1. EMR Remedies AHDI - ACE 2011 Electronic Health Record Solutions Anil Keswani President August 20, 2011

2. Medical Transcription Copyright – EMR Remedies - 2011 Dead or Alive??

3. “That it will ever come into general use, notwithstanding its value, is extremely doubtful because its beneficial application requires much time and gives a good bit of trouble, both to the patient and to the practitioner because its hue and character are foreign and opposed to all our habits and associations.” “That it will ever come into general use, notwithstanding its value, is extremely doubtful because its beneficial application requires much time and gives a good bit of trouble, both to the patient and to the practitioner because its hue and character are foreign and opposed to all our habits and associations.” from The London Times in 1834 Commenting on... the “stethoscope” A computer for patient care? Copyright – EMR Remedies - 2011

4. Information Share Copyright – EMR Remedies - 2011

5. Background 30 years of technology experience Electrical Engineering degree – Stevens Institute of Technology 23 years with Texas Instruments in Defense and Information Technology 7 years in Software Development; IT, legal and healthcare services Held positions as Chief Technology Officer and Chief Information Officer Resided in Sweden to improve efficiencies for a global software company Worked with physicians on identifying and deploying EHR, LIS and PACS technologies Published an article on bar code technology for the defense industry Married 27 years Copyright – EMR Remedies - 2011

6. Evolution of Transcription Copyright – EMR Remedies - 2011 In the beginning…

7. Your Business…… Imagine you are the only MTSO… You have 100% of the market & revenue… In 3 – 5 years what will be your market & revenue… - 100% - 50% - 25% Copyright – EMR Remedies - 2011

8. Reality Check… 25 – 30% WHY?? Copyright – EMR Remedies - 2011

9. Enabling Technologies Voice Recognition NLP (Natural Language Processing) Wireless - iPhone- iPad - Smart phones- Android Tablet Cloud Infrastructure/ Hosted Environment EHRs What else…… ??? Copyright – EMR Remedies - 2011

10. Voice Recognition Document Editing vs. Full Transcribing Integration into EHR platforms Key suppliers  Nuance  M*Modal (MedQuist)  InfraWare Shorter Turn Around Times Less work for the MTs Different skills required by MT Copyright – EMR Remedies - 2011

11. Cloud Computing General Definition – Delivery of hosted services which are sold on demand and are elastic (use as much as is needed). Businesses will not need to have on-site infrastructure or expertise. MTSOs and Hospitals can reduce the investment cost for servers & applications and focus on service efficiencies. Can integrate the workflow tools that best suite their clients and staff. Caters to the distributed workforce. Security is more complicated. Information resides off-site in a data center. Copyright – EMR Remedies - 2011

12. EHR Technologies Integration with MT software applications Direct documentation into the product Built in modules Improved productivity for practices and hospitals Copyright – EMR Remedies - 2011

13. Financial Impact to Medical Practices and Hospitals Technology investments Transfer of cost from MT payments to EHR payments Reduction in Medicare/Medicaid reimbursements beginning…2015 Reduction in private insurance reimbursements beginning…?? Copyright – EMR Remedies - 2011

14. Let’s talk about the future Copyright – EMR Remedies - 2011

15. You Must be Ready… Yesterday & Today Today & Tomorrow Copyright – EMR Remedies - 2011

16. Predictions are dangerous, especially when you are talking about the future. - Yogi Berra Copyright – EMR Remedies - 2011

17. Strategies for MTSOs Sell to the highest bidder or close your doors Morph into a strategic partner of your client by offering other services Refocus your skills to editing documents Develop technical skills with the voice recognition, NLP, etc Become an enabler of technology…Invest Copyright – EMR Remedies - 2011

18. Strategies for Hospitals Stay the current course and hope for the best Outsource and require the vendor to integrate to your EHR Accept the EHR transcription capability and develop skills to efficiently use the technology Refocus your MT skills to editing documents Develop technical skills with the voice recognition, NLP, etc Copyright – EMR Remedies - 2011

19. Is this half-full or half-empty? Personality Test Copyright – EMR Remedies - 2011

20. Summary The Medical Transcription Industry is not Dead … It is Alive and maturing

21. Questions?? Copyright – EMR Remedies - 2011

22. Thank You! Anil Keswani anil@EMRremedies.com 214-546-4608 www.EMRremedies.com Copyright – EMR Remedies - 2011