1. Overview of the Medical Records Marketplace C. Peter Waegemann CEO, Medical Records Institute

2. What I’ll be Talking About... 1.Defining EHRs and EMRs 2.Identifying Markets 3.Analyzing Domain Issues 4.International Perspective

3. History of Computer-based Patient Record Systems 1960sFirst Attempts 1970s and 80sProgress slowed 1991IOM Study 1995-98Failures and Decline of Interest 1999Focus on Personal Web-based Records Since 2002Back to the Top of the List

4. Health IT Product Categories per Year (US) Financial Solutions$ 800 million Administrative Solutions$ 200 million Imaging Solutions $7,000 million Clinical Solutions$26,000 mill. Other Non-Provider Solutions? –Public Health –Bio-terrorism, etc. NHIN (?)?

5. What Is an Electronic Health Record? CPR - Computer-based Patient Record CMR – Computerized Medical Record PMRI – Patient Medical Record Information ICRS – Integrated Care Record Services PCR – Patient-carried (Card-based) Patient Record PHR – Personal Health Record EMR – Electronic Medical Record DMR – Digital Medical Record EPR – Electronic Patient Record EHR – Electronic Health Record

6. EHR Structure: Loosely Connected or Unconnected Data Islands Prenatal Record Family Record Pediatric Record Potentially multiple providers/records Primary Care Record Specialty Provider Record Personal Health Record Hospital Record Wellness Health Information Pharmacy/Medication Records Employer/Other Health Records Payer/Financial Health History Information Many other Health History Repositories Emergency Care Record Legend EMRS How many EMRs are in an EHR?

7. Seven Domains 1.Integrated Healthcare Delivery Organizations 2.Hospitals Teaching Hospitals (500+) Hospitals (5500) 3.Ambulatory Care Providers (600,000) By Medical Specialty (165+ Subspecialties) 4.Personal (Consumer Health Records) 5.Home Healthcare 6.Long-term Care (37,000) 7.Specialty Systems (Dental, Alternative Care, Sports Medicine, etc.)

8. Integrated Delivery Services and Hospitals Focus on Enterprise-wide Interoperability Competition-driven Patient Safety Driven User Considerations –Industry –Standards –User Acceptance

9. Ambulatory Care Providers 75% of Physicians in Small Practices Many Specialties 318 Vendors Prices Range from $200 to $60,000 per Physician

10. EMR Benefits in Ambulatory Field Pressure to Implement an EMR Potential Benefits 1.More money 2.Better competitiveness 3.Remote working 4.Workflow benefits 5.Better decision support 6.Easier reporting 7.Be better informed about patients 8.Attract more patients 1.More money 2.Better competitiveness 3.Remote working 4.Workflow benefits 5.Better decision support 6.Easier reporting 7.Be better informed about patients 8.Attract more patients

11. 1.More money 2.Better competitiveness 3.Remote working 4.Workflow benefits 5.Better decision support 6.Easier reporting 7.Be better informed about patients 8.Attract more patients 1.More money 2.Better competitiveness 3.Remote working 4.Workflow benefits 5.Better decision support 6.Easier reporting 7.Be better informed about patients 8.Attract more patients Savings from Transcription Patient Information Capture System Efficiency Better Coding (not guaranteed) Back-end Speech Recognition Front-end Speech Recognition Speech Recognition Automated coding Higher Revenues from ‘Lost’ Charges and Better Coding Success Varies

12. 1.More money 2.Better competitiveness 3.Remote working 4.Workflow benefits 5.Better decision support 6.Easier reporting 7.Be better informed about patients 8.Attract more patients 1.More money 2.Better competitiveness 3.Remote working 4.Workflow benefits 5.Better decision support 6.Easier reporting 7.Be better informed about patients 8.Attract more patients Patient Attraction Connectivity with Medical Community Email Refills Trust Technology Attraction Email Refills Trust Technology Attraction Referrals Reports Labs Hospital Communication CCR Referrals Reports Labs Hospital Communication CCR

13. 1.More money 2.Better competitiveness 3.Remote working 4.Workflow benefits 5.Better decision support 6.Easier reporting 7.Be better informed about patients 8.Attract more patients 1.More money 2.Better competitiveness 3.Remote working 4.Workflow benefits 5.Better decision support 6.Easier reporting 7.Be better informed about patients 8.Attract more patients Remote Computing and Remote Documentation Working at home or anywhere Arranging your time accordingly

14. 1.More money 2.Better competitiveness 3.Remote working 4.Workflow benefits 5.Better decision support 6.Easier reporting 7.Be better informed about patients 8.Attract more patients 1.More money 2.Better competitiveness 3.Remote working 4.Workflow benefits 5.Better decision support 6.Easier reporting 7.Be better informed about patients 8.Attract more patients Workflow Benefits No waiting or searching for charts (for example, think of phone calls) Easier refills Easier results management Signatures Immediate availability of patient data Point-of-care documentation Better time management

15. 1.More money 2.Better competitiveness 3.Remote working 4.Workflow benefits 5.Better decision support 6.Easier reporting 7.Be better informed about patients 8.Attract more patients 1.More money 2.Better competitiveness 3.Remote working 4.Workflow benefits 5.Better decision support 6.Easier reporting 7.Be better informed about patients 8.Attract more patients Computer and Internet Support for Decision Making Formularies Diagnostic information Information about medications Other decision support info

16. 1.More money 2.Better competitiveness 3.Remote working 4.Workflow benefits 5.Better decision support 6.Easier reporting 7.Be better informed about patients 8.Attract more patients 1.More money 2.Better competitiveness 3.Remote working 4.Workflow benefits 5.Better decision support 6.Easier reporting 7.Be better informed about patients 8.Attract more patients Query system by condition or medication Follow-up and reminders Ad hoc reports Other reports

17. 1.More money 2.Better competitiveness 3.Remote working 4.Workflow benefits 5.Better decision support 6.Easier reporting 7.Be better informed about patients 8.Attract more patients 1.More money 2.Better competitiveness 3.Remote working 4.Workflow benefits 5.Better decision support 6.Easier reporting 7.Be better informed about patients 8.Attract more patients Receive patient information electronically Integrate and create CCR All insurance information Health status from other providers

18. 1.More money 2.Better competitiveness 3.Remote working 4.Workflow benefits 5.Better decision support 6.Easier reporting 7.Be better informed about patients 8.Attract more patients 1.More money 2.Better competitiveness 3.Remote working 4.Workflow benefits 5.Better decision support 6.Easier reporting 7.Be better informed about patients 8.Attract more patients Communication by email Less waiting time Computer-generated patient education Guidance to websites Web portals

19. Issues Funding and Benefits –Change in Care Work Flow –Information Capture Complexity of Decision Making Hurdles of RHIOs CCHIT Lack of Guidance

21. Workflow Issues and Functionality Data Collection Verification Documentation Order Entry Communication Practice Management Reference Management Confidentiality Security Analyzability Interoperability Paperlessness Decision Support Disease Management

22. Personal/Consumer Health Record Marketplace 2000/2001 104 PHR Vendors 13 million PHRs 2006 16 PHR Vendors 1 million PHRs 2007/8 24 PHR Vendors 3 million PHRs

23. Issues Hype about PHR Market Business Models New Industries Major Hurdles –Assembling Paper Copies –Authentication –Lack of Standards –Consumer Awareness

24. Disappointing Home Healthcare Market Long-term Care Market Specialty Systems (Dental, Alternative Care, Sports Medicine, etc.)

25. Outlook: US Will Regional and National Projects Accelerate or Slow Implementations? When will the Hospital Market Change to an Open System? When will the LTC and HH Markets be Integrated? When will the Consumer PHR Market take off? And Who will be the Players?

26. International HIT Market US Is The Largest HIT Market Germany Is The Second Largest –Close To US In Export Focusing On Different Regions UK Scandinavian Markets Asian Markets What is Success?

27. Thank You Contact info: peter@medrecinst.com