NUVODIA Our Story Prepared for the Executive War College May 2013

NUVODIA Our Story Prepared for the Executive War College May 2013

Nuvodia History Nuvodia means New Day and originated in 2013 as a combination of the Inland Imaging Information Technology (IT) Division and two other IT companies we acquired in 2012. Nuvodia is a wholly owned subsidiary of Inland Imaging - a large (3 rd largest in the USA today) Radiology Practice originating in the Pacific Northwest. Nuvodia has offices in Seattle, Spokane and St Louis. We employ 97 information technology experts. Nuvodia is committed to enabling our customers organizational excellence through innovative, results-oriented technology solutions.

Our Beginnings Radiology Goes Digital with Picture Archiving and Communications Systems (PACS) 1999-2012 Our PACS volumes grew from 50K exams/year to 2.0+ million imaging exams archived per year. We now have over 15 million patient medical imaging exams archived. We are growing at 3TB per week of data. In 1999 we used to loan out 16,000 film jackets per month and now it is zero. Medical records is closed. Today we have 8,000 + active internet based users looking at radiology images online. Over 3,000 different imaging devices are connected (MRI, CT, etc.) to our servers.

More Informatics Story - 2006 PACS enabled Sub-Specialization for Radiologists and improved patient care. Sub-specialization required radiology groups to get larger to do more volume so we could drive enough of a specific exam type to individual sub-specialties. Inland Imaging grew from 12 Radiologists in 1996 to over 60 in 2006 and was serving multiple health systems. Today we are now 97 Radiologists.

More Informatics Story 2006 We were sub-specialized but still needed to move the work around electronically more effectively. Images were electronic workflow was not. We had voice recognition for our reporting but we were still inefficient in workflow and patient information. We could not track our productivity by radiologist. Sometimes we billed the exam ourselves - professional component or global in the case of our JV. Sometimes we got a per exam reading fee from our customer hospitals/clinics. We were serving and using multiple IT and PACS infrastructures. Our reach expanded horizontally across organizations Our systems needed to enable this reach. Pressures were forcing efficiency and quality. We needed a layer to sit on top of all of this an Aggreagator

More Informatics Story 2007: We built RadWorkFlow (RWF, LLC) - a software workflow layer to integrate disparate information. It did radiologist workload balancing across our enterprise and tracked quality. US Patents were filed. We retained rights to the IP outside of Radiology. 2009: RWF Go Live results in a 15% gain in radiologist productivity, improved turnaround times and quality measures. Reduced 60% variation by slot to around 15%. 2010: We sold RWF to Medicalis a radiology decision support company founded our of the Brigham and based in Waterloo, Canada.

More of Our Story 2012: We join The Consortium with The Brigham, Cornell, UCSF and Nuvodia/Inland Imaging to build with Medicalis the next generation radiology workflow solutions. 2012: Nuvodia partners further with Philips Healthcare implementing sites that do less than 80,000 radiology exams per year. As partners Nuvodia and Philips do a revenue share. 2013 Philips Healthcare and Nuvodia discuss further partnerships for cardiac systems, intensive care monitoring, home patient monitoring, and other healthcare IT that Philips provides. 2013 Inland Imaging and Seattle Radiologists merge (now 97 radiologists 3 rd largest private group in the USA).

PACS Full Archive Sites Image Distribution HIE Sites Nuvodia Northwest PACS Footprint A Horizontal Connection Tonasket Colville Republic Omak Newport Chewelah Bonners Ferry Sandpoint Brewster Bothell Grand Coulee Deer Park Leavenworth Davenport Coeur d Alene Kellogg Quincy Moses Lake Odessa Ritzville Plummer St. Maries South Bend Othello Colfax Great Falls, Missoula, Helena Orofino Ilwaco Buena Clarkston Helena Cottonwood Goldendale Hermiston Phoenix Phoenix Confidential

Less than 25 bed Hospitals in the USA We see a market opportunity here Critical Access Hospitals (<25 bed) in dark blue Nuvodia customers highlighted in light blue and red

Nuvodia Offerings Medical Imaging Informatics Workflow Solutions Integration Services (HL-7, API, etc.) Help Desk Support Server Management and Hosting Staff Augmentation Consulting Services

The Future Have we been there? The OLOGIES are going digital. Radiology Cardiology Pathology Gastroenterology - Ophthalmology - Dermatology Other ehealth is emerging and needing Video, Image Management and / or Workflow Technologies TelePharmecy, TeleHospitalists, TelePsych ehealth centers popping up across the USA furthering the need horizontal integration of information for the PATIENT centric record. Mercy Health System in St Louis, MO has a 40,000+ ehealth Center (all epatients) Traditional single vendor proprietary PACS systems de-couple: Visualization Tools (workstations, ipads, browsers, etc.) Workflow Layers - Managing the integration and presentation of images and data Archive Layer (the cloud) We can help span SILOS of patient information and BIG data? Digital Pathology is a whole new world of BIG Data. Molecular Genetics

The Future have we been there? Patient exam reporting becomes live and interactive The static reports that pathology, radiology, lab and others deliver will convert into live interactive and collaborative communication tools for physicians and patients alike. Natural Language Processing emerges and enables interactive and structured information where previously not possible. Mobility Rules Private to Public Cloud Solutions Prevail We see significant opportunities in patient information integration across organizations.

The Future have we been there? Sacramento 18 years ago 95% managed care We built the Utilization Management System (UMS) A Managed Care story. Today Financial Risk is coming our way. Decision Support Systems & Protocol systems on the front end of ordering complex & costly exams. Outcomes based learning systems at the end. Financial system tied to the front not 30-60 days after the service is performed. Radiology needs to be at the table.

Thank You Jon Copeland CEO Nuvodia Jcopeland@nuvodia.com 509-363-7300