PerfectServe Survey Results. Presented by: Nielsen Consumer Insights Public Relations Research April 2015

PerfectServe Survey Results Presented by: Nielsen Consumer Insights Public Relations Research April 2015 1

Table of Contents Research Method 3 Report Notes 5 Executive Summary 6 Detailed Findings 15 General Perspective 16 Current Organizational Strategy 26 Current Experiences and Preferences 31 Communication: Barriers 42 Security: Current Experiences and Procedures 49 Demographics 56

Research Method The PerfectServe survey was conducted online by Harris Poll on behalf of PerfectServe between February 12 and March 6, 2015. The research was conducted among 955 medical professionals in the following occupations: hospitalist, primary care physician in an office, specialist physician in a hospital, specialist physician in an office, hospital administrator, office manager/practice administrator, nurse in a hospital, and case manager. Office-based respondents work in an office with 25 or more physicians. Hospital-based respondents work in a hospital with 200 or more beds. Physician respondents are duly licensed in the state where they practice. Data were not weighted and are only representative of those who completed the survey. All sample surveys and polls, whether or not they use probability sampling, are subject to multiple sources of error which are most often not possible to quantify or estimate, including sampling error, coverage error, error associated with nonresponse, error associated with question wording and response options, and post-survey weighting and adjustments. Therefore, Harris Poll avoids the words margin of error as they are misleading. All that can be calculated are different possible sampling errors with different probabilities for pure, unweighted, random samples with 100% response rates. These are only theoretical because no published polls come close to this ideal. Respondents for this survey were selected among those who have agreed to participate in online surveys. No estimates of theoretical sampling error can be calculated. 9 Office Managers/Practice Administrators work in an office with fewer than 25 physicians.

Research Method (continued) Sample Size Field Period Hospitalist n=150 February 12 27, 2015 PCP, Office n=150 February 12 March 3, 2015 Specialty Physician, Hospital n=102 February 12 19, 2015 Specialty Physician, Office n=101 February 12 23, 2015 Hospital Administer n=170 February 12 26, 2015 Office Manager n=81* February 12 March 3, 2015 Nurse, Hospital n=101 February 12 19, 2015 Case Manager n=100 February 12 23, 2015 *low base size (n<100); results should be treated as directional in nature

Report Notes In tables and charts: A dash (-) denotes a value of zero. An asterisk (*) denotes a value less than one percent but greater than zero. Percentages may not add up to 100% due to weighting and/or computer rounding. Throughout this report: Clinicians refers to all physicians, case mangers, and nurses. Physicians refers to hospitalists, primary care physicians, and specialty physicians. denotes the group is significantly higher than at least three other respondent groups.

Executive Summary

Population Health Management: General Perspective Successful Population Health Management Requires Better Communication, Collaboration and Technology Nearly all respondents emphasize the need for collaboration across a patient s extended care team, advocating that successful collaboration leads to at least one key healthcare metric: reduced readmissions. Effective population health management is a valuable tool that can aid in this collaboration. However, for population health management to be effective, there is nearly universal agreement that improved communication (and coordination) is necessary. And the reverse is also true, that inefficient communication is overwhelmingly perceived as a barrier that needs to be overcome. Moreover, to be effective, about 9 in 10 respondents believe that investment in sophisticated data analytics technology needs to be made. Similar proportions say that interoperable communication technology and/or mobile health communication technology are essential to effective population health management. 95% believe that successful care collaboration leads to reduced readmissions (66% strongly agree), more so among nurses who work in hospitals and case managers than other groups. For effective population health management: Nearly all (98%) feel that improved communication with patients is required (72% strongly agree). Nearly all (97%) believe that it is essential to have collaboration across the extended care team (69% strongly agree). Nearly all (95%) believe that interoperable communication technology across the care continuum is a necessary component (48% strongly agree). 87% of respondents feel that investment in sophisticated data analytics technology is crucial (36% strongly agree). 88% say that mobile health communication technology is an integral component (33% strongly agree). 96% say that inefficient communication is a barrier to effective population health management (66% strongly agree). Four in 10 respondents do not believe that the electronic health record is enough to successfully coordinate and communicate with other members of the extended care team. 4 in 10 respondents (40%) believe that the electronic health record is not sufficient for care coordination and collaboration across the continuum. More than 1 in 2 nurses and case managers (53%) do not believe the electronic health record is adequate for effective communication with physicians. 7

Population Health Management: Current Organizational Strategy Some Investment Has Been Made; But a Priority for Only Half Approximately 3 in 4 respondents say they are familiar with their organization s population health management strategy. Only about 1 in 2, however, believe it is a funded top-5 initiative for the coming year. That said, the majority are currently taking steps to improve their organization s population health management strategy either by acquiring, or more likely by actively partnering with, other organizations like insurers, physician practices, technology vendors, and home healthcare providers. The majority (76%) are familiar with their organization s population health management strategy. Hospital administrators, office managers, and case managers (and to a certain extent specialty physicians in offices) appear more familiar than other groups with their organization s population health management strategy. Only about 1 in 2 (51%) say that population health management is a funded top-5 initiative in 2015-2016 for their organization. 19% say it is not a priority, and nearly 1 in 3 (31%) are not sure. Hospital administrators, office managers, case managers, and specialty physicians in offices are more likely than other groups to say population health management is a top priority (and specialty physicians in hospitals are less likely). Hospitalists, PCPs in large offices, specialty physicians in hospitals, and specialty physicians in offices are more likely to be unsure, compared to other groups. The majority are taking steps to improve their organization s population health management by actively partnering with or acquiring the following (note: organizations appear twice as likely to partner with an organization than to acquire one, 85% compared to 61%): Insurers/payers (59% partnered/17% acquired) Physician practices (55% partnered/39% acquired) Technology vendors/consultants (52% partnered/21% acquired) Home healthcare providers (51% partnered/25% acquired) Post-acute care facilities (46% partnered/23% acquired) Pharmacies (40% partnered/21% acquired) Population health strategy consultants (33% partnered/18% acquired) Retail medicine providers (28% partnered/14% acquired) 8

Population Health Management: Current Organizational Strategy Some Investment Has Been Made; But a Priority for Only Half (cont.) Most also believe their organization currently uses (or plans to use) a wide range of technologies in the coming year to support and optimize their population health management outcomes, which is good news given the emphasis placed on technology to achieve success. In fact, 3 in 4 say their organization has already made an investment in patient engagement communication technology. Generally, the same groups hospital administrators, office managers, and case managers who are familiar with and prioritize population health management for their organization, are also more likely to have put some investment behind their strategy by: 1) partnering with or acquiring other organizations and 2) using or planning to use various technologies. Hospital administrators, office managers in large offices, case managers, (and to some extent nurses in hospitals and hospitalists) are more likely than other groups to have taken steps to partner or acquire in order to improve their organization s population health management; less so specialty physicians in hospitals, PCPs in large offices and hospitalists. Three-quarters of respondents (75%) believe that their organization has invested in patient engagement communication technology. Many say their organization currently uses or plans to use the following technologies within the next 12 months to optimize population health management: Follow-up patient phone calls (83% currently uses/10% plan to use) Online patient portals (74% currently uses/16% plan to use) Unified secure communication platform (46% currently uses/25% plan to use) Patient text reminders/updates (41% currently uses/26% plan to use) Telemedicine (39% currently uses/22% plan to use) Video conferencing (36% currently uses/19% plan to use) Remote coordination (36% currently uses/24% plan to use) Remote consults (31% currently uses/23% plan to use) Remote monitoring (32% currently uses/25% plan to use) Mobile care team communications (32% currently uses/24% plan to use) Hospital administrators, office managers, and case managers are more likely than other groups to use or plan to use various technologies in order to improve their organization s population health management; less so specialty physicians in hospitals, PCPs in large offices, and hospitalists. 9

Communication: Current Experiences and Preferences Communication is Not Unified; Phone Calls and Face-to-Face Top List Communication across the extended care team takes on a variety of forms depending on the nature, content, and people involved in the interaction. No one method appears to dominate; rather, the options are spread predominantly across face-to-face conversations, phone calls, text messages, emails, and electronic health records in different combinations. Notably, face-to-face is the most prevalent (and most preferred) for both brief and complex conversations inside the organization, while communication outside the organization most often relies on (and is benefited by) a phone call. That said, neither phone calls nor face-to-face conversations are preferred by a majority of respondents. Within the organization, face-to-face is the most frequent and most preferred method of communication for the following (but still only about 4 in 10 or fewer prefer face-to-face for any one scenario): Brief information/questions with non-physician care team members (25% most frequent; 25% most preferred) Brief information/questions with physician care team members (23% most frequent; 25% most preferred) Complex/in-depth information/questions with nonphysician care team members (37% most frequent; 37% most preferred) Complex/in-depth information/questions with physician care team members (40% most frequent; 41% most preferred) Outside the organization, a phone call is the most frequent and most preferred method of communication for the following (but still only about 1 in 2 or fewer prefer phone for any given scenario): Brief information/questions with non-physician care team members (48% most frequent; 25% most preferred) Brief information/questions with physician care team members (55% most frequent; 29% most preferred) Complex/in-depth information/questions with non-physician care team members (57% most frequent; 42% most preferred) Complex/in-depth information/questions with physician care team members (62% most frequent; 46% most preferred) 10

Communication: Barriers Overall Communication Rated Well; but Many Obstacles Still Cited A majority of clinicians (more than 6 in 10) rate their communication with the broader care team as efficient and are relatively satisfied with the technology they currently use. Most nurses, case managers, and physicians say they are generally able to contact, consult or collaborate with other colleagues in a timely manner. That said, the majority also cite communication lags or complications as being responsible for many deficiencies in care, for example: obstructing discharges/transitions; wasting time trying to find the right medical professional; delaying care while waiting for patient information; and receiving low-priority interruptions in the middle of care. And, about 6 in 10 feel that the HIPAA regulations pose an obstacle to efficient communication and collaboration within the care team. The majority say they are: Usually able to contact my peers and non-physician colleagues in an efficient manner (88% nurses/case managers) Usually know what physician to contact based on patient need (87% nurses/case managers) Usually able to contact colleagues to request a consult or collaborate in an efficient manner (82% physicians) Usually able to contact the needed physician in a timely manner (79% nurses/case managers) Overall, 69% of clinicians believe that communication among the broader care team is efficient. 62% of clinicians are satisfied with the communication technology available to them within their organization, though only 11% agree strongly. Nearly 3 in 4 physicians (72%) feel that their organization has the right technology in place to keep referrals within their network. 11

Communication: Barriers Overall Communication Rated Well; but Many Obstacles Still Cited (cont.) But many also have negative feedback on communication, for example: Communication obstacles often delay patient discharges and transitions to lower cost care settings (76% clinicians, more so hospitalists, specialty physicians in hospitals, nurses, and case managers than other groups) They have wasted valuable time attempting to communicate with the broader care team (71% physicians, more so specialty physicians in hospitals than other groups) They have wasted valuable time attempting to communicate with the right physician for the particular situation (71% nurses/case managers) Patient care is often delayed while waiting for important information about the patient (69% clinicians) They often receive pages or calls that are of low priority which disrupt patient care (67% clinicians) They do not always know the correct care team member (e.g. physician, nurse, therapist, etc.) to contact for a given situation (52%, more so specialty physicians in hospitals than other groups) They are frequently erroneously contacted when they are not the physician caring for the patient or on-call at the time (48% physicians, more so hospitalists than other groups). The majority (84%) say their organization has a HIPAAcompliance mitigation plan, and more than half (61%) feel that HIPAA regulations pose an obstacle to efficient communication and collaboration within the care team. In particular hospitalists, PCPs in large offices, specialty physicians in hospitals, and office managers more than other groups. 12

Security: Current Experiences and Procedures Security Is a Top Priority; but Mistakes Still Happen More than 8 in 10 respondents believe that secure communication is a top priority at their organization, and almost half have instituted new security protocols in response to the 2014 data breaches within the industry. To ensure that communication is secure, nearly 7 in 10 say their organization uses a mix of different applications and technologies (rather than one unified platform). Most feel relatively though not overwhelmingly satisfied with this technology, the chief complaints being lack of consistency or access across team members. However, despite taking clear steps to maintain security, many (approximately 3 in 10) have been part of some sort of security violation recently, either experiencing a data breach at their organization or personally sending/receiving unsecure texts or voice messages. Notably, certain groups hospital administrators, office managers in large offices, and case managers are more likely to feel secure communication is a key concern at their organization. Therefore, perhaps not surprisingly, these same groups are more likely to say that their organization has put new security measures in place and express higher satisfaction with the technology they currently use. Perhaps due to (or in spite of) this emphasis, hospital administrators are more likely (and office managers in large offices less likely) to have experienced a data breach within the past three years. More than 8 in 10 (83%) believe that secure communication is a top priority at their organization, most strongly hospital administrators, office managers, and to a certain extent case managers than other groups. In the past year, 46% say their organization has instituted security measures in response to 2014 healthcare data breaches, more so hospital administrators, office managers, and to a certain extent case managers than other groups. Most organizations (69%) say they use several applications and technologies (e.g. texting, messaging, and phone etc.) for secure communication. Only 20% use one unified communications platform, and 10% are unsure. 13

Security: Current Experiences and Procedures Security Is a Top Priority; but Mistakes Still Happen (cont.) 71% are satisfied (only 9% are extremely satisfied) with the technology their organization uses for secure communications, more so case managers, hospital administrators, and office managers than other groups. However among those who are dissatisfied, the primary reasons include: Not all members of the community utilize the same technologies (68%) Not all care team members have access to secure communication technology (55%) The technology is outdated (36%) 12% say their organization has suffered from data breaches within the last 3 years. Nearly 3 in 10 (27%) are unsure. Hospital administrators are more likely (while office managers are less likely) than other groups to report a breach. Hospitalists, PCPs in large offices, specialist physicians in hospitals, and specialist physicians in offices are more likely to say they are not sure, compared to other groups. In the last 12 months, many (more so hospitalists than other groups) say: They have received unsecure texts or voice messages to their personal smart phone containing Patient Health Information (PHI) in order to facilitate patient care (21%) Those who say that secure communication is a top priority at their organization are less likely to have received such texts or voice messages, compared to their counterparts. They personally have sent unsecure text messages or left unsecure voice messages from their personal smart phone containing PHI in order to facilitate patient care (13%) 31% say their organization has had a security violation, either a data breach within the past three years, and/or sending or receiving unsecure text or voice messages to their personal smart phone. 14

Detailed Findings

Population Health Management: General Perspective Nearly all respondents emphasize the need for collaboration across a patient s extended care team, advocating that successful collaboration leads to at least one key healthcare metric: reduced readmissions. Effective population health management is a valuable tool that can aid in this collaboration. However, for population health management to be effective, there is nearly universal agreement that improved communication (and coordination) is necessary. And the reverse is also true, that inefficient communication is overwhelmingly perceived as a barrier that needs to be overcome. Moreover, to be effective, about 9 in 10 respondents believe that investment in sophisticated data analytics technology needs to be made. Similar proportions say that interoperable communication technology and/or mobile health communication technology are essential to effective population health management. Four in 10 respondents do not believe that the electronic health record is enough to successfully coordinate and communicate with other members of the extended care team. 16

More than 9 in 10 agree successful care collaboration leads to reduced readmissions Respondent Agreement 95% 97% 94% 94% 94% 94% 95% 97% 98% 66% 68% 56% 57% 55% 66% 69% 81% 82% 29% 29% 38% 37% 39% 28% 26% 16% 16% Total Hospitalists PCP in Large Office Specialty physician, Hospital Somewhat agree Specialty physician, Office Strongly agree Hospital administrator Office manager Nurse, hospital Case manager denotes the group is significantly higher than at least three other respondent groups. BASE: ALL QUALIFIED RESPONDENTS Total (n=955) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Hospital administrator (n=170) Office manager (n=81*) Nurse, Hospital (n=101) Case Manager (n=100) Q805 To what extent do you agree or disagree with each of the following statements about population health management? Successful care collaboration leads to reduced readmissions. 17 *low base size (n<100); results should be treated as directional in nature

Near universal agreement that improved communication with patients is required for effective population health management Respondent Agreement 98% 97% 98% 96% 99% 97% 96% 98% 99% 72% 73% 66% 59% 64% 72% 72% 87% 85% 26% 25% 32% 37% 35% 25% 25% 11% 14% Total Hospitalists PCP in Large Office Specialty physician, Hospital Somewhat agree Specialty physician, Office Strongly agree Hospital administrator Office manager Nurse, hospital Case manager BASE: ALL QUALIFIED RESPONDENTS Total (n=955) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Hospital administrator (n=170) Office manager (n=81*) Nurse, Hospital (n=101) Case Manager (n=100) Q805 To what extent do you agree or disagree with each of the following statements about population health management? Improved communication with patients is required for effective population health management. *low base size (n<100); results should be treated as directional in nature denotes the group is significantly higher than at least three other respondent groups. 18

Nearly all feel it is essential to have collaboration across the extended care team for effective population health management Respondent Agreement 97% 98% 95% 95% 98% 96% 99% 99% 97% 69% 69% 58% 58% 60% 76% 63% 83% 80% 28% 29% 37% 37% 38% 20% 36% 16% 17% Total Hospitalists PCP in Large Office Specialty physician, Hospital Somewhat agree Specialty physician, Office Strongly agree Hospital administrator Office manager Nurse, hospital Case manager denotes the group is significantly higher than at least three other respondent groups. BASE: ALL QUALIFIED RESPONDENTS Total (n=955) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Hospital administrator (n=170) Office manager (n=81*) Nurse, Hospital (n=101) Case Manager (n=100) Q805 To what extent do you agree or disagree with each of the following statements about population health management? It is essential to have collaboration across the extended care team for effective population health management. 19 *low base size (n<100); results should be treated as directional in nature

Large Majorities in agreement that interoperable communication technology across the care continuum is a necessary component of a population health management strategy Respondent Agreement 95% 96% 94% 93% 90% 93% 99% 97% 97% 48% 52% 41% 45% 42% 50% 44% 60% 51% 46% 44% 53% 48% 49% 43% 54% 37% 46% Total Hospitalists PCP in Large Office Specialty physician, Hospital Somewhat agree Specialty physician, Office Strongly agree Hospital administrator Office manager Nurse, hospital Case manager denotes the group is significantly higher than at least three other respondent groups. BASE: ALL QUALIFIED RESPONDENTS Total (n=955) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Hospital administrator (n=170) Office manager (n=81*) Nurse, Hospital (n=101) Case Manager (n=100) Q805 To what extent do you agree or disagree with each of the following statements about population health management? Interoperable communication technology across the care continuum is a necessary component of a population health management strategy. 20 *low base size (n<100); results should be treated as directional in nature

Nearly 9 in 10 agree investment in sophisticated data analytics technology is crucial for effective population health management Respondent Agreement 87% 86% 81% 85% 80% 91% 95% 88% 88% 36% 33% 30% 24% 35% 51% 36% 40% 38% 50% 53% 51% 62% 46% 41% 59% 49% 50% Total Hospitalists PCP in Large Office Specialty physician, Hospital Specialty physician, Office Hospital administrator Office manager Nurse, hospital Case manager denotes the group is significantly higher than at least three other respondent groups. BASE: ALL QUALIFIED RESPONDENTS Total (n=955) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Hospital administrator (n=170) Office manager (n=81*) Nurse, Hospital (n=101) Case Manager (n=100) Q805 To what extent do you agree or disagree with each of the following statements about population health management? Investment in sophisticated data analytics technology is crucial for effective population health management. 21 *low base size (n<100); results should be treated as directional in nature

Majorities believe mobile health communication technology is an integral component of population health management Respondent Agreement 88% 90% 79% 83% 81% 91% 91% 92% 94% 33% 31% 21% 31% 30% 34% 35% 50% 42% 54% 59% 59% 52% 51% 58% 57% 42% 52% Total Hospitalists PCP in Large Office Specialty physician, Hospital Somewhat agree Specialty physician, Office Strongly agree Hospital administrator Office manager Nurse, hospital Case manager denotes the group is significantly higher than at least three other respondent groups. BASE: ALL QUALIFIED RESPONDENTS (Total (n=955) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Hospital administrator (n=170) Office manager (n=81*) Nurse, Hospital (n=101) Case Manager (n=100) Q805 To what extent do you agree or disagree with each of the following statements about population health management? Mobile health communication technology is an integral component of population health management. 22 *low base size (n<100); results should be treated as directional in nature

Nearly all respondents agree that inefficient communication is a barrier to effective population health management Respondent Agreement 96% 97% 97% 96% 97% 95% 96% 97% 92% 66% 68% 59% 58% 62% 67% 67% 80% 67% 30% 29% 37% 38% 35% 28% 30% 17% 25% Total Hospitalists PCP in Large Office Specialty physician, Hospital Somewhat agree Specialty physician, Office Strongly agree Hospital administrator Office manager Nurse, hospital Case manager denotes the group is significantly higher than at least three other respondent groups. BASE: ALL QUALIFIED RESPONDENTS Total (n=955) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Hospital administrator (n=170) Office manager (n=81*) Nurse, Hospital (n=101) Case Manager (n=100) Q805 To what extent do you agree or disagree with each of the following statements about population health management? Inefficient communication is a barrier to effective population health management. 23 *low base size (n<100); results should be treated as directional in nature

Hospitalists and physicians least like to agree the electronic health record is sufficient for care coordination and collaboration across the continuum Respondent Agreement 60% 51% 51% 51% 61% 65% 78% 69% 59% 19% 15% 12% 17% 17% 22% 40% 21% 14% 41% 35% 39% 34% 45% 43% 38% 49% 45% Total Hospitalists PCP in Large Office Specialty physician, Hospital Specialty physician, Office Somewhat agree Hospital administrator Strongly agree Office manager Nurse, hospital Case manager denotes the group is significantly higher than at least three other respondent groups. BASE: ALL QUALIFIED RESPONDENTS Total (n=955) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Hospital administrator (n=170) Office manager (n=81*) Nurse, Hospital (n=101) Case Manager (n=100) Q805 To what extent do you agree or disagree with each of the following statements about population health management? The electronic health record is sufficient for care coordination and collaboration across the continuum. 24 *low base size (n<100); results should be treated as directional in nature

More than half of nurses and case managers say the electronic health record is not adequate for effective communication with physicians 47% AGREE NET RN & CM Only 11% 36% Strongly agree Somewhat agree 39% Somewhat disagree Strongly disagree 14% THE ELECTRONIC HEALTH RECORD IS ADEQUATE FOR EFFECTIVE COMMUNICATION WITH PHYSICIANS. BASE: ALL QUALIFIED NURSES AND CASE MANAGERS (n=201) Q1015 To what extent do you agree or disagree with each of the following statements about communications? The electronic health record is adequate for effective communication with physicians. 25

Population Health Management: Current Organizational Strategy Approximately 3 in 4 respondents say they are familiar with their organization s population health management strategy. Only about 1 in 2, however, believe it is a funded top-5 initiative for the coming year. That said, the majority are currently taking steps to improve their organization s population health management strategy either by acquiring, or more likely by actively partnering with, other organizations like insurers, physician practices, technology vendors, and home healthcare providers. Most also believe their organization currently uses (or plans to use) a wide range of technologies in the coming year to support and optimize their population health management outcomes, which is good news given the emphasis placed on technology to achieve success. In fact, 3 in 4 say their organization has already made an investment in patient engagement communication technology. Generally, the same groups hospital administrators, office managers, and case managers who are familiar with and prioritize population health management for their organization, are also more likely to have put some investment behind their strategy by: 1) partnering with or acquiring other organizations and 2) using or planning to use various technologies. 26

Administrators and case managers most familiar with their organization s population health management strategy Respondent Familiarity 76% 61% 67% 63% 77% 94% 95% 65% 91% FAMILIAR NET 24% 11% 20% 6% 27% 34% 13% 33% Very familiar 51% Familiar 53% 49% 47% 57% 50% 52% Not very familiar Not at all familiar 60% 58% 20% 34% 27% 31% 18% 4% 5% 5% 6% 5% 4% 2% 2% 2% 5% 8% 1% Total Hospitalists PCP in Large Specialty Hospital Office manager Nurse, hospital Case manager Office physician, Office administrator Specialty physician, Hospital BASE: ALL QUALIFIED RESPONDENTS Total (n=955) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Hospital administrator (n=170) Office manager (n=81*) Nurse, Hospital (n=101) Case Manager (n=100) Q905 How familiar are you with your organization s population health management strategy? 44% 30% denotes the group is significantly higher than at least three other respondent groups. 27 *low base size (n<100); results should be treated as directional in nature

More than half say population health management is a top-5 initiative in their organization POPULATION HEALTH MANAGEMENT IS A FUNDED TOP-5 INITIATIVE IN 2015-2016 FOR MY ORGANIZATION. 19% 51% 31% Not sure MY ORGANIZATION HAS INVESTED IN PATIENT ENGAGEMENT COMMUNICATION TECHNOLOGY. 11% 14% Not sure 75% No Yes BASE: ALL QUALIFIED RESPONDENTS (N=955) Q910 Please indicate whether or not each the following describes your organization s population health management strategy. 28

Partnerships a key strategy in improving population health management PARTNERED/ ACQUIRED NET PHYSICIAN PRACTICES 9% 55% 39% 85% INSURERS/PAYERS 12% 59% 17% 74% TECHNOLOGY VENDORS/CONSLTANTS 13% 52% 21% 71% HOME HEALTHCARE PROVIDERS 18% 51% 25% 71% POST-ACUTE CARE FACILITIES 22% 46% 23% 66% PHARMACIES 27% 40% 21% 58% POPULATION HEALTH STRATEGY CONSULTANTS 23% 33% 18% 49% RETAIL MEDICINE PROVIDERS 36% 28% 14% 40% Neither Yes, partnered with Yes, acquired BASE: ALL QUALIFIED RESPONDENTS (N=955) Q915 Which of the following has your organization actively partnered with or acquired to improve your population health management? Please select all that apply. 29

Most common communication technologies used are not necessarily leading edge CURRENTLY USE/ PLAN TO USE NET FOLLOW-UP PATIENT PHONE CALLS 3% 83% 10% 92% ONLINE PATIENT PORTALS 4% 74% 16% 90% UNFIED SECURE COMMUNICATION PLATFORM 11% 46% 25% 70% PATIENT TEXT REMINDERS/UPDATES 15% 41% 26% 66% TELEMEDICINE 26% 39% 22% 61% REMOTE COORDINATION 19% 36% 24% 60% REMOTE MONITORING 23% 32% 25% 58% MOBILE CARE TEAM COMMUNICATIONS 22% 32% 24% 56% VIDEO CONFERENCING 29% 36% 19% 55% REMOTE CONSULTS 27% 31% 23% 54% No plans to use within the next 12 months Currently use Plan to use in the next 12 months BASE: ALL QUALIFIED RESPONDENTS (N=955) Q920 Which of the following technologies does your organization currently use or plan to use within the next 12 months to optimize population health management? 30

Communication: Current Experiences and Preferences Communication across the extended care team takes on a variety of forms depending on the nature, content, and people involved in the interaction. No one method appears to dominate; rather, the options are spread predominantly across face-to-face conversations, phone calls, text messages, emails, and electronic health records in different combinations. Notably, face-to-face is the most prevalent (and most preferred) for both brief and complex conversations inside the organization, while communication outside the organization most often relies on (and is benefited by) a phone call. That said, neither phone calls nor face-to-face conversations are preferred by a majority of respondents. 31

Phone calls are the most frequently utilized mode of communication Most Common Pick For Most Frequent Mode of Communication Phone Call Face to Face Conversation Electronic Health Record Email MOST FREQUENT MODE OF COMMUNICATON HOSPITALIST PCP OFFICE SPECIALIST HOSPITAL SPECIALIST OFFICE RN HOSPITAL CASE MANAGER Brief information/questions with non-physician care team members within my organization Brief information/questions with physician care team members within my organization Brief information/questions with non-physician care team members outside my organization Brief information/questions with physician care team members outside my organization Complex/in-depth information/questions with nonphysician care team members within my organization Complex/in-depth information/questions with physician care team members within my organization Complex/in-depth information/questions with nonphysician care team members outside my organization Complex/in-depth information/questions with physician care team members outside my organization BASE: ALL QUALIFIED RESPONDENTS EXCEPT ADMINISTRATION Total (n=704) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Nurse, Hospital (n=101) Case Manager (n=100) Q1005 Now thinking specifically about how you communicate with your care team members, what is your most frequent method for each of the following types of communication? 32

Face to face and phone calls are the most preferred modes of communication Most Common Pick For Most Preferred Mode of Communication Phone Call Face to Face Conversation Electronic Health Record Text Message Email MOST PREFFERED MODE OF COMMUNICATION HOSPITALIST PCP OFFICE SPECIALIST HOSPITAL SPECIALIST OFFICE RN HOSPITAL CASE MANAGER Brief information/questions with non-physician care team members within my organization Brief information/questions with physician care team members within my organization Brief information/questions with non-physician care team members outside my organization Brief information/questions with physician care team members outside my organization Complex/in-depth information/questions with nonphysician care team members within my organization Complex/in-depth information/questions with physician care team members within my organization Complex/in-depth information/questions with nonphysician care team members outside my organization Complex/in-depth information/questions with physician care team members outside my organization BASE: ALL QUALIFIED RESPONDENTS EXCEPT ADMINISTRATION Total (n=704) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Nurse, Hospital (n=101) Case Manager (n=100) Q1010 What is or would be your most preferred method for each of the following types of communication, whether or not you currently communicate using this method? 33

PCPs in large offices are the most likely to prefer using the electronic health record Brief information/questions with non-physician care team members within my organization Most Common Pick For Most Preferred Mode of Communication Phone Call 48% 48% Most Frequent Most Prefered Face to Face EHR 43% 41% Text Message Email 25% 25% 33% 28% 33% 23% 29% 26% 30% 29% TOTAL HOSPITALISTS PCP IN LARGE OFFICE SPECIALTY PHYSICIAN, HOSPITAL SPECIALTY PHYSICIAN, OFFICE NURSE, HOSPITAL CASE MANAGER BASE: ALL QUALIFIED RESPONDENTS EXCEPT ADMINISTRATION Total (n=704) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Nurse, Hospital (n=101) Case Manager (n=100) Q1005 Now thinking specifically about how you communicate with your care team members, what is your most frequent method for each of the following types of communication? Q1010 What is or would be your most preferred method for each of the following types of communication, whether or not you currently communicate using this method? 34

Overall, face to face is the preferred method, yet PCPs and specialty physicians in offices are more likely to utilize and prefer the EHR Brief information/questions with physician care team members within my organization Most Common Pick For Most Preferred Mode of Communication Phone Call Face to Face EHR Text Message Email 23% 25% 22% 32% 41% 45% 34% 27% 27% 21% 30% 38% Most Frequent Most Prefered 31% 32% TOTAL HOSPITALISTS PCP IN LARGE OFFICE SPECIALTY PHYSICIAN, HOSPITAL SPECIALTY PHYSICIAN, OFFICE NURSE, HOSPITAL CASE MANAGER BASE: ALL QUALIFIED RESPONDENTS EXCEPT ADMINISTRATION Total (n=704) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Nurse, Hospital (n=101) Case Manager (n=100) Q1005 Now thinking specifically about how you communicate with your care team members, what is your most frequent method for each of the following types of communication? Q1010 What is or would be your most preferred method for each of the following types of communication, whether or not you currently communicate using this method? 35

Overall, phone calls are the most preferred and utilized method of communication Brief information/questions with non-physician care team members outside my organization Most Common Pick For Most Preferred Mode of Communication Phone Call 48% 47% 54% 53% 53% 48% Most Frequent Most Prefered Face to Face EHR Text Message Email 25% 25% 35% 34% 28% 28% 29% 31% TOTAL HOSPITALISTS PCP IN LARGE OFFICE SPECIALTY PHYSICIAN, HOSPITAL SPECIALTY PHYSICIAN, OFFICE NURSE, HOSPITAL CASE MANAGER BASE: ALL QUALIFIED RESPONDENTS EXCEPT ADMINISTRATION (Total (n=704) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Nurse, Hospital (n=101) Case Manager (n=100) Q1005 Now thinking specifically about how you communicate with your care team members, what is your most frequent method for each of the following types of communication? Q1010 What is or would be your most preferred method for each of the following types of communication, whether or not you currently communicate using this method? 36

Phone calls are the preferred and utilized method of communication, yet PCPs in large offices are most likely to say they prefer the EHR Brief information/questions with physician care team members outside my organization Most Common Pick For Most Preferred Mode of Communication Phone Call Face to Face 55% 55% 57% 60% 50% 56% 53% Most Frequent Most Prefered EHR Text Message Email 29% 27% 35% 32% 31% 29% 29% TOTAL HOSPITALISTS PCP IN LARGE OFFICE SPECIALTY PHYSICIAN, HOSPITAL SPECIALTY PHYSICIAN, OFFICE NURSE, HOSPITAL CASE MANAGER BASE: ALL QUALIFIED RESPONDENTS EXCEPT ADMINISTRATION Total (n=704) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Nurse, Hospital (n=101) Case Manager (n=100) Q1005 Now thinking specifically about how you communicate with your care team members, what is your most frequent method for each of the following types of communication? Q1010 What is or would be your most preferred method for each of the following types of communication, whether or not you currently communicate using this method? 37

Overall, face to face and phone calls are the most common and preferred methods of communication Complex/in-depth information/questions with non-physician care team members within my organization Most Common Pick For Most Preferred Mode of Communication Phone Call Face to Face 50% 53% Most Frequent Most Prefered 47% 44% EHR Text Message Email 37% 37% 37% 34% 33% 29% 39% 38% 38% 30% TOTAL HOSPITALISTS PCP IN LARGE OFFICE SPECIALTY PHYSICIAN, HOSPITAL SPECIALTY PHYSICIAN, OFFICE NURSE, HOSPITAL CASE MANAGER BASE: ALL QUALIFIED RESPONDENTS EXCEPT ADMINISTRATION Total (n=704) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Nurse, Hospital (n=101) Case Manager (n=100) Q1005 Now thinking specifically about how you communicate with your care team members, what is your most frequent method for each of the following types of communication? Q1010 What is or would be your most preferred method for each of the following types of communication, whether or not you currently communicate using this method? 38

Generally, face to face is the most common and preferred method of communication Complex/in-depth information/questions with physician care team members within my organization Most Common Pick For Most Preferred Mode of Communication Phone Call 56% 55% Most Frequent Most Prefered 53% Face to Face EHR Text Message Email 40% 41% 39% 38% 37% 33% 42% 43% 39% 39% 47% TOTAL HOSPITALISTS PCP IN LARGE OFFICE SPECIALTY PHYSICIAN, HOSPITAL SPECIALTY PHYSICIAN, OFFICE NURSE, HOSPITAL CASE MANAGER BASE: ALL QUALIFIED RESPONDENTS EXCEPT ADMINISTRATION Total (n=704) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Nurse, Hospital (n=101) Case Manager (n=100) Q1005 Now thinking specifically about how you communicate with your care team members, what is your most frequent method for each of the following types of communication? Q1010 What is or would be your most preferred method for each of the following types of communication, whether or not you currently communicate using this method? 39

All agree, phone calls are the most frequent and preferred method of communication Complex/in-depth information/questions with non-physician care team members outside my organization Most Common Pick For Most Preferred Mode of Communication Phone Call Face to Face 57% 56% 59% 54% 52% 60% 58% Most Frequent Most Prefered EHR Text Message 42% 45% 44% 45% 40% 40% 39% Email TOTAL HOSPITALISTS PCP IN LARGE OFFICE SPECIALTY PHYSICIAN, HOSPITAL SPECIALTY PHYSICIAN, OFFICE NURSE, HOSPITAL CASE MANAGER BASE: ALL QUALIFIED RESPONDENTS EXCEPT ADMINISTRATION Total (n=704) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Nurse, Hospital (n=101) Case Manager (n=100) Q1005 Now thinking specifically about how you communicate with your care team members, what is your most frequent method for each of the following types of communication? Q1010 What is or would be your most preferred method for each of the following types of communication, whether or not you currently communicate using this method? 40

All agree, phone calls are the most frequent and preferred method of communication Complex/in-depth information/questions with physician care team members outside my organization Most Common Pick For Most Preferred Mode of Communication Phone Call Face to Face 62% 61% 67% 61% 59% Most Frequent Most Prefered 61% 60% EHR Text Message 46% 52% 49% 47% 48% Email 39% 39% TOTAL HOSPITALISTS PCP IN LARGE OFFICE SPECIALTY PHYSICIAN, HOSPITAL SPECIALTY PHYSICIAN, OFFICE NURSE, HOSPITAL CASE MANAGER BASE: ALL QUALIFIED RESPONDENTS EXCEPT ADMINISTRATION Total (n=704) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Nurse, Hospital (n=101) Case Manager (n=100) Q1005 Now thinking specifically about how you communicate with your care team members, what is your most frequent method for each of the following types of communication? Q1010 What is or would be your most preferred method for each of the following types of communication, whether or not you currently communicate using this method? 41

Communication: Barriers A majority of clinicians (more than 6 in 10) rate their communication with the broader care team as efficient and are relatively satisfied with the technology they currently use. Most nurses, case managers, and physicians say they are generally able to contact, consult or collaborate with other colleagues in a timely manner. That said, the majority also cite communication lags or complications as being responsible for many deficiencies in care, for example: obstructing discharges/transitions; wasting time trying to find the right medical professional; delaying care while waiting for patient information; and receiving low-priority interruptions in the middle of care. And, about 6 in 10 feel that the HIPAA regulations pose an obstacle to efficient communication and collaboration within the care team. 42

Most are satisfied with the communication technology available to them, yet a strong minority are not Care team communications 69% 62% AGREE NET 10% 11% 59% 51% Strongly agree Somewhat agree Somewhat disagree Strongly disagree 28% 3% OVERALL, COMMUNICATION AMONG THE BROADER CARE TEAM IS EFFICIENT. 30% 8% I AM SATISFIED WITH THE COMMUNICATION TECHNOLOGY AVAILABLE TO ME WITHIN MY ORGANIZATION. BASE: ALL QUALIFIED RESPONDENTS EXCEPT ADMINISTRATION (n=704) Q1015 To what extent do you agree or disagree with each of the following statements about communications? 43

More than 7 in 10 physicians feel their organization has the right technology in place to keep referrals within the network 72% AGREE NET Phys. Only 20% 52% Strongly agree Somewhat agree Somewhat disagree Strongly disagree 22% 6% MY ORGANIZATION HAS THE RIGHT TECHNOLOGY IN PLACE TO KEEP REFERRALS WITHIN OUR NETWORK. BASE: ALL QUALIFIED PHYSICIANS (n=503) Q1015 To what extent do you agree or disagree with each of the following statements about communications? My organization has the right technology in place to keep referrals within our network. 44

About 1 in 5 physicians say they are not able to contact colleagues in an efficient manner Care team communications 88% 87% 82% 79% AGREE NET RN & CM Only 34% RN & CM Only 43% Phys. Only RN & CM Only 25% 23% Strongly agree Somewhat agree 54% 43% 57% 56% Somewhat disagree Strongly disagree 15% 18% 10% 13% 1% 0% 4% 3% I AM USUALLY ABLE TO CONTACT MY PEERS AND NON-PHYSICIAN COLLEAGUES IN AN EFFICIENT MANNER. I USUALLY KNOW WHAT PHYSICIAN TO CONTACT BASED ON PATIENT NEED. I AM USUALLY ABLE TO CONTACT COLLEAGUES TO REQUEST A CONSULT OR COLLABORATE IN AN EFFICIENT MANNER. I AM USUALLY ABLE TO CONTACT THE NEEDED PHYSICIAN IN A TIMELY MANNER. BASE: ALL QUALIFIED RESPONDENTS EXCEPT ADMINISTRATION Total (n=704) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Nurse, Hospital (n=101) Case Manager (n=100) Q1015 To what extent do you agree or disagree with each of the following statements about communications? 45

Majorities say they have wasted time attempting to communicate with the broader care team Communication barriers 76% 71% 71% 69% AGREE NET Phys. Only 27% 24% 21% 20% RN & CM Only Strongly agree 49% 47% 50% 49% Somewhat agree Somewhat disagree Strongly disagree 20% 23% 24% 27% 4% 6% 5% 5% COMMUNICATION OBSTACLES OFTEN DELAY PATIENT DISCHARGES AND TRANSITIONS TO LOWER COST CARE SETTINGS. I HAVE WASTED VALUABLE TIME ATTEMPTING TO COMMUNICATE WITH THE BROADER CARE TEAM. I HAVE WASTED VALUABLE TIME ATTEMPTING TO COMMUNICATE WITH THE RIGHT PHYSICIAN FOR THE PARTICULAR SITUATION. PATIENT CARE IS OFTEN DELAYED WHILE WAITING FOR IMPORTANT INFORMATION ABOUT THE PATIENT. BASE: ALL QUALIFIED RESPONDENTS EXCEPT ADMINISTRATION Total (n=704) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Nurse, Hospital (n=101) Case Manager (n=100) Q1015 To what extent do you agree or disagree with each of the following statements about communications? 46

More than half say they do not always know the correct care team member to contact for the given situation. Communication barriers 67% 52% 48% AGREE NET 22% 44% 25% 9% I OFTEN RECEIVE PAGES OR CALLS THAT ARE OF LOW PRIORITY WHICH DISRUPT PATIENT CARE. 10% 12% 42% 36% 32% 35% 16% 17% I DO NOT ALWAYS KNOW THE CORRECT CARE TEAM MEMBER TO CONTACT FOR THE GIVEN SITUATION. Phys. Only I AM FREQUENTLY ERRONEOUSLY CONTACTED WHEN I AM NOT THE PHYSICIAN CARING FOR THE PATIENT OR ON-CALL AT THE TIME. Strongly agree Somewhat agree Somewhat disagree Strongly disagree BASE: ALL QUALIFIED RESPONDENTS EXCEPT ADMINISTRATION Total (n=704) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Nurse, Hospital (n=101) Case Manager (n=100) Q1015 To what extent do you agree or disagree with each of the following statements about communications? 47

The majority agree that HIPAA regulations pose an obstacle to efficient communications HIPAA Regulations 61% AGREE NET 13% 15% Yes No Not sure 3% 84% 45% 28% Strongly agree Somewhat agree Somewhat disagree Strongly disagree 11% Does your organization have a HIPAA-compliance risk mitigation plan? HIPAA regulations pose an obstacle to efficient communications and collaboration within the care team. BASE: ALL QUALIFIED RESPONDENTS (N=955) Q1145 Does your organization have a HIPAA-compliance risk mitigation plan? Q1150 To what extent do you agree or disagree that: HIPAA regulations pose an obstacle to efficient communication and collaboration within the care team. 48

Security: Current Experiences and Procedures More than 8 in 10 respondents believe that secure communication is a top priority at their organization, and almost half have instituted new security protocols in response to the 2014 data breaches within the industry. To ensure that communication is secure, nearly 7 in 10 say their organization uses a mix of different applications and technologies (rather than one unified platform). Most feel relatively though not overwhelmingly satisfied with this technology, the chief complaints being lack of consistency or access across team members. However, despite taking clear steps to maintain security, many (approximately 3 in 10) have been part of some sort of security violation recently, either experiencing a data breach at their organization or personally sending/receiving unsecure texts or voice messages. Notably, certain groups hospital administrators, office managers in large offices, and case managers are more likely to feel secure communication is a key concern at their organization. Therefore, perhaps not surprisingly, these same groups are more likely to say that their organization has put new security measures in place and express higher satisfaction with the technology they currently use. Perhaps due to (or in spite of) this emphasis, hospital administrators are more likely (and office managers in large offices less likely) to have experienced a data breach within the past three years. 49

Majorities agree secure communication is a top priority at their organization. Respondent Agreement 83% 81% 83% 79% 85% 85% 86% 79% 82% 53% 49% 42% 41% 49% 68% 65% 50% 61% 30% 31% 41% 38% 37% 18% 21% 30% 21% Total Hospitalists PCP in Large Office Specialty physician, Hospital Somewhat agree Specialty physician, Office Hospital administrator Strongly agree Office manager Nurse, hospital Case manager denotes the group is significantly higher than at least three other respondent groups. BASE: ALL QUALIFIED RESPONDENTS Total (n=955) Hospitalist (n=150) PCP office (n=150) Specialty physician, hospital (n=102), Specialty physician, office (n=101) Hospital administrator (n=170) Office manager (n=81*) Nurse, Hospital (n=101) Case Manager (n=100) Q1105 To what extent do you agree or disagree that: Secure communication is a top priority at my organization. 50 *low base size (n<100); results should be treated as directional in nature

Nearly half say their organization has instituted security measures in response to 2014 healthcare data breaches Physicians (39%) are more likely to be unsure compared to administrators (11%) 30% 46% Yes No Not sure 24% BASE: ALL QUALIFIED RESPONDENTS (N=955) Q1140 In the past 12 months, has your organization instituted security measures in response to 2014 healthcare data breaches? 51

Most organizations are communicating with several applications and technologies 69% 20% 10% SEVERAL APPLICATIONS AND TECHNOLOGIES (E.G. TEXTING, MESSAGING, AND PHONE ETC.) ONE UNIFIED COMMUNICATIONS PLATFORM NOT SURE BASE: ALL QUALIFIED RESPONDENTS (N=955) Q1110 Which of the following does your organization have for secure communications? 52

About 3 in 10 are not satisfied with the communication their organization uses for security, primarily due to non-unified technologies How satisfied are you with the technology your organization uses for secure communications? Which of the following are reasons why you are not satisfied? 71% Extremely satisfied Satisfied 9% 63% Not all members of the community utilize the same technologies Not all care team members have access to secure communication technology The technology is outdated 36% 55% 68% Not very satisfied Not at all satisfied The technology is not reliable 30% 25% The technology is too complex 24% 4% Other 3% BASE: ALL QUALIFIED RESPONDENTS (N=955) Q1115 How satisfied are you with the technology your organization uses for secure communications? BASE: ALL QUALIFIED RESPONDENTS NOT SATISFIED WITH COMMUNCATION (n=273) Q1120 You mentioned that you are not satisfied with the technology your organization uses for secure communications. Which of the following are reasons why you are not satisfied? Please select all that apply. 53

More than 1 in 4 aren t sure if their organization had any data breaches in the past 3 years Has your organization suffered from any data breaches within the last 3 years? In the last 12 months, have you received or sent any unsecure texts or voice messages to your personal smart phone containing PHI in order to facilitate patient care? 82% 75% 12% 27% Yes No Not sure 62% 13% 21% 5% 5% Yes No Not Sure Sent Received BASE: ALL QUALIFIED RESPONDENTS (n=955) Q1125 Has your organization suffered from any data breaches within the last 3 years? Q1130 In the last 12 months, have you received any unsecure texts or voice messages to your personal smart phone containing Patient Health Information (PHI) in order to facilitate patient care? Q1135 In the last 12 months, have you sent any unsecure text messages or left unsecure voice messages from your personal smart phone containing Patient Health Information (PHI) in order to facilitate patient care? 54

Demographics

Demographics PRACTICE SETTING All Qualified Respondents (N=955) Hospital 65% Office 35% GENDER All Qualified Respondents (N=955) Male 57% Female 43% AGE All Qualified Respondents (N=955) 18-34 13% 35-44 31% 45-54 31% 55-64 21% 65+ 4% MEAN 46.7 MEDIAN 46 OFFICE SIZE Works in an Office (n=333) Less than 25 3% 25-30 31% 31-35 12% 36-40 5% 41-45 5% 46-50 8% 51+ 35% MEAN 78.8 MEDIAN 40 HOSPITAL SIZE Works in a Hospital (n=622) Fewer than 200 beds - 200-299 beds 26% 300-499 beds 36% 500-699 beds 19% 700-899 beds 9% 900+ beds 10% PRACTICE SETTING Physicians and Hospitalists (n=503) Mostly office- or clinic-based 45% Mostly hospital- or lab-based 21% Exclusively hospital- or lab-based 21% Equally hospital-based and office/clinic-based 10% Mostly hospice-based 2% Mostly long-term care facility-based * PRACTICE SETTING Case Mangers (n=100) Inpatient 71% Outpatient 11% Both 18% 56

Demographics cont. NUMBER OF PATIENTS A WEEK All Qualified Respondents Except Administration (n=704) 1-50 31% 51-100 38% 101-150 21% 151+ 10% MEAN 98.9 MEDIAN 90 YEARS AS A RN Nurses (n=101) 0 1% 1-10 33% 11-20 30% 21-30 28% 30+ 9% MEAN 17.3 MEDIAN 17 HOSPITAL TYPE Works in a Hospital (n=586) Community Hospital (part of Hospital system) 34% Large Medical Center (part of hospital system) 28% Large Hospital/Medical Center (not part of a hospital system) 15% University Hospital 10% Independent Community Hospital (not part of a hospital system) 8% VA Medical Center/Veterans Hospital 2% Physician Office * Urgent care center * Outpatient Surgical Center (part of a hospital system) * Outpatient Surgical Center (independent) - Other 2% EMPLOYMENT STATUS All Qualified Respondents (N=955) Employed full-time 95% Employed part-time 2% Self-employed 2% Retired * Not employed and looking for work * Not employed and unable to work due to a disability or illness * PRACTICE ACCREDITATION All Qualified Respondents (N=955) Physician-Hospital Organization (PHO) 35% Accountable Care Organization (ACO) 32% Integrated Delivery System (IDS) 26% Independent Practice Association (IPA) 20% Some other type of organization 9% 57

Demographics cont. PRIMARY MEDICAL SPECIALTY Specialist Physicians (n=203) Cardiovascular Diseases 14% Abdominal Surgery 1% Orthopedic Surgery 10% Pediatric Endocrinology * Endocrinology, Diabetes & Metabolism 9% Pediatric Hematology-Oncology * Gastroenterology 8% Colon & Rectal Surgery * Pediatric Radiology 7% Allergy or Allergy & Immunology * Neurology 6% Plastic Surgery * Psychiatry 3% Geriatric Medicine * Anesthesiology 2% Cardiothoracic Surgery * Pulmonary Critical Care Medicine 2% Pulmonary Diseases * Interventional Cardiology 2% Surgical Oncology * General Surgery 2% Urology * Infectious Diseases 2% Pain Management-Anesthesiology * Child Neurology 1% Pediatric Emergency Medicine * Family Practice/General Pediatrics 1% Practice/Internal Medicine * Hematology/Oncology 1% Nephrology * Emergency Medicine 1% Other specialty 14% Vascular Surgery 1% Unspecified specialty * Vascular Medicine 1% Other 1% HOSPITAL TYPE Administrators (n=251) Director 22% Practice Administrator 18% Chief Operating Officer (COO) 13% Chief Financial Officer (CFO) 9% Office Manager 8% Chief Executive Officer (CEO) or President 5% Vice President 4% Chief Information Officer (CIO) 4% Senior Manager 4% Practice Manager 4% Medical Director/Chief of Medicine 3% Manager 2% Chief Technology Officer (CTO) 2% Senior Vice President 1% Associate Medical Director * Other 2% Not sure * 58