRESCRIPTIVE VS. ADAPTIVE? For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

28. PRESCRIPTIVE VS. ADAPTIVE? For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543 Nearly 70% Customization Still 45% Customization

29. IT VS. CLINICIANS: AVOIDABLE? For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

30. SHARED NEEDS ITClinicians Quick, Impactful Implementation System Stability & Reliability Efficiency –Hassles –Waste Quality of Care –Benefits of Outcomes –Error Avoidance Go home –Sooner –More worry-free Quick, Impactful Implementation System Stability & Reliability Efficiency –Hassles –Waste Quality of Care –Benefits of Outcomes –Error Avoidance Go home –Sooner –More worry-free For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

31. CONTRASTING NEEDS ITClinicians TCO –Maintenance & Upkeep –Interface requirements –Staff requirements –Vendor relationships Coding accuracy –Financial repercussions –Administration's needs –Integrated across settings Infinite customers –Needs and expectation –Evolving requirements Specialty-specifics –Workflows –Diagnostics –Documentation –Information access Population Management Ease of Use –Quick uptake –Intuitiveness Productivity Clinical decision support –Error avoidance –Patient outcomes Across Settings … For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

32. CAN BOTH SETS OF URGENCIES BE MET? YES –System Interoperability and Integration Adaptability to Evolving Requirements –Coding –Reporting –Clinical Models –Culture Balance of Stability with Adaptability Silos versus Team Work Micro versus Macro Perspectives –Vision Population Health balanced with Individual Patient Needs Exceptional Coding balanced with Information Value Efficiency balanced with Quality For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

33. WHAT MATTERS MOST … Score Product Works as Promoted8.5 Ease of Use8.4 Overall Product Quality8.3 Delivery of New Technology8.3 Lives up to Expectations8.3 Likely to Recommend8.2 Overall Satisfaction8.2 Product Response Time8.2 Forecasted Overall Satisfaction8.1 Money's Worth8.0 Quality of Phone/Web Support8.0 Supports Integration Goals8.0 Implementation on Time7.9 Proactive Service7.8 Quality of Implementation7.7 Overall Communication7.7 Quality of Training7.5 Contracting Experience7.4 Executive Involvement7.3 Customer Ratings Predictive Importance (Correlation with Overall Satisfaction) Anchors Fires Commodities Nuisances

34. WHAT MATTERS MOST? *Statistically Significant p<.01 Predictive Correlation to ‘Overall Satisfaction’ in Time Series *Statistically Significant p<.01 Predictive Correlation to ‘Overall Satisfaction’ in Time Series

35. KEYS TO SUSTAINABLE IMPACTS FROM VENDOR Delivery of “New Technology” Supports Integration Goals Relationship / Partnership Usability –Strong, focused implementation –Internal relationships –Mission-focused culture For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

36. KEYS TO SUSTAINABLE IMPACTS FROM PROVIDER ORGANIZATION Incorporation of “New Technology” Quest for Integration Goals Relationship / Partnership Clinician Usability –Strong, focused implementation –Internal relationships –Mission-focused culture For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543

37. Prof. Steven H. Shaha, PhD, DBA Centre for Public Policy & Administration KLAS Research CLINICAL SYSTEMS APPLICATIONS AND RELATED TECHNOLOGY: TODAY AND INTO THE FUTURE For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543