1. HMS & HomeTown Health: ROI of an EHR Integrated Clinical and Financial Hospital IT Solutions 12/10/09

2. HMS AGENDA Identifying Opportunities to realize ROI –A simple case study for a 30 bed hospital –How the technology solutions reduce risk, enhance quality of care and impacts financial performance Realizing your ROI –Qualifying for Funds –Roadmap to the Electronic Health Record Focus on Adoption –Maximizing your reimbursement –Timeline to convert INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS

3. HMS HMS Customers Complete focus on community hospitals –650 hospitals nationwide who believe in the integration approach 100+ are Critical Access Hospitals –Hospitals that are typically the sole provider of care within their community –Understand the urgency of reaching an EHR and are planning accordingly 50 customers are on their way with CPOE –Believe in the benefits of an integrated system –Believe in the importance of CCHIT/ARRA certification –Value flexibility and vendor relationship INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS

4. HMS Simple Case Study A community hospital requested assistance to predict possible ROI that could be realized with a technology investment –Baseline statistics Average Census 25 patients Average LOS 2-3 days –Data collection method and sources On site one day survey to observe and discuss current processes Simple survey to collect basic hospital statistics such as admissions statistics, nursing staffing levels and labor costs, order statistics, etc. Industry Sources- HIMSS Analytics, Cost Report data INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS

5. HMS Potential Inpatient Savings With conservative estimates, we typically see $300K of ROI Year 1… –Where are the savings? Eliminating addressograph and chart set up times Common database for sharing of allergies and home meds Single electronic record that multiple care givers can view eliminating chart wait times Elimination of hand written MAR processes Streamlined patient assessment and care planning processes –Potential savings not included Pre printed forms expense- typically 50- 70% reduction with eForms Enhanced charge capture from nursing point of issue charging Reduction in overtime due to quicker shift report and post shift documentation Automated Vital Sign capture from monitoring equipment Accounts receivable and collections impact INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS

6. HMS Potential Inpatient Savings INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS Patient Activity HMS Inpatient Clinical Admission/Ordering Process Current SystemHMS Time Savings - eForms print to the floor or arrive with patient eliminating paper chart set up 15 min/admit7 min/admit - Nurse reviews the electronic chart with no waiting time 30 minutes per day/nurse3 nursing hours/day - Patient care documentation process begins with admission assessment 1 hours/admit4 nursing hours/day -Physician pharmacy and procedure orders using CPOE 400 hand written AND electronically placed 1.8 clerical hours/day -Medication orders are filled. Orders placed through CPOE eliminate the following steps:  Delivery of hand written order to pharmacy. Orders appear in an unverified queue for pharmacist verification  Current process includes hand writing a 2 day MAR for each patient and posting a daily MAR to each chart for physician review. Both eliminated.  With electronic system nursing alert is sent to eMAR to notify the nurse of new physician Orders 45 min/admit for hand written MAR 1 hr per day of pharmacy Verification.75 hrs per day to post 1 day MAR 3.5 nursing hour/day 50 min/day pharmacy time.75 clerical hours/day

7. HMS Potential Inpatient Savings INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS Patient Activity HMS Inpatient Clinical Documentation Process Current System HMS Time Savings - Nursing assessment triggers orders, suggested nursing diagnoses and multi disciplinary care plan. The care plan creates an interactive worklist. Documentation occurs against the tasks on the worklist. 15-20 minutes per patient/shift for care plan updates and changes 9 hours of nursing time/day

8. HMS Identification of Other Potential Inpatient Savings -in one day, didn’t have time to get hard $ INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS Patient Activity HMS Inpatient Clinical Documentation Process Current System - Physician is notified via Clinical View alerts of new reports, critical values, orders from other physicians, and new incoming documents. Physician may input daily rounds note. Multiple physician log ons and paper chart review - Discharge or transfer. Personalized patient education and on line medication reconciliation occurs from within HMS patient care documentation. Notifications are sent to all departments. Future orders are auto cancelled. Hand written medication reconciliation and discharge plan

9. HMS Qualitative vs. Quantitative Challenge Qualitative is difficult to measure –If the system alerts and prevents a possible medication error, you do not have a crystal ball to predict the outcome or cost to the hospital –In many instances, near misses are not documented. Without having a baseline to start, it is challenging to show immediate improvement. INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS

10. HMS HMS Clinical Value Delivered Reduce risk –Medicare Never Events Pressure Ulcers- Braden Skin Scale, auto orders Acute Renal Failure- Pharmacy monitoring Deep Vein Thrombosis- Multi disciplinary worklist alerts care givers when ambulation is due or PAST due –Physician Alerts Critical results alerts and acknowledgement New medication orders alert for nursing INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS

11. HMS HMS Clinical Value Delivered Improved Patient Safety through eMAR Implementation –Average annual preventable ADEs= 25 –Average Treatment Cost per ADE= $7000* –Annual Treatment Cost for all preventable ADEs= $175,000 –Percent of ADEs med administration related (38%) –Annual Treatment Cost for Administration ADEs= $66,500 –Late and missed dose reporting –Clinical Screening- Allergies, Weight based dosing INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS

12. HMS Qualitative Value of HMS: clinical implementation Increased Patient Satisfaction –Streamlined admission process –Increased bedside care and nursing interaction (40/60 OR 60/40?) –Quicker discharge process Increased Physician Satisfaction –Web enabled access to the patient chart from home or office including PACS images –Outreach scheduling availability –Digital Patient Record allows electronic chart signature to occur from any location INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS

13. QUALIFYING FOR FUNDS INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS

14. HIT Policy Update ONC & HIT Policy Committee Chair, Dr. Blumenthal Opening Remarks 2011 MU criteria… ARRA “…your work is done…” ARRA/HITECH legislation totally separate from health reform

15. INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS QUALIFYING FOR FUNDS ARRA Step 1: Implement Certified EHR Technology Step 2: Adopt Technology & Achieve Meaningful Use Step 3: Submit Application for Payment -2007 CCHIT Certification -2011 Comprehensive - Inpatient & Ambulatory Certification -Willing to Reengineer Current Processes -Ongoing Education/Training -ARRA Dashboard -CMS

16. INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS CERTIFIED EHR ARRA, CCHIT and HMS Proactive Approach CCHIT 2011 Comprehensive Inpatient and Ambulatory Certification Contains all of the 2011 ARRA, “meaningful use”, requirements –Goes above and beyond these requirements HMS will resubmit for certification in 2010 (Spring) –Programming cut off is December 31, 2009 ARRA 1 2 3

17. INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS ARRA ADOPTING EHR TECHNOLOGY 1 2 3 Big Picture: Improving Outcomes with an Integrated EHR EHR

18. INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS MAXIMIZE ROI THROUGH ADOPTION INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS

19. ARRA What You Can Do to Prepare - PPT Process Technolog y People 1 2 3

20. INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS ARRA What You Can Do to Prepare PPT People 100% Executive buy in HIT vision team or steering committee Includes department leaders Clear goals and objectives –Do you have the right resources Timeline to get there (How, When, Where, Why and Who) Physician champion Believing in the benefits of a complete EHR Internal communication plan Ongoing education HMS Learning Institute 1 2 3

21. INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS ARRA What You Can Do to Prepare PPT People Process Moving from paper to electronic system Dedicated account manager from your vendor Operational, financial, clinical and technical assessments SWOT analysis Strengths Weaknesses Opportunities Threats 1 2 3

22. INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS ARRA What You Can Do to Prepare PPT People Process Technology HMS has the complete solution for you to obtain a certified EHR and achieve meaningful use How complete is your current solution? Do you have CPOE? 1 2 3

23. INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS ADOPTION TIMELINE Future Release Schedule and MU Criteria 2011 MU Criteria HMS Release 9.0: June 2010 1 st year hospital incentive begins October 2010 10% CPOE utilization 2013 MU Criteria HMS Release 11.0: June 2012 100% CPOE utilization 2015 MU Criteria HMS Release 13.0: June 2014 ARRA 1 2 3

24. INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS MAXIMIZE YOUR REIMBURSEMENT INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS

25. Path to Meaningful Use For Those with a Certified EHR and use it in a Meaningful Manner PPS hospitals $2million base plus $200 based on number of discharges Medicare share and yearly transition factor Example: $3.5million over 4 years HMS EHR $1.2million proposal: your incentive $3.5million $2.3million remains What could your hospital do with an extra $2.3million Network upgrade, construction project New computers, pen tablets, COWs Ongoing education, recruiting/retainment The time is now: 12 months remain for 1 st year’s reimbursement ARRA 1 2 3

26. INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS MAXIMIZE YOUR REIMBURSEMENT Maximize Your Investment Benefits of an integrated approach Community hospitals typically have fewer IT resources –Lowers your cost of ownership as system requires less IT resources –Eliminates costly interfaces and staff needed to maintain –Fewer points of failure and having to deal with multiple vendors ARRA 1 2 3

27. INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS TIMELINE AT A GLANCE INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS

28. ARRA TIMELINE

29. INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS THANK YOU INTEGRATED CLINICAL AND FINANCIAL HOSPITAL IT SOLUTIONS