1. 1 Overview of the “Virtua’s PHR Strategy” ~ A presentation for the NJ /DV HIMSS Annual Conference Alfred Campanella, VP & CIO, Virtua Health, Inc. Anne Stone, Sales Executive, Health Solutions Group, Microsoft September 23, 2010, Atlantic City, NJ

2. 2 Introduction and Agenda Setting the Context About Virtua Microsoft Amalga – data stage for PHR Virtua PHR technology portfolio Questions

3. 3 Current Challenges for Patients The Health Data Silo’s: Clinical Systems, with no data transfer to patients Patient Portals within Provider’s EMRs Insurance Carriers’ PHR’s Employer-Based PHR’s Private consumer PHR’s Results in: Patients cannot take the data when they move or change employers, healthcare coverage or physician practices. Patient cannot easily share their health data with specialists, family members or care-givers. Patient is limited in their level of involvement in their care via the PHR.

4. 4 © 2010 Microsoft Corporation. All rights reserved. Microsoft Confidential Two EP Types for both Medicare & Medicaid Source: http://www.cms.gov/EHRIncentivePrograms/Downloads/EHR_Incentive_Program_Agency_Training_v8-20.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/EHR_Incentive_Program_Agency_Training_v8-20.pdf

5. 5 © 2010 Microsoft Corporation. All rights reserved. Microsoft Confidential Hospitals must comply with all 14 Source: http://www.cms.gov/EHRIncentivePrograms/Downloads/EHR_Incentive_Program_Agency_Training_v8-20.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/EHR_Incentive_Program_Agency_Training_v8-20.pdf

6. 6 © 2010 Microsoft Corporation. All rights reserved. Microsoft Confidential Hospitals Choose 5/10 for Stage I Source: http://www.cms.gov/EHRIncentivePrograms/Downloads/EHR_Incentive_Program_Agency_Training_v8-20.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/EHR_Incentive_Program_Agency_Training_v8-20.pdf

7. 7 © 2010 Microsoft Corporation. All rights reserved. Microsoft Confidential Eligible Provider Core Measures Reporting Core Measures for Hospital or Critical Access Hospital "More than 50 percent of all patients of the inpatient or emergency departments of the eligible hospital or CAH (POS 21 or 23) who request an electronic copy of their health information are provided it within 3 business days." [source: http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf, § 495.6(f)(11)(ii), p. 257]http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf "More than 50 percent of all patients who are discharged from an eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) and who request an electronic copy of their discharge instructions are provided it." [source: http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf, § 495.6(f)(12)(ii), p. 257]http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf

8. 8 © 2010 Microsoft Corporation. All rights reserved. Microsoft Confidential HealthVault Solution Benefits Free platform supports sharing electronic health information with patients http://msdn.microsoft.com/en-us/healthvault/default.aspxhttp://msdn.microsoft.com/en-us/healthvault/default.aspx Support Hospital Meaningful Use requirement Allow Hospitals to provide information electronically CCR/CCD (C32 format) Accepts content exchange format & stores as either document or computable elements Differentiates elements: lab result is different from a medication Mayo Clinic Health Manager Looks for values in content & fires rules: use LOINC & RxNorm Assists with Med Rec or drug alerts Partner Solutions for HealthVault (two examples): American Heart Association 360 guides patient based on profile & values IGuard (drug interaction & recalls) sends e-mail notification

9. 9 11 EMS Units 2 Rehabilitation Centers 2 Home Care Agencies 3 Surgery Centers 2 Health Fitness Centers 2 Outpatient Centers 145 employed physicians MemorialBerlinMarltonVoorhees – opens Q2 2011 Overview of Virtua Health 4 Hospitals – 1,000 beds

10. 10 Microsoft Enterprise – Windows, Office, many others Microsoft Health Solutions Group – –Amalga (Early Adopter) – –HealthVault & Mayo Clinic Health Manager Sentillion customer Customer of Microsoft Certified Gold Partners – –CitiusTech – –Perficient Touch points in the Microsoft-Virtua relationship

11. 11 EMR Business Continuity during Disaster Recovery & Downtime “One Virtual Record” - Right Time, Right Place, Right Person, Right Care Access, Scheduling & Customer Relationship Management (“One Virtua”) EMR Business & Clinical Intelligence / KPIs / Data-Driven Mgt Core IT Infrastructure (network, security, remote access, telephony, etc.) Core Business Tools: Billing, Finance, HR, Materials Mgt, etc. Non-Core Technologies (e.g., digital signage) Technology Experimentation & Innovation 1 2 3 4 5 6 7 8 9 EMR Acute Care Ambulatory (hospital-based) Home Care Surgical Joint Ventures Virtua Medical Group Community Physicians Long- Term Care Patients PHR Virtua’s IT Framework ► ► ► ► ► Where Amalga & HealthVault support Strategy ►

12. Stage Achievement Jan ’06 N=3977 Mar ’10 N=5217 7 Medical record fully electronic; Data sharing with community; Data warehousing in use 0.00%0.08% 6 Physician documentation, full clinical decision support, full PACS.001%2.6% 5Closed-loop medication administration.004%3.2% 4CPOE1.4%9.7% 3 Nursing documentation – Flow Sheets & Vital Signs 6.3%50.2 2 Clinical Data Repository – Diagnostic Results Access 51.9%15.5 1 Ancillaries: Laboratory, Radiology, Pharmacy 20.5%6.8 0All Three Ancillaries Not Installed19.3%11.2 HIMSS EMR Adoption Stages

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15. 15 Microsoft Health Solutions Portfolio Microsoft HIE SolutionMicrosoft HIE Solution APPLICATION ECOSYSTEMAPPLICATION ECOSYSTEM

16. 16 24 data feeds Supports Customary Amalga usage – Customized views of data and business intelligence reporting Virtua’s acute-care “downtime” solution Pre-stages data for Virtua’s Wellogic Health Information Exchange and HealthVault PHR Component of Secure Patient Forms Exchange solution (via CitiusTech custom application) Highlights of Amalga Use

17. 17 Amalga: Overlaps of data are intentional Other in-house systems Wellogic HIE Inpatient EMR Ambulatory EMR Legacy systems do what they do best Amalga – Core functions:   Data aggregator for business intelligence   Infinite combinations of data for presentation to end users   Some data normalization   Data feeder-receiver for data-exchange With HIE and PHR