Norton Healthcare. Faith-Based Integrated Delivery Network of Five Not-for-Profit Hospitals 15 Out-patient Centers 130+ Physician Practices

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2 Norton Healthcare Faith-Based Integrated Delivery Network of Five Not-for-Profit Hospitals 15 Out-patient Centers 130+ Physician Practices 2.2 Million yearly patient encounters $1.6 Billion yearly revenue 12,000+ Employees 650+ Employed Providers 2,000+ Physician Medical Staff 1,857 Licensed Beds 61,000 Admissions/year

3 Background More than 1 million serious medication errors occur every year in U.S. Hospitals 1 Medication errors can result in preventable adverse drug events (ADE) 20% of ADE are life threatening. 2 1 ADE adds more that $2,000 on avg to the cost of hospitalization. 3 = $7.5 billion per year nationwide in Hospital costs alone J Am Med Inform Assoc. 2007; 14(1): Am J Health Sys Pharm Aug 1;63(15): J Am Med Inform Assoc.2004 Jul-Aug;11(4): Estimating Lives and Dollars Saved from Universal Adoption of the Leapfrog Safety and Quality Standards: 2008 Update. TheLeapfrog group. Washington, DC: 2008.

4 Regulations Influencing Technical Trends in Healthcare The American Recovery and Reinvestment Act ARRA 2009 Health Information Technology for Economic and Clinical Health Act HITECH Electronic Medical Records and Meaningful use Health Information Exchanges Community Affiliations Leveraging Cloud Technology

5 Expectation

6 Reality

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8 Early adoption of Technology

9 Meaningful Use CMS will provide an EHR incentive payment to providers that show they are meaningfully using their EHRs by meeting thresholds for a number of objectives Failure to adopt by 2015 will result in penalties in Medicare reimbursements that start at 1% per year, up to a max of 5%

10 Expectations Gains in Efficiency More volume from time saved Lower health care costs overall Reduced Transcription costs Reduced office staff EHR and PM software integration Improved Safety Improved Quality Reductions in duplicate testing

11 Efficiency Implementation can result in a 25 to 33% drop in productivity for approximately 1 month Productivity improves over 6 months to near pre- EMR levels EMRs help documentation of more procedure oriented specialties Interactive- intensive and cognitive specialties need tools that are designed differently (pediatrics and family medicine) Bhargava, Hemant K. and Mishra, Abhay, Electronic Medical Records and Physician Productivity: Evidence from Panel Data Analysis (November 1, 2011). Available at SSRN: orhttp://dx.doi.org/ /ssrn

12 Clinician Perceptions EHR/ CPOE requires more time Older doctors may refuse IT All Processes have to be redesigned Access to older patient data Lack of well defined down time solution Computer response time

13 Health Care Costs Sharp rise in Medicare Payments Hospitals received $1 billion more in MC reimbursements in 2010 compared to 2005 Increase in aggressive coding NY Times, September 2012

14 Health Care Costs 1,700 of the 440,000 doctors in the country cost Medicare $100 million in 2010 alone (most specialized in family practice, internal medicine and emergency care) Copy/ Paste Cloned Records September 2012, HHS and Justice Department warned hospitals of increased audits on misuse and upcoding

15 January, 2012 February, 2012 March, 2012 April, 2012 May, 2012 June, 2012 July, 2012 August, 2012 September, 2012 October, 2012 November, 2012 December, 2012 January, 2013 February, 2013 March, 2013 April, 2013 May, 2013 June, 2013 July, 2013 August, 2013 September, 2013 October, 2013 November, 2013 December, 2013 January, 2014 February, 2014 March, 2014 April, 2014 May, 2014 June, 2014 July, 2014 August, 2014 September, 2014 Transcription 1,800,000 Lines of Transcription per Month 1,600,000 1,400,000 1,200,000 1,000, , ,000 Lines of Transcription per Month 400, ,000 0

16 Health Information Management Pre EMR/ Speech recognition 47.3 Medical Transcriptionists 3.0 Electronic Health record analysts Post EMR/ Speech recognition 13.0 Medical Transcriptionists Added 5.0 Physician Support 1.0 Electronic Health record analyst Total reduction in 31.3 FTEs

17 Better Patient Outcomes Pt satisfaction with medication e-prescribing High provider satisfaction with reduced after hours clinic calls Duffy L, et. al. "Effects of electronic prescribing on the clinical practice of a family medicine residency"web Site Disclaimers, Fam Med. 2010;42(5): % decrease in near miss medication events Bell, B, Thornton, K. (2011). From promise to reality achieving the value of an EHR. Healthcare Financial Management, 65(2), Improved quality of care screenings Breast Cancer Diabetes Colorectal Cancer Increase in Services Blood pressure control Breast cancer screenings BMI and blood testing for diabetics Lisa Kern et al., "Electronic Health Records and Ambulatory Quality of Care," Journal of General Internal Medicine, Oct. 3, 2012

18 Improved patient process Clinical Decision Support Order Sets and Evidence Based Medicine CPOE Closed loop medication administration Dosing Alerts Best Practice Advisories

19 Physician Buy In Safety Chart Access Reductions in Duplications/ LOS/TAT Subsidy/ Contract Cost Savings ARRA Stimulus It s not the progress I mind, it s the change I don t like. Mark Twain

20 Alerts

21 Interoperability Electronic medical record vendors don t play well with others. $25 billion in EHR incentives paid to providers and hospitals. <50% providers believe their EHR vendor is Interoperable with other vendors. Klas, EMR Interoperability Where are we on the yellow brick road? September, 2014.

22 KHIE

23 Technology and Patient Engagement Pts are footing more of the bill as much as 25% to 30% out of pocket 62% want to correspond online with their PCP about their health 65% want appointment reminders via 75% are willing to go online to view their medical records 2 out of 3 people would consider switching to a physician who offers access to medical records online Centers for Disease Control and Prevention, Center for National Health Statistics, Survey of Health Care Consumers in the United States: Key Finding, Strategic Implications, Deloitte Center for Health Solutions, 2011

24 Patient Portals

25 Physician Groups and Pt Portals Visionary (20%) young, tech savvy, consumer facing specialties, realize the ROI Students (33%) older, primary care, desire the ability to use but take significant help Legacy (25%) all the values and beliefs of visionaries, but have been using alternate platform. They don t want to change Stubborn (22%)- comfortable with current setup. No interest in patient engagement now or ever. Likely doesn t own a smartphone. Landman, Zachary. Why your patient portal failed: Physicians need engagement too. HealthcareITnews.com. September 26, 2013

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27 Mobility

28 After the Honeymoon Optimization/ Upgrade Regulatory compliance Patient/ Physician Engagement Population Health Management Data Reports Report Writers New Modules New Analysts Safety and Quality Review

29 Questions?