1. Reinventing the Electronic Medical Record (EMR) Position We are making a national investment of billions of dollars to scale up the use of EMRs to improve the access, quality and cost of care in the US. There are seven major challenges to using our current products (EMR 1.0) to achieve that goal. Fortunately, we can meet all seven challenges but doing so requires a complete rethinking of products and approaches. We need to develop an EMR 2.0. This presentation describes the challenges with scaling EMR 1.0 and how EMR 2.0 will meet them.

2. Copyright © 2009, New Value Streams Consulting LLC 2 Seven EMR 1.0 Challenges 1.Implementation Complexity 2.High Cost and Low Interoperability 3.Limited and Delayed Value 4.Lack of Cognitive Support 5.Information Sharing Disincentive 6.Improved Care Disincentive 7.Threaten Provider Business Model

3. Copyright © 2009, New Value Streams Consulting LLC 3 1. Implementation Complexity EMR 1.0 Implementations are long, complex and involve large software modules that cause significant disruptions to operations EMR 2.0 Rearchitect from transaction-oriented modules to small components and services that can be implemented quickly and used as needed

4. Copyright © 2009, New Value Streams Consulting LLC 4 2. High Cost and Low Interoperability EMR 1.0 Costs are too large for many clinics and hospitals. Patient data is locked in as EMR 1.0 does not promote exchange between payers and providers EMR 2.0 Use cloud computing to dramatically lower costs and achieve interoperability within the enterprise, across enterprises, regionally, nationally and globally (e.g. medical tourism)

5. Copyright © 2009, New Value Streams Consulting LLC 5 3. Limited and Delayed Value EMR 1.0 Benefits can take years to realize and are hard to measure EMR 2.0 Focus first on creating value not simply turning paper forms into electronic documents (value informatics)

6. Copyright © 2009, New Value Streams Consulting LLC 6 4. Lack of Cognitive Support EMR 1.0 Does not provide natural support for strong situational awareness, making effective decisions or changing behaviors EMR 2.0 Go from data to semantic content and knowledge to provide a world-class level of cognitive and behavior change support

7. Copyright © 2009, New Value Streams Consulting LLC 7 5. Information Sharing Disincentive EMR 1.0 Have to spend time capturing, using and sharing information with no direct benefit EMR 2.0 Provides a fee for information service, to those that have vital information but do not directly receive a benefit from capturing, sharing or using it

8. Copyright © 2009, New Value Streams Consulting LLC 8 6. Improved Care Disincentive EMR 1.0 Sharing information and improving care will lower provider revenue EMR 2.0 Create an electronic marketplace to implement P4P incentives to accelerate the adoption of best practices in preventative, acute and chronic care

9. Copyright © 2009, New Value Streams Consulting LLC 9 7. Threatens Provider Business Model EMR 1.0 Allows new entrants to influence patient’s consumption decisions and threatens providers business model. You are eating my lunch! EMR 2.0 Offer forward thinking providers caught on the wrong side of the value migration an opportunity to reinvent

10. Copyright © 2009, New Value Streams Consulting LLC 10 Recap of EMR 2.0 Solutions Develop a service-oriented architecture (SOA) for EMRs Deliver EMR services from a cloud computing platform Build high value applications from the cloud-based services rather than automating forms and paper charts Develop semantic or knowledge-based services that directly support situational awareness, decision making and behavior change Provide a mechanism for determining, tracking and paying P4P incentives to support the information sharing and improved care needed to drive EMR 2.0 services Offer new information-based revenue opportunities to providers that face business model disruption