1. EMR - The Time is Now: Physician Alignment through IT Panel Discussion Richard Eshbach & Bill Moran

2. 9/10/20152 The President’s Bold Vision for HIT “Every American will have access to an electronic health record by 2014”

3. 9/10/20153 –What is our Definition of an Electronic Medical Record –WHS and MSHA Current/Future State of the EMR  In-Patient  Out-Patient Stark Safe Harbors Regional Out-reach Programs/Opportunities EMR and our Connected Care Community

4. 9/10/20154 Definition of an EMR CPR PHR EMR EHR Are we all speaking the same language…..?

5. Cardiology/Pulmonary Pharmacy Care Giver Notes Physician Notes Scanned Images of Documents History & Physical Demographic Information Prior Encounters Laboratory Radiology Discharge Summary Components of a Patient Record Boxed Components are Unstructured Information

6. 9/10/20156 EMR Adoption Model Q2 2008 5%

7. 9/10/20157 Hospital involvement in community EMR Deployments Hospitals will represent 38% of all EMR purchases up from 11% in 2007 – AC Group, Feb 2008

8. 9/10/20158 Electronic Medical Record Industry – Only 22% of Hospitals across the country have successfully deployed an EMR

9. 9/10/20159 EMR Scores by Comparison EMR Scores by Bed Size 2008MeanMediann 0-100 beds 1.54132.01502,487 101-200 beds 2.39962.2380996 201-300 beds 2.64603.0710629 301-400 beds 2.74433.1240406 401-500 beds 2.85393.1470209 501-600 beds 3.08593.2475140 600+ beds 3.11143.2440181 EMR Scores by State StateMeanMediann Alabama2.07852.198098 Georgia2.24652.2250152 Kentucky2.13912.1460105 North Carolina2.50612.3190117 South Carolina2.34672.262066 Tennessee2.33672.2100137 Virginia2.67193.139083 West Virginia1.95752.099550

10. 9/10/201510 Who will take the lead? How will we get there?

11. 9/10/201511 Electronic Medical Record

12. 9/10/201512 MSHA EMR Strategies Inpatient / Outpatient EMR In 2003, strategic EMR initiative launched to build upon a new integrated technology solution powered by a workflow engine $40+ million committed by MSHA Board for a multi-year implementation Physician Office EMR Implemented Misys EMR in practices in 2005 and now offering as an MSO hosted service to non-employed physician practices Regional Integration Varying levels of integration with physician practice EMRs depending on their status of EMR adoption Exploiting CCHIT compliant inter-operability tools Collaboration in regional connectivity initiatives such as CareSpark RHIO

13. Technical Infrastructure/Foundation Increasing Value On Journey to Patient Safety, Quality and Efficiency Network Wireless Monitors Single Sign OnHardware Pharmacy EDED Clinical Access Cardiology Rad Upg Orders Interdisciplinary Charting Bar Coding - MAK Live 6 months >6 months PACs eHIM 2008-09 2009-11 2009-10 2007 Computerized Patient Record Journey Phases I-III

14. 9/10/201514 MSHA In/Out-Patient Approach Mountain States EMR consist of the following: (We are 75% deployed)  An electronic Clinical Data Repository - √ Completed (Soarian Clinical Access) − Contains 8 years of detailed clinical data  An electronic Order Management System - √ Underway (New Soarian Orders)  A Picture Archival Communication (PACs) System which allows the capture of medical images – √ Completed (GE Radiology PACs and Siemens Cardiology PACs (echos, caths, nuclear studies…)  An electronic flow sheets of vitals and I/O - √ Completed (Soarian Critical Care and MegaCare)  An electronic Pharmacy System - √ Completed (Soarian Pharmacy)  An electronic Radiology System - √ Completed (Siemens Radiology)  An electronic Transcription System - √ Completed (Dolby with Voice Recognition)  An electronic Laboratory System - √ Completed (Cerner Classic, replaced w/ SoftLab)  An electronic Nursing/Ancillary documentation System - √ Completed (Soarian Clinical Team)  An electronic Paper Medical Record - √ Completed (Soarian HIM) − eHIM helps you fill gaps in areas throughout your hospitals, where you do not have electronic functionality by scanning, storing and retrieving the paper medical record. Also allows on-line abstraction, coding and completion management and signature by physicians from any location.  electronic workflow engine is “listening” to any care event or condition and can be automatically triggered to pro- actively monitor, notify and escalate steps in the care process across all caregivers. Hardwired process workflows minimize lag-time between care handoffs and eliminate “dropping the ball!”

15. 9/10/201515 MSHA In/Out Patient Approach What’s Next……………….. In order to have a “Completed” Electronic Medical Record, these components are scheduled for implementation: Nursing Plans of Care CPOE/ Physician Orders Physician Progress Notes Continued/Enhanced Integration to Physician Office EMR’s Deployment of Home Health Clinical Documentation On-going enhancement of workflows as more clinical information is available and more clinicians are on-line

16. Timeframe for Implementation Foundation Systems 2004-05200620072008200920102011-12 Replace Ancillaries Physician Order Entry Progress Notes Plans of Care Orders and Documentation Pharmacy MAK eHIM Dictation ED PACs Rad EKG Cardio Clinical Repository Monitors Wireless Single- sign-on Orders Alerts Workflows Vital Signs Assessments Documentation Forms Clinical Decision Support

17. 9/10/201517 MSHA Ambulatory Approach Physician Office EMR Over a decade of utilizing the Misys office management system in all physician practices and providing as contracted MSO service Implemented Misys EMR in practices in 2005 and now offering as a service to private physician practices (under Stark Safe Harbor guidelines)

18. 9/10/201518 MSHA Connectivity Approach Regional Integration Varying levels of integration with physician practice EMRs depending on their status of EMR adoption Exploiting CCHIT compliant inter-operability tools Collaboration in regional connectivity initiatives such as CareSpark RHIO

19. 9/10/201519 Electronic Medical Record

20. EMR – Approach Understanding how WHS EMR Strategies − In-Patient EMR (76% completed)  Our In-patient EMR consists of several software applications that make up the chemistry of a EMR. − Out Patient EMR  Our Out reach (out-patient) EMR currently consists of a purchased package – AllScripts product − Ancillary Strategies around EMR’s  Complexity surrounding multiple EMR strategies – allows us to take advantage of true interoperability through Relay Health.

21. 9/10/201521 WHS EMR Strategies Inpatient / Outpatient EMR 99.2% of Positive adoption through our WHS/Physician Portal – our connectivity tool for our Physicians. Over 1,000 Physician Population Our Physician voice is critical in shaping our outcomes. Physicians ‘decide’ how our electronic medical record is defined – through Physician Technology Committees. Board initiative to commit information technology and the exchange of health record exchange for the improvement of patient care within our community. Physician Office EMR Today we have over 60+ physician clinics/offices affiliated with Wellmont. We currently Implemented Misys practice management EMR, and currently have installed AllScripts as our out patient clinical EMR solution. Regional Integration Continued education and participation in sharing health exchange information to every town/city/and region within our community Regional Quarterly IT collaboration initiatives  Hosting service, regional/industry benchmarking, best practices Establishing a Chime/HIMSS chapter within our Region

22. 9/10/201522 Navigating through the technology “Nobody said it would be easy”

23. Phase 1 PACS (AGFA), RIS (STAR), OR (HSM), Transcription/Dictatn. Phase 2 LAB (Cerner), Pharmacy (HMM), Cardiology Phase 3 Nursing Doc (HED), AdminRx (barcoding) Phase 4 Horizon Lab, Anesthesia, ER Phase 4 Physician Office,CPOE Physician Office, CPOE Phase 5EMR EMR evolution…. In Patient - EMR

24. 9/10/201524 EMR – In Patient Approach… Wellmont’s EMR consist of the following: (We are 76% deployed)  An electronic Order Management System - √ Completed (STAR HOM/Orders)  An Picture Archival Communication (PAC’s) System which allows the capture of medical images – √ Completed (PAC’s)  An electronic Pharmacy System - √ Completed (HMM)  An electronic Radiology System - √ Completed (Star RIS)  An electronic Transcription System - √ Completed (Cquence, Star/HPF, Lanier)  An electronic Laboratory System - √ Completed (Cerner Classic)  An electronic Nursing documentation System - √ Completed (HED)  An electronic Horizon Patient Folder Application - √ Completed (HPF) − HPF helps you fill gaps in areas throughout your hospitals, where you do not have electronic functionality. This application allow scanned documents and having them back available in ‘REAL-TIME electronically.

25. 9/10/201525 WHS EMR – What’s Next… In order to have a “Completed” Electronic Medical Record, these components are scheduled for implementation: − CPOE/Orders − Physician Notes − Integration to Physician Office EMR’s and Clinician Care Plans − Cardiology products have to be fully integrated (90% done) − Emergency Departments need to be fully integrated − Anesthesia needs to be fully integrated

26. Ambulatory Strategy and Solution Update Ambulatory Strategy

27. Traditional Methods of Delivering Test Results/Transcriptions Portal Fax or Mail HL7 Interfaces Manual Process and Costly – Not Actionable Passive Notification – Requires Provider to Search for Result – Not Actionable IT Overhead- Costly to Maintain – Not Actionable Point to Point Interfaces

28. Interoperability through RelayHealth RelayHealth provides an intelligent network that enables constituents across healthcare to connect interactively, share information, and collaborate to improve the quality and efficiency of care. Improves clinical communication, Enhances business performance Facilitates the delivery of high-quality care

29. Connectivity Through the RelayHealth Network Physician-to- Physician Networking  Referrals  Patient care collaboration Hospital- Physician Connectivity  Electronic prescriptions  Renewals  Appointment scheduling  Billing questions and online payments Physician- Patient Admin Interaction  Test results  webVisit consultations  Rx renewals  Personal health records Physician-Hospital- Pharmacy-Patient Clinical Interaction Payors Retail Rx Patients Physicians Financial Institutions Hospitals RelayHealth Connectivity Physician- Retail Rx Connectivity  Emergency Dept connectivity  Care mgmt  Results distribution

30. Connected and Actionable Network RH Network Specialist Primary Care Patient HL7 Bi-directional Communication

31. 9/10/201531 Physician Practice EMR Adoption

32. 9/10/201532 Congress Passes Medicare Bill with e-Prescribing Incentives (July 15, 2008) Medicare physicians who use e-prescribing technology will be eligible for incentive payments: ▲2% in fiscal year 2009 and 2010 ▲1% in 2011 and 2012 ▲0.5% in 2013 Physicians participating in Medicare who do not e-prescribe: ▼1% payment cut in 2012 ▼1.5% payment cut in 2013 ▼2% in subsequent years Provision exempts physicians who infrequently use prescriptions

33. 9/10/201533 Stark Safe Harbors – “Rules of Engagement”

34. 9/10/201534 Stark: Long-awaited Regulatory Relief  On August 8, 2006, the U.S. Department of Health and Human Services (HHS) published the final rules regarding provisions in the Medicare Modernization Act.  Facilitate the distribution and adoption of HIT related to electronic prescribing and electronic health records (EHRs)  Rules address ambiguity in current prohibitions to physician self- referral (known as the Stark laws) and anti-kickback statutes

35. Overview of the Regulations Permitted technology Minimum technology standards Permitted donors Permitted recipients Payment obligations Technology not duplicative Documentation

36. 9/10/201536 Regional Out-reach Programs/Opportunities

37. 9/10/201537 Regional Out-Reach Programs/Opportunities Payor Patient Hospital PhysiciansPhysicians Connected Community Financial Institution Pharmacy

38. 9/10/201538 Hospital involvement in community EMR Deployments “…hospital organizations are trying to figure out how they are going to … propel EMR solutions to community physicians” – Jared Peterson, VP, Research KLAS, June 2008, when asked about the biggest EMR trends in the next few years

39. 9/10/201539 Integration with existing physician EMRs at various levels Encouraging the adoption by physician practices Offering EMR hosting (within SSH guidelines) Adoption of CCHIT standards and “exchange” technologies Charter involvement in CareSpark (RHIO) initiative Regional Connectivity Initiatives Gaining Momentum

40. 9/10/201540 QUESTIONS ?