1. The Future of Health Information Technology Necessary Evil or Blessing in Disguise Mark R. Anderson, FHIMSS, CPHIMS AC Group, Inc.

2. Mark Anderson, FHIMSS, CPHIMSS Healthcare IT Futurist 34+ Years In Healthcare IT IDN Expertise –CIO Position at Three Multi Facility Regional IDN’s –Executive Team Member at 5 Different IDN’s –Worked In 158 Hospitals and 21 Payer Organizations Physician Expertise –Managed 50 Physician Practices in the Late 1980’s –Former CIO of a 2,300+ physician (500+ Practices) IPA –Currently Conducting EHR Searches for > 100 Practices –National Speaker on EHR - > 380 sessions since 2001 –Negotiated more than 100 EHR contracts Installed over $1B in technologies since 1972

3. Disclosure Speaking at numerous professional associations and at vendor meetings (over 100/Year) White Papers on the use of technology Serve on numerous conference boards EHR Search and Selections (> 100 Practices) DOQ-IT and CMS EHR Selection Tool NO Revenue from any vendor based on any Sales or increase in Revenues

4. Why is this session important In 2006, the healthcare industry saw an explosion in interest in the ambulatory EHR marketplace Partially driven by quality indicators, P4P, and a relaxing in the Stark law that prohibited hospitals from funding community EHR initiatives. Partially driven by quality indicators, P4P, and a relaxing in the Stark law that prohibited hospitals from funding community EHR initiatives. What does this mean for the average Physician Practice?

5. Topics How will EHR initiatives are changing the way practices look technology decisions? What is the government’s involvement in EHRs? How are hospitals leveraging EHR projects to increase physician bonding? How with EHR affect your revenue stream? Why do systems fail? How the EHR vendors are rated and why many will not survive?

6. Vision “Technology is simply a catalyst that will empower providers to drive meaningful changes in care.” “ People love progress … but hate change”

7. Page No: 7 What issues are physicians interested in? Maintain or improve Quality More timely and accurate payments from carriers. Save time and money. Allow them to see more patients per day. More productive organization's. Provide information about their organization's.

8. The Thing About the Future…

9. …You Hate Getting It Wrong!

10. And Big Surprises Aren’t Much Better !

11. With Only the Past for a Compass… Who will guide you?

12. Patterns Must Lead to Action Success = Teamwork

13. The Digital Medical Office of the Future

14. Page No: 14 C C R Post Exam Appointment Scheduling Check-in Update patient demographics Scan Insurance cards/ Scan Driver’s license Sign consent forms Receive Appointment Request Schedule/Reschedule Appointments Perform eligibility check Perform Treatment Procedures Draw specimen for Diagnostic Procedures Fax/Transmit Rx and Diagnostic Orders Charge Codes Billing Take patient picture Collect Co-pay Create Encounter Exam Pre-exam Document PFSH Document ROS Take Vitals Review PFSH/ROS/Vitals/ Diagnostic Reports Perform Physical Exam Document Assessment Order Rx/Diagnostic Procedures/Treatment Procedures Provide Patient Education Check-out Schedule follow-up appointment Perform referral authorization Obtain Referral appointment Collect payments Refer out Refer in C C D The EHR Process

15. Information Overload

16. % who already have implemented EHR Applications

17. What is the government’s involvement in EHRs? Free EHR - Vista Congress – What till 2009 Personal Health Record Initiatives Setting Standards – CCHIT CMS and P4P Setting Guidelines - HIE Relaxation in Stark Law

18. Wireless Tablet Wireless Access Point EMR/PM Application Wireless Tablet Wireless Access Point EMR/PM Application Enabling Responsive Local Patient Care Wireless Tablet Wireless Access Point CCD Data Patient Demographics Patient Insurance Medications Allergies Health Maint Alerts Lab Results Dictated Reports Vital Signs DX and CPT codes Patient Demographics Patient Insurance Medications Allergies Health Maint Alerts Lab Results Dictated Reports Vital Signs DX and CPT codes EMR/PM Application Physician at Home Patient’s Home Practice 1Practice 2Practice 3

19. Connecting Physicians Delivers the Connected Community In-patient Clinical & Physician Portal Physician Office Solutions Broad Community Connectivity Patients Payers & PBMs Retail Pharmacy Homecare Providers Employers Physicians Hospitals Ancillary Departments HIE Technology is best positioned to lead the way to a connected care community

20. It shouldn't take a brain surgeon to design one patient centric community EHR

21. Page No: 21 Results Printing Auto-route to the office Auto-print to the office $30-$50 Clinical Access Physician Portal Results Viewing Messaging and Alerts $50-$70 Level 1 Practice Support eRX Orders Results $55-$100 Level 2 Practice Support EMR Light Charge capture Hlth Maint Plan Referral Management $500-$700 Level 3 Practice Support Fully functional EMR CDS KBS $700-$1,000 EHR/Interoperability Offering Physicians Choices A Flexible and Modular Path to EMR

22. Http://www.acgroup.org Page No: 22 Hospital Benefits Physician Bonding ER has access to extensive information about patients (prior Meds, allergies, lab results, chronic issues, health maintenance alerts) Single source Enterprise Wide documentation –Nursing, PT, OT, Dietary, Social Workers Reduce errors by up to 78% Nursing has access to prior patient clinical information in a summary format and detailed data by date 35% of nursing documentation is auto generated Physician Order Entry adoption based on best practices No change in registration, scheduling, and billing Auto generation of HPI and Discharge Summary 98% reduction in HPI and Discharge Transcription Costs

23. Http://www.acgroup.org Page No: 23 Physician Benefits Hospital Sponsorship Help with cost (Relaxation in the Stark Law) One system for all charting One system for orders Reduce charting while in the hospital by 73% Auto Charge Capture for physician office visits Hospital Lab results delivered 87% faster Access to hospital data from home (with security)

24. Http://www.acgroup.orgPage No: 24 Benefits to the Physician  Clinical Integration  Reduce operating cost > 8%  Improve Revenue Capture > 3%  Lower costs = 40% reduction  Monthly fixed costs with local support  Pay-for-performance - $5K-10K  Interfaces to all sources  Data exchange between Primary Care, Specialists, and Hospitals  Contract terms and conditions  P4P

25. Http://www.acgroup.org Page No: 25 Potential Business Benefits Clinician time savings of between 19% and 26% of non direct pt. care time MA/Nurse time savings of between 20% and 28% of daily activities Medical Record cost reduction of between 64% to 74% Transportation cost reduction of between 80% and 92% Paper cost reduction of between 61% and 68% Transcription costs reduction of between 73% and 87% Billing costs reduction of between 6% and 12%

26. Http://www.acgroup.orgPage No: 26 Potential Business Benefits Charge capture and coding costs reduction of between 84% and 90% Reception costs reduction of between 10% and 14% Lab handling costs reduction of between 61% and 70% Rx handling costs reduction of between 57% and 64% Scheduling costs reduction of between 6% and 12% EOB Posting costs reduction of between 61% and 68% Collection costs reduction of between 4% and 8% QA Reporting costs reduction of between 46% and 60% ER costs decrease by 31% since the ED physicians has access to prior clinical records and results.

27. Http://www.acgroup.orgPage No: 27 Benefit to the patient Answer questions one time Centralized Patient Record Reduced potential errors Improved clinical quality and outcomes Reduced unnecessary tests by 73% Reduce costs by reducing waste in the clinical process ER has access to data at the point of care

28. Http://www.acgroup.orgPage No: 28 Why systems FAIL!

29. Http://www.acgroup.org Page No: 29 EHR Failure rate Through 2007, the EHR failure rate continues to increase. When asked, “1 year of EHR installation, are you seeing 80% of your patients using the EHR for charting, ROS, HPI, Evaluation, coding, orders and results reporting”. –73% of the physicians (3,245) indicated that no, they were NOT using the EHR for 80% of their patients. –18% replaced or were not using EHR –Why, are 73% of the physicians NOT fully utilizing the EHR after 1 year? So why are there so many failures?

30. Http://www.acgroup.org Page No: 30  Poor planning  Unrealistic expectations  Lack of physician and provider support  Flawed selection process  Mismanagement of workflow and staffing changes  Poor Contract Terms  Workflow redesign - COT Why do Implementations Fail?

31. Organizational and Clinical Transformation

32. Http://www.acgroup.org Page No: 32 Delivery Model – Levels of Value Delivery Install: EMR Usage Implement: EMR Process Change Transform: Maximum Value Realization

33. Http://www.acgroup.orgPage No: 33 Roles & Responsibilities EMR Vendor TransformationPractice Deliver Technology Product Ensure Value Delivery & Facilitate Exchange Adopt & Perform with New Solution Provide EMR Best Practices Provide EMR Best Practices Strategy – Goal Alignment Strategy – Goal Alignment Provide Sponsorship Provide Sponsorship Tech System Assessment Tech System Assessment Assess Readiness Assess Readiness Commit Resources Commit Resources Build Technology Interface Build Technology Interface Create Program Structure Create Program Structure Make Decisions Make Decisions Present Standard Templates Present Standard Templates Program Communications Program Communications Steering Committee Steering Committee Train Super Users Train Super Users Program Planning & Management Program Planning & Management Practice Management Liaison Practice Management Liaison Train Users Train Users Process Development Process Development Clinical Liaison Clinical Liaison Configure Software Configure Software Benefit Tracking Benefit Tracking Administrative Workflow Team Administrative Workflow Team Load Software Load Software Change Management Activity Change Management Activity Clinical Staff Workflow Team Clinical Staff Workflow Team Test Support Test Support Vendor Management Vendor Management Provider Workflow Team Provider Workflow Team Respond to Change Requests Respond to Change Requests Roll Out Management Roll Out Management Billing Workflow Team Billing Workflow Team Integrate Lessons Integrate Lessons Technical Workflow Team Technical Workflow Team

34. What are Practices Purchasing Source: AC Group annual survey of buying patterns

35. When will Physicians Purchase Source: AC Group annual survey of buying patterns

36. When will Physicians Purchase Source: AC Group annual survey of buying patterns Implementation Gap

37. Who will be purchasing % of sales by Service AC Group annual survey of buying patterns

38. How the EHR vendors are rated and why many will not survive? Too many vendors to count Too many vendor promising the world Too many failures How do you tell them apart? What are you looking for? How do you evaluate them?

39. Market Change over time Over 380 vendors claiming to sell EHRs Selecting the wrong vendor could cost you over $50K per provider

40. EMR/EHR Selection Tool AC Group conducted extensive evaluation of the EHR marketplace –9th report –Completed in October 2007 –Included over 3,000 functional questions –48 categories of functionality –26 subcategories of charting functionality 114 Vendors have participated

41. EMR/EHR Selection Tool Charting Vendors EMR Light Vendors EMR Vendors EHR Vendors CHR Vendors Combined PMS/EHR FQHC Mental Health

42. AC Group Product Evaluations EHR Functionality Only PMS – EHR Functionality Only –End-User Satisfaction KLAS AAFP AC Group Total Company Rating –Company Stability Revenues Revenues CCHIT CCHIT Total Ambulatory Revenues Client Base Technology

43. Http://www.acgroup.orgPage No: 43 Certification Commission for Healthcare Information Technology CCHIT is the recognized certification authority for electronic health records and their networks, and an independent, voluntary, private-sector initiative. The mission is to accelerate the adoption of health information technology by creating an efficient, credible and sustainable product certification program.

44. Http://www.acgroup.org Page No: 44 CCHIT Certified EHR Vendors Certification is good for 3 years – but!!!!! 2006 Certified vendors will need to renew again in 2007 As of Feb 1, 2008 only 13 vendors have passed the 2007 CCHIT

45. Top EMR/EHR Vendor Applications Practices with > 100 Physicians Based on 2,750 Functional Questions Divided Between 46 Categories GE does not want their ranking published

46. Top EMR/EHR Vendor Applications Practices with 20 to 99 Physicians Based on 2,750 Functional Questions Divided Between 46 Categories

47. Top EMR/EHR Vendor Applications Practices with 6 to 19 Physicians Based on 2,750 Functional Questions Divided Between 46 Categories GE does not want their ranking published

48. Top EMR/EHR Vendor Applications Practices with 1 to 5 Physicians Based on 2,750 Functional Questions Divided Between 46 Categories GE does not want their ranking published

49. Bottom Line What does it take to thrive?

50. BOTTOM LINE  Physicians need help when it comes to technology  Physicians need local support  Physicians need help with contracts and pricing  The community needs to share data  80% of the data is in the office  Lets empower the physician

51. For More Information Mark R. Anderson, FHIMSS, CPHIMS CEO and Healthcare Futurist AC Group, Inc. 118 Lyndsey Drive Montgomery, TX 77316 (281) 413-5572 eMail: mark.anderson @ acgroup.org www.acgroup.org

52. Questions