EHR FOR LONG-TERM AND POST-ACUTE CARE

A LeadingAge CAST Report EHR FOR LONG-TERM AND POST-ACUTE CARE A Primer on Planning and Vendor Selection 2013

EHR FOR LONG-TERM AND POST-ACUTE CARE: A Primer on Planning and Vendor Selection 2013 A program of LeadingAge 2519 Connecticut Ave., NW Washington, DC 20008-1520 Phone 202-508-9438 Fax 202-783-2255 Website: LeadingAge.org/CAST Copyright 2013 LeadingAge LeadingAge Center for Aging Services Technologies: The LeadingAge Center for Aging Services Technologies (CAST) is focused on development, evaluation and adoption of emerging technologies that will transform the aging experience. As an international coalition of more than 400 technology companies, aging-services organizations, businesses, research universities and government representatives, CAST works under the auspices of LeadingAge, an association of 6,000 not-for-profit organizations dedicated to expanding the world of possibilities for aging. For more information, please visit LeadingAge.org/CAST

Table of Contents 1 Purpose and Executive Summary... 1 1.1 Purpose of Whitepaper... 1 1.2 Executive Summary... 2 1.3 Disclaimer...2 2 Definitions... 3 2.1 Electronic Health Records (EHR)... 3 2.2 Electronic Medical Record (EMR)... 3 2.3 Personal Health Record (PHR)... 3 2.4 Health Information Technology (HIT)... 4 3 Planning for and Implementing an EHR System... 4 3.1 Assess...4 3.1.1 Visioning and Strategic Planning... 4 3.1.1.1 Software Applications...4 3.1.1.2 Hardware...6 3.1.2 Assessing Organizational Readiness: IT Infrastructure, IT Staffing, Skills & Attitudes... 6 3.1.2.1 HIT Attitudes Assessment...6 3.1.2.2 Surveying and Determining Results... 6 3.1.2.3 Computer Skills Survey...7 3.1.2.4 IT Staffing Inventory...7 3.1.2.5 IT System Inventory...7 3.1.2.6 Application Interface Inventory...8 3.1.3 Assess Financials... 8

3.1.3.1 Financing Resources...8 3.1.3.2 Sources of Funds...8 3.2 Plan...9 3.2.1 Goal Setting... 9 3.2.1.1 Importance of Goals...9 3.2.1.2 Writing Goals...10 3.2.1.3 Templates for Tracking Goals...10 3.2.1.4 Resources for Goal Settings...11 3.2.2 Mapping Chart Data...11 3.2.2.1 Chart Conversion Planning...11 3.2.3 Workflow and Process Redesign...12 3.2.3.1 Importance of Workflow and Process Improvement...12 3.2.3.2 Process Mapping as a Means to Manage Change...12 3.2.3.3 Workflow and Process Mapping...12 3.2.3.4 Mapping Current Workflow and Processes...13 3.2.3.5 Workflow and Process Redesign...13 3.2.4 Different EHR Models...13 3.3 Select...15 3.3.1 Vendor Selection...15 3.3.1.1 What Are You Buying?...15 3.3.1.2 The Marketplace...15 3.3.1.3 Price Ranges...15 3.3.1.4 Interoperability, Integration, Integration Engines and Certification...16

4 EHR Selection Matrix Components...19 5 Acknowledgements...22 5.1 EHR Workgroup...22 5.2 Participating EHR Vendors...23 6 Appendix...24 6.1 Stratis Health - Toolkit for Home Health Agencies...24 6.2 Stratis Health - Toolkit for Nursing Homes...24 6.3 EHR Selection Matrix...25

1 1 Purpose and Executive Summary 1.1 Purpose of Whitepaper This whitepaper updates our 2012 whitepaper. The purpose of this paper is to aid LeadingAge members, CAST members and other aging services organizations in choosing an Electronic Health Record (EHR) system that fits the needs of the organization, its providers and consumers/patients/clients. Aging Services of Minnesota contracted with Stratis Health of Bloomington, MN, to develop Health Information Technology (HIT) Toolkits for Nursing Homes and Home Health Agencies. The purpose of these toolkits was to help organizations assess readiness, plan, select, implement, make effective use of EHRs, and exchange important information about the people they serve. LeadingAge and CAST helped Aging Services of Minnesota to promote the toolkits, publicly available on the Stratis Health website, which help organizations to understand what they should look for in EHRs and the steps for implementation. This paper builds upon these two excellent toolkits by summarizing the important steps a provider should take while referencing the specific tools from the Stratis Health Toolkits. The paper then hones in on the next step of examining the fit of EHR products to the organization, its processes, needs and requirements, based on the functionalities these products offer. The paper examines functionalities needed or desired in different lines of aging services within long-term and post-acute care (LTPAC) including home health/home care, hospice, adult day care, assisted living facilities, acute rehab facilities, long-term acute care hospitals, long-term care rehab facilities, skilled nursing facilities, intermediate care facilities, intellectual disabilities/mental retardation/developmental disabilities (ID/MR/DD) facilities, continuing care retirement communities (CCRC) and the Program of All-Inclusive Care for the Elderly (PACE), as well as the actual vendors offering EHR systems specifically for LTPAC. CAST asked vendors to provide information about implemented interoperability standards, integration and health information exchange capabilities, as well as certification status and/or plans. We engaged experts from both provider members, as well as EHR vendor communities. Case studies were collected highlighting providers impacts and benefits of either a) clinical decision support systems including those aimed at reducing inappropriate hospital admission and acute care transfers (i.e. INTERACT, On-Time Quality Improvement, etc.) or b) interoperability and health information exchange with other care providers either directly or through a health information exchange (HIE). These will be published separately. This paper is available in a PDF format as a living document with links. CAST updates the EHR Selection Matrix annually. Finally, the EHR Selection Matrix will be used to update CAST s online Selection Tool to simplify and facilitate the EHR selection process for LTPAC providers; the online tool is updated as needed. This whitepaper and the companion EHR Selection Matrix, online Selection Tool and case studies, represent a continuation of CAST s efforts to produce hands-on tools that help LTPAC providers adopt appropriate aging services technologies that enable them to deliver innovative care delivery models, po- 2013 EHR for Long-Term and Post-Acute Care: A Primer on Planning and Vendor Selection

2 sition them well for strategic partnerships and the future. EHRs, particularly interoperable ones that are capable of exchanging information with other providers and technologies, were the first enabling technology identified in the CAST strategic Scenario Planning exercise (please see: A Look into the Future: Evaluating Business Models for Technology- Enabled Long-Term Services and Supports). 1.2 Executive Summary The paper begins with definitions for Electronic Health Records (EHR), Electronic Medical Records (EMR), Personal Health Records (PHR) and Health Information Technology (HIT) and then moves on to the steps involved in planning and implementing electronic records, summarized from the Stratis Health Toolkits, in Section 3. The steps to adopting technologies like these include assessing hardware, software and staffing needs, and assessing financial resources and sources of funds. Planning and implementation stages include assessing goals, measuring those goals and ensuring that the organization is on track to meet those goals. Successful purchase and implementation involves mapping chart data, a process that aligns currently used data elements with the features of an EHR; planning the conversion process; and reviewing the workflow for opportunities to improve processes. These are essential to maximizing the benefits of HIT. There are differences between several models of EHRs including locally hosted software, Application Service Providers (ASPs) and Software as a Service (SaaS), with clear positives and negatives of the options available depending on an organization s needs. Another key aspect is understanding what the organization is actually purchasing or leasing and what is available in the marketplace, as well as the price ranges and capacity for interoperability and integration with other software systems. The Vendor Selection section of the Stratis Health Toolkits assists with this task. The paper concludes with an EHR Selection Matrix that compares 36 EHR products on close to 200 features and functionalities, including the fit for different business lines, integration, interoperability capabilities, certification status, software/hardware requirements, and legal/regulatory and cyberliability. Information from the EHR Selection Matrix is available as an online EHR Selection Tool to help LTPAC organizations narrow their selections to a manageable list of EHR products that meet their business line, care applicability needs and essential requirements, based on their answers to key questions. 1.3 Disclaimer The information included in this paper is meant to assist in the understanding and selection of Electronic Health Record (EHR) systems. A few vendors elected not to participate. Functionalities and capabilities of listed EHR products are as reported by the vendors and have not been verified, tested, independently evaluated or endorsed by LeadingAge or LeadingAge CAST. Products mentioned in this paper serve as illustrative examples. Please use this as a general guideline in understanding functionalities and examples of current EHR systems. The EHR Selection Matrix may help providers identify potential EHR solutions that may meet their requirements, and is intended to help them target LeadingAge Center for Aging Services Technologies (CAST)

3 vendors to whom to submit a Request for Proposal (RFP). Where appropriate, provider case studies have been identified and published separately. However, providers are strongly advised to verify functionalities of the EHRs prior to final selection through demonstrations, site visits, reference checking and other due diligence. 2 Definitions 2.1 Electronic Health Records (EHR) A longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR automates and streamlines the clinician s workflow. The EHR has the ability to generate a complete record of a clinical patient encounter as well as supporting other care-related activities directly or indirectly via interface including evidence-based decision support, quality management, and outcomes reporting (Source: HIMSS). 2.2 Electronic Medical Record (EMR) An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization (Source: The National Alliance for Health Information Technology Report to the Office of the National Coordinator for Health Information Technology on Defining Key Health Information Technology Terms, released on April 28, 2008). An EMR is an application environment composed of the clinical data repository, clinical decision support, controlled medical vocabulary, order entry, computerized provider order entry, pharmacy, and clinical documentation applications. This environment supports the patient s electronic medical record across inpatient and outpatient environments, and is used by healthcare practitioners to document, monitor, and manage health care delivery within a care delivery organization (CDO). The data in the EMR is the legal record of what happened to the patient during his or her encounter at the CDO and is owned by the CDO (Source: HIMSS). 2.3 Personal Health Record (PHR) A universally accessible, layperson comprehensible, lifelong tool for managing relevant health information, promoting health maintenance and assisting with chronic disease management via an interactive, common data set of electronic health information and e-health tools. The PHR is owned, managed, and shared by the individual or his or her legal proxy(s) and must be secure to protect the privacy and confidentiality of the health information it contains. It is not a legal record unless so defined and is subject to various legal limitations (Source: HIMSS). Some EHRs offer patients/consumers the ability to view their records through web portals or the ability to export data to a PHR. 2013 EHR for Long-Term and Post-Acute Care: A Primer on Planning and Vendor Selection

4 2.4 Health Information Technology (HIT) HIT encompasses a broad array of technologies involved in managing and sharing patient information electronically, rather than through paper records. HIT performs information processing using both computer hardware and software for the entry, storage, retrieval, sharing, and use of health care information (Source: Alliance for Health Reform). EHR, EMR and PHR are examples of HIT. 3 Planning for and Implementing an EHR System Aging Services of Minnesota contracted with Stratis Health, a non-profit organization based in Bloomington, MN, to develop Health Information Technology (HIT) Toolkits for Nursing Homes and Home Health Agencies. The purpose of these toolkits was to help providers assess readiness, plan, select, implement, make effective use of, and exchange important information about the people they serve. The toolkits, which are publicly available on Stratis Health s website and were promoted by LeadingAge, CAST and Aging Services of Minnesota, helped organizations understand steps they need to take in planning for implementing an EHR, and what to look for in an EHR. This paper leverages these toolkits by summarizing the important steps a provider needs to take, borrowing or adapting from the toolkits, and where appropriate pointing to specific tools that members would find helpful. This paper then hones in on the next step, examining the fit of existing EHR products to the organization, its processes, needs and requirements, all based on the functionalities these products offer. The following subsections provide a summary of the most important steps in planning for and implementing an EHR from the Stratis Health Toolkits. 3.1 Assess 3.1.1 Visioning and Strategic Planning HIT refers to the broad class of information technology that aids health care organizations in achieving efficient and effective care delivery. HIT encompasses software applications and hardware, as well as requisite people, policies, and processes. Getting true value from HIT comes from the organization s ability to understand their operational needs, set strategic goals, set their own course, communicate expectations, engage all stakeholders, and celebrate success. 3.1.1.1 Software Applications Within HIT there are many types of information system applications. These include: Financial systems, administrative systems including resident/client registrationadmission, discharge, transfer (R-ADT), resident/client financial services, and billing systems. Departmental, or ancillary, systems support the operations of various departments or types of staff; examples include nutrition and food services (N&FS), and therapy services (e.g., rehabilitation, physical therapy, and respiratory therapy). In addition these systems include management functions LeadingAge Center for Aging Services Technologies (CAST)

5 such as quality management, materials management, and executive decision support. Clinical information systems support health care professionals in direct care delivery. When these clinical systems work together, they are often described as an EHR system. These systems often include several distinct modules such as the applications used for nursing documentation, nurse assessments, interdisciplinary care plans, clinical pathways, vital signs documentation, and workflow support. Other applications include those for imaging and laboratory results retrieval, and medical device data integration. More sophisticated clinical systems include computerized provider order entry (CPOE), electronic prescribing (eprescribing), electronic/ barcode medication administration records (emar/bc-mar) that depend heavily on robust pharmacy information and automation and other point-ofcare (POC) charting. Clinical decision support systems (CDS) are advanced applications that usually work in conjunction with the EHR, CPOEs and eprescribing. ӽӽ ӽӽ Clinical data repository (CDR) is the means by which data from the various applications come together for various forms of processing. Electronic document management system (EDMS) is often used where a bridging strategy is needed to ӽӽ ӽӽ ӽӽ ӽӽ achieve a paperless environment when clinical systems are being implemented. Portals are another important application to connect different providers to one another, such as physicians to a long-term or postacute care facility, or to provide patients or family access to their information. In general, a portal is a Web interface that serves as a secure door to related sets of data and services. Data warehouse, on the other hand, is also a database, but one that has been optimized to collect and manage data on which complex queries and analyses, such as data mining, can be performed. Telehealth, personal health records (PHR), and health information exchange (HIE) services are yet other forms of HIT that are rapidly evolving and being adopted by large and small health care delivery organizations. Middleware is a final type of software that is important to include in HIT. While often not a concern to end users, various report writing applications, presentation layer utilities, interfaces, database management systems, and other software are required to make all of the end-user applications work. 2013 EHR for Long-Term and Post-Acute Care: A Primer on Planning and Vendor Selection

6 3.1.1.2 Hardware Information system applications require computer hardware. Hardware includes the various processing devices and servers needed to run the software applications. If an organization is using a hosted application, application service provider, software as a service (SaaS), or an on-demand application, the organization will not need to acquire servers in house; the vendor maintains these, and the organization pays a monthly fee for their use. Data entry requires various input devices (e.g., desktop computers, laptops, tablets, personal data assistants [PDAs], speech microphones, etc.) and output devices (monitors, display screens, printers, fax machines, speakers, etc.); they are all hardware elements your organization will need. Data also must be archived, so storage functionality is needed. This may be part of your remote hosting, or something the organization needs in-house. As the HIT becomes more mission critical, backup storage and redundant processing devices are necessary, often with middleware applications to provide automatic failover. All of these devices must connect to one another in a network, so various network devices and their associated media (including various forms of cable for wired networks and wireless network capability) must be acquired and maintained. If the organization is using any form of hosted application, internal IT network capabilities will be critical. The organization must have sufficient speed and bandwidth, and have some form of redundancy, or backup, in the event the organization s primary network connection fails. For instance, the organization will very likely need a dedicated high-speed Internet line from an Internet service provider, but may also keep a commercial consumer Internet account for emergencies. 3.1.2 Assessing Organizational Readiness: IT Infrastructure, IT Staffing, Skills & Attitudes There is a wide-ranging set of assessments necessary for effective planning for HIT. While the list may seem overwhelming, and the temptation may be to skip some or all of these steps, experience shows that a thorough understanding of the current state of organizational readiness is the single most critical factor in subsequent success in HIT adoption, implementation, and use. 3.1.2.1 HIT Attitudes Assessment This assessment helps an organization understand its readiness for adopting an EHR and other HIT. Understanding early attitudes and beliefs can help with effectively planning and providing the right education and subsequent adoption. 3.1.2.2 Surveying and Determining Results The toolkit provides a sample survey in paper and/ or electronic form which you can contribute to clinicians affiliated with your organization and to all staff who work on all shifts. Plan for one to two months to catch all of the visiting physicians and nurse practitioners as they make their rounds. For staff, indicate a relatively short response time (one week). Tally the results for each of the three respondent position types (physicians, other clinicians, administrative/operations staff) and record results. The survey should question attitudes on: Does HIT, in general, increase overall efficiency? Can computerized alerts and reminders be annoying? LeadingAge Center for Aging Services Technologies (CAST)

7 Are residents/clients and/or their families likely expecting the organization to use a computer for their records? Will HIT improve personal productivity? Is HIT difficult to learn how to use? Is the use of HIT in front of residents/ clients or their family members depersonalizing? Is HIT as accurate or complete as paper records? Does HIT improve quality of care and resident/client safety? Once all documents are scanned into the system, will staff have a complete EHR? Is this a first step toward a successful EHR in addressing workflow and process changes? Is this an age where the organization must exchange data electronically with others and does HIT help do this? Is health care too complex without access to clinical decision support provided by HIT? Is HIT as secure as paper records? Can the organization afford an EHR? Can HIT have unintended consequences if the organization doesn t apply professional judgment in its use? The sample instrument from the Stratis Health Toolkit developed for Aging Services of Minnesota is available here. 3.1.2.3 Computer Skills Survey A computer skills survey will help the organization identify training needs and the available skills needed to plan for implementing an EHR and other HIT. The survey should cover basic computer skills as well as more advanced skills, such as the use of devices like handhelds, point of care (POC) technologies, and specific clinical applications. A sample instrument from the Stratis Health Toolkit developed for Aging Services of Minnesota is available here. 3.1.2.4 IT Staffing Inventory An IT Staffing Inventory will help the organization determine what IT staffing skills may be needed to implement specific HIT. Assess the needs that exist including skills, staff, clinicians, third parties and planning for adding the needed skills. A sample instrument from the Stratis Health Toolkit developed for Aging Services of Minnesota is available here. 3.1.2.5 IT System Inventory The IT System Inventory will allow you to identify and document all existing IT hardware and assess and budget for hardware required for each HIT application acquired. It will guide you to look at servers (if available/applicable), operating systems, CPU type and speed (GHz), RAM size (GB), hard disk size, type and configuration, storage type and capacity, client servers, peripherals (e.g., wireless cards, speech recognition microphones), networks (LAN/WAN), routers/switches, firewalls, VPN, Internet Service Provider (ISP), broadband capability, wireless access points, transmission standards, encryption type, network monitoring tools (available or conducted by third party), storage and other peripherals including mobile devices and POC 2013 EHR for Long-Term and Post-Acute Care: A Primer on Planning and Vendor Selection

8 technologies used by staff. Also, software, licenses (general purpose), application provisions, database management systems, report writers and storage management system. A sample instrument from the Stratis Health Toolkit developed for Aging Services of Minnesota is available here. 3.1.2.6 Application Interface Inventory This inventory will help the organization identify all current applications, who is responsible for each application, and describe how they may interface with one another. This inventory serves as a foundation for assessing which interfaces may be needed with new applications. A sample instrument from the Stratis Health Toolkit developed for Aging Services of Minnesota is available here. 3.1.3 Assess Financials 3.1.3.1 Financing Resources Making a major investment in HIT is challenging for every organization. Of course, the size of the investment will depend on the scope of your project and choices the organization makes during planning and product/vendor selection. Assessing financing should be re-visited as you continue planning and implementation of your HIT project. The following provides a description of the various sources of funds that may be available for HIT implementation. While not every source is applicable to every organization, the list may generate ideas not previously considered. 3.1.3.2 Sources of Funds Cash flow from operations Use of reserves Philanthropy: Although few organizations consider philanthropy, it can be an important source of funds, products, services or in-kind contributions and should not be discounted. There are various forms of philanthropy including charitable contributions and grants from foundations; a few foundations that may fund projects in technology and aging are listed on the CAST website here. Grants: Obtaining grants requires skills experience in writing the grant proposals or completing grant applications, and in preparing reports to funders. You may hire/contract with a grant writer to help; just be aware of the associated costs. A few foundations that may fund projects in technology and aging are listed on the CAST website here. Local businesses, religious organizations, charities Malpractice premium relief: If your facility/operation carries malpractice insurance, the insurer may be willing to provide a discount or not increase premiums when certain HIT investments are made. Tax advantages: An accountant can help identify tax advantages for providers that are for-profit. LeadingAge Center for Aging Services Technologies (CAST)

9 Group purchasing discounts: These discounts can be significant. Check LeadingAge Savings and Solutions Center. Vendor financing options: Many vendors offer an application service provider (ASP) or software as a service (SaaS) model that is both a form of financing of the software as well as management of IT operations. The ASP or SaaS models are like renting an apartment, while the licensure model is like owning a home. The ASP/SaaS models require little or no downpayment, generally demand less staffing, have lower hardware costs, and allow your organization to pay as you go. But, they may offer less control and customization capability and the longterm cost may end up being higher. Remote hosting or outsourcing: This option is similar to the ASP model, but typically refers only to management of the data center (remote or local) and its hardware/telecommunications, not the software. Although outsourcing can help reduce the cost of IT staffing and may make it more reliable with a strong service level agreement, organizations may also find it more expensive than having only one full-time equivalent (FTE) staff member. Local markets and availability of employees can make a difference as well. that you manage yourself or include in an outsourcing arrangement. Debt and equity financing: Bank loans and lines of credit are frequently tapped to support HIT purchases. Open source products: Consider evaluating HIT based on Open Source code, like VistA, the Department of Veterans Affairs EHR, which was made available by the federal government in fall 2005 through the Freedom of Information Act. There are licensing fees associated with Open Source systems for the database systems the software runs on, various subscriptions to support code sets and other utilities, vendors who help implement the system and potentially help maintain it, and development/ customization of any needed interfaces with existing billing or other systems. 3.2 Plan 3.2.1 Goal Setting 3.2.1.1 Importance of Goals An important step in HIT planning is for all stakeholders to identify and commit to achieving specific, measurable goals. These goals establish the expectations for learning about HIT, preparing for change, selecting a suitable product, ensuring a solid implementation, and optimizing the technologies use. Leasing: This option generally applies only to the hardware you acquire and 2013 EHR for Long-Term and Post-Acute Care: A Primer on Planning and Vendor Selection

10 3.2.1.2 Writing Goals Many organizations recognize the importance of S.M.A.R.T. goals. The acronym has taken on many meanings to fit specific organizations needs. Specific: Goals should identify who, what, where, when, and why. They should be well defined and clear to anyone who has a basic knowledge of the workings of the organization. Some also suggest that the goals not only need to be Significant enough to make the investment in achieving the goal but Stretching for the organization to push itself to continuously strive for improvement. Measurable: Goals should answer the questions how much? and how many?, so you can determine when a goal has been accomplished. To be measurable, goals must contain specific Metrics, be Meaningful, and be Motivational. Attainable and Agreed upon: Although the most common citations of S.M.A.R.T. goals refer to the need to develop attitudes, abilities, skills, and financial capacity to reach the goals being set, gaining consensus on Acceptable goals and commitment to Achieving the goals are critical as well. Realistic, Relevant, Reasonable, Rewarding, and Result-oriented: Goals must reflect the availability of resources, knowledge, and time so they can be achieved. Timely, Tangible and Trackable: Enough time must be given to acquire and learn to use HIT in support of achieving goals. Once adequate time has been determined, specific target dates should be assigned to key deliverables to incite a sense of urgency while giving the organization a transparent way to track its progress towards meeting the goals. 3.2.1.3 Templates for Tracking Goals LTPAC provider organizations may be concerned about writing S.M.A.R.T. goals because they do not have baseline data, or because they fear results will be difficult to achieve. These issues are actually a part of the problem not a reason for inaction. If baseline data are not available today, now is the time to start collecting current data for the most important functions. Cultivating a culture of quality measurement, reporting, and improvement is often more important than implementing the HIT. It is essential to engage the end users in setting expectations, providing the commitment and support to achieving the expectations, and then measuring, reporting, and celebrating success. Consider using the nursing home or home health template from the Stratis Health toolkits developed for Aging Services of Minnesota to help write goal statements. Start out with a general statement, such as the example in the column labeled Objective in the above-referenced documents. As you dissect the organization s goal to determine how HIT can help achieve it, you will be describing the intended ac- LeadingAge Center for Aging Services Technologies (CAST)

11 tion. Identify the sources of data and which application within HIT or EHR will enable you to make improvements. Define the metrics so you have a clear understanding of what data to collect. Record your current baseline data. Then set your goal by summarizing the improvement you think can be made within a realistic timeframe and target dates when possible for using the new HIT or EHR application. You might also want to record the rationale for setting the goal and any obstacles to achieving it that you see. For instance, some expected outcomes may be set for you by regulations or contract. An obstacle may be that the pharmacy you work with is not yet up on eprescribing so you may not be able to fully achieve your goal until they adopt the technology. Finally, record results periodically until the target date for achieving your goal is reached. If you wait until the targeted time, you will not know whether you are on course to meet the goal and you will not be able to implement corrective action to meet your deadline. While the deadlines are selfimposed, timeliness is a key motivator. In the example from an actual nursing home in the template referenced above, the goal to eliminate Adverse Drug Events (ADEs) may sound impossible, but nursing homes that set this goal expected to achieve it, and got very close within the first six months of implementing an eprescribing system. 3.2.1.4 Resources for Goal Settings Identifying all the goals for a given HIT project may take some time. To help structure your goals, consider the major functions your facility/operation performs. Examples are provided in the tables included in the Goal Setting templates created by Stratis Health for nursing homes or home health agencies; these tables list many of these functions for the respective settings as well as some of the complementary functions relevant to health information exchanges (HIE). Add or delete descriptions in the table to fit the functions of your facility/ operation. Focus on the functions that need HIT support. 3.2.2 Mapping Chart Data Mapping resident/client chart data is a process that aligns currently used data elements with the features of an EHR. 3.2.2.1 Chart Conversion Planning Although chart conversion should not be performed until after EHR implementation and immediately prior to going live, careful planning in advance can help in both selecting a product and making the chart conversion process go smoothly when applied. The two primary means to convert chart content are abstracting data and scanning documents to be stored in the EHR. Starting this process with chart analysis in the planning phase of your project helps you identify data elements that are currently kept in the chart, their source, format and how frequently they are needed, accessed and by whom. During this process you can determine data essential to have in your EHR, how the data are processed and other EHR requirements; these data generally need to be abstracted from existing charts. You can also identify documents that you will scan and store in the EHR, as well as ones that will remain in paper form. After vendor selection and EHR implementation, the process of chart conversion pre-populates the new EHR with select resident/client information, 2013 EHR for Long-Term and Post-Acute Care: A Primer on Planning and Vendor Selection

12 making adoption easier for staff. Consider what support the vendor can offer in this process. If you are selecting an EHR vendor, your preference for one chart conversion method over another becomes an important consideration. This chart conversion tool from the Stratis Health Toolkit developed for Aging Services of Minnesota aids in evaluating how to move key information from current active paper charts into EHRs. You need to consider the following: Scanning all documents to free the chart room and use the space differently. Cost on all factors. Quality control on abstracting. Some vendors will provide a special template for abstracting for chart conversion. Will paper be destroyed, warehoused, or miniaturized? Do you currently have a retention schedule and destruction policy? Does it have special legal requirements? Do not destroy any records where there may be potential litigation. What policies and procedures will ensure that hybrid records (i.e., part electronic/ part paper) will not be created? 3.2.3 Workflow and Process Redesign 3.2.3.1 Importance of Workflow and Process Improvement Change due to HIT needs to be managed not only to help individuals overcome their concerns and adopt the technology well, but also to ensure that the change brought about by the technology is the right change for the organization. Workflow and process changes must be understood and managed. Workflow and process changes should be made to take advantage of HIT, but must also point out the control points that must be present or should be added to the systems for optimal results. Professional judgment must be applied when using any tool, including all forms of HIT. Computers can crunch data tirelessly and remind humans who may be forgetful in the rush of their everyday lives. However, they are not substitutes no matter how wellprogrammed for the experience that trained workers bring to health care. Workflow and process changes should aid professionals, but are not substitutes for them. 3.2.3.2 Process Mapping as a Means to Manage Change Process improvement experts suggest that the best way to help potential new users of information systems overcome resistance to the change is to demonstrate the quality efficiencies and patient safety of computer systems and to engage users in making their own changes. 3.2.3.3 Workflow and Process Mapping Process mapping is a fairly well-defined science, with a number of tools and techniques that can be deployed to understand current workflows and processes as well as identify opportunities for improvement. LeadingAge Center for Aging Services Technologies (CAST)

13 3.2.3.4 Mapping Current Workflow and Processes The following steps should be used to map current workflow and processes: 1. Identify processes to be mapped, those that will be impacted by the HIT being acquired. 2. Use individuals who actually perform the process; they know it best and they need to own the impending change. 3. Instruct persons on process mapping, why it is being done and how it is done. 4. Map current processes. Avoid identifying opportunities for improvement now, because critical controls built into current processes may be overlooked. 5. Validate maps to ensure they reflect current processes, all variations, and all the information needed. This is the time to be candid about how processes and workflow really occur in the current state, including workarounds, so that the new HIT-supported processes can be developed in ways that are most productive and helpful. 6. Collect all forms and reports that are part of processes to be automated through HIT. 7. Obtain benchmark data to define expectations for change and for use in benefits realization studies. 3.2.3.5 Workflow and Process Redesign Map how the workflows and processes will be performed with HIT. Identify potential problems in current workflows and processes and determine their root cause. Things to look for include bottlenecks, sources of delay, rework due to errors, role ambiguity, unnecessary duplications, unnecessary steps, long cycle time, lack of adherence to standards, lack of information and lack of quality controls. Various tools may be helpful in identifying root cause for the aforementioned problems. A process flow chart template and a sample systems flow chart from the Stratis Health Toolkit developed for Aging Services of Minnesota can be found here. 3.2.4 Different EHR Models Not all EHRs are the same. As with all enterprise solutions, there are options for the organization that include: Locally Hosted Software - Option to own the hardware and purchase the EHR software and host it on servers local to the organization Hosted - Outsource the hosting of purchased/licensed application to a third-party hosting service provider that manages the hardware, communications and data center on behalf of the organization Software as a Service (SaaS) - Applications are hosted remotely by the vendor 2013 EHR for Long-Term and Post-Acute Care: A Primer on Planning and Vendor Selection

14 With SaaS and hosted services, you will need to have a reliable Internet connection in order to access data; however, a real benefit is that the information is already being backed up offsite. With local, self-hosted software, you have it all onsite, but that also means that any system upgrades must be done locally, whereas you may not even notice the small tweaks that may occur on the backend with SaaS. Price can also play a factor, where purchasing software can be more expensive from the onset, but less expensive over time as the software is bought and owned outright. SaaS may be less expensive to initially get up and running; however, the lease payments may go on indefinitely. The table below provides a quick comparison between the three models: Locally Hosted Software Hosted SaaS Software and license are purchased and installed on each desktop/client device or local servers Software updates must be downloaded and installed Central server onsite; information stored locally at individual computer level and/or local servers On-site IT support needed for clients and servers Internet connectivity not required except for exchanging information with other sites; no downtime without Internet Cost: High upfront investment in hardware and software, ongoing licensing fees, and high IT staffing cost. Software (including commercial packages originally designed for individual users) installed on remote servers and accessed via desktops computers or thin client device to multiple users on a lease or per-use basis; but software may need to be installed on local machines Software updates on remotely hosted applications are managed by the application/hosting service provider; updates to local software may need to be downloaded and installed Information stored offsite in the cloud Onsite IT support needed for clients Internet connectivity required; downtime without Internet Cost: Medium upfront investment in hardware and software, ongoing hosting fees, ongoing licensing fees, and medium IT staffing cost. Leased software installed on remote servers and accessed via desktop computers or thin client device, but special browser-like software may need to be installed on local machines Allows for immediate software updates Information stored offsite in the cloud On-site IT support generally not needed Internet connectivity required; downtime without Internet Cost: Low upfront investment in hardware and software, ongoing use fees, and low IT staffing cost. LeadingAge Center for Aging Services Technologies (CAST)

15 Other things to consider: IT staffing: skills and availability/staffing levels Downtime Data backup Data security Power outage Internet connectivity: reliability/outage and speed 3.3 Select 3.3.1 Vendor Selection 3.3.1.1 What Are You Buying? The first question an organization should ask in the process of acquiring HIT is what are we buying? This may seem like a strange question, but you may set out to acquire an EHR and find great variation including everything from an automated system to document minimum data sets (MDS) to a robust product that supports all aspects of documentation, communication across the continuum of care, and clinical decision support. As a result, you need to undertake a thoughtful and thorough vendor selection process to ensure you get what you need, as well as a product that will enable you to grow into additional HIT as it becomes available. You may find that some EHR vendors will suggest replacing your financial/administrative system so that these functions are more integrated with the EHR. Based on your strategic plan, you may first need to acquire some source systems that your EHR will communicate with, such as a laboratory information system. You may wish to follow a migration path that enables you to acquire modules one at a time in some sequence that is logical for your organization. If you belong to a corporate structure that supplies a standard system, you may be going to market to acquire a module that you have special need for, but is not included in the standard system. So, what are you buying? The most important thing about this question is to answer it for your organization. Please see section 3.3.1.4 Interoperability, Integration, Integration Engines and Certification for more information. 3.3.1.2 The Marketplace The marketplace for EHR vendors in LTPAC providers includes products designed for nursing homes as well as assisted living providers, durable medical equipment providers, home care providers, pharmacy, rehabilitation providers and continuing care retirement communities offering services at different levels of care. This market is highly volatile: vendors come and go, merge and get acquired, and fail to respond to surveys or regulatory changes. Many claim that they have an EHR when by most definitions they do not. 3.3.1.3 Price Ranges Very little information is publicly available concerning the price of products for the LTPAC market. A few generic cautions apply: Very inexpensive products may be based on Microsoft Office products such as Word, Excel, or Access and have 2013 EHR for Long-Term and Post-Acute Care: A Primer on Planning and Vendor Selection

16 minimal processing capability. They primarily make information more readily accessible. The next tier of products may be somewhat more robust in their functionality but do not yet have all the sophisticated clinical decision support or other functionality of a top tier product, do not interface (or do not interface well) with other systems, and often are not very customizable. This tier of products may also include electronic document management systems (EDMS) that only provide scanning and indexing functions for paper documents and other information in digital form. Being digital does not mean the data within the digital structure are discrete. For example, a transcribed document may be digital because it can be electronically loaded into a repository and retrieved for viewing from multiple sites. An electronic signature may be able to be affixed to this document. You may even be able to index the document to highlight allergy information or certain other standard information. This information can only be viewed; specific data cannot be retrieved by the computer for reports. Another tier of products may be EHRlite versions of more robust products. They look and feel like their more expensive counterparts, but don t have the same flexibility or support. These are frequently offered in Hosted or SaaS mode, which provides a source of financing support as well as reduces the cost to the organization for maintaining its own servers. More expensive products generally provide greater levels of functionality, include more robust decision support, and are more highly customizable. The vendor spends considerable money on research and development to continuously provide new functionality. The level of interoperability within these product suites and with other vendors products is variable. Vendors are making concerted efforts to become more interoperable. Service levels, attention to workflow and process support, testing and training, and customer responsiveness are generally stronger in this tier of products. In this paper, we attempted to get pricing information from vendors who contributed information about their products, as well as sample contracts. The majority of vendors would be willing to provide such information during the Request for Proposals (RFP) phase or under a Non-Disclosure Agreement (NDA). For examples of the cost of different EHR systems, please see the CIO Consortiums EMR Cost Study Report. 3.3.1.4 Interoperability, Integration, Integration Engines and Certification Interoperability means that two disparate systems are able to communicate with one another to exchange data. To end users and many in the industry, interoperability means every product works togeth- LeadingAge Center for Aging Services Technologies (CAST)

17 er seamlessly. Unfortunately, this is an expectation that not even the most highly integrated suite of components in a product fully achieves yet. When modules or components are integrated, they generally have been built by the same group that did the original development and programming, have similar design characteristics, and most data are able to be exchanged. In general, the components or modules in highly integrated suites of products work well together, but will not work with any other vendor s product without specialized interfacing. Products with modules and components for different clinical and administrative needs may save considerable money in managing interfaces and is a very good strategy. However, you may find that these products do not offer what you need. EHR products that implement interoperability standards facilitate exchanging information between systems and make system integration easier. Moreover, such EHRs facilitate health information exchange with other care providers either directly, point-to-point, or via a regional or state-level health information exchange organization like Regional Health Information Organizations (RHIOs) and state Health Information Exchange (HIE) entities. When a single vendor system does not meet the required needs, the options are to acquire a complementary product that meets the more critical needs (e.g. an acute care EHR for clinical and health information exchange needs), wait because the state of affairs has been improving for the last several years and products that implement interoperability standards and certification are expected, or acquire a different product altogether and adopt one or more of the following strategies: Work with the vendors of the different components on integration and interoperability. Attempt to interface with other organizations for exchange of minimum essential information. Health care organizations that want to interface directly with another organization should also consider whether this is necessary or only desirable. The volume and type of data that actually needs to be exchanged between most organizations may not warrant full interfacing or integration, but merely the ability to gain access to view or retrieve print files. Use a secure portal to provide access to view information and in some cases to use one or more of the hospital s applications directly. Integration engines add flexibility to EHRs and assist with connecting data from various applications and typically non-integrated systems. The goal is for the interface to be user friendly and based on modern technology so that there is compatibility with smart phones, tablets and other mobile devices. Integration engines allow changing applications as needed and interfacing with telehealth monitors and other telemedicine devices. Integration engines can be either built into the EHR software or standalone. Integration engines have the capability to interface with data entry points that replicate to all other fields that require the information, obtain data from source applications, collect resident/client clinical data, accept non-standard data transmission (Excel, text, etc.), support Electronic Data Interchange 2013 EHR for Long-Term and Post-Acute Care: A Primer on Planning and Vendor Selection

18 (EDI) formats for exchanging data (ANSI X12) and identify, prioritize and escalate uncompleted tasks. Mapping functions allow the Integration engine to transform and filter data from source applications, route transactional data, filter user-defined demographic elements and generate standard Health Level 7 (HL7) transactions. Clinical analytics enable the development of clinical and business rules, tracking occupancy and utilization on a daily basis and generating reports automatically as well as making the data accessible without running the reports. External integration may include integration with eprescribing systems, lab orders and results, public health reporting, ereferrals (electronic referrals), and HIE as well as inventory management and other provider management information systems. Interoperability certification testing is important for EHR users, particularly for exchanging health information with other EHR systems, other providers and HIE organizations. The Certification Commission for Health Information Technology (CCHIT ) is a nonprofit 501(c)(3) organization with the public mission of accelerating the adoption of health IT. CCHIT is the only certification body that has a certification program dedicated for LTPAC EHRs; the program has certification criteria for EHRs for nursing homes as well as home health agencies. CCHIT Certified EHR certification is an independently developed, rigorous inspection of integrated EHR functionality, interoperability, and security. As part of the process, successful use is verified at live sites and product usability is rated. It is intended to serve providers looking for greater assurance that a product will meet their complex needs. Many CCHIT Certified products are also certified in the ONC-ATCB EHR certification program. The Office of the National Coordinator for Health Information Technology - Authorized Testing and Certification Bodies (ONC-ATCB), on the other hand, signifies to eligible professionals, hospitals, and critical access hospitals that an EHR technology has the capabilities necessary to support their efforts to meet the goals and objectives of Meaningful Use. ONC-ATCB certification inspection is limited to the Health and Human Services (HHS) criteria and standards. It is modular so the technology inspected may not meet all of the requirements. The Certification Facts label shares which of the criteria are met. Providers are responsible for assuring that certified EHR technology meets all of the requirements in order to demonstrate Meaningful Use and achieve incentives. No site verification or usability testing is done under this program. In this paper, we gathered information about interoperability standards implemented in the EHR products as well as whether these products are certified for interoperability by one of the bodies that certify interoperability of EHR products. Moreover, we identified EHRs that have integrated ancillary clinical, financial and human resources systems, EHR that are capable of integrating with third-party ancillary systems, as well as integration engines that facilitate integration between different information systems. Finally, we identified the certification status for EHRs included. For more information about Meaningful Use, applicability to LTPAC settings, and eligibility of LTPAC providers for Meaningful Use incentives, please see the following CAST FAQ Article. LeadingAge Center for Aging Services Technologies (CAST)

19 4 EHR Selection Matrix Components CAST s EHR workgroup, consisting of providers, vendors and consultants, compiled a list of EHR products that serve the LTPAC market, as well as a list of functionalities and capabilities that would help providers choose the EHR product that fits their business line and functional requirements best. Each of the EHR vendors was then provided the opportunity to complete a self-review of the workgroup s pre-determined questions. Some of these vendors chose not to participate. Those who did participate were then offered the opportunity to nominate a case study from a provider s perspective on the use of the vendor s EHR product. The EHR Selection Matrix includes the following information: Business Line/Care Applicability illustrates the various business lines to which the EHR software is applicable, including Home Health/Home Care, Hospice, Adult Day Care, Assisted Living, Acute Rehab Facilities, Long-term Acute Care Hospitals, Long-term Care Rehab Facilities, Skilled Nursing Facilities, Intermediate Care Facilities, ID/MR/DD Facilities, CCRCs and PACE. Provider Functional Requirements are the basic requirements that a user would look for in identifying an appropriate EHR. These include Resident/Client Demographics; Advance Directives; Resident/Client Medical History; Clinical Notes; Lists: Problems, Allergies, Medications; Resident/ Client Scheduling; Staff Scheduling; Census; Single Medical Record Support; Customizable Templates; Workflow Management/Next Step Prompts; and Reminders. Regulatory Assessments include Resident Assessment Instruments such as Minimum Data Set (MDS), Care Area Assessments (CAA), Outcome and Assessment Information Set (OASIS), In- Patient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI), Preadmission Assessment, Admission Assessment, Fall Assessment, Skin Assessment, Bowel and Bladder Assessment, Physical Restraint Assessment, Self-Administration of Medication, Nutrition Assessment, Activities/Recreation/Leisure Interest Assessment, Social Service Assessment, Mental and Psychosocial Functioning Assessment, Restorative/Rehab Nursing Assessment and Rehabilitation Services Assessment. There are also opportunities for vendors to share Customizable Assessments and to List Additional Assessments they offer. Medicare Documentation/Service Delivery Records are documentation records that include Skilled Nursing Charting, Therapy Charting, Supporting Documentation for the MDS, Therapy Treatment Time, ADL Charting, Mood and Behavior Documentation, Hospital Documentation, Medicare Certification/Recertification, Other Clinical Flow Records, Lab Orders, Lab Results, Radiology Orders, Radiology Results, Diagnostic Test Orders Other than Radiology and Labs, Diagnostic Test Results Other than Radiology and Labs, Public Health Reporting (e.g., Tuberculosis), Physician Documentation, Admission Orders and Physician Order Recaps/Renewals. Physician Progress Notes are specific documentation for clinicians include NP/PA Documentation, History and Physical, Other Professional and Consultation Records/Notes, Resident/Client Diagnoses, Physician Documentation, Final Progress Note/Discharge Note 2013 EHR for Long-Term and Post-Acute Care: A Primer on Planning and Vendor Selection

20 and Pharmacist Drug Review Capability. Drug Therapy involves the various options available from EHR vendors for tracking and administering medications include Evaluation of a Resident/Client s Signs and Symptoms, Frequency and Monitoring of the Medication, Dose Reduction Schedules and Documentation, emar, etar, Med Orders, Closed-Loop Medication Verification (the ability to cross check that medication was properly administered from start to finish, using bar code scanning for patients and medications at administration) and eprescribing - Bi-Directional. Consents, Acknowledgements and Notices including Informed Consent for Use of a Restraint, Consent, Notice and Authorization to Use/Release Clinical Records, Notice of Bed Hold Policy and Readmission, Notice of Legal Rights and Services, Notice Before Transfer, and Notice Prior to Change of Room or Roommate. Transitions of Care, Shared Care & Discharge Documents include Shareable Plan of Care (including Goals and Instructions), Summary Reports for Discharge, Transfers and Consults, Diagnostic Imaging Report (DIR), Operative Notes, Procedure Notes, Progress Notes, History and Physical Notes, Continuity of Care Document (CCD), Discharge Order, Discharge Note, Transfer Form and Physician s Discharge Summary vs. Discharge Record. This year we expanded the section on Clinical Decision Support Systems (CDSS) that link health observations with health knowledge to influence health choices by clinicians for improved health care. The Selection Matrix breaks out CDSS for Falls, Medication Management (Drug-Drug and Drug-Allergy Interactions), Pressure Ulcers, Inappropriate Hospitalization/Readmission, Reduction of Health Care-Acquired Infections, Interventions to Reduce Inappropriate Hospital Admission and Acute Care Transfers Tool, and Other CDSS Systems. Next, the EHR Selection Matrix goes into Provider Non-Functional Requirements beginning with Interfacing, Integration and Add-ons that provide the ability to integrate or add on systems to the functionality of the EHR including Telehealth/ Telemonitoring Technologies, Wellness Monitoring Technologies, Safety Monitoring Technologies, Medication Self-Adherence (Individual Med. Dispenser). Integration Engine functionality, whether an EHR is a Fully Integrated System that includes Financial, Ancillary Clinical Systems, and Human Resource Management or has a modular system with a) Financial (Billing/AR/AP/General Ledger, etc.), b) Human Resources Management (Scheduling, Time and Attendance, Payroll), c) Third party Ancillary Clinical Systems (Pharmacy, Labs, Radiology etc.) and/or d) Other Management Software/Systems. This year, we also asked vendors the following question: Does the EHR Require Third-Party Software/Interfaces for any Functionality Checked? and asked them to list Third-Party Software/Interfaces Required for Checked Functionalities. The EHR s ability to provide Multiple Site Integration and Dashboard Views was moved to the end of this section. Supportability allows providers to understand what sort of support the EHR system offers around 24-Hour Support-Phone, Limited Hours Support- Phone, 24-Hour Support-Web, Limited Hours Support-Web, Email Support, Listserv and/or Usergroup, Onsite Training, or Other forms of support. Interoperability is the ability of applications to exchange data with other applications. These include LeadingAge Center for Aging Services Technologies (CAST)

21 Send via Fax (Interim Interoperability), Receive via Fax (Interim Interoperability), Send/Receive via ONC s DIRECT Project (Interim Interoperability), Direct Provider-Provider Transfer of Care, Direct Provider-Provider Shared Care/Care Coordination, Provider-Consumer/Consumer-Provider, Health Information Exchange (HIE)/Regional Health Information Exchange (RHIO), eprescribing and Medication Management, Intra-Provider System Interoperability, Interoperability/Health Information Exchange - Non-Standards-Based, Hybrid and Standards-Based, Exporting to PHR and/or Resident/Client Portal (e.g. Human-Readable Blue Button), Interface with Hospital/Discharge System, Interface to Consultant Pharmacy Systems, ability for the EHR Product to Exchange Data as Codes, Freeform Text or Both. Interoperability Standards Implemented include ISO5 Consumer Empowerment and Access to Clinical Information via Portable Media Version 1, ISO6 Quality Version 1, NCPDP 10.6 or Higher, HL7 CCD, HL7 CDA, HL7 Consolidated CDA, HL7 CDA Personal Health Monitoring Report, HL7 CDA Framework for Functional Assessment Questionnaire, Other HL7 Standards, Blue Button - Machine Readable, ICD-9/ICD-10 Diagnosis and Procedures, LOINC - Laboratory and Clinical results, HCPCS/CPT - Ancillary Services, Procedures and Modifiers, NDC- Medications (Manufacturers), RxNorm - Medications (Ordering), UNII - Allergies and Adverse Reactions, SNOMED CT - Reference Terminology for Clinical Data or Other Standards. ONC-ATCB certification status is enhanced with links to provide verification as well as information about the certified modules, and the CCHIT / LT- PAC certification types (Home Health and Skilled Nursing) were also clarified this year as well as verified with links. Hardware and Software Requirements include Desktop/Laptop Specifications, Operating System compatibility, Mobile Support, Network Specifications, Wireless Specifications, Browser Based Requirements, Internet/Bandwidth Specifications, Miscellaneous Software/Applets Needed (i.e. Citrix), Miscellaneous Reporting Specifications (i.e. Crystal Reports), Scalability, Local Model, Hosted Model, Software as a Service Model (SaaS), Remote Access, Off-Line Functionality (Functions During Internet Outage for Hosted and SaaS Models) and Ability to Store/Handle Attachments (Insurance card, Historical Notes, etc.). Legal/Regulatory/Cyberliability requirements include the capability to generate an acceptable representation of a legal health record, intellectual property rights, adherence to telecommunication requirements, and other features. This is a requirement of critical interest to health care organizations. The system must be able to support upgrades to any required data collection process, rules for regulatory review, and new code sets as they may become mandated (such as ICD-10-CM). Company s Experience and Viability includes Number of Years in Business, Release Date of Current Version, Number of Facility/Site/Agency Installations and Core Customer Base, Focus of Line of Business. Strengths, Areas for Improvement, Ongoing Development and References also provide Links to Additional Case Studies. 2013 EHR for Long-Term and Post-Acute Care: A Primer on Planning and Vendor Selection

22 5 Acknowledgements We would like to thank Stratis Health for their original work on the toolkits. We also would like to thank Jennifer Lundblad, CEO, Stratis Health; Dr. Paul Kleeberg, CMIO, Stratis Health; Stratis Health Nursing Home team; tool builders; and their HIT consultants for completing a review of the 2012 version of this paper. 5.1 EHR Workgroup Majd Alwan, LeadingAge CAST Bob Bardach, Jewish Home at Rockleigh John Becker, Baptist Retirement Homes of North Carolina Eva Bering, Landis Homes B.J. Boyle, Cerner Extended Care Paul Burnstein, LeadingAge CAST Brandon Busch, St. Paul s Peter Carcia, Renaissance Technology Consultants Group Jennifer Clement, American Healthtech Jenny Copeland, BridgeGate Jennifer D Angelo, Christian Health Care Center Robert Davis, Optimus EMR, Inc. Audrey DeFeo, Jewish Geriatric Services, Inc. Dusanka Delovska-Trajkova, Ingleside at King Farm Doc Devore, AOD Software Brian Dimit, PointClickCare David Dring, Selfhelp Community Services, Inc. Celma Dumaguing, Providence Rest Syed Faisal, Miami Jewish Health Systems Josephine Felicilda, Providence Rest Kristina George, SigmaCare Michael Gillmer, Moravian Hall Square Colleen Goodwin, Goodwin House Bailey s Crossroads Craig Griffin, Optimus EMR, Inc. Doron Gutkind, Lintech Bob Hendrix, Episcopal Senior Communities Fran Hinckley, Hebrew SeniorLife Linda Jansen, Shell Point Retirement Community Linda Kleinfeld, Health Care Software, Inc. Rick Mallia, Francis E. Parker Memorial Home Travis Masonis, Jewish Senior Life John Mastronardi, Morningside House Carrie McGlaughlin, Ohio Presbyterian Retirement Services Lori Meyer, Aging Services of Minnesota Tom Mottl, Renaissance Technology Consultants Group Carrie O Connell, Health Care Software, Inc. John Passe, Jennings Center for Older Adults Vannia Posada, Morningside House Webster Roth, Kansas Veterans Home Zane Schott, BridgeGate International Lynne Seligman, Workflow Analytics Darrell Shreve, Aging Services of Minnesota Bill Southerland, Yardi/ALMSA Kevin, Stagg, Christian Health Care Center Nancy Stoddard, Jewish Home Lifecare Sunghee Tak, University of Memphis LeadingAge Center for Aging Services Technologies (CAST)

23 Anne Veno, Episcopal Church Home Billy Waldrop, BridgeGate International Kristal Wood, PointClickCare Scott Zacks, Medical Business Solutions 5.2 Participating EHR Vendors 6N Systems, Rob Mikulec ADS Data Systems, Beth Scovill American Data, John E. Eder American HealthTech, Jennifer Clement Americana Corp., Brian Hood Answers on Demand (AOD), Doc Devore BlueStep, Roy Rasband BridgeGate International, Jenny Copeland CareVoyant, Inc., Rob Love, Steve Salazar Catalyst Healthcare, Ltd., Mark Tompkins, Kasumi Oda Cerner Extended Care, B.J. Boyle, Chris Hare Extended Care Professional, Joel Moyer Galaxy Hosted Software, LLC, Mike Rosenberg, Nick D Angelo Health Care Software, Thomas Fahey, Linda S. Kleinfeld HealthMEDX, Gerry McCarthy Hi-Tech Software Solutions, Lynne Hammond LINTECH, Doron Gutkind MDI Achieve, Louis Lenzmeier, Ben Malakoff, Yuliya Pruzhanskaya Melyx Corporation, Rick Johnston, Mitch Manoski Microsolutions (Eldersuite), Vince Cotton Momentum Healthware, Matthew Mullins, Rod Kamins New Tech Computer System, Shawn Rourke NextGen Healthcare, Tom Farmer, Catie Lawrence NTT DATA, Robert Skinner, Kim Allen, Susan Dryden Optimus EMR, Inc., Bob Davis, Craig Griffin PointClickCare, Heath Odom, Brian Dimit, Kristal Wood Procura, Ashley Peeters Progresa Health Systems, Ashley Peeters Reliable Health Systems, LLC, Steven Rapps ResCare, LLC, Judy Younger Saunders Associates, Marie Saunders, RN BC, BSN, Lori Schwab SigmaCare, Greg Anderson, Rick Hammer SOS Corp., Joshua Shupp Suncoast Solutions, Teresa Craig, Donnette Threats Yardi/ALMSA, Bill Southerland, Sharon Ashcraft 2013 EHR for Long-Term and Post-Acute Care: A Primer on Planning and Vendor Selection

24 6 Appendix 6.1 Stratis Health - Toolkit for Home Health Agencies http://www.stratishealth.org/expertise/healthit/homehealth/hhtoolkit.html 6.2 Stratis Health - Toolkit for Nursing Homes http://www.stratishealth.org/expertise/healthit/nursinghomes/nhtoolkit.html LeadingAge Center for Aging Services Technologies (CAST)

6.3 EHR Selection Matrix 2013 EHR Selection Matrix Disclaimer The information included in this paper is meant to assist in the understanding and selection of Electronic Health Record (EHR) systems. A few vendors elected not to participate. Functionalities and capabilities of listed EHR products are as reported by the vendors and have not been verified, tested, independently evaluated or endorsed by LeadingAge or LeadingAge CAST. Products mentioned in this paper serve as illustrative examples. Please use this as a general guideline in understanding functionalities and examples of current EHR systems. The EHR Selection Matrix may help providers identify potential EHR solutions that may meet their requirements, and is intended to help them target vendors to whom to submit a Request for Proposal (RFP). Where appropriate, provider case studies have been identified and published separately. However, providers are strongly advised to verify functionalities of the EHRs prior to final selection through demonstrations, site visits, reference checking and other due diligence. 25

Business Line/Care Applicability Home Health/Home Care Hospice Adult Day Care Assisted Living Acute Rehab Facilities Long-term Acute Care Hospitals Long-term Care Rehab Facilities Skilled Nursing Facilities Intermediate Care Facilities Intellectual Disabilities/ Mental Retardation/ Developmental Disabilities (ID/MR/DD) Facilities Continuing Care Retirement Communities (CCRC) Program of All-Inclusive Care for the Elderly (PACE) 6N Systems www.6nsystems.com ADS Data Systems www.adsdatasystems.com American Data www.american-data.com American HealthTech www.healthtech.net Americana Corp's AmeraCare System www.ameracaresystem.com AOD - Answers Certified EHR www.aodsoftware.com BlueStep Systems, LLC www.bluestep.net BridgeGate International www.bridgegateintl.com CareVoyant www.carevoyant.com Catalyst Healthcare, Ltd www.catalystrms.com Cerner - Millennium www.cerner.com ElderSuite www.eldersuite.com Extended Care Professional www.ecp123.com Galaxy Hosted Software www.galaxyhosted.com Health Care Software, Inc. (HCS) INTERACTANT www.hcsinteractant.com HealthMEDX www.healthmedx.com Hi-Tech Software Solutions www.hi-techsoftware.com LINTECH www.lintechsoftware.com MDI Achieve - MatrixCare www.mdiachieve.com No No Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes No Yes Yes No No No No No Yes Yes No Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes No No Yes Yes No Yes Yes Yes Yes Yes Yes No No Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes No Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No Yes No No No No No No No No No Yes Yes Yes Yes No No No Yes Yes Yes Yes No No No No Yes No No Yes Yes Yes No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes No No Yes Yes Yes No Yes No

Business Line/Care Applicability Home Health/Home Care Hospice Adult Day Care Assisted Living Acute Rehab Facilities Long-term Acute Care Hospitals Long-term Care Rehab Facilities Skilled Nursing Facilities Intermediate Care Facilities Intellectual Disabilities/ Mental Retardation/ Developmental Disabilities (ID/MR/DD) Facilities Continuing Care Retirement Communities (CCRC) Program of All-Inclusive Care for the Elderly (PACE) MelyxPro www.melyx.com Momentum Healthware, Inc. www.momentumhealthware.com New Tech Computer Systems - PioneerACMS www.newtechsys.com NextGen Ambulatory EHR NextGen Inpatient Clinicals NTT DATA www.nttdataltc.com Optimus EMR www.optimusemr.com PointClickCare www.pointclickcare.com Procura Health Management Systems www.goprocura.com Progresa Health Systems www.progresahealthsystems.com Reliable Health Systems www.reliablehealth.com ResCare, LLC www.rescaresoftware.com Saunders Associates SAEnCompass www.saencompass.com SigmaCare www.sigmacare.com SOS Corporation www.sosc.com Suncoast Solutions www.sncoast.com Yardi/ALMSA www.almsahealth.com No No No Yes No Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes No No Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No No Yes No No No No Yes No No Yes No No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes Yes No No No Yes Yes Yes Yes Yes Yes Yes No Yes No Yes Yes No Yes No No No Yes No No Yes Yes Yes Yes No No No No No Yes No No No No No No No No No Yes Yes Yes No No No No No Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes No No Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes No Yes No Yes Yes Yes No No No No Yes No No Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes No

Provider Functional Requirements List Resident/Client Demographics Advance Directives Resident/Client Medical History Clinical Notes Lists: Problems Lists: Allergies Lists: Medications Resident/Client Scheduling Staff Scheduling Census Single Medical Record Support Customizable Templates Workflow Management/ Next Step Prompts and Reminders 6N Systems www.6nsystems.com ADS Data Systems www.adsdatasystems.com American Data www.american-data.com American HealthTech www.healthtech.net Americana Corp's AmeraCare System www.ameracaresystem.com AOD - Answers Certified EHR www.aodsoftware.com BlueStep Systems, LLC www.bluestep.net BridgeGate International www.bridgegateintl.com CareVoyant www.carevoyant.com Catalyst Healthcare, Ltd www.catalystrms.com Cerner - Millennium www.cerner.com ElderSuite www.eldersuite.com Extended Care Professional www.ecp123.com Galaxy Hosted Software www.galaxyhosted.com Health Care Software, Inc. (HCS) INTERACTANT www.hcsinteractant.com HealthMEDX www.healthmedx.com Hi-Tech Software Solutions www.hi-techsoftware.com LINTECH www.lintechsoftware.com MDI Achieve - MatrixCare www.mdiachieve.com Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No Yes Yes Yes No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Provider Functional Requirements List Resident/Client Demographics Advance Directives Resident/Client Medical History Clinical Notes Lists: Problems Lists: Allergies Lists: Medications Resident/Client Scheduling Staff Scheduling Census Single Medical Record Support Customizable Templates Workflow Management/ Next Step Prompts and Reminders MelyxPro www.melyx.com Momentum Healthware, Inc. www.momentumhealthware.com New Tech Computer Systems - PioneerACMS www.newtechsys.com NextGen Ambulatory EHR NextGen Inpatient Clinicals NTT DATA www.nttdataltc.com Optimus EMR www.optimusemr.com PointClickCare www.pointclickcare.com Procura Health Management Systems www.goprocura.com Progresa Health Systems www.progresahealthsystems.com Reliable Health Systems www.reliablehealth.com ResCare, LLC www.rescaresoftware.com Saunders Associates SAEnCompass www.saencompass.com SigmaCare www.sigmacare.com SOS Corporation www.sosc.com Suncoast Solutions www.sncoast.com Yardi/ALMSA www.almsahealth.com Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Regulatory Assessments Resident Assessment Instrument - Minimum Data Set (MDS) Resident Assessment Instrument - Care Area Assessments (CAA) Resident Assessment Instrument - Outcome and Assessment Information Set (OASIS) Resident Assessment Instrument - In-Patient Rehabilitation Facility- Patient Assessment Instrument (IRF-PAI) Preadmission Assessment Admission Assessment Fall Assessment Skin Assessment Bowel and Bladder Assessment Physical Restraint Assessment Self-Administration of Medication Assessment Nutrition Assessment Activities/Recreation/ Leisure Interest Assessment Social Service Assessment Mental and Psychosocial Functioning Assessment Restorative/Rehab Nursing Assessment Rehabilitation Services Assessment 6N Systems www.6nsystems.com ADS Data Systems www.adsdatasystems.com American Data www.american-data.com American HealthTech www.healthtech.net Americana Corp's AmeraCare System www.ameracaresystem.com AOD - Answers Certified EHR www.aodsoftware.com BlueStep Systems, LLC www.bluestep.net BridgeGate International www.bridgegateintl.com CareVoyant www.carevoyant.com Catalyst Healthcare, Ltd www.catalystrms.com Cerner - Millennium www.cerner.com ElderSuite www.eldersuite.com Extended Care Professional www.ecp123.com Galaxy Hosted Software www.galaxyhosted.com Health Care Software, Inc. (HCS) INTERACTANT www.hcsinteractant.com HealthMEDX www.healthmedx.com Hi-Tech Software Solutions www.hi-techsoftware.com LINTECH www.lintechsoftware.com MDI Achieve - MatrixCare www.mdiachieve.com Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Regulatory Assessments Resident Assessment Instrument - Minimum Data Set (MDS) Resident Assessment Instrument - Care Area Assessments (CAA) Resident Assessment Instrument - Outcome and Assessment Information Set (OASIS) Resident Assessment Instrument - In-Patient Rehabilitation Facility- Patient Assessment Instrument (IRF-PAI) Preadmission Assessment Admission Assessment Fall Assessment Skin Assessment Bowel and Bladder Assessment Physical Restraint Assessment Self-Administration of Medication Assessment Nutrition Assessment Activities/Recreation/Leisure Interest Assessment Social Service Assessment Mental and Psychosocial Functioning Assessment Restorative/Rehab Nursing Assessment Rehabilitation Services Assessment MelyxPro www.melyx.com Momentum Healthware, Inc. www.momentumhealthware.com New Tech Computer Systems - PioneerACMS www.newtechsys.com NextGen Ambulatory EHR NextGen Inpatient Clinicals NTT DATA www.nttdataltc.com Optimus EMR www.optimusemr.com PointClickCare www.pointclickcare.com Procura Health Management Systems www.goprocura.com Progresa Health Systems www.progresahealthsystems.com Reliable Health Systems www.reliablehealth.com ResCare, LLC www.rescaresoftware.com Saunders Associates SAEnCompass www.saencompass.com SigmaCare www.sigmacare.com SOS Corporation www.sosc.com Suncoast Solutions www.sncoast.com Yardi/ALMSA www.almsahealth.com Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes No Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No

Additional Assessments 6N Systems www.6nsystems.com ADS Data Systems www.adsdatasystems.com American Data www.american-data.com American HealthTech www.healthtech.net Customizable Assessments No Library of over 100 interdisiplinary assessments. Yes Assessment tools can easily be customized. Several assessment tools already exist. Yes Library of over 300 interdisiplinary assessments. Yes Any desired assessment can be created. List Additional Assessments Americana Corp's AmeraCare System www.ameracaresystem.com AOD - Answers Certified EHR www.aodsoftware.com BlueStep Systems, LLC www.bluestep.net BridgeGate International www.bridgegateintl.com Yes Users can develop their own assessment forms and reports and select from a library by categories. Yes Users can develop their own assessment forms or import assessments from a library. Yes Provides for complete customizable assessments, forms and reports. Yes Continuity of Care Document containing standard assessment, administered medication, laboratory, radiology, therapy, dietary & custom. CareVoyant www.carevoyant.com Yes Standard library of over 100 interdisciplinary assessments. User Defined Assessment Tool enables providers to create custom forms/assessments. Assessments include auto-populated fields, scoring systems, skip logic, integration with care planning Catalyst Healthcare, Ltd www.catalystrms.com Cerner - Millennium www.cerner.com ElderSuite www.eldersuite.com Extended Care Professional www.ecp123.com Galaxy Hosted Software www.galaxyhosted.com Yes User Defined Assessment Tool enabling clinicicans to create customized assessments. Yes A robust clinical evaluation catalog including LTC specific documentation. Also the ability to design custom forms through a tool or for fee for service. No All assessments required for licensing in Texas for Day Activity Health Services (DAHS/Adult Day Care). Yes Any existing assessment can easily be added by user and linked to related care plan templates to automatically modify care plan and scheduled tasks. Yes Large library of assessments updated regularly plus an Assessment Tool enabling clinicicans to create customized assessments. Health Care Software, Inc. (HCS) INTERACTANT www.hcsinteractant.com Yes Abnormal involuntary movement, alcoholism screening, dehydration risk assessment, geriatric depression scale, education record, elopement risk assessment, enteral feeding assessment, pain assessment, respiratory assessment, side rail assessment, wandering risk assessment, ventilator assessment, wandering risk assessment. HealthMEDX www.healthmedx.com Hi-Tech Software Solutions www.hi-techsoftware.com LINTECH www.lintechsoftware.com Yes Library included plus a toolset for customization and development Yes The library of clinical assessments is open to authorized users. Users can edit exisiting assessments or create new ones. Yes User Defined Assessment Tool enabling creation of customized assessments MDI Achieve - MatrixCare www.mdiachieve.com Yes Library of over 100 interdisciplinary templates used across the industry based on the Resident Assessment Instrument process, TNA, AMDA, NADA and other clinical resources. All templates can be used as is or customized. MDS questions can be pulled into templates and responses are shared across the record.

Additional Assessments MelyxPro www.melyx.com Momentum Healthware, Inc. www.momentumhealthware.com Customizable Assessments Yes User Defined Assessment Tool enabling clinicicans to create customized assessments. Yes Complete library of interdisiplinary assessments. List Additional Assessments New Tech Computer Systems - PioneerACMS www.newtechsys.com NextGen Ambulatory EHR NextGen Inpatient Clinicals NTT DATA www.nttdataltc.com Optimus EMR www.optimusemr.com PointClickCare www.pointclickcare.com Procura Health Management Systems www.goprocura.com Progresa Health Systems www.progresahealthsystems.com Reliable Health Systems www.reliablehealth.com ResCare, LLC www.rescaresoftware.com Saunders Associates SAEnCompass www.saencompass.com SigmaCare www.sigmacare.com SOS Corporation www.sosc.com Suncoast Solutions www.sncoast.com Yardi/ALMSA www.almsahealth.com Yes User Defined Assessment allow users to build facility unique assessments accessible anywhere in the application. Yes User may modify templates Yes Facility staff will need to particpate in a product-specific class in order to use the forms builder tool. Yes User Defined Assessment software with library of templates and tools to create custom assessments. Yes Structured Assessments for every type of assessment used in LTPAC. In addition, user may add text to the existing assessment. Yes More than 30 templates available in content libraries. Yes Library of over 100 integrated interdisciplinary assessments and flowsheets. User Defined Assessment Tool enabling clinicians to create customized assessments. Yes Library of over 100 integrated interdisciplinary assessments. User Defined Assessment Tool enabling clinicians to create customized assessments. Yes Ability to custom create any type of assessments. Yes Library of 75+ interdisiplinary assessments and screens in addition to multiple flow sheets, as well as the ability to create customized care plan library. Yes Library of assessments. Will create custom assessments at user request. Yes Library of standard assessments (IDT, nursing, medical, social services, dietary, therapy, etc.) and ability to customize or build assessments using User Defined Assessment Tool. Yes User Defined Assessment Tool enabling clinicicans to create customized assessments. Yes Library of over 350 interdisciplinary assessments and customizable care plans. Yes User Defined Assessment Tool enabling clinicicans to create customized assessments.

Medicare Documentation/ Service Delivery Records Skilled Nursing Charting Therapy Charting Supporting Documentation for the MDS Therapy Treatment Time ADL Charting Mood and Behavior Documentation Hospital Documentation Medicare Certification/ Recertification Other Clinical Flow Records (Please List) Lab Orders Lab Results Radiology Orders Radiology Results Diagnostic Test Orders Other than Radiology and Labs Diagnostic test results Other than Radiology and Labs Public Health Reporting (e.g., Tuberculosis) Admission Orders Physician Order Recaps/Renewals 6N Systems www.6nsystems.com ADS Data Systems www.adsdatasystems.com American Data www.american-data.com American HealthTech www.healthtech.net Americana Corp's AmeraCare System www.ameracaresystem.com AOD - Answers Certified EHR www.aodsoftware.com BlueStep Systems, LLC www.bluestep.net BridgeGate International www.bridgegateintl.com CareVoyant www.carevoyant.com Catalyst Healthcare, Ltd www.catalystrms.com Cerner - Millennium www.cerner.com ElderSuite www.eldersuite.com Extended Care Professional www.ecp123.com Galaxy Hosted Software www.galaxyhosted.com Health Care Software, Inc. (HCS) INTERACTANT www.hcsinteractant.com HealthMEDX www.healthmedx.com Hi-Tech Software Solutions www.hi-techsoftware.com LINTECH www.lintechsoftware.com MDI Achieve - MatrixCare www.mdiachieve.com Yes Yes Yes Yes Yes Yes Yes No Yes; Library of over 100 forms Yes Yes Yes No Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes; BIMS, Aspiration Risk, Pain Scale, Advanced Dementia Pain Scale, Depression Scale, Diabetes Health Management, CHF, Asthma/COPD, Seizure management Yes; Library of over 300 interdisciplinary assessments Yes; Huge online library plus ability to create any user-defined assessment No No No No No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes; Unlimited user- defined assessments Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes; User Defined Forms have unlimited possibilities Yes; User Defined Forms have unlimited possibilities Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No Yes Yes Yes Yes Yes Yes No No No Yes Yes Yes Yes Yes Yes No Yes Yes; Library of over 100 interdisciplinary assessments and ability to track days Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes; Activities of Daily Living Yes Yes Yes No Yes No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes; Ability to customize forms, rules, and Clinical Decision Support Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes No Yes Yes No No No No No No No No No Yes Yes Yes No No Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes; emar, follow-ups, any task can be charted Yes; Care Plan libraries, flow sheets, assessments and user definables Yes; Flow sheets including wound, pain, pressure, ulcer, restraint, respiratory, restorative, and ventilator Yes; 3 Care Plan libraries with more than 150 standard forms. No No No No No No No No Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes; Other LTC charting No No No No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes; Activities, Skin, Snack Intake, Family provided care, Oxygen, Blood Glucose, Infections, Wound Care, Coumadin, Disclosures Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes; User definable Yes Yes Yes Yes No Yes No Yes Yes

Medicare Documentation/ Service Delivery Records Skilled Nursing Charting Therapy Charting Supporting Documentation for the MDS Therapy Treatment Time ADL Charting Mood and Behavior Documentation Hospital Documentation Medicare Certification/ Recertification Other Clinical Flow Records (Please List) Lab Orders Lab Results Radiology Orders Radiology Results Diagnostic Test Orders Other than Radiology and Labs Diagnostic test results Other than Radiology and Labs Public Health Reporting (e.g., Tuberculosis) Admission Orders Physician Order Recaps/Renewals MelyxPro www.melyx.com Momentum Healthware, Inc. www.momentumhealthware.com New Tech Computer Systems - PioneerACMS www.newtechsys.com NextGen Ambulatory EHR NextGen Inpatient Clinicals NTT DATA www.nttdataltc.com Optimus EMR www.optimusemr.com PointClickCare www.pointclickcare.com Procura Health Management Systems www.goprocura.com Progresa Health Systems www.progresahealthsystems.com Reliable Health Systems www.reliablehealth.com ResCare, LLC www.rescaresoftware.com Saunders Associates SAEnCompass www.saencompass.com SigmaCare www.sigmacare.com SOS Corporation www.sosc.com Suncoast Solutions www.sncoast.com Yardi/ALMSA www.almsahealth.com Yes Yes Yes Yes Yes Yes No No Yes; CAA flow for problems etc. No Yes No Yes No Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes; Library of approximately 50+ forms that can be used as-is or modified, plus the ability to create user-defined assessments Yes; Library of over 40 clinical and interdisciplinary assessments Yes Yes Yes No Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes No Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes; Library of over 200 clinical and interdisciplanary assessments and flowsheets Yes; Resorative Flowsheets, Behavioral Flowsheets, User-Defined Flowsheets Yes; Many interdisplinary assessments and clinical pathways with check box progress notes based on specific diseases or conditions Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes; User definable through several modules Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes No Yes Yes; Library of over 100 integrated interdisciplinary assessments and flowsheets. User Defined Assessment Tool enabling clinicians to create customized assessments. Yes; Library of over 100 integrated interdisciplinary assessments. User Defined Assessment Tool enabling clinicians to create customized assessments. Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes No No Yes; Comprehensive Library Yes Yes Yes No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes; Blood Glucose, Pain, Behavior, Anticoagualant, Immunizations, Functional Maintenance Program, Vitals, Weight Mgmt, Bowel/Bladder, Bath, Meals/Snacks, I&O, Neuro, plus numerous additional flow records Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes; Ability to track days Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes; Assessment and CNA Documentation to the MDS, PT/INR values, and all clinical monitoring values Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes; Customizable interdisciplinary assessments Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes No Yes Yes; Library of over 300 interdisciplinary assessments No Yes No Yes No Yes No Yes Yes Yes Yes Yes Yes Yes Yes No No Yes; Ability to track days Yes Yes Yes Yes Yes Yes No No No

Final Progress Note/ Discharge Note Pharmacist Drug Review Capability Physician Progress Notes and Other Documentation NP/PA Documentation History and Physical Other Professional and Consultation Records/ Notes Resident/Client Diagnoses Physician Documentation 6N Systems www.6nsystems.com ADS Data Systems www.adsdatasystems.com American Data www.american-data.com American HealthTech www.healthtech.net Americana Corp's AmeraCare System www.ameracaresystem.com AOD - Answers Certified EHR www.aodsoftware.com BlueStep Systems, LLC www.bluestep.net BridgeGate International www.bridgegateintl.com CareVoyant www.carevoyant.com Catalyst Healthcare, Ltd www.catalystrms.com Cerner - Millennium www.cerner.com ElderSuite www.eldersuite.com Extended Care Professional www.ecp123.com Galaxy Hosted Software www.galaxyhosted.com Health Care Software, Inc. (HCS) INTERACTANT www.hcsinteractant.com HealthMEDX www.healthmedx.com Hi-Tech Software Solutions www.hi-techsoftware.com LINTECH www.lintechsoftware.com MDI Achieve - MatrixCare www.mdiachieve.com Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Final Progress Note/ Discharge Note Pharmacist Drug Review Capability Physician Progress Notes and Other Documentation NP/PA Documentation History and Physical Other Professional and Consultation Records/ Notes Resident/Client Diagnoses Physician Documentation MelyxPro www.melyx.com Momentum Healthware, Inc. www.momentumhealthware.com New Tech Computer Systems - PioneerACMS www.newtechsys.com NextGen Ambulatory EHR NextGen Inpatient Clinicals NTT DATA www.nttdataltc.com Optimus EMR www.optimusemr.com PointClickCare www.pointclickcare.com Procura Health Management Systems www.goprocura.com Progresa Health Systems www.progresahealthsystems.com Reliable Health Systems www.reliablehealth.com ResCare, LLC www.rescaresoftware.com Saunders Associates SAEnCompass www.saencompass.com SigmaCare www.sigmacare.com SOS Corporation www.sosc.com Suncoast Solutions www.sncoast.com Yardi/ALMSA www.almsahealth.com Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

eprescribing- Bi-Directional Medication Adherence/ Dispensers Drug Therapy Evaluation of a Resident/Client s Signs and Symptoms Frequency and Monitoring of the Medication Dose Reduction Schedules and Documentation emar etar (SNF, AL, CCRCs) Med Orders Closed-Loop Medication Verification 6N Systems www.6nsystems.com ADS Data Systems www.adsdatasystems.com American Data www.american-data.com American HealthTech www.healthtech.net Americana Corp's AmeraCare System www.ameracaresystem.com AOD - Answers Certified EHR www.aodsoftware.com BlueStep Systems, LLC www.bluestep.net BridgeGate International www.bridgegateintl.com CareVoyant www.carevoyant.com Catalyst Healthcare, Ltd www.catalystrms.com Cerner - Millennium www.cerner.com ElderSuite www.eldersuite.com Extended Care Professional www.ecp123.com Galaxy Hosted Software www.galaxyhosted.com Health Care Software, Inc. (HCS) INTERACTANT www.hcsinteractant.com HealthMEDX www.healthmedx.com Hi-Tech Software Solutions www.hi-techsoftware.com LINTECH www.lintechsoftware.com MDI Achieve - MatrixCare www.mdiachieve.com Yes Yes No Yes Yes Yes Yes Yes No No No No Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes Yes Yes No Yes No Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

eprescribing- Bi-Directional Medication Adherence/ Dispensers Drug Therapy Evaluation of a Resident/ Client s Signs and Symptoms Frequency and Monitoring of the Medication Dose Reduction Schedules and Documentation emar etar (SNF, AL, CCRCs) Med Orders Closed-Loop Medication Verification MelyxPro www.melyx.com Momentum Healthware, Inc. www.momentumhealthware.com New Tech Computer Systems - PioneerACMS www.newtechsys.com NextGen Ambulatory EHR NextGen Inpatient Clinicals NTT DATA www.nttdataltc.com Optimus EMR www.optimusemr.com PointClickCare www.pointclickcare.com Procura Health Management Systems www.goprocura.com Progresa Health Systems www.progresahealthsystems.com Reliable Health Systems www.reliablehealth.com ResCare, LLC www.rescaresoftware.com Saunders Associates SAEnCompass www.saencompass.com SigmaCare www.sigmacare.com SOS Corporation www.sosc.com Suncoast Solutions www.sncoast.com Yardi/ALMSA www.almsahealth.com Yes Yes No Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes No Yes Yes Yes Yes No Yes No Yes Yes Yes Yes Yes Yes No Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes No No No No Yes Yes Yes No Yes No No No No No No Yes No Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes No Yes No Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes

Notice Prior to Change of Room or Roommate Notice Prior to Change of Room or Roommate Consents, Acknowledgements and Notices Consent, Notice and Authorization to Use/Release Clinical Records Notice of Bed Hold Policy and Readmission Notice of Legal Rights and Services Notice Before Transfer 6N Systems www.6nsystems.com ADS Data Systems www.adsdatasystems.com American Data www.american-data.com American HealthTech www.healthtech.net Americana Corp's AmeraCare System www.ameracaresystem.com AOD - Answers Certified EHR www.aodsoftware.com BlueStep Systems, LLC www.bluestep.net BridgeGate International www.bridgegateintl.com CareVoyant www.carevoyant.com Catalyst Healthcare, Ltd www.catalystrms.com Cerner - Millennium www.cerner.com ElderSuite www.eldersuite.com Extended Care Professional www.ecp123.com Galaxy Hosted Software www.galaxyhosted.com Health Care Software, Inc. (HCS) INTERACTANT www.hcsinteractant.com HealthMEDX www.healthmedx.com Hi-Tech Software Solutions www.hi-techsoftware.com LINTECH www.lintechsoftware.com MDI Achieve - MatrixCare www.mdiachieve.com No No No No No No No No No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes Yes Yes No Yes No No No No Yes Yes Yes Yes Yes Yes No No No Yes No No No No No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Notice Prior to Change of Room or Roommate Notice Prior to Change of Room or Roommate Consents, Acknowledgements and Notices Consent, Notice and Authorization to Use/Release Clinical Records Notice of Bed Hold Policy and Readmission Notice of Legal Rights and Services Notice Before Transfer MelyxPro www.melyx.com Momentum Healthware, Inc. www.momentumhealthware.com New Tech Computer Systems - PioneerACMS www.newtechsys.com NextGen Ambulatory EHR NextGen Inpatient Clinicals NTT DATA www.nttdataltc.com Optimus EMR www.optimusemr.com PointClickCare www.pointclickcare.com Procura Health Management Systems www.goprocura.com Progresa Health Systems www.progresahealthsystems.com Reliable Health Systems www.reliablehealth.com ResCare, LLC www.rescaresoftware.com Saunders Associates SAEnCompass www.saencompass.com SigmaCare www.sigmacare.com SOS Corporation www.sosc.com Suncoast Solutions www.sncoast.com Yardi/ALMSA www.almsahealth.com Yes Yes Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes Yes Yes Yes Yes No Yes No No No Yes No Yes No No Yes Yes Yes Yes Yes Yes Yes Yes No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes Yes Yes

Transitions of Care, Shared Care Documents & Discharge Documents Shareable Plan of Care (including Goals and Instructions) Summary Report - Discharge Summary Report - Transfer Summary Report - Consults Diagnostic Imaging Report (DIR) Operative Notes Procedure Notes Progress Notes History and Physical Notes Continuity of Care Document (CCD) Discharge Order Discharge Note Transfer Form Physician s Discharge Summary vs. Discharge Record 6N Systems www.6nsystems.com ADS Data Systems www.adsdatasystems.com American Data www.american-data.com American HealthTech www.healthtech.net Americana Corp's AmeraCare System www.ameracaresystem.com AOD - Answers Certified EHR www.aodsoftware.com BlueStep Systems, LLC www.bluestep.net BridgeGate International www.bridgegateintl.com CareVoyant www.carevoyant.com Catalyst Healthcare, Ltd www.catalystrms.com Cerner - Millennium www.cerner.com ElderSuite www.eldersuite.com Extended Care Professional www.ecp123.com Galaxy Hosted Software www.galaxyhosted.com Health Care Software, Inc. (HCS) INTERACTANT www.hcsinteractant.com HealthMEDX www.healthmedx.com Hi-Tech Software Solutions www.hi-techsoftware.com LINTECH www.lintechsoftware.com MDI Achieve - MatrixCare www.mdiachieve.com Yes Yes Yes Yes No Yes Yes Yes Yes No No Yes No No Yes Yes Yes No No No No Yes No No Yes Yes Yes No Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes No No No Yes Yes No Yes Yes Yes Yes No Yes Yes Yes No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes No Yes No No No No Yes No No No No No No No No No Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes No No No Yes Yes No No Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No Yes Yes Yes Yes Yes No Yes No No Yes Yes No No No No No Yes Yes No No No No No Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No Yes Yes No Yes Yes Yes Yes Note: For technical specifications of sharing Care Plan and Transition of Care Documents, please see Interoperability Standards Worksheet

Transitions of Care, Shared Care Documents & Discharge Documents Shareable Plan of Care (including Goals and Instructions) Summary Report - Discharge Summary Report - Transfer Summary Report - Consults Diagnostic Imaging Report (DIR) Operative Notes Procedure Notes Progress Notes History and Physical Notes Continuity of Care Document (CCD) Discharge Order Discharge Note Transfer Form Physician s Discharge Summary vs. Discharge Record MelyxPro www.melyx.com Momentum Healthware, Inc. www.momentumhealthware.com New Tech Computer Systems - PioneerACMS www.newtechsys.com NextGen Ambulatory EHR NextGen Inpatient Clinicals NTT DATA www.nttdataltc.com Optimus EMR www.optimusemr.com PointClickCare www.pointclickcare.com Procura Health Management Systems www.goprocura.com Progresa Health Systems www.progresahealthsystems.com Reliable Health Systems www.reliablehealth.com ResCare, LLC www.rescaresoftware.com Saunders Associates SAEnCompass www.saencompass.com SigmaCare www.sigmacare.com SOS Corporation www.sosc.com Suncoast Solutions www.sncoast.com Yardi/ALMSA www.almsahealth.com Yes Yes Yes No No Yes Yes Yes Yes No No Yes Yes No Yes Yes Yes No Yes No Yes Yes Yes No Yes Yes Yes No Yes Yes Yes Yes No No Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes No No No No Yes Yes No Yes Yes Yes No Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes Note: For technical specifications of sharing Care Plan and Transition of Care Documents, please see Interoperability Standards Worksheet

CDSS - Interventions to Reduce Inappropriate Hospital Admission and Acute Care Transfers Tool CDSS - Other (List) Clinical Decision Support Systems* CDSS - Falls CDSS - Medication Management (Drug- Drug and Drug-Allergy Interactions) CDSS - Pressure Ulcers CDSS - Inappropriate CDSS - Reduction of Health Hospitalization/Readmission Care-Acquired Infections 6N Systems www.6nsystems.com ADS Data Systems www.adsdatasystems.com American Data www.american-data.com American HealthTech www.healthtech.net Americana Corp's AmeraCare System www.ameracaresystem.com AOD - Answers Certified EHR www.aodsoftware.com BlueStep Systems, LLC www.bluestep.net BridgeGate International www.bridgegateintl.com CareVoyant www.carevoyant.com Catalyst Healthcare, Ltd www.catalystrms.com No No No No No No No No No No No No No No Yes Yes Yes Yes Yes Yes No No No No No No Yes No Yes Yes Yes Yes Yes Yes Yes; Customizable Yes Yes Yes Yes Yes Yes Yes; Customizeable workflows and summary data panels and alerts can be user defined No No No No No No No No Yes No No No No No No Yes No No No No No Yes No Yes No No No No Cerner - Millennium www.cerner.com Yes Yes Yes Yes Yes No Yes; over 30 clinical care rules covering diverse situations such as admission activity, discharge needs, falls risk, isolation precautions, restraints, and many others ElderSuite www.eldersuite.com Extended Care Professional www.ecp123.com Galaxy Hosted Software www.galaxyhosted.com Health Care Software, Inc. (HCS) INTERACTANT www.hcsinteractant.com HealthMEDX www.healthmedx.com Hi-Tech Software Solutions www.hi-techsoftware.com LINTECH www.lintechsoftware.com MDI Achieve - MatrixCare www.mdiachieve.com Yes Yes Yes No No No No No No No No No No No Yes Yes Yes Yes Yes Yes No No Yes No No No No Yes Yes Yes Yes Yes Yes Yes; Drug and food alerts on lab orders Yes; Wounds, readmission, First Data Bank Drug Information Framework No No No No No No No Yes Yes Yes Yes Yes No No Yes Yes Yes Yes No Yes Yes; COMS Interactive, First Data Bank interaction and safety alerts, MDS analytics *Clinical Decision Support Systems (CDSS) link health observations with health knowledge to influence health choices by clinicians for improved health care.

CDSS - Interventions to Reduce Inappropriate Hospital Admission and Acute Care Transfers Tool CDSS - Other (List) Clinical Decision Support Systems* CDSS - Falls CDSS - Medication Management (Drug- Drug and Drug-Allergy Interactions) CDSS - Pressure Ulcers CDSS - Inappropriate CDSS - Reduction of Health Hospitalization/Readmission Care-Acquired Infections MelyxPro www.melyx.com Momentum Healthware, Inc. www.momentumhealthware.com New Tech Computer Systems - PioneerACMS www.newtechsys.com NextGen Ambulatory EHR Yes Yes Yes No No No No Yes Yes Yes Yes Yes Yes No No Yes No No No No No No Yes No No No No No NextGen Inpatient Clinicals Yes Yes Yes Yes No Yes Yes; Additional CDSS rules can be written based on the facilty's needs NTT DATA www.nttdataltc.com Optimus EMR www.optimusemr.com PointClickCare www.pointclickcare.com Procura Health Management Systems www.goprocura.com Progresa Health Systems www.progresahealthsystems.com Reliable Health Systems www.reliablehealth.com ResCare, LLC www.rescaresoftware.com Saunders Associates SAEnCompass www.saencompass.com SigmaCare www.sigmacare.com SOS Corporation www.sosc.com Suncoast Solutions www.sncoast.com Yardi/ALMSA www.almsahealth.com Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes; Formulary alerts, MDS analytics Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes; Alerts, standard orders, step-based pathways, triggered flow sheets, MDS No No No No No No No No No No No No No No Yes No Yes No No No No Yes Yes Yes No No No No No Yes No No No No Yes; Formulary alerts, MDS analytics No No No No No No No No No No No No No No Yes Yes Yes Yes Yes Yes No *Clinical Decision Support Systems (CDSS) link health observations with health knowledge to influence health choices by clinicians for improved health care.

Interfacing, Integration & Add-Ons Telehealth/Telemonitoring Technologies Wellness Monitoring Technologies Safety Monitoring Technologies Medication Self-Adherence (Individual Med. Dispenser) - Applicable ONLY in Home Health & in some states in AL Does your software function as an Integration Engine? Fully Integrated System that includes Financial, Ancillary Clinical Systems, and Human Resource Management -Financial: Billing/AR/AP/ General Ledger, etc. -Human Resources Management: Scheduling, Time and Attendance, Payroll -Third party Ancillary Clinical Systems: Pharmacy, Labs, Radiology etc. -Other Management Software/Systems Does your EHR Require Third-Party Software/ Interfaces for any Functionality Checked? List Third-Party Software/ Interfaces Required for Checked Functionalities Multiple Site Integration Dashboard Views Yes No 6N Systems www.6nsystems.com ADS Data Systems www.adsdatasystems.com American Data www.american-data.com American HealthTech www.healthtech.net Americana Corp's AmeraCare System www.ameracaresystem.com AOD - Answers Certified EHR www.aodsoftware.com BlueStep Systems, LLC www.bluestep.net BridgeGate International www.bridgegateintl.com CareVoyant www.carevoyant.com Catalyst Healthcare, Ltd www.catalystrms.com Cerner - Millennium www.cerner.com ElderSuite www.eldersuite.com Extended Care Professional www.ecp123.com Galaxy Hosted Software www.galaxyhosted.com Health Care Software, Inc. (HCS) INTERACTANT www.hcsinteractant.com HealthMEDX www.healthmedx.com No No No No Yes Yes Yes No Yes Yes Yes Quickbooks or Greatplains for GL Yes Yes No No No No No No Yes Yes No No No N/A Yes Yes No Yes Yes No Yes Yes Yes Yes Yes Yes Yes No No No No Yes Yes Yes No Yes Yes Yes No No No No Yes Yes Yes Yes Yes Yes Yes Yes No Yes No Yes Yes Yes Yes Yes Yes Yes Via HL7 with any other HL7 compliant software List is dynamic and constantly changing; contact for current list IMAR, therapy, account interfaces Empower Time & Attendance Yes Yes Yes Yes Yes No Yes Yes No No No Yes Yes No Yes No Yes No Yes Practice Suite, Keane Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes No N/A Yes Yes No No No No Yes Yes Yes Yes Yes Yes Yes Microsoft Dynamics GP (recommended) or other financials Yes Yes No No Yes Yes Yes No No No Yes Yes No N/A Yes Yes No Yes Yes No Yes Yes Yes Yes Yes Yes Yes Select human resource, payroll functionality and financial functionality Yes Yes No No No No No No Yes No No No Yes Clearing House No No No No No Yes Yes No Yes No Yes Yes No N/A Yes Yes No No No No Yes Yes Yes Yes Yes Yes No N/A Yes Yes No No No Yes No Yes Yes Yes Yes Yes Yes Lab and radiology Yes Yes No Yes Yes No Yes Yes Yes Yes Yes Yes Yes General financial (GL, AP) Yes Yes Hi-Tech Software Solutions www.hi-techsoftware.com No No No No No Yes Yes No No No Yes ExactMed's IMAR for emar LINTECH www.lintechsoftware.com MDI Achieve - MatrixCare www.mdiachieve.com Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No N/A Yes Yes No Yes Yes No Yes Yes Yes Yes Yes Yes No N/A Yes Yes

Interfacing, Integration & Add-Ons Telehealth/ Telemonitoring Technologies Wellness Monitoring Technologies Safety Monitoring Technologies Medication Self-Adherence (Individual Med. Dispenser) - Applicable ONLY in Home Health & in some states in AL Does your software function as an Integration Engine? Fully Integrated System that includes Financial, Ancillary Clinical Systems, and Human Resource Management -Financial: Billing/ AR/AP/General Ledger, etc. -Human Resources Management: Scheduling, Time and Attendance, Payroll -Third party Ancillary Clinical Systems: Pharmacy, Labs, Radiology etc. -Other Management Software/Systems Does your EHR Require Third- Party Software/ Interfaces for any Functionality Checked? List Third-Party Software/ Interfaces Required for Checked Functionalities Multiple Site Integration Dashboard Views Yes Yes MelyxPro www.melyx.com Momentum Healthware, Inc. www.momentumhealthware.com New Tech Computer Systems - PioneerACMS www.newtechsys.com No No No No No No Yes No Yes Yes No N/A Yes No No No Yes No Yes No Yes No No No No N/A Yes Yes No Yes Yes Yes No Yes Yes Yes Yes Yes No N/A Yes Yes NextGen Ambulatory EHR No Yes No Yes Yes No No No Yes No Yes Rosetta HL7 interfaces required to communicate with external systems like LIS, RIS/PACS, HIS, HIE practice management systems and Transcription systems Yes Yes NextGen Inpatient Clinicals NTT DATA www.nttdataltc.com No No No No Yes No Yes Yes Yes Yes Yes ExitCare, StarGarden No Yes No No Yes No Yes Yes Yes Yes Yes Yes Yes Offers integration with numerous providers and third-party vendors Yes Yes Optimus EMR www.optimusemr.com No No No No Yes No Yes No Yes No Yes Integration with third-party vendors and providers (pharmacy, lab, radiology, HIEs) Yes Yes PointClickCare www.pointclickcare.com Procura Health Management Systems www.goprocura.com Progresa Health Systems www.progresahealthsystems.com Reliable Health Systems www.reliablehealth.com ResCare, LLC www.rescaresoftware.com Saunders Associates SAEnCompass www.saencompass.com SigmaCare www.sigmacare.com No No No No Yes No Yes Yes Yes Yes Yes Yes No No No No No Yes Yes No Yes Yes Yes No No No No No Yes Yes No No Yes Able to integrate with a variety of third party vendor and provider systems Various financials and payroll interfaces available Various financials and payroll interfaces available Yes Yes Yes Yes Yes No No No No No Yes Yes Yes Yes Yes No No N/A No Yes No No No No Yes No Yes No Yes Yes No Able to integrate with thirdparty vendors and providers Yes Yes No No No No No No Yes No Yes No No N/A Yes Yes No No No No Yes No Yes No Yes Yes Yes Integration with third-party vendors and providers (pharmacy, lab, radiology, HIEs, rehab systems) Yes Yes SOS Corporation www.sosc.com Suncoast Solutions www.sncoast.com No No No No Yes Yes Yes Yes Yes Yes Yes emar, Time & Attendance Yes Yes No No No No No Yes Yes Yes No No No N/A Yes Yes Yardi/ALMSA www.almsahealth.com No Yes No No Yes Yes Yes No Yes Yes Yes Integration with third-party vendors and providers (pharmacy, lab, radiology, HIEs, rehab systems)

Supportability 24-Hour Support-Phone Limited Hours Support - Phone 24-Hour Support - Web Limited Hours Support - Web Email Support Listserv and/or Usergroup Onsite Training Other (Please List) 6N Systems www.6nsystems.com Yes No Yes No Yes No Yes N/A ADS Data Systems www.adsdatasystems.com No Yes No Yes Yes Yes Yes Desktop help data module, online training & support webinars, customer discussion module American Data www.american-data.com American HealthTech www.healthtech.net Americana Corp's AmeraCare System www.ameracaresystem.com AOD - Answers Certified EHR www.aodsoftware.com BlueStep Systems, LLC www.bluestep.net BridgeGate International www.bridgegateintl.com CareVoyant www.carevoyant.com Catalyst Healthcare, Ltd www.catalystrms.com Yes No Yes No Yes Yes Yes Massive free video library Yes No No Yes Yes Yes Yes Free elearning, product webinars, industry-specific webinars No Yes Yes No Yes No Yes Web training Yes No Yes No Yes Yes Yes N/A Yes No Yes No Yes No Yes N/A Yes No Yes No Yes No Yes N/A No Yes No Yes Yes Yes Yes Client portal/forum Yes No Yes No Yes No Yes Online training and support webinars Cerner - Millennium www.cerner.com Yes No Yes No Yes Yes Yes elearning client portal, consulting training, and client peer-to-peer social and support network ElderSuite www.eldersuite.com Extended Care Professional www.ecp123.com Galaxy Hosted Software www.galaxyhosted.com Health Care Software, Inc. (HCS) INTERACTANT www.hcsinteractant.com HealthMEDX www.healthmedx.com Hi-Tech Software Solutions www.hi-techsoftware.com LINTECH www.lintechsoftware.com MDI Achieve - MatrixCare www.mdiachieve.com No Yes No Yes Yes No Yes N/A Yes No Yes No Yes Yes Yes Videos and documents No Yes No Yes Yes No Yes N/A Yes No Yes No Yes No Yes Yes No Yes No Yes Yes Yes No Yes No No Yes No Yes Yes No Yes No Yes Yes Yes Yes No No Yes Yes Yes Yes Dedicated account management Online help files and a named customer service coordinator assigned to each customer Regular live webinars, scheduled web training, on screen user's manual Cutomized implemenation conversions Online tutorials, refresher/ new staff training

Supportability 24-Hour Support-Phone Limited Hours Support - Phone 24-Hour Support - Web Limited Hours Support - Web Email Support Listserv and/or Usergroup Onsite Training Other (Please List) MelyxPro www.melyx.com Momentum Healthware, Inc. www.momentumhealthware.com New Tech Computer Systems - PioneerACMS www.newtechsys.com NextGen Ambulatory EHR NextGen Inpatient Clinicals No Yes No Yes Yes No Yes Webinars, Internet training, in-house training Yes No Yes No Yes No Yes N/A Yes No No No Yes No Yes Call one number 24/7 and live on-staff support persons answer directly Yes No Yes No No Yes Yes N/A Yes No No No Yes Yes Yes Submission of support tickets on the web NTT DATA www.nttdataltc.com Yes No No Yes Yes Yes Yes Webinars, client conferences, client newsletter, client portal, training videos, elearning Optimus EMR www.optimusemr.com PointClickCare www.pointclickcare.com Procura Health Management Systems www.goprocura.com Progresa Health Systems www.progresahealthsystems.com Reliable Health Systems www.reliablehealth.com Yes No Yes No Yes Yes Yes User webinars and user group meetings to advance education Yes No Yes No Yes Yes Yes N/A No Yes No Yes Yes Yes Yes North American and Australian support hours No Yes No Yes Yes Yes Yes N/A Yes No No No Yes Yes Yes N/A ResCare, LLC www.rescaresoftware.com Yes No Yes No Yes No Yes E-mail communications, update letters, regular phone communication, on-site support upon request, help documentation Saunders Associates SAEnCompass www.saencompass.com SigmaCare www.sigmacare.com SOS Corporation www.sosc.com Suncoast Solutions www.sncoast.com Yardi/ALMSA www.almsahealth.com Yes No No No Yes No Yes Yes No Yes No Yes Yes Yes Instruction and reference integrated into program Online help and learning center with complete elearning course catalog Yes No Yes No Yes Yes Yes N/A Yes No No Yes Yes Yes Yes N/A Yes No Yes No Yes Yes Yes Instant Messenger/Skype

Interoperability Send via Fax (Interim Interoperability) Receive via Fax (Interim Interoperability) Send/Receive via ONC's DIRECT Project (Interim Interoperability) Direct Provider-Provider Transfer of Care Direct Provider-Provider Shared Care/Care Coordination Provider-Consumer/Consumer- Provider Health Information Exchange (HIE)/Regional Health Information Exchange (RHIO) eprescribing and Medication Management Intra-Provider System Interoperability Interoperability/Health Information Exchange - Non- Standards -Based Interoperability/Health Information Exchange - Hybrid Interoperability/Health Information Exchange - Standards-Based Exporting to PHR and/or Resident/Client Portal (e.g. Human-Readable Blue Button) Interface with Hospital/ Discharge System Interface to Consultant Pharmacy Systems Does Your Product Exchange Data as Codes, Freeform Text or Both? 6N Systems www.6nsystems.com ADS Data Systems www.adsdatasystems.com American Data www.american-data.com American HealthTech www.healthtech.net Americana Corp's AmeraCare System www.ameracaresystem.com AOD - Answers Certified EHR www.aodsoftware.com BlueStep Systems, LLC www.bluestep.net BridgeGate International www.bridgegateintl.com CareVoyant www.carevoyant.com Catalyst Healthcare, Ltd www.catalystrms.com Cerner - Millennium www.cerner.com ElderSuite www.eldersuite.com Extended Care Professional www.ecp123.com Galaxy Hosted Software www.galaxyhosted.com Health Care Software, Inc. (HCS) INTERACTANT www.hcsinteractant.com HealthMEDX www.healthmedx.com Hi-Tech Software Solutions www.hi-techsoftware.com LINTECH www.lintechsoftware.com MDI Achieve - MatrixCare www.mdiachieve.com Yes No No No No No Yes Yes Yes No No No No Yes Yes Both Yes Yes No No No No No No No No No No No No No Both Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes No Yes Yes Both No No No Yes Yes No Yes Yes Yes Yes Yes Yes No Yes Yes Codes No No No No No No No Yes Yes Yes No Yes No No Yes Both Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Both Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Both Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Both No No No No No No No Yes No No No No No No Yes Both Yes No No No No No No No No No No No No No Yes Both Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Both No No No No No No No No Yes Yes Yes No Yes No No Both Yes No No No No No No Yes No No No No No No Yes Both No No No No No No No Yes Yes Yes No Yes No Yes No Both Yes Yes No Yes Yes No No No Yes Yes Yes Yes No Yes No Both Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Both No No No No No No Yes No No No No No No No Yes Both Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No Yes Yes No No No No Yes No Both Codes, except notes and comments

Interoperability Send via Fax (Interim Interoperability) Receive via Fax (Interim Interoperability) Send/Receive via ONC's DIRECT Project (Interim Interoperability) Direct Provider-Provider Transfer of Care Direct Provider-Provider Shared Care/Care Coordination Provider-Consumer/Consumer- Provider Health Information Exchange (HIE)/Regional Health Information Exchange (RHIO) eprescribing and Medication Management Intra-Provider System Interoperability Interoperability/Health Information Exchange - Non- Standards -Based Interoperability/Health Information Exchange - Hybrid Interoperability/Health Information Exchange - Standards-Based Exporting to PHR and/or Resident/Client Portal (e.g. Human-Readable Blue Button) Interface with Hospital/ Discharge System Interface to Consultant Pharmacy Systems Does Your Product Exchange Data as Codes, Freeform Text or Both? MelyxPro www.melyx.com Momentum Healthware, Inc. www.momentumhealthware.com New Tech Computer Systems - PioneerACMS www.newtechsys.com NextGen Ambulatory EHR NextGen Inpatient Clinicals NTT DATA www.nttdataltc.com Optimus EMR www.optimusemr.com PointClickCare www.pointclickcare.com Procura Health Management Systems www.goprocura.com Progresa Health Systems www.progresahealthsystems.com Reliable Health Systems www.reliablehealth.com ResCare, LLC www.rescaresoftware.com Saunders Associates SAEnCompass www.saencompass.com SigmaCare www.sigmacare.com SOS Corporation www.sosc.com Suncoast Solutions www.sncoast.com Yardi/ALMSA www.almsahealth.com No No No No No No Yes No No No No Yes No Yes No Both Yes Yes No No No No Yes Yes Yes Yes Yes Yes No No Yes Freeform Text Yes Yes No No Yes Yes Yes Yes Yes No No No Yes No No Both Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Both Yes No No Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes No Both Yes No No Yes Yes No Yes Yes Yes Yes Yes Yes No Yes No Both No No No Yes Yes No Yes Yes Yes No No Yes No Yes No No No No No Yes No Yes Yes Yes Yes Yes Yes No Yes No Both Yes Yes No No No No No No No Yes No No No Yes No Both Yes Yes No No No No No No No No No No No Yes No Both Yes No No No No No Yes Yes No Yes Yes Yes No Yes Yes Both Yes No No No No No Yes Yes No No No No No No No Both Codes and documents Yes Yes No Yes Yes No No Yes Yes No No No No No No Freeform Text Yes Yes No Yes Yes Yes Yes Yes Yes No No Yes No No Yes Both No No No No No No Yes Yes Yes No No No No Yes Yes Both No No No No No No Yes Yes No No No No No No Yes Both No No No No No No No No No No No No Yes No Yes Both

Interoperability Standards Implemented ISO5 Consumer Empowerment and Access to Clinical Information via Portable Media Version 1 ISO6 Quality Version 1 NCPDP 10.6 or Higher HL7 CCD HL7 CDA HL7 Consolidated CDA HL7 CDA Personal Health Monitoring Report HL7 CDA Framework for Functional Assessment Questionnaire Other HL7 Standards (Please List) Blue Button - Machine Readable ICD-9/ICD-10 Diagnosis and Procedures LOINC - Laboratory and Clinical results HCPCS/CPT Ancillary Services, Procedures and Modifiers NDC Medications (Manufacturers) RxNorm Medications (Ordering) UNII Allergies and Adverse Reactions SNOMED CT - Reference Terminology for Clinical Data Other Standards (Please List) Yes; ASTM, EDI ANSI X.12 (specifically transaction sets of X.12, version 5010), and custom or proprietary standards 6N Systems www.6nsystems.com ADS Data Systems www.adsdatasystems.com American Data www.american-data.com American HealthTech www.healthtech.net Americana Corp's AmeraCare System www.ameracaresystem.com AOD - Answers Certified EHR www.aodsoftware.com BlueStep Systems, LLC www.bluestep.net BridgeGate International www.bridgegateintl.com CareVoyant www.carevoyant.com Catalyst Healthcare, Ltd www.catalystrms.com No No No No No No No No Yes; Utilizes Corepoint Health s HL7 engine to facilitate the exchange of vital HL7 data No Yes No Yes Yes No No No No No No No No No No No No No No Yes No No No No No No No No No No Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes No No No No Yes No No No No Yes; ADT and Pharmacy Messages No Yes No Yes Yes No Yes No MDS No No No Yes Yes Yes No No Yes; HL7 capable No Yes Yes Yes Yes No Yes No No No No No Yes No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes; HL7 2.x for ADT, OMP, ORU, RDE, RDS, RSP Yes; Utilizes any available interoperability protocols via BridgeGate Internatioanal technology No Yes No Yes Yes No No No No Yes Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes Yes Yes Yes; All HL7 2.x/3.x-CDA/CCD Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No Yes; Utilizes CareVoyant's HL7 engine to facilitate the exchange of vital HL7 data. No Yes No Yes Yes Yes Yes No No No No No No No No No No Yes; HL7 2.5 No Yes No No No No No Yes No Cerner - Millennium www.cerner.com Yes Yes Yes Yes Yes Yes Yes Yes Yes; Equipped with an embedded interface engine tool set referred to as Open Engine that supports interface formats for multiple standards, including HL7 data No Yes Yes Yes Yes Yes Yes YES ElderSuite www.eldersuite.com Extended Care Professional www.ecp123.com Galaxy Hosted Software www.galaxyhosted.com Health Care Software, Inc. (HCS) INTERACTANT www.hcsinteractant.com HealthMEDX www.healthmedx.com Hi-Tech Software Solutions www.hi-techsoftware.com LINTECH www.lintechsoftware.com MDI Achieve - MatrixCare www.mdiachieve.com No No No No No No No No No No Yes No Yes No No No No No No No No No No No No No HL7 interface for emar with pharmacy software programs No No No No Yes No No No Medication database link No No No No No No No No Yes; HL7 capable No Yes No Yes Yes Yes No No No No No No Yes Yes No No No Yes; HL7 2.3 Yes Yes Yes Yes Yes No Yes No Yes; ASC X12N Yes Yes Yes Yes Yes Yes Yes Yes Yes: HL7, PDQ Yes Yes Yes Yes Yes No Yes Yes No No No No Yes No No No No Yes; HL7 capable No Yes No Yes Yes Yes Yes Yes No Yes No Yes Yes Yes Yes Yes Yes Yes; HL7 Version 2.4, 2.5 and 2.6 No Yes Yes Yes Yes Yes Yes Yes No No No Yes No No No No No Yes; HL7 capable No Yes No No Yes Yes No Yes Yes

Interoperability Standards Implemented ISO5 Consumer Empowerment and Access to Clinical Information via Portable Media Version 1 ISO6 Quality Version 1 NCPDP 10.6 or Higher HL7 CCD HL7 CDA HL7 Consolidated CDA HL7 CDA Personal Health Monitoring Report HL7 CDA Framework for Functional Assessment Questionnaire Other HL7 Standards (Please List) Blue Button - Machine Readable ICD-9/ICD-10 Diagnosis and Procedures LOINC - Laboratory and Clinical results HCPCS/CPT Ancillary Services, Procedures and Modifiers NDC Medications (Manufacturers) RxNorm Medications (Ordering) UNII Allergies and Adverse Reactions SNOMED CT - Reference Terminology for Clinical Data Other Standards (Please List) MelyxPro www.melyx.com Momentum Healthware, Inc. www.momentumhealthware.com New Tech Computer Systems - PioneerACMS www.newtechsys.com NextGen Ambulatory EHR NextGen Inpatient Clinicals NTT DATA www.nttdataltc.com Optimus EMR www.optimusemr.com PointClickCare www.pointclickcare.com Procura Health Management Systems www.goprocura.com Progresa Health Systems www.progresahealthsystems.com Reliable Health Systems www.reliablehealth.com ResCare, LLC www.rescaresoftware.com Saunders Associates SAEnCompass www.saencompass.com SigmaCare www.sigmacare.com SOS Corporation www.sosc.com Suncoast Solutions www.sncoast.com Yardi/ALMSA www.almsahealth.com No No No Yes Yes Yes Yes No No No Yes No Yes Yes No No No No No No No No No No No No Yes; Utilizes Corepoint Health s HL7 engine to facilitate the exchange of vital HL7 data Yes Yes Yes No No Yes No No No No No Yes Yes Yes Yes Yes No Yes; ADT No Yes Yes Yes Yes No Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes; HL7 capable Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No Yes; HL7 capable No Yes Yes Yes Yes No No Yes No No No Yes Yes No No No No Yes; HL7 capable No Yes No Yes Yes No No No No No No No Yes Yes Yes No Yes Yes; HL7 capable No Yes No Yes Yes No Yes No No No No Yes No No No No No No No No No No No No No No No No No No No No No Yes; HL7 2.5 for ADT and Pharmacy; HL7 2.4 and NCPDP messaging for Pharmacy Yes; HL7 2.3, 2.6 for ADT and Schedule Information Yes; HL7 2.3, 2.6 for ADT and Schedule Information No Yes No Yes Yes No No No No No Yes No Yes No No No No InterRAI-HC, InterRAI-CA, InterRAI-PS, InterRAI-CHA No Yes No Yes No No No No No No No Yes Yes Yes Yes No No Yes; HL7 capable No Yes Yes Yes Yes Yes No No No No No No No No No No Yes Yes; HL7 capable No Yes No Yes No No No No No No No No No No No No No Yes; HL7 capable No Yes Yes No Yes Yes No No No No No No Yes No Yes No No Yes; HL7 messages for ADT, lab results and clinical orders No Yes Yes Yes Yes No No Yes No No No No Yes Yes Yes Yes Yes Yes; HL7 capable No Yes No Yes No No No No No No No No Yes No No No No No No Yes No Yes Yes No Yes No No Yes No No Yes Yes Yes Yes Yes Yes; HL7 capable No Yes Yes No Yes Yes Yes No No

Interoperability Certification ONC-ATCB Certification (Please provide a link for verification) CCHIT - LTPAC (Please List Modules Certified: Home Health and/or Skilled Nursing; Please provide a link for verification) 6N Systems www.6nsystems.com ADS Data Systems www.adsdatasystems.com American Data www.american-data.com American HealthTech www.healthtech.net Americana Corp's AmeraCare System www.ameracaresystem.com AOD - Answers Certified EHR www.aodsoftware.com BlueStep Systems, LLC www.bluestep.net BridgeGate International www.bridgegateintl.com CareVoyant www.carevoyant.com Catalyst Healthcare, Ltd www.catalystrms.com Cerner - Millennium www.cerner.com ElderSuite www.eldersuite.com Extended Care Professional www.ecp123.com Galaxy Hosted Software www.galaxyhosted.com Health Care Software, Inc. (HCS) INTERACTANT www.hcsinteractant.com HealthMEDX www.healthmedx.com Hi-Tech Software Solutions www.hi-techsoftware.com LINTECH www.lintechsoftware.com MDI Achieve - MatrixCare www.mdiachieve.com No No No No Yes; See current list at http://ldng.ag/x9r4xd Yes; Home Health & Skilled Nursing; See certification link at http://ldng.ag/16xpatd Yes; See current list at: http://ldng.ag/wwxwz0 No No No Yes; See current list at http://ldng.ag/xsrdx1 Yes; Home Health & Skilled Nursing; See certification link at http://ldng.ag/wkakow No No No No No No No No Yes; See current list at http://ldng.ag/ygjqs1 No No No No No No No No No Yes; See current list at http://ldng.ag/yh7r3b Yes; Home Health & Skilled Nursing; See certification link at http://ldng.ag/ydtqmx No No No No Yes; See current list at http://ldng.ag/122er6k No

Interoperability Certification ONC-ATCB Certification (Please provide a link for verification) CCHIT - LTPAC (Please List Modules Certified: Home Health and/or Skilled Nursing; Please provide a link for verification) MelyxPro www.melyx.com Momentum Healthware, Inc. www.momentumhealthware.com New Tech Computer Systems - PioneerACMS www.newtechsys.com NextGen Ambulatory EHR NextGen Inpatient Clinicals NTT DATA www.nttdataltc.com Optimus EMR www.optimusemr.com PointClickCare www.pointclickcare.com Procura Health Management Systems www.goprocura.com Progresa Health Systems www.progresahealthsystems.com Reliable Health Systems www.reliablehealth.com ResCare, LLC www.rescaresoftware.com Saunders Associates SAEnCompass www.saencompass.com SigmaCare www.sigmacare.com SOS Corporation www.sosc.com Suncoast Solutions www.sncoast.com Yardi/ALMSA www.almsahealth.com No No No No No No Yes; See current list at http://ldng.ag/xotylg No Yes; See current list at http://ldng.ag/wrwmvx No No No No Yes; Skilled Nursing; See certification link at http://ldng.ag/ywj3hf No No No No No No No No No No No No No No No No No No No No

Hardware/Software Requirements Desktop/Laptop Specifications Operating System (OS) - Apple Operating System (OS) - Unix/Linux Operating System (OS) - Windows Mobile OS - Android Mobile OS - Blackberry Mobile OS - ios Mobile OS - Unix/ Linux Mobile OS - Windows Network Specifications Wireless Specifications Browser Based (List Browser Requirements) Internet/Bandwidth Specifications Miscellaneous Software/Applets Needed (i.e. Citrix) Miscellaneous Reporting Specifications (i.e. Crystal Reports) Scalability Local Model Hosted Model Software as a Service Model (SaaS) Remote Access Off-Line Functionality (Functions During Internet Outage for Hosted and SaaS Models) Ability to Store/ Handle Attachments (Insurance card, Historical Notes, etc.) 6N Systems www.6nsystems.com ADS Data Systems www.adsdatasystems.com American Data www.american-data.com American HealthTech www.healthtech.net Americana Corp's AmeraCare System www.ameracaresystem.com AOD - Answers Certified EHR www.aodsoftware.com BlueStep Systems, LLC www.bluestep.net BridgeGate International www.bridgegateintl.com CareVoyant www.carevoyant.com Catalyst Healthcare, Ltd www.catalystrms.com Cerner - Millennium www.cerner.com ElderSuite www.eldersuite.com Extended Care Professional www.ecp123.com Galaxy Hosted Software www.galaxyhosted.com Health Care Software, Inc. (HCS) INTERACTANT www.hcsinteractant.com HealthMEDX www.healthmedx.com Hi-Tech Software Solutions www.hi-techsoftware.com LINTECH www.lintechsoftware.com MDI Achieve - MatrixCare www.mdiachieve.com Intel Processer No No Yes No No No No No Ethernet 802.11 b/g/n N/A T1 None Cyrstal Reports Yes No Yes Yes Yes No Yes Agnostic Yes No Yes Yes No Yes No Yes Any Desktop or Laptop Contact for current specs doc Any highspeed 802.11 b/g/n Internet connection IE 9.0+, Firefox, Chrome, Safari Any high-speed Internet connection None None Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes No N/A Yes None Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No Yes T1, Ethernet, 802.11 a/g/n No T1 Citrix or TS Yes Yes Yes Yes Yes Yes Yes Yes Wi-Fi Intel Processer No No Yes No No No No Yes Ethernet 802.11 IE 9.0, Chrome 10 Mb/s Citrix or TS Crystal Reports Yes Yes Yes Yes Yes Yes Yes Intel Processer No No Yes Yes No Yes Yes Yes Ethernet 802.11 b/g/n Agnostic Yes Yes Yes Yes Yes Yes Yes Yes Web-based 802.11 b/g/n IE 9.0+, Firefox, Chrome, Safari IE 9.0+, Firefox, Chrome, Safari 100 Mb/s Mobile may ODBC compliant require RDP Yes Yes Yes Yes Yes No Yes database client 1.5 Mb/s None None Yes No Yes Yes Yes Yes Yes Agnostic Yes Yes Yes Yes Yes Yes Yes Yes Ethernet All CSS 2.0+/HTML 3.2 All None None Yes Yes Yes Yes Yes Yes Yes Intel, AMD Processer No No Yes No No No No No Ethernet 802.11 N/A N/A Citrix/TS Agnostic No No Yes No No No No No Yes Yes Yes Yes Yes No Yes No No Wi-Fi or Ethernet Wi-Fi or Ethernet Microsoft SQL Server Reporting Yes Yes Yes Yes Yes Yes Yes Services 802.11 b/g/n IE 9.0+, Firefox Implementation specific None N/A Yes No Yes Yes Yes Yes Yes 802.11 b/g/n IE 6.0 or later (Chrome, If thin client deployment, Safari may be used, but then Citrix not supported) Citrix N/A Yes Yes Yes Yes Yes No Yes PC No No Yes No No No No No LAN 802.11 b/g/n IE 6.0 or later Dial-Up None Integrated Yes Yes No Yes Yes Yes Yes Agnostic Yes Yes Yes Yes No Yes No Yes None 802.11 b/g/n Intel Processer No No Yes Yes No Yes Yes Yes None 802.11 b/g/n Chrome, Safari, Firefox, IE 9.0+ IE 9.0+, Firefox, Chrome, Safari Agnostic No No No Yes No Yes No Yes Ethernet 802.11 i IE 8.0+ 5 MB/s Intel/AMD/ Atom Yes Yes Yes No No Yes Yes Yes TCP/IP, Wi-Fi, LAN, WAN 802.11 b/g/n/i 1 Mb/s None PDF Viewer Yes No No Yes Yes No Yes DSL and up None None Yes No Yes Yes Yes No Yes Adobe Reader MS Excel, Crystal, Yes Yes Yes No Yes No Yes ODBC IE TCP/IP, Wi-Fi, LAN, WAN None SQL Yes Yes Yes Yes Yes Yes Yes Agnostic No Yes Yes Yes No No No Yes Ethernet 802.11 b/g/n N/A N/A None None No Yes Yes No Yes Yes Yes Internet Browser Yes Yes Yes Yes Yes Yes Yes Yes TCP/IP Any IE 8.0+ or webkit based 1 Mb/s None Agnostic No No Yes No No Yes No Yes Any 802.11 b/g/n IE 7, 8, 9 100 Kbps upload and download per user ODBC compliant Yes Yes Yes Yes Yes Yes Yes Adobe None Yes No Yes Yes Yes Yes Yes

Hardware/Software Requirements Desktop/Laptop Specifications Operating System (OS) - Apple Operating System (OS) - Unix/Linux Operating System (OS) - Windows Mobile OS - Android Mobile OS - Blackberry Mobile OS - ios Mobile OS - Unix/ Linux Mobile OS - Windows Network Specifications Wireless Specifications Browser Based (List Browser Requirements) Internet/Bandwidth Specifications Miscellaneous Software/Applets Needed (i.e. Citrix) Miscellaneous Reporting Specifications (i.e. Crystal Reports) Scalability Local Model Hosted Model Software as a Service Model (SaaS) Remote Access Off-Line Functionality (Functions During Internet Outage for Hosted and SaaS Models) Ability to Store/ Handle Attachments (Insurance card, Historical Notes, etc.) MelyxPro www.melyx.com Momentum Healthware, Inc. www.momentumhealthware.com New Tech Computer Systems - PioneerACMS www.newtechsys.com NextGen Ambulatory EHR NextGen Inpatient Clinicals NTT DATA www.nttdataltc.com Optimus EMR www.optimusemr.com PointClickCare www.pointclickcare.com Procura Health Management Systems www.goprocura.com Progresa Health Systems www.progresahealthsystems.com Reliable Health Systems www.reliablehealth.com ResCare, LLC www.rescaresoftware.com Saunders Associates SAEnCompass www.saencompass.com SigmaCare www.sigmacare.com SOS Corporation www.sosc.com Suncoast Solutions www.sncoast.com Yardi/ALMSA www.almsahealth.com Intel Processer No No Yes No No No No No Contact for current specs doc Dual Core processor & 2GB Ram No No Yes Yes No Yes No Yes No No Yes No No No No No Depends on service Depends on service N/A IE 9.0+, T1 Connectivity 802.11 b/g/n Firefox, Chrome Ethernet or Web-based Depends on Service Dual Core No No Yes Yes Yes No No Yes Ethernet 802.11G Explorer 6 50K per user Citrix Intel i3 proc or better, 4GB RAM, 1280x1024 screen resolution No Yes Yes Yes Yes Yes Yes Yes Agnostic No No Yes No No No No No 50kBPS per concurrent user N/A None Yes Yes Yes Yes Yes Yes No 5 Mb/s Citrix None Yes No Yes Yes Yes Yes Yes 802.11 b/g/n IE 7.0+ 3 Mb/s Citrix optional None Yes Yes Yes Yes Yes No Yes 50kBPS per concurrent user HTTP/ HTTPS over 802.11 g/n or Ethernet, better LAN/WAN IE 9 Same as network if ASP hosted, 3rd party interfaces and support only if local severs. Windows, MS SQL, CentOS, Acrobat Reader, ProvideX, XML rendering, VMware. IE8.0+ 100 Kb/s per user Yes Minimum standards No No Yes No No No No Yes Ethernet 802.11 b/g/n IE 1.5 Mb/s None IE 9.0+, T1 Agnostic Yes Yes Yes Yes No Yes Yes Yes Connectivity 802.11 b/g/n Firefox, Chrome, Safari Agnostic Agnostic Via RDP Client (e.g. Jump) Via RDP Client (e.g. Jump) No Yes Yes Yes No No No Agnostic Agnostic N/A (Portal accepts all browsers) Crystal Reports Crystal & SDS General Report Writer Crystal Reports Embedded Crystal Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes No Yes Yes no Yes Yes Yes Yes Yes 1 Mb/s None None Yes No Yes Yes Yes No Yes Thin-Client Citrix, MS TS Integrated Report Writer Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes No No Agnostic Agnostic N/a Thin-Client Citrix, MS TS Crystal Yes Yes Yes Yes Yes Yes Yes Agnostic No No Yes Yes Yes Yes No Yes Agnostic 802.11 b/g/n IE 1.5 Mb/s None None No Yes Yes Yes Yes Yes Yes RDP connection; able to use most operating systems Yes Yes Yes Yes No Yes Yes Yes Ethernet; Wireless Windows OS No No Yes No No No No No Ethernet 802.11i N/A N/A Agnostic Yes No Yes No No Yes No Yes 802.11 N/A Min. 3 Mb/s None None Yes No Yes No Yes No Yes T1 Connectivity 802.11 b/g/n IE, Firefox, Chrome, Safari Advantage Database Server None Yes Yes Yes Yes Yes Yes Yes 1.5 Mb/s Adobe Reader Yes Yes No Yes Yes Yes Yes Yes By Request No No Yes Yes Yes Yes No Yes By Request 802.11 b/g/n IE 9+ By Request None None Yes Yes Yes Yes Yes Yes Yes IE 9.0+, T1 Intel Processer No No Yes Yes No Yes No Yes Connectivity 802.11 b/g/n Firefox, Chrome, Safari 10 Mb/s None None Yes Yes Yes Yes Yes Yes Yes All Yes Yes Yes Yes Yes Yes Yes Yes Any All All DSL and up None Yes Yes Yes Yes Yes Yes Yes Yes

E-Signature for Beneficiary or Authorized User Federal or State Level Regulatory Surveys/Reports Legal/Regulatory/Cyberliability List Applicable Regulatory Requirements Met Provide a Link to Company's Cyberliability Policy List Any Other Legal Requirements Security - List HIPAA & HITECH Act Requirements Met Provide link to Sample Contract 6N Systems www.6nsystems.com ADS Data Systems www.adsdatasystems.com American Data www.american-data.com American HealthTech www.healthtech.net Americana Corp's AmeraCare System www.ameracaresystem.com AOD - Answers Certified EHR www.aodsoftware.com BlueStep Systems, LLC www.bluestep.net BridgeGate International www.bridgegateintl.com CareVoyant www.carevoyant.com Catalyst Healthcare, Ltd www.catalystrms.com Cerner - Millennium www.cerner.com ElderSuite www.eldersuite.com Extended Care Professional www.ecp123.com Galaxy Hosted Software www.galaxyhosted.com Health Care Software, Inc. (HCS) INTERACTANT www.hcsinteractant.com HealthMEDX www.healthmedx.com Hi-Tech Software Solutions www.hi-techsoftware.com LINTECH www.lintechsoftware.com MDI Achieve - MatrixCare www.mdiachieve.com Medicare and Medicaid regulations Medicaid & licensing regulations in multiple states for adult day health care, 5010 billing MDS, Medicare and Medicaid regulations, 5010 All mandated federal & state requirements are met MDS, Medicare and Medicaid regulations, 5010 All required regulatory concerns, for example, HIPAA 5010, MDS 3.0, CCHIT certification and ONC- ATCB etc. MDS, CMS 5010 HIPAA EDI 5010/Rx NCPDP, Medicare, Medcaid, PHI/HITECH, SOX MDS, OASIS Medicare and Medicaid regulations, ANSI 5010/837/835 CIHI CCRS RAI-MDS 2.0 2012-2013 Meets all HIPAA, HITECH and ONC-ATCB requirments Texas Medicaid regulations, 4010, 5010 N/A N/A All are met N/A No Yes N/A N/A All are met Available upon request No No N/A N/A All are met N/A Yes Yes Upon request Please contact for more information All mandated federal requirements are met Available upon request Yes Yes N/A N/A All are met Available upon request Yes Yes http://www.aodsoftware. com/content/faq/hipaacompliance http://www.bluestep.net/ p3p/termsofuse.jsp Attestation provided to customers N/A All regulatory requirements for business associates as defined by the HIPAA Act of 1996 and amendments, including modifications made by HITECH Act of 2009 Available upon request Yes Yes N/A All are met Available upon request Yes Yes Meets federal e-signature and record retention requirements Attestation provided to customers Available upon request Yes No N/A N/A All are met Available upon request No No N/A N/A All are met Available upon request No No N/A N/A Meets all HIPAA, HITECH and ONC-ATCB requirments Meets Texas digital ink requirements Meets all HIPAA, HITECH and ONC-ATCB requirments N/A Yes No All are met No contract required No Yes N/A N/A N/A All are met Available upon request No No MDS, Medicare and Medicaid regulations HCS will contractually comply with all regulatory billing requirements MDS, Medicare and Medicaid regulations, 5010, ONC-ATCB MDS, Medicare and Medicaid regulations, 5010, ICD-10 Oct. 2013 "CMS Medicaid Medicare 5010 HIPPA" MDS, Medicare and Medicaid regulations, 5010, ONC-ATCB, ICD 10-Oct. 2013 N/A N/A All are met Available upon request Yes Yes www.hcsinteracant.com/ privacypolicy.cfm N/A www.hcsinteractant.com/ Services/HIPAA.cfm Available upon request Yes Yes Available upon request N/A All are met Available upon request Yes Yes Available upon request Available upon request Meets federal e-signature and record retention requirements Meets federal e-signature and record retention requirements Available upon request Available upon request Yes Yes All are met Available upon request No Yes Available with signed NDA Available with signed NDA All are met Available with a signed NDA No Yes

E-Signature for Beneficiary or Authorized User Federal or State Level Regulatory Surveys/ Reports Yes Yes Legal/Regulatory/Cyberliability List Applicable Regulatory Requirements Met Provide a Link to Company's Cyberliability Policy List Any Other Legal Requirements Security - List HIPAA & HITECH Act Requirements Met Provide link to Sample Contract MelyxPro www.melyx.com Momentum Healthware, Inc. www.momentumhealthware.com New Tech Computer Systems - PioneerACMS www.newtechsys.com MDS, Medicare and Medicaid regulations, 5010 MDS, Medicare and Medicaid regulations, 5010 Mds, Medicare & Medicaid regulations, 5010 format, ICD-9 Coding N/A N/A All are met N/A Yes Yes N/A N/A All are met N/A Yes Yes N/A N/A All are met Available Upon Request Yes Yes NextGen Ambulatory EHR NextGen Inpatient Clinicals NTT DATA www.nttdataltc.com Optimus EMR www.optimusemr.com PointClickCare www.pointclickcare.com Procura Health Management Systems www.goprocura.com CMS regulations, 5010 N/A N/A All are met Available upon request Yes Yes N/A N/A N/A N/A N/A Yes Yes MDS, Medicare and Medicaid regulations, 5010 MDS, Medicare and Medicaid regulations, 5010 Currently meet all federal and state requiremnets for providers InterRAI (HC, CA, CHA, PS), Medicare, Medicaid, 5010 N/A N/A All are met Available upon request No Yes Included in contract documents and is confidential Customers are provided this information upon request. Meets all HIPAA, HITECH and CCHIT requirements As a provider of Health Care SaaS North American-wide we are also required to meet all Canadian PIPEDA regulations N/A N/A Meets all requirements plus has unique security access controls All current HIPAA & HITECH requirments have been met Via business associate agreement Available upon request Yes Yes Available with a signed NDA No Yes N/A Yes Yes Progresa Health Systems www.progresahealthsystems.com Medicare and Medicaid regulations, 5010 Confidential & available w/ contract N/A Via business associate agreement N/A Yes Yes Reliable Health Systems www.reliablehealth.com Medicare and Medicaid regulations N/A N/A All are met N/A Yes Yes ResCare, LLC www.rescaresoftware.com Meets federal & state requirements (ie; MDS, Medicare, Medicaid, 5010) Confidential & available w/ contract N/A All are met Confidential & available w/ contract Saunders Associates SAEnCompass www.saencompass.com Medicare and Medicaid regulations N/A Meets federal e-signature and record retention requirements All are met Available upon request Yes Yes SigmaCare www.sigmacare.com Meets all federal and state regulatory requirements Please contact for more information Please contact for more information All are met Available upon request No Yes SOS Corporation www.sosc.com MDS, Medicare and Medicaid regulations, 5010 N/A N/A All are met Available upon request Yes Yes Suncoast Solutions www.sncoast.com Medicare and Medicaid regulations N/A Meets federal e-signature and record retention requirements All are met Available upon request Yes Yes Yardi/ALMSA www.almsahealth.com Currently meet all federal and state requiremnets for providers N/A Meets federal e-signature and record retention requirements All are met Available upon request Yes Yes

Core Customer Base, Focus of Line of Business Company s Experience and Viability Number of Years in Business Release Date of Current Version Number of Facility/Site/Agency Installations (NOTE THIS IS REGARDLESS OF NUMBER OF MODULES INSTALLED AND PATIENTS/RECORDS) 6N Systems www.6nsystems.com ADS Data Systems www.adsdatasystems.com American Data www.american-data.com American HealthTech www.healthtech.net Americana Corp's AmeraCare System www.ameracaresystem.com AOD - Answers Certified EHR www.aodsoftware.com BlueStep Systems, LLC www.bluestep.net BridgeGate International www.bridgegateintl.com CareVoyant www.carevoyant.com Catalyst Healthcare, Ltd www.catalystrms.com Cerner - Millennium www.cerner.com ElderSuite www.eldersuite.com Extended Care Professional www.ecp123.com Galaxy Hosted Software www.galaxyhosted.com Health Care Software, Inc. (HCS) INTERACTANT www.hcsinteractant.com HealthMEDX www.healthmedx.com Hi-Tech Software Solutions www.hi-techsoftware.com LINTECH www.lintechsoftware.com MDI Achieve - MatrixCare www.mdiachieve.com 11 Dec. 2012 74 CCRC, SNF 5 Jan. 2013 40 Adult Day Care, Care Management, Home Care (Non-Medical), Residential Services 29 Jan. 2013 700 AL, CCRC, IL, Rehab, SNF 30+ Mar. 2013 2,600+ AL, CCRC, IL, LTAC, SNF 22 Feb. 2013 160 CCRC, SNF 17 Nov. 2012 900+ AL, CCRC, IL, SNF 13 Nov. 2012 450 AL, IL, Rehab, SNF 14 July 2012 500+ Home Health, Rehab, SNF 20 Dec. 2012 Over 500 CCRC, Home Health, SNF 6 Jan. 2013 200+ Long-term care facilities and their respective pharmacy providers 30 Jan. 2013 5+ Millennium and 3,330+ CareTracker Module Installations AL, CCRC, IL, Rehab, SNF 18 Dec. 2012 228 Adult Day Care 9 Oct. 2012 500+ ALF, CCRC, SNF 9 Feb. 2013 183 CCRC, SNF 45 Mar. 2013 3,000 AL, Adult Day Care, CCRC, IL, LTC Hospitals, PACE, SNF 12 Jan. 2013 3,000+ CCRC, Home Care, Hospice, LTC 30 Feb. 2013 300 AL, NF, SNF 25 2012 250 AL, Acute Rehab, Adult Day Care, CCRC, Hospice, Intermediate Care, LTC Hospitals, LTC Rehab, MRDD, SNF 30+ Nov. 2012 7,500 AL, CCRC, IL, SNF

Core Customer Base, Focus of Line of Business Company s Experience and Viability Number of Years in Business Release Date of Current Version Number of Facility/Site/Agency Installations (NOTE THIS IS REGARDLESS OF NUMBER OF MODULES INSTALLED AND PATIENTS/RECORDS) MelyxPro www.melyx.com Momentum Healthware, Inc. www.momentumhealthware.com New Tech Computer Systems - PioneerACMS www.newtechsys.com NextGen Ambulatory EHR NextGen Inpatient Clinicals NTT DATA www.nttdataltc.com Optimus EMR www.optimusemr.com PointClickCare www.pointclickcare.com Procura Health Management Systems www.goprocura.com Progresa Health Systems www.progresahealthsystems.com Reliable Health Systems www.reliablehealth.com ResCare, LLC www.rescaresoftware.com Saunders Associates SAEnCompass www.saencompass.com SigmaCare www.sigmacare.com SOS Corporation www.sosc.com Suncoast Solutions www.sncoast.com Yardi/ALMSA www.almsahealth.com 32 Nov. 2012 200 CCRC, County NF, Hospital-based SN, NF, SNF 17 Jan. 2013 350+ AL, Home Care, SNF 8 Jan. 2013 60 AL, CCRC, Correctional, Home Health, Hospice, Pace, SNF 17 Aug. 2012 3,700 Ambulatory Previously Opus Healthcare - 20 Mar. 2013 ~220 all NGHS clients Hospitals/Surgical Facilities 40+ Dec. 2012 3,000 AL, Apartments, CCRC, SNF, Subacute Units 12 Sep. 2012 300 CCRC, SNF 12 Nov. 2012 7,000 CCRC, SNF 24 Jan. 2013 1,400 Home and Community Based Care 24 (Owned by Procura) Jan. 2013 70 Home Care and Hospice 30 Jan. 2013 249 SNF 8 Oct. 2012 12 AL, Rehab, SNF 25 Dec. 2012 42 SNF 8 Jan. 2013 464 AL, CCRC, SNF 42 Feb. 2013 450+ CCRC, SNF 14 Feb. 2013 180 Home Health, Hospice 12 Feb. 2013 3,500 AL, CCRC, SNF

None None None www.healthtech.net/post-acute-carecase-studies Upon Request www.aodsoftware.com/brochures/ Presbyterian%20EHR%20Success%20 Story%20by%20AOD%20Software%20 800-311-8252.pdf www.leadingage.org/uploadedfiles/ Content/About/CAST/Resources/Lorien_ Health_Systems.pdf www.leadingage.org/uploadedfiles/ Content/About/CAST/Resources/Lorien_ Health_Systems.pdf www.carevoyant.com/cvsales/ltc_cs1. pdf Strengths, Areas for Improvement, Ongoing Development and References Strengths Areas for Improvement Ongoing Development References Links to Additional Case Study/ies 6N Systems www.6nsystems.com ADS Data Systems www.adsdatasystems.com American Data www.american-data.com American HealthTech www.healthtech.net Americana Corp's AmeraCare System www.ameracaresystem.com AOD - Answers Certified EHR www.aodsoftware.com BlueStep Systems, LLC www.bluestep.net BridgeGate International www.bridgegateintl.com CareVoyant www.carevoyant.com Automated resident plan of care through an integrated financial & EMR system Facility defined clinical workflow engine with integrated charting, ordering and task management Hands on approach to training & implementation Online training and support Completely integrated EHR w/ CPs, billing, physician orders, progress notes and more with alerts for follow up and "due dates" Fully customizable & available on multiple platforms Dashboards Completely integrated EMR Fully customizable Hands-on experts, onsite, training you step by step Easy to use, integration, system support One integrated system for a 360 degree view of resident across the spectrum of care Customizable clinical decision support LTPAC certified by CCHIT" Integrated application Complete customizable forms, reports and decision support formulas Very robust MDS integration with all billable clinical items and analytics Rapid Integration Platform Vendor & System Agnostic No Programming required Data flows/auto-populates across modules Fully integrated CPOE, care planning, EHR, MDS, emar, ADLs, billing, dashboards, events & alerts User-friendly development of custom forms/assessments Streamline discharge planning Enhanced collection module Treatment Administration Record Transportation scheduling & tracking Recreational therapy tracking Integration with additional clinical service providers Expanding all data modules for web access Native apps for multiple devices Native apps for multiple devices Accelerate interoperability across the continuum of care Integration with other emar applications Increased interoperability with more ancillary systems such as labs, therapy, vital collection devices, etc. Provide greater depth in a few areas of the clinincal module Accelerate affordable interoperability to small providers such as $50/month HIE integration via KeyHIE Transform Expand relationships and capabilities with LTPAC EHR providers Provide better per patient revenue/ cost per day against quality and risk factors for ACO initiatives Employee scheduling Standardized content Computer-based (online) training and support materials Accelerate interoperability across the continuum of care Expanding outside provider access Continue expanding clinical decision support including management of avoidable hospitilizations Additional depth in the MAR with enhanced medication database information Enhanced graphic user interfaces - improved usability Enhanced billing capabilities " National build-out of lab interfaces growing beyond 5 million lab messages per year Deeper HIE integration with LTPAC patient data and facility quality measures Enabling ACOs and IDNs to have full interoperability in LTPAC CCHIT certification for LTPAC (Q4 2013) Enhancements to therapy and ADL functions Development of additional standard assessments, pharmacy integrations, clinical decision support, transition of care documentation References are generally part of the RFP process. References are generally part of the RFP process. References are generally part of the RFP process. References are generally part of the RFP process. References are generally part of the RFP process. References are generally part of the RFP process. References are generally part of the RFP process. References supplied when requested. References are generally part of the RFP process.

Strengths, Areas for Improvement, Ongoing Development and References Strengths Areas for Improvement Ongoing Development References Links to Additional Case Study/ies Catalyst Healthcare, Ltd www.catalystrms.com Best-in-class electronic medical record platform Unique inventory driven software allows for unprecedented quality and accuracy in medication administration while promoting transparency and seamless communication between long-term care facilities and their pharmacy providers When used in combination with multidose packaging, the barcode scanning at the point-of-care provides the highest possible level of accountability, efficiency and safety Integration to other non-emar applications User-initiated workflow improvements More configurable user experience Comuterized physician order entry (CPOE) CCHIT certification Integration with additional vendors that complement product offering References are generally part of the RFP process. www.leadingage.org/uploadedfiles/ Content/About/CAST/Resources/Three_ Links_Care_Centre.pdf Cerner - Millennium www.cerner.com ElderSuite www.eldersuite.com Extended Care Professional www.ecp123.com Galaxy Hosted Software www.galaxyhosted.com Health Care Software, Inc. (HCS) INTERACTANT www.hcsinteractant.com HealthMEDX www.healthmedx.com Leverages power of EHR platform that is leveraged by major health systems throughout the world and is built to optimize transitions of care and HIE Fully integrated MDS and MDS analytics, and MDS intelligence solution Best point-of-care and analytics solution Complete management system for Texas-based adult day Care facilities Centralized billing for multi-facility companies Ease of use - ease of training Completely integrated EMR, emar Fully customizable assessments, forms Completely integrated EMR Business intelligence implementation Bi-lingual MDS, care plan and patient information/medication leaflets Full integrated, comprehensive EHR system EHR complete with a multitude of prompts and alerts based on evidencebased best practice New LTCH care data set available in SaaS model Single, person-centric record across LTC, CCRC, rehab, home care and hospice with integrated CRM and financials Care transition across the entire care continuum Interoperability with hospitals and physicians Utilizes own data cube analytics tool to provide standard state/federal specific report library Improve upon readmission and transition of care workflows for population health management English is only supported language Inclusion of MDS assessments Employee scheduling Offline support" Need to move rest of clinical modules to mobile devices Clinical competency by discipline for all lines of business Increased presence in state HIE programs eprescribing Significant investments in our products and services with input from our product advisory board and special interest groups Building cloud technologies for population health management solutions to support ACOs and capitated payment models Expand specific product agent into LTC space Expanding HIE and Direct Connect models to further support the LTC space Currently undergoing complete re-write to allow for "occassionally connected" ecosystem Advanced marketing module Integration with property management software Employee scheduling Additional interfaces Additional mobile capabilities NCPDC eprescriping ICD-10 development Enhanced user defined reporting in dashboard plus application Adding to integration/interface library References are generally part of the RFP process. References are generally part of the RFP process. References are generally part of the RFP process. Available upon request None None References provided upon request. None References provided upon request. References provided during your selection process. www.hcsinteractant.com/documents/ CaseStudies.cfm www.leadingage.org/uploadedfiles/ Content/About/CAST/Resources/Lantis_ Enterprises.pdf

Strengths, Areas for Improvement, Ongoing Development and References Hi-Tech Software Solutions www.hi-techsoftware.com LINTECH www.lintechsoftware.com MDI Achieve - MatrixCare www.mdiachieve.com MelyxPro www.melyx.com Momentum Healthware, Inc. www.momentumhealthware.com New Tech Computer Systems - PioneerACMS www.newtechsys.com NextGen Ambulatory EHR NextGen Inpatient Clinicals Strengths Areas for Improvement Ongoing Development References Links to Additional Case Study/ies Customer support and personalized training Ease of conversion and installation Excellent integration of clinical and billing Integrated clinical and financial Turns data into meaningful and actionable information User defined and adoptable" Fully integrated clinical and financial solution with powerful built-in business intelligence for large enterprises to drive business decisions for entire interdisciplinary team Easy to use intuitive software layout coupled with excellent implementation and support services to make sure EHR adoption a success ONC Federal EHR certification enabling powerful partnerships with referring hospitals Integration with robust billing software Embedded pictures with notes Flexible notes Configurable Completely integrated EMR Fully customizable CPOE Windows-based and able to be hosted for a web feel Completely integrated EMR which is proprietarily designed/programmed Scalability, flexibility, customization and accountability measures Streamline Meaningful Use reporting using embedded MU criteria and receive Meaningful Use credit without leaving workflow Improve care management using guidelines embedded in workflow and an automatic risk factor display Reduce charting time, and chart by exception, while simultaneously creating a full patient note Scalable, secure, can fit hospitals needs Critical access, rural community, and specialty hospitals transitioning to meet federal Meaningful Use requirements Reduce errors and improve care quality through better information, workflow efficiency, and communication Improving CPOE Resident appointment scheduling Mobile Access Financial Dashboard Continuing improvements to position clients for smooth operations within a bundled payment enviornment - data exchange with partners, financials, etc. Integration with more ancillary systems including labs, radiology, therapy, vital collection devices, etc. Increased mobile capability for physician engagement Expanding integration to other health care systems Expanding into CPOE Reduction of pharmacy workflow Integration to other non-emar applications Integration to other pharmacy automation systems Payroll Additional assessments A number of significant existing system enhancements and additional program application projects underway. These are research and development efforts confidential, intellectual properties not available in a forum of this type. A number of significant existing system enhancements and additional program application projects underway. These are research and development efforts confidential, intellectual properties not available in a forum of this type. Complete redesign in progress Clinical records anticipated release Dec. 2013 Incorporate SNOWMED New UI Blue Button Continuing improvements to position clients for smooth operations within a bundled payment enviornment - data exchange with partners, financials, etc. Integration with more ancillary systems including labs, radiology, therapy, vital collection devices, etc. Increased mobile capability for physician engagement" Expanding integration to other health care systems Expanding into CPOE Expanding the capabilities of clinical decision support and certified eprescriptions OASIS Payroll A number of significant existing system enhancements and additional program application projects underway. These are research and development efforts confidential, intellectual properties not available in a forum of this type. A number of significant existing system enhancements and additional program application projects underway. These are research and development efforts confidential, intellectual properties not available in a forum of this type. References are generally part of the RFP process. Available upon request. Benedictine Health Systems- Minnesota Health Concepts-Rhode Island Plum Healthcare-California For contact information on these references, please contact Louis Lenzmeier at Louis.Lenzmeier@ mdiachieve.com References are generally part of the RFP process. References are generally part of the RFP process. Ruthy Starkey, Village Healthcare at The Glen (318) 213-3500 Sandy Barbee, James L West (817) 877-1199 Sheila Greenfield, Chandler Nursing Center (405) 258-1131 References are generally part of the RFP process. References are generally part of the RFP process. None http://leadingage.org/uploadedfiles/ Content/About/CAST/Resources/ Monroe_Community_Hospital.pdf www.mdiachieve.com/solutions/matrix/ None None www.leadingage.org/uploadedfiles/ Content/About/CAST/Resources/St_ Clare_Manor.pdf http:///why-nextgen/ Why-Nextgen.aspx http:///why-nextgen/ Why-Nextgen.aspx

www.nttdataltc.com/documents/about/ maria-joseph-ccc-keyhie-success-story. pdf www.leadingage.org/uploadedfiles/ Content/About/CAST/Resources/ Lifespace_Communities_Inc.pdf www.leadingage.org/uploadedfiles/ Content/About/CAST/Resources/Fort_ Hudson_Nursing_Center.pdf http://goprocura.com/company/newsevents/articles http://www.progresahealthsystems.com/ news-and-events/case-studies.htm None Strengths, Areas for Improvement, Ongoing Development and References Strengths Areas for Improvement Ongoing Development References Links to Additional Case Study/ies NTT DATA www.nttdataltc.com Depth of features and ability to customize Document management apps including edocuments, test results Interoperability among our application suite and third-party products Electronic signature Resident scheduling eprescribing expansion CCHIT certification as LTPAC EHR technology HIE expansion References are generally part of the RFP process. Optimus EMR www.optimusemr.com Automation of MDS, clinical alerts, active interfaces and realtime management The only system with Internet outage protection See Hardware tab CDS to be enhanced and physician portal added Integration of Interact II and other clinical decision tools References are generally part of the RFP process. PointClickCare www.pointclickcare.com Highly integrated, intuitive platform with automatic seamless data flow between modules enabling staff to quickly acclimate to the system with minimal training and data entry requirements on clinical and financial staff Pharmacy integrations, including bi-directional capabilities with scalable integration capacity for unlimited pharmacy partner relationships Access to largest client advisory group in North America Enhanced dashboards/business intelligence reporting, including custom user reporting functionalities Increased engagment in HIE initiatives Interoperability capabilities for labs and radiology Exclusive relationship with Florida Atlantic University to embed INTERACT III tools and protocols in development of einteract for HIT systems Physician and NP engagement for further adoption of HIT in post-acute settings Fort Hudson Fort Edward, New York www.forthudson.com (518) 747-2811 Contact: Andy Cruikshank Presbyterian Homes & Services Roseville, MN www.preshomes.com (651) 631-6100 Contact: Shelly Dahlgren United Church Homes Marion, Ohio www.unitedchurchhomes.org (740) 382-4885 Contact: Rob Weisbrodbt Procura Health Management Systems www.goprocura.com Agency management: workforce management solutions for highvolume service organizations, multiservice community case management capabilities, flexible billing rules and workflow engine Client care: document design studio for care plan/ pathways, assessessments, and HR documents is robust Completely integrated EMR, pediatric feature set New to hospice, so development of value-added components are in progress. Additional interoperability standards development is important going forward Interoperability enhancements, integration with ancillary applications. References are generally part of the RFP process. Progresa Health Systems www.progresahealthsystems.com Client care: document design studio for care plan/ pathways, assessessments, and HR documents is robust Completely integrated EMR, pediatric feature set Improve care plan maintenance feature set Improvements to UI and UE References are generally part of the RFP process. Reliable Health Systems www.reliablehealth.com Dashboards Completely integrated EMR Fully customizable CPOE Additional Interoperability standards development is important going forward Develop continued improvements in clinical decision support References are generally part of the RFP process.

None None www.sigmacare.com/category. asp?category_id=1&content=newsdir/case None None None Strengths, Areas for Improvement, Ongoing Development and References Strengths Areas for Improvement Ongoing Development References Links to Additional Case Study/ies ResCare, LLC www.rescaresoftware.com Integrated software to complement facility goal to provide compassionate, efficient and affordable long-term care Ease of use, intuitive, completely integrated EMR (med rec, emar/tar, MDS, billing) including ALL disciplines decreasing duplicity, increasing productivity Relationship-based; 24/7 support; transition quickly - at cost data entry, remote & onsite training Enhance business function capabilities Streamlining physician access & usability Develop continued improvements in clinical decision support Enhance and facilitate communication with acute-care regarding admission/ readmission References are generally part of the RFP process. Saunders Associates SAEnCompass www.saencompass.com Completely integrated EMR emar that informs of side effects, interactions and most recent administrations during the administration process Guidelines throughout to facilitate compliance with CMS regulations English is only supported language Workflow planning References are generally part of the RFP process. SigmaCare www.sigmacare.com Industry leading medication management solution with complete clinical workflow and embedded decision support and alerts Extensive interoperability with national and local vendors and providers (pharmacy, lab, radiology, HIEs) Focus on clinical and financial outcomes through high user adoption, performance optimization and consulting services Enhanced broadcast messaging Integrations with additonal national and local lab and radiology vendors and HIEs References are generally part of the RFP process. SOS Corporation www.sosc.com Suncoast Solutions www.sncoast.com Yardi/ALMSA www.almsahealth.com Customization Interoperability with other systems Easy to implement Completely integrated EMR, that handles multiple service lines seamlessly Robust integrated scheduling Physician & nursing portals Industry leading medication management solution with complete clinical workflow Interoperability with national and local vendors and providers (pharmacies) Focus on clinical and financial outcomes - introduction of business intelligence for clinical Simplifying physician access Resident appointment scheduling English is the only supported language Providing more web-based functionality Provide device-agnostic solution Interoperability engine Provide and refine better workflow patterns into platform Resident appointment scheduling Streamlining physician access Growing the list of integration partners Providing more web-based functionality Provide device-agnostic solution Other portals to enchance community connections MDS in progress Home health modules in progress Integration with devices to interface data into platform References are generally part of the RFP process. References are generally part of the RFP process. References are generally part of the RFP process.