2007 Ambulatory spend $448B on Communication, Technology, Information Systems Market View: Total Healthcare Spend Healthcare presents a sizable growth market offering future opportunities The American Medical Association, National Health Insurer Report Card U.S Total Healthcare Expenditures = $2.1 trillion (~$7,500 per resident) $448B Communication, Tech, & IS Spending ~ $3B Software & Services Spending Need to size the $3B plus ARRA $: EHR Practice Mgmt EMR HIE CHC etc.

Prevention & Wellness Education & Training Telemedicine SCHIP Infrastructure, HIE, CHC, Indian Health Research EHR Incentives In Billions What is the Impact of ARRA/HITECH Act? The American Recovery and Reinvestment Act contains bonus payments of $44,000 to $64,000 to physicians who adopt and use EHRs in a meaningful way, beginning in 2011 and continuing through 2015 after which doctors who do not use EHRs will be penalized.

HHS - $167 Billion in ARRA Funding ONC Funding –Privacy and Security – $24.3 million –NIST – $20 million –Regional HIT Exchange – $300 million –Unspecified – $1.65 billion –Total, HIT - $2 billion CMS Funding: –State Medicaid Administration – $1.05 billion –Medicare Administrative Costs – $745.0 million –Medicaid Administrative Costs – $300 million –Medicare Incentives – $23.1 billion (available starting in FY11) –Medicaid Incentives – $21.6 billion (available starting in FY11) –(Total Mandatory Recovery Act HIT Funds $46.8 billion) HRSA – CHC Funding –Capital Improvement Grants- $850 million for use on capital improvements, including EHR adoption (will be spent in FY09) –Health Information Technology Systems/Networks Grants- $125 million (will be spent in FY09) –Facility Investment Grants- $512.5 million (will be spent in FY 2010) –(Total: $1.5 billion) HRSA – Workforce Training –Loan Forgiveness - $300 million –Workforce Training - $200 million

HHS - $167 Billion in ARRA Funding Indian Health Service (IHS) Funding for IT Adoption –Certified Electronic Health Record Adoption - $61.7 million (34.8 in FY09 and 26.9 in FY10) CPOE Clinical Decision Support Quality Reporting Health Information Exchange Certification Deployment –Personal Health Record Adoption - $2.5 million ($1.7 million in FY09 and $0.8 million in FY10) –Telehealth and Network Infrastructure - $16.7 million ($12.7 million in FY09 and $4.0 million in FY10) –Administration Costs- $4.1 million HHS, AHRQ, and NIH Comparative Effectiveness Research –HHS Discretionary Funding- $400 million –AHRQ- $300 million –NIH- $400 million HHS Information Technology Security –HHS Information Technology Security-$50 million ($31.9 million in FY09, $18.1 million in FY10) Non-HHS Funding of Note: FCC, USDA and Commerce – Broadband –$7.3 billion for broadband

How is Sage preparing? Staying plugged in Actively monitoring legislative and regulatory changes Ongoing employee and business partner education Products & Certification Sage Intergy EHR v6 – our meaningful use version ONC-required Meaningful Use certification CCHIT 2011 certification

How is Sage preparing? Advocacy Participation in industry groups shaping the dialog with the federal government Written responses to the proposed rules per public comment provision Readiness Education –Meaningful Use White Paper –Meaningful Use Summits –Educational webinars –Updated stimulus information on –Articles in Sage CheckUp and Sage e-briefs Developing practical tools and resources for customers Consultative discussions with Sage customers about reaching meaningful use

The Coming Months State HIE Procurements from ONC could be released as early as mid-August July 2009AugustOctoberDecemberJanuary 2010AprilOct 2010 ONC releases HIE implementation plans and Regional Extension Center definitions and procurement HIT Policy & Standards Committees deliver and approve Meaningful Use Recommendations State funding applications likely due; ONC to issue guidance on EHR loan program; ONC to craft Meaningful Use definition ONC to release Meaningful Use definition and CMS to issue proposed rule by end of December day public comment period First round of administrative HIT payments could be released in Q Final Rule issued on Meaningful Use Earliest Medicare payments will be made available

Meaningful Use Overview Policy Vision & Goals* Vision Enable significant and measurable improvements in population health through a transformed health care delivery system. Goals Improve quality, safety, and efficiency Engage patients and their families Improve care coordination Improve population and public health Ensure privacy and security protections *Source: Health IT Policy Committee Meaningful Use Workgroups June 23, 2009 presentation

Meaningful Use Overview Regulatory Definition In HITECH, Congress specified three types of requirements for meaningful use: 1.use of certified EHR technology in a meaningful manner (e.g. Electronic Prescribing); 2.that the certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of care; and 3.that, in using certified EHR technology, the provider submits to the Secretary information on clinical quality measures and such other measures selected by the Secretary. To be a meaningful user, EPs must use a certified EHR to satisfy all Criteria and all Measures.

CMS Vision for Stages Requirements Scaling Up Over Time Stage 1Stage 2Stage 3 1.Capturing health information in a coded format 2.Using the information to track key clinical conditions 3.Communicating captured information for care coordination purposes 4.Reporting of clinical quality measures and public health information 1.Disease management, clinical decision support 2.Medication management 3.Support for patient access to their health information 4.Transitions in care 5.Quality measurement 6.Research 7.Bi-directional communication with public health agencies 1.Achieving improvements in quality, safety and efficiency 2.Focusing on decision support for national high priority conditions 3.Patient access to self- management tools 4.Access to comprehensive patient data 5.Improving population health outcomes For Stage 2, CMS may also consider applying the criteria more broadly to both the inpatient and outpatient hospital settings. CMS expects to propose Stage 2 criteria by the end of CMS expects to propose Stage 3 criteria by the end of 2013.

Meaningful Use Measures – Stage 1 Measures are grouped into two categories: Each measure is linked to a related Meaningful Use Objective 18 Electronic Health Record Technology Functionality Measures (8) Clinical Quality Measures (17)

Immediate Action for Practices! Decide if you will participate Pick your program Develop detailed implementation plan –Set goals & detailed timelines –Set expectations –Gain buy in –Plan for the unexpected Make EHR selection Keep your end goal in mind Process Redesign!Process Redesign!

Process Redesign | Bottom Line Results Automating current manual processes will provide simple efficiencies like finding a patients chart in seconds to complex situations such as patient flow monitoring and clinical treatment plan effectiveness. The key is to understand the process before and after the introduction of technology into your practice. Our staff collaborates with your team to assess workflows and design a system to streamline the unique needs of your practice.

Sage Value in Partnership – our program is growing and offering multiple opportunities to partner in select areas and/or segments – Referral, Reseller and Channel Partner Arrangements Multi-Year Contracts No Admin Fee Channel Partner Portal Attractive Margins Custom Training Brian Muck Vice President - Indirect Distribution Sage Healthcare Division 4301 W. Boy Scout Blvd. Suite 800 Tampa, FL Mobile: Fax: visit us at: