1. Adoption and Use of Electronic Medical Records (in Federally Qualified Health Centers) and Supporting an ASP Community Care Network of Virginia, Inc.

2. Outline Who is Community Care Network of Virginia (“CCNV”) Technology Goals Efficient and Productive Use of EMR Center for Data and Informatics – Quality Medical Home and Health Information Exchange Innovation eClinicalWorks Deployment ASP Hosting ASP Architecture Challenges and Benefits

3. Disclaimer

4. Community Care Network of Virginia (CCNV) Provider Network Incorporated in 1996 Owned by all of Virginia’s 24 Federally Qualified Health Centers Located in 90 sites across the Commonwealth 300 providers delivering primary care, dental and behavioral health services

5. Federally Qualified Health Centers Independent non-profit corporations Mission to serve all members of a community regardless of patient’s ability to pay Operate in local communities Over 1,200 across the country Take most if not all third party insurances Receive limited Federal grant dollars to cover the cost of serving the uninsured Commitment to quality

6. CCNV Business Purposes 1.Represent providers/practices in third party payer contracting - single signature authority 2.Provide cost effective management services information technology, medical and dental billing, NCQA certified provider credentialing, etc. 3.Performance Improvement – Center for Data and Informatics

7. CCNV Technology Goals

8. Goal 1: Efficient and Productive Use of EMR Shared purchase pricing Multiple hosting options Readiness evaluations Workflow analysis and improvement Training, training, and more training Central support and ticket management User group on line forums and twice yearly meetings

9. Goal 2: Center for Data and Informatics Establishing clinical outcome measures Collection and aggregation of data Establishing data validity and reliability Reporting and benchmarking Network and local performance improvement activities Quality forums

10. Goal 3: The Medical Home and Health Information Exchange

11. Medical Home [Federally Qualified Health Center] Specialists Hospitals PharmacyHospice Payers Home Health Local Social Service Agencies Medical Home and HIE Health Department Labs Patients

12. Goal 4: Innovation KIOSKS Network wide initiative to fabricate and install waiting room KIOSKS Kiosk content integrated into EMR in real time immediately prior to patient entering exam room Initial content limited to behavioral health assessment (PHQ-2 and PHQ-9) Additional content and functions over time Streamlines total patient time in the office

13. eClinicalWorks Deployment

14. eClinicalWorks (eCW) Deployment Two year due diligence planning period Negotiated network purchase agreement Licenses owned by individual health center Optional hosting infrastructure (individually or ASP) Master implementation schedule based on individual organization readiness Network based, eCW certified trainer and support technician

15. ASP Hosting

16. ASP hosting is optional Our model is client owned not vendor owned Software vendor accommodates both ASP individually hosted architecture Reasons for choosing ASP vary Small practices with limited capital resources and staff Large practices not wanting to make significant hardware investments timing

17. ASP Architecture

18. Located in hosting facility in Richmond Corporate office approximately 6 miles from hosting facility Hosting facility secure, redundant systems, on site technical staff can provide optional services

19. ASP Architecture Currently have 14 servers 15 out of 20 organizations are hosted Currently installed in a single rack Server types - application, data base, document management, reporting Fax servers hosted locally All servers and drive configurations are redundant All sites connect through VPN to data center eCW software manages server\data access

20. ASP Architecture Local engineering support is outsourced Central (CCNV) help desk for triage of problems eCW handles all software issues Set weekly coordination and management calls with eCW

21. Challenges and Benefits of an ASP

22. Challenges and Benefits Internet connectivity issues Hardware upgrades driven by growth, vendor specs, new technology (virtualization), maintenance replacements Lease vs. buy Must have good communications with vendor (eCW) in order to manage software upgrades and fixes Individual practice growth must be accommodated by the ASP Technical Staffing and Support relationships are local and long term Troubleshooting centers on connectivity and performance (latency) issues

23. Challenges and Benefits Eliminates human resources issues for practice Technical expertise available to individual practices that they might otherwise not have access to, or can afford The number and types of issues experienced by a large practice that individually hosts are similar to an ASP hosted configuration Most issues are not eliminated, the responsibility to address them are shifted

24. David Selig Chief Executive Officer Community Care Network of Virginia 6802 Paragon Place Suite 630 Richmond, VA 23230 804-237-7686 dselig@ccnva.com