1. Sales Overview A review of the library, its development and contents

2. August 2008 What is the Content Library? The Greenway Clinical Content Library is a storage vault for Templates and Master files for all Specialties available for import to customize each sites repository of Content appropriate to the types of patients seen by the clinic.

3. August 2008 Basic Terminology Clinical Content: Clinical Content includes Templates for production of specific clinical encounter documentation and the Master Files that provide the structure for all types of documents produced by PrimeChart. Template: Templates provide a framework for quickly creating each individual document for a clinical encounter. –A generic Medication Refill Template might be used in any Specialty. –Templates for Scoliosis, Scoliosis Follow-up and Rheumatoid Arthritis might be particularly relevant to Orthopedics and Rheumatology specialists. The Scoliosis Template would include appropriate selections for documenting the progress of a patient with scoliosis. –Also included in some template types are a wide variety of appropriate options for potential findings, diagnoses, orders, and various treatment including relevant medications choices.

4. August 2008 Basic Terminology Master File: The files and datasets that provide structure and building blocks for different portions of clinical encounter documents produced by PrimeChart, are referred to as Master Files. Master Files include the following: –Physical Exam (PE) Master –Review of Systems (ROS) Master –Diagnosis (Assessment) Favorites –History of Present Illness (HPI) Library –History Files –Orders Favorites

5. August 2008 Master Files PE Master: The Physical Exam (PE) Master includes appropriate options for PE findings in a Specialty for content building and encounter documentation. ROS Master: The Review of Systems (ROS) Master includes appropriate options for ROS documentation for a Specialty for use in content building and encounter documentation. Diagnosis Favorites: Diagnosis (Assessment) Favorites include a variety of Diagnoses useful for a Specialty, a subset of the full diagnosis database included in PrimeSuite in a pick-list easily accessible for content building and encounter documentation. Orders Favorites: Orders (Plan) Favorites include a wide variety of Orders useful for a Specialty, a subset of the full orders (procedure codes) database included in PrimeSuite in a pick-list easily accessible for content building and encounter documentation. History Files: History Files include options for building relevant medical, social, family and other types of histories appropriate to a Specialty for those portions of Patient Charts. HPI Library: The History of Present Illness (HPI) Library includes phrases and sentences useful for building HPI information for the many situations encountered in a Specialty for content building and encounter documentation.

6. August 2008 Who Produces Content? Content Team: Greenways Content Team, led by manager Suzanne Chandler, R.N., B.C., includes medical and technical professionals who produce Content, review Templates and Master Files submitted by clients, edit both internally and externally created Content, maintain Templates and Master Files for updates to billing codes and medications, and prepare Content for release in the Clinical Content Library. Physicians Group: The Physicians Group, includes physicians employed by Greenway who participate in the Content development process by producing, reviewing, editing and maintaining Content in association with the Content Team. The Physicians Group also participates in Greenway Sales and Deployment activities on an as- needed basis. PrimeSuite Users: The care providers who use the electronic health record in PrimeSuite may contribute templates and always contribute input and feedback based on their usage and the work the Content Team and Physicians Group do with them to help them optimize our product in their practices.

7. August 2008 Process Terms Library: The Greenway Clinical Content Library is the storage vault for all files that make up Clinical Content. The Library is accessible to all Greenway employees and clients through the PrimeSuite interface. All Templates and Master files for all Specialties are available for import into the clients database to customize each sites repository of Content appropriate to the types of patients seen by the clinic. Build: Content is released into the Greenway Clinical Content Library in Library builds. A build captures all current source files stored in the Content Teams development database, collected from the servers where Templates and Master files were developed, and places them in the Library on a server accessible through PrimeSuite. Release: When Templates and Master files have been created either by Greenways medical professionals or our clients, have been reviewed and edited by the Content Team and Greenways Physicians Group, they are released for inclusion in the Clinical Content Library.

8. August 2008 Development Phases Identified: When Content for a Specialty is in the Identified phase, it has been Identified for future development but no active work is underway by Greenway to develop Content. Content Development: When Content for a Specialty is in the Content Development phase, Greenways Clinical Content Team and Physicians Group are actively working with medical professionals from PrimeSuite sites to develop Templates and Master Files, usually for use by early beta sites. Beta Testing: When Content for a Specialty is in the Beta Testing phase, it is in use at one or more PrimeSuite sites who have agreed to provide detailed feedback for the improvement of this content prior to its General Release. General Release: When Content for a Specialty reaches the General Release phase, new sites of that Specialty will find all required Templates and a full set of Master files in the Content Library. Enhancement: When Content for a Specialty is being reviewed and revised by Greenways Content Team in conjunction with medical professionals at PrimeSuite sites, it is placed in the Enhancement phase. When updates are complete, the Specialty returns to General Release.

9. August 2008 Information Sources Direct from Greenway: –Monthly summary notifications of Clinical Content updates are sent to users via Direct from Greenway notes in PrimeSuite Messaging. WebCT: –WebCT houses web-based documentation pertaining to PrimeSuite and the Clinical Content Library. It is available through the internet to both Greenway employees and users. –Go to http://webct.greenwaymedical.com/ PrimeSuite Documentation | Clinical Content Library.http://webct.greenwaymedical.com/ SalesLogix: –Copies of this report and listings of Content for each Specialty are available in SalesLogix. Contact Jan Smith.

10. August 2008 Current Content Status The following slides present a brief summary of content status for each of the Specialties currently on the Greenway Content Development list.

11. August 2008 Template Summary Grand Totals Released: 3046 Required: 2342 Identified: 5109 3033

12. August 2008 Allergy & Immunology Status: General Release Templates Released: 231 Development Began: 2004 Contributors: Two allergists & an RN at two sites contributed to development Patient Hours in Point of Care Documentation: 13,363

13. August 2008 Cardiology Status: General Release Templates Released: 52* Development Began: 2002 Contributors: Six cardiologists & two PAs at three sites contributed to development Patient Hours in Point of Care Documentation: 85,523 * Sites preferred large multi-problem templates to many small single-problem templates. One of the two multi-problem templates developed here is the equivalent of 50 single-problem templates.

14. August 2008 Cardiovascular & Thoracic Surgery Status: General Release Templates Released: 62 Development Began: 2003 Contributors: Two cardiovascular surgeons at two sites contributed to development Patient Hours in Point of Care Documentation: 19,756

15. August 2008 Dermatology Status: General Release Templates Released: 99 Development Began: 2003 Contributors: Four dermatologists at two sites contributed to development Patient Hours in Point of Care Documentation: 37,077

16. August 2008 Ear, Nose & Throat Status: General Release Templates Released: 386 Development Began: 2003 Contributors: Five ENT specialists at three sites contributed to development Patient Hours in Point of Care Documentation: 220,323

17. August 2008 Endocrinology Status: Content Development Templates Released: 18 Development Began: June 2006 Patient Hours in Point of Care Documentation: 3,170 Note: Seeking additional Beta site

18. August 2008 Family Practice Status: General Release Templates Released: 267 Development Began: 2003 Contributors: Four primary care physicians and six sites contributed to development Patient Hours in Point of Care Documentation: 305,422

19. August 2008 Gastroenterology Status: General Release Templates Released: 61 Development Began: 2004 Contributors: Four gastroenterologists at three sites contributed to development Patient Hours in Point of Care Documentation: 56,519

20. August 2008 General Surgery Status: General Release Templates Released: 188 Development Began: 2002 Contributors: Four general surgeons and four sites plus a general surgeon on-staff at Greenway contributed to development Patient Hours in Point of Care Documentation: 271,178

21. August 2008 Hand Surgery * Status: General Release Templates Released: 181 Development Began: 2003 Contributors: A hand surgeon and staff at two sites contributed to development Patient Hours in Point of Care Documentation: 17,550 * This specialty formerly known as Hand Microsurgery.

22. August 2008 Internal Medicine Status: General Release Templates Released: 216 Development Began: 2005 Contributors: Four internists and three sites plus an internist on-staff at Greenway, contributed to development Patient Hours in Point of Care Documentation: 247,571

23. August 2008 Nephrology Status: General Release Templates Released: 29 Development Began: 2005 Contributors: Two board- certified nephrologists at two sites contributed to development Patient Hours in Point of Care Documentation: 13,299

24. August 2008 Neurology Status: General Release Templates Released: 160 Development Began: 2003 Contributors: Multiple neurologists at one beta site plus a neurologist on- staff at Greenway have all contributed to development Patient Hours in Point of Care Documentation: 10,933

25. August 2008 Neurosurgery Status: General Release Templates Released: 53 Development Began: 2004 Contributors: One neurosurgeon and staff at two sites contributed to development Patient Hours in Point of Care Documentation: 69,307

26. August 2008 Obstetrics & Gynecology Status: General Release Templates Released: 226 Development Began: 2002 Contributors: 10 obstetrician/ gynecologists, one gynecologist, and 2 two PAs at four sites contributed to development Patient Hours in Point of Care Documentation: 1,668,282

27. August 2008 Ophthalmology Status: General Release Templates Released: 21 Development Began: 2005 Contributors: A retinal surgeon and staff at one site contributed to development Patient Hours in Point of Care Documentation: 2,430 NOTE: This specialty includes the subspecialty Retinal Surgery.

28. August 2008 Orthopedics Status: General Release Templates Released: 415 Development Began: 2004 Contributors: An orthopedist and staff at five sites contributed to development Patient Hours in Point of Care Documentation: 112,245

29. August 2008 Pain Management Status: General Release Templates Released: 73 Development Began: 2005 Contributors: A physician and staff at a PrimeSuite site contributed to development Patient Hours in Point of Care Documentation: 19,181

30. August 2008 Pediatric Pulmonology Status: Identified Templates Released: 0 Development Began: 2003 Contributors: One pediatric pulmonologist at a site has developed templates for the sites use Note: Not yet available

31. August 2008 Pediatrics Status: General Release Templates Released: 146 Development Began: 2003 Contributors: Three pediatricians at three sites contributed to development Patient Hours in Point of Care Documentation: 118,729

32. August 2008 Plastic Surgery Status: Identified Templates Released: 0 Development Began: N/A Note: Related Templates in General Surgery and Dermatology can be used

33. August 2008 Pulmonary Medicine Status: General Release Templates Released: 40 Development Began: January 2005 Contributors: 11 pulmonologists at three sites contributed to development Patient Hours in Point of Care Documentation: 41,500

34. August 2008 Rheumatology Status: General Release Templates Released: 27 Development Began: 2005 Contributors: Two physicians certified in internal medicine and rheumatology and staff at two site contributed to development Patient Hours in Point of Care Documentation: 6,583

35. August 2008 Urology Status: General Release Templates Released: 73 Development Began: 2003 Contributors: Four urologists at three sites contributed to development Patient Hours in Point of Care Documentation: 98,589

36. August 2008 Examples (All Specialties) A total of 21 templates for correspondence, hospital admissions, medication refills and post operative notes have been released for all specialties under a generic Specialty category called All Specialties – Examples. These templates have been developed and revised with input from Greenways medical professionals and from users in the field. More templates for this category are in progress.

37. August 2008 Content Structure Each of the 21 Greenway Specialties in General Release includes a set of Clinical Master Files that are imported into to the sites repository of Clinical Content during PrimeChart deployment. These Master Files are maintained and updated constantly by the Clinical Content Team and the Physician Team. The Master Files types are described in detail in the following slides.

38. August 2008 Physical Exam Designed to meet the demands of each Specialty for: –Evaluation and Management (E&M) Coding requirements –Appropriate findings for the Specialty Improved based on feedback from the field Revised PE goes to next Content Library build for immediate access to current clients Always structurally matches the PE section of the Templates Physical Exam structure and Templates revised and released together Placed in Greenway Specialty Changer utility so new sites get the most current PE at deployment of PrimeChart User-specific file may be tailored to personal documentation style

39. August 2008 Review of Systems Unique for each Specialty When exam is improved, new ROS goes to next Content Library build for immediate access to current clients The Review of Systems in the Library always matches ROS section of Templates Review of Systems structure and Templates revised and released together Placed in Greenway Specialty Changer utility so new sites get the most current PE at deployment of PrimeChart User-specific file may be tailored to personal documentation style

40. August 2008 HPI Library Unique for each Specialty Loaded with sentences and phrases for immediate use in template creation Updated annually Released to Greenway Specialty Changer utility for use by new sites deploying PrimeChart Maintenance of the HPI (History of Present Illness) Library is performed by the user User-specific file may be tailored to personal documentation style

41. August 2008 History File Unique for each Specialty Updated on an as-needed basis (typically annually) Released to Greenway Specialty Changer utility for use by new sites deploying PrimeChart Maintained by sites based on their preferences for history documentation Site-specific rather than user-specific

42. August 2008 Diagnosis Favorites List Subset of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 or ICD-9-CM) list on each sites server Unique to the Specialty Updated every year in conjunction with annual ICD-9 codes maintenance Listed by Local Names created with input from medical staff at Greenway and clinicians at representative sites of each Specialty Full ICD-9 list including every ICD-9 code also updated regularly

43. August 2008 Orders Favorites List Subset of Current Procedural Terminology (CPT) codes list and HCFA (Health Care Financing Administration) Common Procedural Coding System (HCPCS) list on each sites server Unique to each Specialty Most current CPT and HCPCS codes Listed by Local Names created with input from medical staff at Greenway and clinicians at representative sites of each Specialty Full CPT and HCFA lists are also updated regularly

44. August 2008 Content Maintenance Content is not static once it reaches the General Release phase. On the contrary, Templates and Master Files are maintained constantly to keep up with changing requirements for billing codes, medications, E&M coding, etc., and incorporating feedback from care providers who use PrimeSuite. The following slides describe normal content maintenance.

45. August 2008 First DataBank Meds Updated monthly by Greenway with the latest First DataBank list Templates reviewed with First DataBank updates and all obsolete drugs are removed and, where indicated, replaced Affected templates re-released by the end of month Sites identify obsolete medications in users templates by running the Obsolete Drugs Report –Templates referencing obsolete drugs are identified –Owners of templates may remove obsolete drugs from Plan section of identified template(s).

46. August 2008 Changes in CPT Codes Every Fall, the American Medical Association (AMA) releases the new Current Procedural Terminology (CPT) codes for next year Revised codes must be implemented by January of the next year Greenway updates the full CPT lists of every site on or about January 1

47. August 2008 Updates to HCPCS Codes UNICOR/Alpha II releases the new HCFA (Health Care Financing Administration) Common Procedural Coding System (HCPCS) codes quarterly in January, April, July, and October of each year Greenway updates the HCPCS lists at all sites quarterly Orders Favorites list for each Specialty is updated once a year, on or about January 1 –Removes obsolete CPT and HCPCS codes from the Orders Favorites lists –Makes replacements where indicated New sites implementing PrimeChart receive the updated list Existing users maintain their own Orders Favorites lists –May request utility run to automatically remove obsolete codes from the Orders Favorites list –Service performed per site request

48. August 2008 Content Update Notifications Content Library Update on WebCT published for each Library Build –Includes details regarding all new templates all updated templates all Code changes made to Favorites lists Direct from Greenway summary notice sent periodically via PrimeSuite Messaging

49. August 2008 Template Changes Users review and download new or updated Templates from the Greenway Clinical Content Library To access the Library, click Import on the Template Admin page of PrimeSuite Users who dont want to replace customized Templates can update their Templates based on the information contained in the Direct from Greenway message or on WebCT

50. August 2008 Favorites Changes Users review WebCT or the Direct from Greenway message to identify the noted changes for Orders and Diagnosis Favorites and make the changes to their Favorites –Alternatively, request a utility run to identify and delete obsolete codes in both Favorites lists Full ICD-9, CPT, and HCPCS lists automatically updated at each site when third party vendors release information to Greenway –Service automatically performed for all clients Favorites lists should be updated in addition to automatic codes updates Most sites choose to perform maintenance themselves to add appropriate codes to their lists while deleting old ones

51. August 2008 Contact Information Suzanne Chandler, RN, BC Clinical Content Manager, for information on planning and goals for Content and the subjects covered in this document. Ellen Wilson Technical Writer, for assistance with using reports available on WebCT and in SalesLogix.

52. August 2008 Questions?