Meeting Stage 1 Meaningful Use: A View from a Healthcare System Pamela McNutt Sr. VP & CIO Methodist Health System Chair, College of Health Information Management Executives Policy Advisory Committee Member, AHA IT Advisory Committee

Methodist Health System Overview Acute Care Hospitals Methodist Dallas Medical Center – 515 beds Methodist Charlton Medical Center – 254 beds Methodist Mansfield Medical Center – 106 bed Methodist Richardson Medical Center beds Methodist McKinney– 14 bed specialty physician JV Methodist Hospital for Surgery – 44 bed specialty physician JV (opens 11/2010) 15 Satellite Family Practice Care Centers and Teaching Clinics Midlothian Imaging Center Methodist Rehabilitation Hospital 1,120 active physicians Graduate Medical Educational Programs Ob-Gyn Surgery Medicine Internal Medicine Family Practice/Sports Medicine Physicians

-Physician dictated reports -Nurse documentation -Admission assessment -Medication Administration -Bedside Medication Verification -Care Plans -ED Physician’s record -Cath reports -ECHO reports -GI reports -EKG reports -Lab reports + reference labs + blood gases + point of care testing -Perioperative charting -Radiology reports -Physician Notes -CPOE -Flowsheet -Monitor Data -Patient Portal -Scanning and Archiving Enterprise Index Demographics, allergies and medication profile Image Repository -Xray -Ultrasound -CT -MRI -Nuclear Medicine -Cath Lab -ECHO -Mammography (digital only) Acute Care Single Vendor -Visit Data - Patient Portal -Histories - Interface to acute -Problem List care system -Medications -ePrescribing Ambulatory Care -Prenatal Data -Prenatal Chart -Labor and delivery record -Fetal monitor data Linking of patients across visits and site of service Legend In Production Planned Planned 2010/2011 In Progress Hosted major vendor offering - Teaching Clinics Fall 2008 – 2011 (90 physicians and residents) - Private Physicians > -Pavilion Practice Management offering to MedHealth clinics and managed practices (78 physicians) -Private Physicians 10/2010 -> (75 planned) Methodist Health System Electronic Medical Record April 2010 Completely Filmless Fetal Monitor Charting & Archive System Product tightly integrated to acute care vendor

Changes in/or Affirmations of Strategic Direction Delayed some initiatives: ED order entry Monitor interfaces Nursing documentation in outpatient and specialty areas Short case surgical documentation Accelerated some initiatives: Patient portals CPOE in acute care Affirmation of initiatives: ED system replacement Developing an interface between our acute care and physician office system Scanning and archiving to capture loose paper records

Methodist’s Expectation for Obtaining Stimulus Funds  $450,000 for physicians in the teaching clinics  Medicare - $10.4 million for 4 acute care hospitals Like amount for Medicaid  Late 2011/early 2012 with relief on the “all or nothing” meaningful use approach  2013, at best, if the meaningful use and quality metric reporting remain “as is”  Believe we will only get 2 years of funding, Stage 2 and 3 are out of reach

Challenges with HITECH/Stimulus Requirements Manual calculations needed for meaningful use measures Requirement for structured data sets Quality metrics that must be calculated by the electronic record rather than allowing for other data compilation tools Timing of new certification process, upgrades may be needed Lack of functional Health Information Exchanges Vendors pricing on data upload/down load routines Concurrent 5010 billing and ICD-10 implementations Shortage and cost of clinical informatics resources HIPAA change treating the use of EHRs for Treatment, Payment and Operations as a reportable disclosure