1. gloStream and Meaningful Use August, 2010

2. Table of Contents Final rule from the ONC and CMS The gloStream path to truly meaningful use Medicare payment schedule Path to certified EMR technology and MU reporting Review of the Core and Menu requirements –Objective for each requirement –How we’ll measure EMR usage –How gloStream EMR technology addresses requirements 2

3. Final CMS Rule Specifies criteria eligible professionals must meet to demonstrate MU Includes both “core” and “optional” items Outlines a phased approach CMS will establish graduated criteria over time 3

4. Final ONC Rule Sets initial standards, implementation criteria and certification criteria for EMRs Coordinates the standards required of EMR systems with MU criteria Providers can be assured that certified EMRs can help them qualify as MU’s. 4

5. gloStream’s Path to Meaningful Use We believe that MU is a minimum standard –Product: we will develop and deliver a product that is intuitive and easy to use. –Process: our exclusive gloDNA process ensures that we truly understand the Doctor’s needs. –Partner: we only sell through Partners who provide local, responsive, onsite support. 5

6. gloStream’s Path to MU Reporting gloStream’s MU system will automatically monitor MU statistics and provide usage statistics to CMS. gloStream software will feature an MU dashboard, so Doctors will always know how they are performing against MU criteria. 6

7. Core Objectives

8. 8Objective Record patient demographicsRecord patient demographics Required fields are sex, race, ethnicity, DOB, preferred languageRequired fields are sex, race, ethnicity, DOB, preferred language Measure More than 50% of patient’s demographic data must be recorded as structured dataMore than 50% of patient’s demographic data must be recorded as structured data gloStream Strategy gloEMR supports all required demographics Patient demographics usage report (5060 )

9. Core Objectives 9Objective Record vital signs and chart changesRecord vital signs and chart changes Required measurements: height, weight, blood pressure, BMI, growth chart for childrenRequired measurements: height, weight, blood pressure, BMI, growth chart for children Measure More than 50% of patient’s two years of age and older must have height, weight and blood pressure recorded as structured dataMore than 50% of patient’s two years of age and older must have height, weight and blood pressure recorded as structured data gloStream Strategy gloEMR supports all required vitals and growth charts in vitals entry screen Patient vitals usage report (5060)

10. Core Objectives 10Objective Maintain up-to-date problem list of current and active diagnosisMaintain up-to-date problem list of current and active diagnosis Measure More than 80% of patients must have at least one entry recorded as structured dataMore than 80% of patients must have at least one entry recorded as structured data gloStream Strategy gloEMR problems list feature provides full support for ICD-9 based problems Patient problem usage report (5060)

11. Core Objectives 11Objective Maintain an active medication listMaintain an active medication list Measure More than 80% of patients have at least one entry recorded as structured dataMore than 80% of patients have at least one entry recorded as structured data gloStream Strategy gloEMR currently provides a list of prescribed drugs and patient medication history Patient medications usage report (5060)

12. Core Objectives 12Objective Maintain an active medication allergy listMaintain an active medication allergy list Measure More than 50% of patients age 13 or older have smoking status recorded as structured dataMore than 50% of patients age 13 or older have smoking status recorded as structured data gloStream Strategy gloEMR provides patient history which includes smoking status Patient history usage report (5060)

13. Core Objectives 13Objective Record smoking status for patients 13 and olderRecord smoking status for patients 13 and older Measure More than 80% of patients have at least one entry recorded as structured dataMore than 80% of patients have at least one entry recorded as structured data gloStream Strategy gloEMR currently supports drug allergies in the allergies module Patient allergy usage report (5060)

14. Core Objectives 14Objective Provide patients with clinical summaries for each office visitProvide patients with clinical summaries for each office visit Measure Clinical summaries provided to patients for more than 50% of all visits within three business daysClinical summaries provided to patients for more than 50% of all visits within three business days gloStream Strategy gloEMR currently supports templates and can provide patient summaries on paper or PDF gloEMR will support export of a CCD document that meets interoperability standards Clinical summary usage report (5070)

15. Core Objectives 15Objective Upon request, provide patients with an electronic copy of their health informationUpon request, provide patients with an electronic copy of their health information Required data elements: diagnostic test results, problem lists, medication lists, medication allergiesRequired data elements: diagnostic test results, problem lists, medication lists, medication allergies Measure More than 50% of requesting patients must receive an electronic copy within three business daysMore than 50% of requesting patients must receive an electronic copy within three business days gloStream Strategy gloEMR will support export of CCD document that provides a comprehensive electronic medical history (5060) gloEMR also will support clinical document export, which can provide an export of all exams and other documents for a patient CCD usage report (5070)

16. Core Objectives 16Objective Generate and transmit permissible prescriptions electronicallyGenerate and transmit permissible prescriptions electronically Measure More than 40% must be transmitted electronically using certified EMR technologyMore than 40% must be transmitted electronically using certified EMR technology gloStream Strategy gloEMR currently supports electronic prescribing of non-controlled substance Electronic prescribing usage report (5060)

17. Core Objectives 17Objective Computerized Provider entry for medication ordersComputerized Provider entry for medication orders Measure More than 30% of patients with at least one medication in their medication list must have at least one medication ordered through CPOEMore than 30% of patients with at least one medication in their medication list must have at least one medication ordered through CPOE gloStream Strategy gloEMR currently supports order entry for prescriptions Patient prescription usage report (5070)

18. Core Objectives 18Objective Implement drug-drug and drug-allergy formulary checksImplement drug-drug and drug-allergy formulary checks Measure Functionality must be enabled for these checks for the entire reporting periodFunctionality must be enabled for these checks for the entire reporting period gloStream Strategy gloEMR provides full drug interaction checking including drug allergies Reporting will be provided to support attestation (5070)

19. Core Objectives 19Objective Implement capability to electronically exchange key clinical information among providers and patient-authorized entitiesImplement capability to electronically exchange key clinical information among providers and patient-authorized entities Measure Must perform at least one test of the EMR’s capacity to electronically exchange informationMust perform at least one test of the EMR’s capacity to electronically exchange information gloStream Strategy gloEMR will support import and export of a CCD that meets interoperability standards CCD export (5060) CCD and CCR import (5070)

20. Core Objectives 20Objective Implement one clinical decision support rule and track complianceImplement one clinical decision support rule and track compliance Measure One rule must be implementedOne rule must be implemented gloStream Strategy Clinical decision support is provided via disease management rules and by setting up guidelines, health plans, smart treatments, smart orders, and smart diagnoses Reporting will be provided to support attestation (5070)

21. Core Objectives 21Objective Implement systems to protect privacy and security of patient data in the EMRImplement systems to protect privacy and security of patient data in the EMR Measure Must conduct or review a security risk analysis, implement security updates as necessary and correct identified security deficienciesMust conduct or review a security risk analysis, implement security updates as necessary and correct identified security deficiencies gloStream Strategy gloEMR currently supports the security requirements as specified by HHS Partners and Providers will have to perform any additional security risk analysis and remediation at the site

22. Core Objectives 22Objective Report clinical quality measures to CMS or the StatesReport clinical quality measures to CMS or the States Measure Eligible providers must submit 3 core measures and select 3 additional measures from the 44 availableEligible providers must submit 3 core measures and select 3 additional measures from the 44 available For 2011, provider numerator and denominator through attestationFor 2011, provider numerator and denominator through attestation For, 2012 submit measures electronicallyFor, 2012 submit measures electronically gloStream Strategy gloEMR will provide a report to provider numerator and denominator for all quality measures for which we have structured data (this includes all core and alternative measures and the majority, if not all of the 44 measures defined by CMS – 5070)

23. Menu Set

24. 24Objective Implement drug formulary checksImplement drug formulary checks Measure Drug formulary check system must be implemented and access at least one internal or external drug formulary during the reporting periodDrug formulary check system must be implemented and access at least one internal or external drug formulary during the reporting period gloStream Strategy gloEMR provides formulary checking Reporting will be provided to support attestation (5070)

25. Menu Set 25Objective Incorporate clinical laboratory test results into EMRs as structured dataIncorporate clinical laboratory test results into EMRs as structured data Measure More than 40% of clinical laboratory test results are in positive/negative or numerical format and are incorporated into EMRs as structured dataMore than 40% of clinical laboratory test results are in positive/negative or numerical format and are incorporated into EMRs as structured data gloStream Strategy gloEMR includes a labs module as of 5050 which includes electronic ordering and electronic results to many national labs, regional labs, and in- office lab systems Electronic results are also available via HL7 interface to unsupported labs

26. Menu Set 26Objective Generate lists of patients by specific conditions for quality improvements, reduction of disparities, research or outreachGenerate lists of patients by specific conditions for quality improvements, reduction of disparities, research or outreach Measure Must generate one listing of patients with a specific conditionMust generate one listing of patients with a specific condition gloStream Strategy gloEMR currently supports patient list reports based on history, problems, and medication (5050)

27. Menu Set 27Objective Use EMR technology to identify patient- specific education resources and provide those to the patient as appropriateUse EMR technology to identify patient- specific education resources and provide those to the patient as appropriate Measure More than 10% of patients are provided patient specific education resourcesMore than 10% of patients are provided patient specific education resources gloStream Strategy gloEMR currently supports printing patient education materials as part of the guidelines feature Patient guidelines usage report (5070)

28. Menu Set 28Objective Perform medication reconciliation between care settingsPerform medication reconciliation between care settings Measure Medication reconciliation must be performed for more than 50% of transitions of careMedication reconciliation must be performed for more than 50% of transitions of care gloStream Strategy gloEMR provides medication reconciliation of the patient’s medication history against RxHub and will provide reconciliation against a CCD (5070)

29. Menu Set 29Objective Provide summary of care record for patients referred or transitioned to another Provider or settingProvide summary of care record for patients referred or transitioned to another Provider or setting Measure Summary of care record must be provided for more than 50% of patient transitions or referralsSummary of care record must be provided for more than 50% of patient transitions or referrals gloStream Strategy gloEMR will support export of a CCD in 5060 that meets interoperability standards

30. Menu Set 30Objective Submission of electronic immunization data to immunization registries or immunization information systemsSubmission of electronic immunization data to immunization registries or immunization information systems Measure Must perform at least one test of data submission and follow up submissionMust perform at least one test of data submission and follow up submission Applies only where registries can accept electronic submissionsApplies only where registries can accept electronic submissions gloStream Strategy gloEMR interfaces are able to send HL7 immunizations data to registries which support he CDS IIS HL7 standard

31. Menu Set 31Objective Submission of electronic syndromic surveillance data to public health agenciesSubmission of electronic syndromic surveillance data to public health agencies Measure Must perform at least one test of data submission and follow up submissionMust perform at least one test of data submission and follow up submission Applies only where public health agencies can accept electronic submissionsApplies only where public health agencies can accept electronic submissions gloStream Strategy gloEMR interfaces are able to send HL7 syndromic surveillance data to public health agencies that are able to receive it.

32. Menu Set 32Objective Send reminders to patients (per patient preference) for preventative and follow- up careSend reminders to patients (per patient preference) for preventative and follow- up care Measure More than 20% of patients aged 65 or older, or age 5 or younger, must be sent appropriate remindersMore than 20% of patients aged 65 or older, or age 5 or younger, must be sent appropriate reminders gloStream Strategy gloEMR currently supports reminder letters This functionality will be extended to include a patient preference to receive reminders (5070)

33. Menu Set 33Objective Provide patients with timely electronic access to their health informationProvide patients with timely electronic access to their health information Required data elements: laboratory results, problem lists, medication lists, medication allergiesRequired data elements: laboratory results, problem lists, medication lists, medication allergies Measure More than 10% of patients must be provided with electronic access to information within four days of its being updated in the EMRMore than 10% of patients must be provided with electronic access to information within four days of its being updated in the EMR gloStream Strategy gloEMR will support expert of a CCD document in 5060 that meets interoperability standards This CCD will be accessible to the patient via gloPortal or a HealthVault account