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Eric Q ReynoldsVice-PresidentAtlas Medical Corporation
Healthcare EMR Emergence and Laboratory EMR Strategies for 2009
Eric Q ReynoldsEric Q Reynolds
Currently ATLAS Medical VP of Sales and Marketing
Twenty (gulp) years in laboratory industry
Survived a gauntlet of positions
Toxicologist
Client Services
System Deployments and Training
Field Team Management
Sales and Account Management
Joined ATLAS Medical in Fall of 2007
Webinar Agenda
EMR Definition
What an EMR Does
The Role of the EMR in Outpatient Clinics vs Hospitals
EMR Facts and Industry Trends
EMR Market Adoption
Physician EMR Adoption
Government Gets Involved (Stark CCHIT and HITECH)
Physician EMR Requirements for Lab Orders and Results
LabEMR Integration vs ldquoone offrdquo Interfacing
Benefits to LabEMR Integration
Outpatient EMR Definition
PMS (Practice Management System) for Administrative UseRegistrationSchedulingBillingMay be included as part of the EMR or a stand alone productgt 90 adoption nationally
EMR (Electronic Medical Record) for Clinical UsePatient chartsMedications Conditions AllergiesResults (Laboratory ECG Radiology)17 adoption nationally
Source Physicians Practice ldquoIT Enhancement Time at Last for an Upgraderdquo author Shirley Grace February 2007
Source The New England Journal of Medicine ldquoElectronic Health Records in Ambulatory Care - A National Survey of Physiciansrdquo July 3 2008
What Does an Outpatient EMR Do
Electronic Medical Recordbull What was paper isnrsquotbull Anytime access to patientrsquos chartsbull Clinical workflow mgmtbull Clinical assessmentbull Disease managementbull Interfaces tofrom bull Labs bull Radiology bull ECGCath bull Other EMRsbull Outcomes Reporting
EMR Outpatient vs Hospital
EMR Clinical
Outpatient Clinic Hospital or IDN HIS
Administrative
CDR Clinical
PMS Administrative
bullRegistrationbullSchedulingbullBilling
bullRegistrationbullSchedulingbullBillingbullADT
bullPatient ChartsbullMeds problems allergiesbullResults (Labs ECGRad)
bullEnterprise wide repositorybullGenerally labs and documents
EMR Industry Facts and Trends
bullCurrently over 350 EMRs are available in North America
bull32 new EMR vendors have been certified over the past 12 months
bullQuest and LCA investing significant $$ in EMR interfacing and have a head start over hospitals
bull2009 Health Information Technology for Economic and Clinical Health Act (ldquoHITECHrdquo) will spur significant increases in EMR utilization in the outpatient setting
bullSignificant challenges will be placed on independent laboratories and hospital laboratories to integrate with all manner of outpatient EMR systems
bullCurrently over 350 EMRs are available in North America
bull32 new EMR vendors have been certified over the past 12 months
bullQuest and LCA investing significant $$ in EMR interfacing and have a head start over hospitals
bull2009 Health Information Technology for Economic and Clinical Health Act (ldquoHITECHrdquo) will spur significant increases in EMR utilization in the outpatient setting
bullSignificant challenges will be placed on independent laboratories and hospital laboratories to integrate with all manner of outpatient EMR systems
EMR Vendor Snapshot
Top 10 EMR Vendors (smaller 1-10 Physician practices) (largest growth sector)
bullNextGen bullAllscriptsMisys (Merger Completed 1008) (Allscripts purchased A4 Health in 2006)bullMcKesson (puchase Practice Partner 207) (PMSI name change to Practice Partner in 2006)bulle-MDsbulle-ClinicalWorksbulliMedica bullSagebullEmdeon Intergy EMR (WebMD) bullGE CentricitybullMedinotes
Top 10 EMR Vendors (smaller 1-10 Physician practices) (largest growth sector)
bullNextGen bullAllscriptsMisys (Merger Completed 1008) (Allscripts purchased A4 Health in 2006)bullMcKesson (puchase Practice Partner 207) (PMSI name change to Practice Partner in 2006)bulle-MDsbulle-ClinicalWorksbulliMedica bullSagebullEmdeon Intergy EMR (WebMD) bullGE CentricitybullMedinotes
EMR Market Adoption
020000400006000080000
100000120000140000160000180000200000
2005 2007 2009E 2011E
EMR Adoption
EMR Penetration Docs
total 2005 2006 2007 2008E 2009E 2010E 2011E
Solo 181500 33 9075 10391 11898 13623 15607 17898 20556
2-9 220000 40 22000 26840 32754 40000 48911 59899 73470
10-20 55000 10 9020 11095 13642 16763 20592 25295 31078
21-49 38500 7 7816 9691 12021 14921 18512 22929 28361
50+ 38500 7 10203 12855 16129 20063 24600 29567 34982
Total penetration 58114 70872 86444 105370 128222 155588 188477
Total Docs 550000 106 129 157 192 233 283 343
Source CDC Health Affairs AC Group MGMA SFG ResearchCompiled Susquehanna Financial Group investor report on Allscripts published 32207
Physician EMR Adoption ProfileIn
ves
tme
nt
(tim
e t
oo
ls e
tc hellip
)
EMR Implementation Timeline
Minimal workflow impactPopulates chart with clinical data lab results and transcription usually via scanned documentsChart review from home
Phone notesVirtual ldquoto dordquo listOffice efficiencies
Script legibilityInteraction checksFormulary compliance
Face sheet documentationEampM ComplianceBilling efficienciesDisease management
CPOE requirementComplete EMR workflow
View andSign
OfficeCommunication
MedicationManagement
Full EncounterDocumentationLab Results are
required in 90 ofEMR go-lives
Lab Orders areadopted whengeneral ordersare adopted
Orders
2006 ndash Uncle Sam Gets Involved
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT Certification Chronology
CCHIT interoperability requirements that impact laboratoryCurrently itrsquos a Low Bar 32 EMR vendors have been certified
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20091048633Transmit the Lab Test Order Electronically
20091048633Transmit the Lab Test Order Electronically
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
HITECH Begins in 2009
CCHIT expected to be go forward certification body for healthcare IT
$19 billion in incentives and funding
$17 billion in physician incentives
$2 billion in HHS ldquodiscretionary fundsrdquo
Aims to dramatically drive interoperability standards across healthcare IT
90 physician EMR adoption by 2020
2009 Congressional Budget Office2009 Congressional Budget Office
What Physicians Want for Lab
All orders originate from within the physicianrsquos EMR
Must be easy to use Want the fewest ldquoclicksrdquo to order and view lab
Dynamically update physiciansrsquo ordering information
Make it part of physiciansrsquo normal EMR workflow
All results returned to physiciansrsquo EMR and matched to their patientsrsquo record (IPOPOR)
Inform the ordering provider of pending results
EMR Integration
Physician Office Perception
EMR LIS
IntegrationhellipNot the Other ldquoIrdquo Word
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Benefits of EMR Integration Platform
Improve customer service and client satisfactionMake it easier for your customers to order within their EMR
Consolidates inpatient outpatient outreach results
Perform test and bill correctly the first time avoid calling for missing clinical and billing information
Creates another exit barrier with physician
Increase revenue improve efficiency reduce operational costs
Decrease billing and clinical errors
Eliminate data entry at the lab and PSC
Reduce costly data correctionretrieval activities
Reduce medical necessity denials and write-offs
Healthcare EMR Emergence and Laboratory EMR Strategies for 2009
Thank You
Questions
Eric Q ReynoldsEric Q Reynolds
Currently ATLAS Medical VP of Sales and Marketing
Twenty (gulp) years in laboratory industry
Survived a gauntlet of positions
Toxicologist
Client Services
System Deployments and Training
Field Team Management
Sales and Account Management
Joined ATLAS Medical in Fall of 2007
Webinar Agenda
EMR Definition
What an EMR Does
The Role of the EMR in Outpatient Clinics vs Hospitals
EMR Facts and Industry Trends
EMR Market Adoption
Physician EMR Adoption
Government Gets Involved (Stark CCHIT and HITECH)
Physician EMR Requirements for Lab Orders and Results
LabEMR Integration vs ldquoone offrdquo Interfacing
Benefits to LabEMR Integration
Outpatient EMR Definition
PMS (Practice Management System) for Administrative UseRegistrationSchedulingBillingMay be included as part of the EMR or a stand alone productgt 90 adoption nationally
EMR (Electronic Medical Record) for Clinical UsePatient chartsMedications Conditions AllergiesResults (Laboratory ECG Radiology)17 adoption nationally
Source Physicians Practice ldquoIT Enhancement Time at Last for an Upgraderdquo author Shirley Grace February 2007
Source The New England Journal of Medicine ldquoElectronic Health Records in Ambulatory Care - A National Survey of Physiciansrdquo July 3 2008
What Does an Outpatient EMR Do
Electronic Medical Recordbull What was paper isnrsquotbull Anytime access to patientrsquos chartsbull Clinical workflow mgmtbull Clinical assessmentbull Disease managementbull Interfaces tofrom bull Labs bull Radiology bull ECGCath bull Other EMRsbull Outcomes Reporting
EMR Outpatient vs Hospital
EMR Clinical
Outpatient Clinic Hospital or IDN HIS
Administrative
CDR Clinical
PMS Administrative
bullRegistrationbullSchedulingbullBilling
bullRegistrationbullSchedulingbullBillingbullADT
bullPatient ChartsbullMeds problems allergiesbullResults (Labs ECGRad)
bullEnterprise wide repositorybullGenerally labs and documents
EMR Industry Facts and Trends
bullCurrently over 350 EMRs are available in North America
bull32 new EMR vendors have been certified over the past 12 months
bullQuest and LCA investing significant $$ in EMR interfacing and have a head start over hospitals
bull2009 Health Information Technology for Economic and Clinical Health Act (ldquoHITECHrdquo) will spur significant increases in EMR utilization in the outpatient setting
bullSignificant challenges will be placed on independent laboratories and hospital laboratories to integrate with all manner of outpatient EMR systems
bullCurrently over 350 EMRs are available in North America
bull32 new EMR vendors have been certified over the past 12 months
bullQuest and LCA investing significant $$ in EMR interfacing and have a head start over hospitals
bull2009 Health Information Technology for Economic and Clinical Health Act (ldquoHITECHrdquo) will spur significant increases in EMR utilization in the outpatient setting
bullSignificant challenges will be placed on independent laboratories and hospital laboratories to integrate with all manner of outpatient EMR systems
EMR Vendor Snapshot
Top 10 EMR Vendors (smaller 1-10 Physician practices) (largest growth sector)
bullNextGen bullAllscriptsMisys (Merger Completed 1008) (Allscripts purchased A4 Health in 2006)bullMcKesson (puchase Practice Partner 207) (PMSI name change to Practice Partner in 2006)bulle-MDsbulle-ClinicalWorksbulliMedica bullSagebullEmdeon Intergy EMR (WebMD) bullGE CentricitybullMedinotes
Top 10 EMR Vendors (smaller 1-10 Physician practices) (largest growth sector)
bullNextGen bullAllscriptsMisys (Merger Completed 1008) (Allscripts purchased A4 Health in 2006)bullMcKesson (puchase Practice Partner 207) (PMSI name change to Practice Partner in 2006)bulle-MDsbulle-ClinicalWorksbulliMedica bullSagebullEmdeon Intergy EMR (WebMD) bullGE CentricitybullMedinotes
EMR Market Adoption
020000400006000080000
100000120000140000160000180000200000
2005 2007 2009E 2011E
EMR Adoption
EMR Penetration Docs
total 2005 2006 2007 2008E 2009E 2010E 2011E
Solo 181500 33 9075 10391 11898 13623 15607 17898 20556
2-9 220000 40 22000 26840 32754 40000 48911 59899 73470
10-20 55000 10 9020 11095 13642 16763 20592 25295 31078
21-49 38500 7 7816 9691 12021 14921 18512 22929 28361
50+ 38500 7 10203 12855 16129 20063 24600 29567 34982
Total penetration 58114 70872 86444 105370 128222 155588 188477
Total Docs 550000 106 129 157 192 233 283 343
Source CDC Health Affairs AC Group MGMA SFG ResearchCompiled Susquehanna Financial Group investor report on Allscripts published 32207
Physician EMR Adoption ProfileIn
ves
tme
nt
(tim
e t
oo
ls e
tc hellip
)
EMR Implementation Timeline
Minimal workflow impactPopulates chart with clinical data lab results and transcription usually via scanned documentsChart review from home
Phone notesVirtual ldquoto dordquo listOffice efficiencies
Script legibilityInteraction checksFormulary compliance
Face sheet documentationEampM ComplianceBilling efficienciesDisease management
CPOE requirementComplete EMR workflow
View andSign
OfficeCommunication
MedicationManagement
Full EncounterDocumentationLab Results are
required in 90 ofEMR go-lives
Lab Orders areadopted whengeneral ordersare adopted
Orders
2006 ndash Uncle Sam Gets Involved
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT Certification Chronology
CCHIT interoperability requirements that impact laboratoryCurrently itrsquos a Low Bar 32 EMR vendors have been certified
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20091048633Transmit the Lab Test Order Electronically
20091048633Transmit the Lab Test Order Electronically
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
HITECH Begins in 2009
CCHIT expected to be go forward certification body for healthcare IT
$19 billion in incentives and funding
$17 billion in physician incentives
$2 billion in HHS ldquodiscretionary fundsrdquo
Aims to dramatically drive interoperability standards across healthcare IT
90 physician EMR adoption by 2020
2009 Congressional Budget Office2009 Congressional Budget Office
What Physicians Want for Lab
All orders originate from within the physicianrsquos EMR
Must be easy to use Want the fewest ldquoclicksrdquo to order and view lab
Dynamically update physiciansrsquo ordering information
Make it part of physiciansrsquo normal EMR workflow
All results returned to physiciansrsquo EMR and matched to their patientsrsquo record (IPOPOR)
Inform the ordering provider of pending results
EMR Integration
Physician Office Perception
EMR LIS
IntegrationhellipNot the Other ldquoIrdquo Word
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Benefits of EMR Integration Platform
Improve customer service and client satisfactionMake it easier for your customers to order within their EMR
Consolidates inpatient outpatient outreach results
Perform test and bill correctly the first time avoid calling for missing clinical and billing information
Creates another exit barrier with physician
Increase revenue improve efficiency reduce operational costs
Decrease billing and clinical errors
Eliminate data entry at the lab and PSC
Reduce costly data correctionretrieval activities
Reduce medical necessity denials and write-offs
Healthcare EMR Emergence and Laboratory EMR Strategies for 2009
Thank You
Questions
Webinar Agenda
EMR Definition
What an EMR Does
The Role of the EMR in Outpatient Clinics vs Hospitals
EMR Facts and Industry Trends
EMR Market Adoption
Physician EMR Adoption
Government Gets Involved (Stark CCHIT and HITECH)
Physician EMR Requirements for Lab Orders and Results
LabEMR Integration vs ldquoone offrdquo Interfacing
Benefits to LabEMR Integration
Outpatient EMR Definition
PMS (Practice Management System) for Administrative UseRegistrationSchedulingBillingMay be included as part of the EMR or a stand alone productgt 90 adoption nationally
EMR (Electronic Medical Record) for Clinical UsePatient chartsMedications Conditions AllergiesResults (Laboratory ECG Radiology)17 adoption nationally
Source Physicians Practice ldquoIT Enhancement Time at Last for an Upgraderdquo author Shirley Grace February 2007
Source The New England Journal of Medicine ldquoElectronic Health Records in Ambulatory Care - A National Survey of Physiciansrdquo July 3 2008
What Does an Outpatient EMR Do
Electronic Medical Recordbull What was paper isnrsquotbull Anytime access to patientrsquos chartsbull Clinical workflow mgmtbull Clinical assessmentbull Disease managementbull Interfaces tofrom bull Labs bull Radiology bull ECGCath bull Other EMRsbull Outcomes Reporting
EMR Outpatient vs Hospital
EMR Clinical
Outpatient Clinic Hospital or IDN HIS
Administrative
CDR Clinical
PMS Administrative
bullRegistrationbullSchedulingbullBilling
bullRegistrationbullSchedulingbullBillingbullADT
bullPatient ChartsbullMeds problems allergiesbullResults (Labs ECGRad)
bullEnterprise wide repositorybullGenerally labs and documents
EMR Industry Facts and Trends
bullCurrently over 350 EMRs are available in North America
bull32 new EMR vendors have been certified over the past 12 months
bullQuest and LCA investing significant $$ in EMR interfacing and have a head start over hospitals
bull2009 Health Information Technology for Economic and Clinical Health Act (ldquoHITECHrdquo) will spur significant increases in EMR utilization in the outpatient setting
bullSignificant challenges will be placed on independent laboratories and hospital laboratories to integrate with all manner of outpatient EMR systems
bullCurrently over 350 EMRs are available in North America
bull32 new EMR vendors have been certified over the past 12 months
bullQuest and LCA investing significant $$ in EMR interfacing and have a head start over hospitals
bull2009 Health Information Technology for Economic and Clinical Health Act (ldquoHITECHrdquo) will spur significant increases in EMR utilization in the outpatient setting
bullSignificant challenges will be placed on independent laboratories and hospital laboratories to integrate with all manner of outpatient EMR systems
EMR Vendor Snapshot
Top 10 EMR Vendors (smaller 1-10 Physician practices) (largest growth sector)
bullNextGen bullAllscriptsMisys (Merger Completed 1008) (Allscripts purchased A4 Health in 2006)bullMcKesson (puchase Practice Partner 207) (PMSI name change to Practice Partner in 2006)bulle-MDsbulle-ClinicalWorksbulliMedica bullSagebullEmdeon Intergy EMR (WebMD) bullGE CentricitybullMedinotes
Top 10 EMR Vendors (smaller 1-10 Physician practices) (largest growth sector)
bullNextGen bullAllscriptsMisys (Merger Completed 1008) (Allscripts purchased A4 Health in 2006)bullMcKesson (puchase Practice Partner 207) (PMSI name change to Practice Partner in 2006)bulle-MDsbulle-ClinicalWorksbulliMedica bullSagebullEmdeon Intergy EMR (WebMD) bullGE CentricitybullMedinotes
EMR Market Adoption
020000400006000080000
100000120000140000160000180000200000
2005 2007 2009E 2011E
EMR Adoption
EMR Penetration Docs
total 2005 2006 2007 2008E 2009E 2010E 2011E
Solo 181500 33 9075 10391 11898 13623 15607 17898 20556
2-9 220000 40 22000 26840 32754 40000 48911 59899 73470
10-20 55000 10 9020 11095 13642 16763 20592 25295 31078
21-49 38500 7 7816 9691 12021 14921 18512 22929 28361
50+ 38500 7 10203 12855 16129 20063 24600 29567 34982
Total penetration 58114 70872 86444 105370 128222 155588 188477
Total Docs 550000 106 129 157 192 233 283 343
Source CDC Health Affairs AC Group MGMA SFG ResearchCompiled Susquehanna Financial Group investor report on Allscripts published 32207
Physician EMR Adoption ProfileIn
ves
tme
nt
(tim
e t
oo
ls e
tc hellip
)
EMR Implementation Timeline
Minimal workflow impactPopulates chart with clinical data lab results and transcription usually via scanned documentsChart review from home
Phone notesVirtual ldquoto dordquo listOffice efficiencies
Script legibilityInteraction checksFormulary compliance
Face sheet documentationEampM ComplianceBilling efficienciesDisease management
CPOE requirementComplete EMR workflow
View andSign
OfficeCommunication
MedicationManagement
Full EncounterDocumentationLab Results are
required in 90 ofEMR go-lives
Lab Orders areadopted whengeneral ordersare adopted
Orders
2006 ndash Uncle Sam Gets Involved
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT Certification Chronology
CCHIT interoperability requirements that impact laboratoryCurrently itrsquos a Low Bar 32 EMR vendors have been certified
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20091048633Transmit the Lab Test Order Electronically
20091048633Transmit the Lab Test Order Electronically
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
HITECH Begins in 2009
CCHIT expected to be go forward certification body for healthcare IT
$19 billion in incentives and funding
$17 billion in physician incentives
$2 billion in HHS ldquodiscretionary fundsrdquo
Aims to dramatically drive interoperability standards across healthcare IT
90 physician EMR adoption by 2020
2009 Congressional Budget Office2009 Congressional Budget Office
What Physicians Want for Lab
All orders originate from within the physicianrsquos EMR
Must be easy to use Want the fewest ldquoclicksrdquo to order and view lab
Dynamically update physiciansrsquo ordering information
Make it part of physiciansrsquo normal EMR workflow
All results returned to physiciansrsquo EMR and matched to their patientsrsquo record (IPOPOR)
Inform the ordering provider of pending results
EMR Integration
Physician Office Perception
EMR LIS
IntegrationhellipNot the Other ldquoIrdquo Word
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Benefits of EMR Integration Platform
Improve customer service and client satisfactionMake it easier for your customers to order within their EMR
Consolidates inpatient outpatient outreach results
Perform test and bill correctly the first time avoid calling for missing clinical and billing information
Creates another exit barrier with physician
Increase revenue improve efficiency reduce operational costs
Decrease billing and clinical errors
Eliminate data entry at the lab and PSC
Reduce costly data correctionretrieval activities
Reduce medical necessity denials and write-offs
Healthcare EMR Emergence and Laboratory EMR Strategies for 2009
Thank You
Questions
Outpatient EMR Definition
PMS (Practice Management System) for Administrative UseRegistrationSchedulingBillingMay be included as part of the EMR or a stand alone productgt 90 adoption nationally
EMR (Electronic Medical Record) for Clinical UsePatient chartsMedications Conditions AllergiesResults (Laboratory ECG Radiology)17 adoption nationally
Source Physicians Practice ldquoIT Enhancement Time at Last for an Upgraderdquo author Shirley Grace February 2007
Source The New England Journal of Medicine ldquoElectronic Health Records in Ambulatory Care - A National Survey of Physiciansrdquo July 3 2008
What Does an Outpatient EMR Do
Electronic Medical Recordbull What was paper isnrsquotbull Anytime access to patientrsquos chartsbull Clinical workflow mgmtbull Clinical assessmentbull Disease managementbull Interfaces tofrom bull Labs bull Radiology bull ECGCath bull Other EMRsbull Outcomes Reporting
EMR Outpatient vs Hospital
EMR Clinical
Outpatient Clinic Hospital or IDN HIS
Administrative
CDR Clinical
PMS Administrative
bullRegistrationbullSchedulingbullBilling
bullRegistrationbullSchedulingbullBillingbullADT
bullPatient ChartsbullMeds problems allergiesbullResults (Labs ECGRad)
bullEnterprise wide repositorybullGenerally labs and documents
EMR Industry Facts and Trends
bullCurrently over 350 EMRs are available in North America
bull32 new EMR vendors have been certified over the past 12 months
bullQuest and LCA investing significant $$ in EMR interfacing and have a head start over hospitals
bull2009 Health Information Technology for Economic and Clinical Health Act (ldquoHITECHrdquo) will spur significant increases in EMR utilization in the outpatient setting
bullSignificant challenges will be placed on independent laboratories and hospital laboratories to integrate with all manner of outpatient EMR systems
bullCurrently over 350 EMRs are available in North America
bull32 new EMR vendors have been certified over the past 12 months
bullQuest and LCA investing significant $$ in EMR interfacing and have a head start over hospitals
bull2009 Health Information Technology for Economic and Clinical Health Act (ldquoHITECHrdquo) will spur significant increases in EMR utilization in the outpatient setting
bullSignificant challenges will be placed on independent laboratories and hospital laboratories to integrate with all manner of outpatient EMR systems
EMR Vendor Snapshot
Top 10 EMR Vendors (smaller 1-10 Physician practices) (largest growth sector)
bullNextGen bullAllscriptsMisys (Merger Completed 1008) (Allscripts purchased A4 Health in 2006)bullMcKesson (puchase Practice Partner 207) (PMSI name change to Practice Partner in 2006)bulle-MDsbulle-ClinicalWorksbulliMedica bullSagebullEmdeon Intergy EMR (WebMD) bullGE CentricitybullMedinotes
Top 10 EMR Vendors (smaller 1-10 Physician practices) (largest growth sector)
bullNextGen bullAllscriptsMisys (Merger Completed 1008) (Allscripts purchased A4 Health in 2006)bullMcKesson (puchase Practice Partner 207) (PMSI name change to Practice Partner in 2006)bulle-MDsbulle-ClinicalWorksbulliMedica bullSagebullEmdeon Intergy EMR (WebMD) bullGE CentricitybullMedinotes
EMR Market Adoption
020000400006000080000
100000120000140000160000180000200000
2005 2007 2009E 2011E
EMR Adoption
EMR Penetration Docs
total 2005 2006 2007 2008E 2009E 2010E 2011E
Solo 181500 33 9075 10391 11898 13623 15607 17898 20556
2-9 220000 40 22000 26840 32754 40000 48911 59899 73470
10-20 55000 10 9020 11095 13642 16763 20592 25295 31078
21-49 38500 7 7816 9691 12021 14921 18512 22929 28361
50+ 38500 7 10203 12855 16129 20063 24600 29567 34982
Total penetration 58114 70872 86444 105370 128222 155588 188477
Total Docs 550000 106 129 157 192 233 283 343
Source CDC Health Affairs AC Group MGMA SFG ResearchCompiled Susquehanna Financial Group investor report on Allscripts published 32207
Physician EMR Adoption ProfileIn
ves
tme
nt
(tim
e t
oo
ls e
tc hellip
)
EMR Implementation Timeline
Minimal workflow impactPopulates chart with clinical data lab results and transcription usually via scanned documentsChart review from home
Phone notesVirtual ldquoto dordquo listOffice efficiencies
Script legibilityInteraction checksFormulary compliance
Face sheet documentationEampM ComplianceBilling efficienciesDisease management
CPOE requirementComplete EMR workflow
View andSign
OfficeCommunication
MedicationManagement
Full EncounterDocumentationLab Results are
required in 90 ofEMR go-lives
Lab Orders areadopted whengeneral ordersare adopted
Orders
2006 ndash Uncle Sam Gets Involved
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT Certification Chronology
CCHIT interoperability requirements that impact laboratoryCurrently itrsquos a Low Bar 32 EMR vendors have been certified
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20091048633Transmit the Lab Test Order Electronically
20091048633Transmit the Lab Test Order Electronically
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
HITECH Begins in 2009
CCHIT expected to be go forward certification body for healthcare IT
$19 billion in incentives and funding
$17 billion in physician incentives
$2 billion in HHS ldquodiscretionary fundsrdquo
Aims to dramatically drive interoperability standards across healthcare IT
90 physician EMR adoption by 2020
2009 Congressional Budget Office2009 Congressional Budget Office
What Physicians Want for Lab
All orders originate from within the physicianrsquos EMR
Must be easy to use Want the fewest ldquoclicksrdquo to order and view lab
Dynamically update physiciansrsquo ordering information
Make it part of physiciansrsquo normal EMR workflow
All results returned to physiciansrsquo EMR and matched to their patientsrsquo record (IPOPOR)
Inform the ordering provider of pending results
EMR Integration
Physician Office Perception
EMR LIS
IntegrationhellipNot the Other ldquoIrdquo Word
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Benefits of EMR Integration Platform
Improve customer service and client satisfactionMake it easier for your customers to order within their EMR
Consolidates inpatient outpatient outreach results
Perform test and bill correctly the first time avoid calling for missing clinical and billing information
Creates another exit barrier with physician
Increase revenue improve efficiency reduce operational costs
Decrease billing and clinical errors
Eliminate data entry at the lab and PSC
Reduce costly data correctionretrieval activities
Reduce medical necessity denials and write-offs
Healthcare EMR Emergence and Laboratory EMR Strategies for 2009
Thank You
Questions
What Does an Outpatient EMR Do
Electronic Medical Recordbull What was paper isnrsquotbull Anytime access to patientrsquos chartsbull Clinical workflow mgmtbull Clinical assessmentbull Disease managementbull Interfaces tofrom bull Labs bull Radiology bull ECGCath bull Other EMRsbull Outcomes Reporting
EMR Outpatient vs Hospital
EMR Clinical
Outpatient Clinic Hospital or IDN HIS
Administrative
CDR Clinical
PMS Administrative
bullRegistrationbullSchedulingbullBilling
bullRegistrationbullSchedulingbullBillingbullADT
bullPatient ChartsbullMeds problems allergiesbullResults (Labs ECGRad)
bullEnterprise wide repositorybullGenerally labs and documents
EMR Industry Facts and Trends
bullCurrently over 350 EMRs are available in North America
bull32 new EMR vendors have been certified over the past 12 months
bullQuest and LCA investing significant $$ in EMR interfacing and have a head start over hospitals
bull2009 Health Information Technology for Economic and Clinical Health Act (ldquoHITECHrdquo) will spur significant increases in EMR utilization in the outpatient setting
bullSignificant challenges will be placed on independent laboratories and hospital laboratories to integrate with all manner of outpatient EMR systems
bullCurrently over 350 EMRs are available in North America
bull32 new EMR vendors have been certified over the past 12 months
bullQuest and LCA investing significant $$ in EMR interfacing and have a head start over hospitals
bull2009 Health Information Technology for Economic and Clinical Health Act (ldquoHITECHrdquo) will spur significant increases in EMR utilization in the outpatient setting
bullSignificant challenges will be placed on independent laboratories and hospital laboratories to integrate with all manner of outpatient EMR systems
EMR Vendor Snapshot
Top 10 EMR Vendors (smaller 1-10 Physician practices) (largest growth sector)
bullNextGen bullAllscriptsMisys (Merger Completed 1008) (Allscripts purchased A4 Health in 2006)bullMcKesson (puchase Practice Partner 207) (PMSI name change to Practice Partner in 2006)bulle-MDsbulle-ClinicalWorksbulliMedica bullSagebullEmdeon Intergy EMR (WebMD) bullGE CentricitybullMedinotes
Top 10 EMR Vendors (smaller 1-10 Physician practices) (largest growth sector)
bullNextGen bullAllscriptsMisys (Merger Completed 1008) (Allscripts purchased A4 Health in 2006)bullMcKesson (puchase Practice Partner 207) (PMSI name change to Practice Partner in 2006)bulle-MDsbulle-ClinicalWorksbulliMedica bullSagebullEmdeon Intergy EMR (WebMD) bullGE CentricitybullMedinotes
EMR Market Adoption
020000400006000080000
100000120000140000160000180000200000
2005 2007 2009E 2011E
EMR Adoption
EMR Penetration Docs
total 2005 2006 2007 2008E 2009E 2010E 2011E
Solo 181500 33 9075 10391 11898 13623 15607 17898 20556
2-9 220000 40 22000 26840 32754 40000 48911 59899 73470
10-20 55000 10 9020 11095 13642 16763 20592 25295 31078
21-49 38500 7 7816 9691 12021 14921 18512 22929 28361
50+ 38500 7 10203 12855 16129 20063 24600 29567 34982
Total penetration 58114 70872 86444 105370 128222 155588 188477
Total Docs 550000 106 129 157 192 233 283 343
Source CDC Health Affairs AC Group MGMA SFG ResearchCompiled Susquehanna Financial Group investor report on Allscripts published 32207
Physician EMR Adoption ProfileIn
ves
tme
nt
(tim
e t
oo
ls e
tc hellip
)
EMR Implementation Timeline
Minimal workflow impactPopulates chart with clinical data lab results and transcription usually via scanned documentsChart review from home
Phone notesVirtual ldquoto dordquo listOffice efficiencies
Script legibilityInteraction checksFormulary compliance
Face sheet documentationEampM ComplianceBilling efficienciesDisease management
CPOE requirementComplete EMR workflow
View andSign
OfficeCommunication
MedicationManagement
Full EncounterDocumentationLab Results are
required in 90 ofEMR go-lives
Lab Orders areadopted whengeneral ordersare adopted
Orders
2006 ndash Uncle Sam Gets Involved
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT Certification Chronology
CCHIT interoperability requirements that impact laboratoryCurrently itrsquos a Low Bar 32 EMR vendors have been certified
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20091048633Transmit the Lab Test Order Electronically
20091048633Transmit the Lab Test Order Electronically
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
HITECH Begins in 2009
CCHIT expected to be go forward certification body for healthcare IT
$19 billion in incentives and funding
$17 billion in physician incentives
$2 billion in HHS ldquodiscretionary fundsrdquo
Aims to dramatically drive interoperability standards across healthcare IT
90 physician EMR adoption by 2020
2009 Congressional Budget Office2009 Congressional Budget Office
What Physicians Want for Lab
All orders originate from within the physicianrsquos EMR
Must be easy to use Want the fewest ldquoclicksrdquo to order and view lab
Dynamically update physiciansrsquo ordering information
Make it part of physiciansrsquo normal EMR workflow
All results returned to physiciansrsquo EMR and matched to their patientsrsquo record (IPOPOR)
Inform the ordering provider of pending results
EMR Integration
Physician Office Perception
EMR LIS
IntegrationhellipNot the Other ldquoIrdquo Word
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Benefits of EMR Integration Platform
Improve customer service and client satisfactionMake it easier for your customers to order within their EMR
Consolidates inpatient outpatient outreach results
Perform test and bill correctly the first time avoid calling for missing clinical and billing information
Creates another exit barrier with physician
Increase revenue improve efficiency reduce operational costs
Decrease billing and clinical errors
Eliminate data entry at the lab and PSC
Reduce costly data correctionretrieval activities
Reduce medical necessity denials and write-offs
Healthcare EMR Emergence and Laboratory EMR Strategies for 2009
Thank You
Questions
EMR Outpatient vs Hospital
EMR Clinical
Outpatient Clinic Hospital or IDN HIS
Administrative
CDR Clinical
PMS Administrative
bullRegistrationbullSchedulingbullBilling
bullRegistrationbullSchedulingbullBillingbullADT
bullPatient ChartsbullMeds problems allergiesbullResults (Labs ECGRad)
bullEnterprise wide repositorybullGenerally labs and documents
EMR Industry Facts and Trends
bullCurrently over 350 EMRs are available in North America
bull32 new EMR vendors have been certified over the past 12 months
bullQuest and LCA investing significant $$ in EMR interfacing and have a head start over hospitals
bull2009 Health Information Technology for Economic and Clinical Health Act (ldquoHITECHrdquo) will spur significant increases in EMR utilization in the outpatient setting
bullSignificant challenges will be placed on independent laboratories and hospital laboratories to integrate with all manner of outpatient EMR systems
bullCurrently over 350 EMRs are available in North America
bull32 new EMR vendors have been certified over the past 12 months
bullQuest and LCA investing significant $$ in EMR interfacing and have a head start over hospitals
bull2009 Health Information Technology for Economic and Clinical Health Act (ldquoHITECHrdquo) will spur significant increases in EMR utilization in the outpatient setting
bullSignificant challenges will be placed on independent laboratories and hospital laboratories to integrate with all manner of outpatient EMR systems
EMR Vendor Snapshot
Top 10 EMR Vendors (smaller 1-10 Physician practices) (largest growth sector)
bullNextGen bullAllscriptsMisys (Merger Completed 1008) (Allscripts purchased A4 Health in 2006)bullMcKesson (puchase Practice Partner 207) (PMSI name change to Practice Partner in 2006)bulle-MDsbulle-ClinicalWorksbulliMedica bullSagebullEmdeon Intergy EMR (WebMD) bullGE CentricitybullMedinotes
Top 10 EMR Vendors (smaller 1-10 Physician practices) (largest growth sector)
bullNextGen bullAllscriptsMisys (Merger Completed 1008) (Allscripts purchased A4 Health in 2006)bullMcKesson (puchase Practice Partner 207) (PMSI name change to Practice Partner in 2006)bulle-MDsbulle-ClinicalWorksbulliMedica bullSagebullEmdeon Intergy EMR (WebMD) bullGE CentricitybullMedinotes
EMR Market Adoption
020000400006000080000
100000120000140000160000180000200000
2005 2007 2009E 2011E
EMR Adoption
EMR Penetration Docs
total 2005 2006 2007 2008E 2009E 2010E 2011E
Solo 181500 33 9075 10391 11898 13623 15607 17898 20556
2-9 220000 40 22000 26840 32754 40000 48911 59899 73470
10-20 55000 10 9020 11095 13642 16763 20592 25295 31078
21-49 38500 7 7816 9691 12021 14921 18512 22929 28361
50+ 38500 7 10203 12855 16129 20063 24600 29567 34982
Total penetration 58114 70872 86444 105370 128222 155588 188477
Total Docs 550000 106 129 157 192 233 283 343
Source CDC Health Affairs AC Group MGMA SFG ResearchCompiled Susquehanna Financial Group investor report on Allscripts published 32207
Physician EMR Adoption ProfileIn
ves
tme
nt
(tim
e t
oo
ls e
tc hellip
)
EMR Implementation Timeline
Minimal workflow impactPopulates chart with clinical data lab results and transcription usually via scanned documentsChart review from home
Phone notesVirtual ldquoto dordquo listOffice efficiencies
Script legibilityInteraction checksFormulary compliance
Face sheet documentationEampM ComplianceBilling efficienciesDisease management
CPOE requirementComplete EMR workflow
View andSign
OfficeCommunication
MedicationManagement
Full EncounterDocumentationLab Results are
required in 90 ofEMR go-lives
Lab Orders areadopted whengeneral ordersare adopted
Orders
2006 ndash Uncle Sam Gets Involved
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT Certification Chronology
CCHIT interoperability requirements that impact laboratoryCurrently itrsquos a Low Bar 32 EMR vendors have been certified
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20091048633Transmit the Lab Test Order Electronically
20091048633Transmit the Lab Test Order Electronically
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
HITECH Begins in 2009
CCHIT expected to be go forward certification body for healthcare IT
$19 billion in incentives and funding
$17 billion in physician incentives
$2 billion in HHS ldquodiscretionary fundsrdquo
Aims to dramatically drive interoperability standards across healthcare IT
90 physician EMR adoption by 2020
2009 Congressional Budget Office2009 Congressional Budget Office
What Physicians Want for Lab
All orders originate from within the physicianrsquos EMR
Must be easy to use Want the fewest ldquoclicksrdquo to order and view lab
Dynamically update physiciansrsquo ordering information
Make it part of physiciansrsquo normal EMR workflow
All results returned to physiciansrsquo EMR and matched to their patientsrsquo record (IPOPOR)
Inform the ordering provider of pending results
EMR Integration
Physician Office Perception
EMR LIS
IntegrationhellipNot the Other ldquoIrdquo Word
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Benefits of EMR Integration Platform
Improve customer service and client satisfactionMake it easier for your customers to order within their EMR
Consolidates inpatient outpatient outreach results
Perform test and bill correctly the first time avoid calling for missing clinical and billing information
Creates another exit barrier with physician
Increase revenue improve efficiency reduce operational costs
Decrease billing and clinical errors
Eliminate data entry at the lab and PSC
Reduce costly data correctionretrieval activities
Reduce medical necessity denials and write-offs
Healthcare EMR Emergence and Laboratory EMR Strategies for 2009
Thank You
Questions
EMR Industry Facts and Trends
bullCurrently over 350 EMRs are available in North America
bull32 new EMR vendors have been certified over the past 12 months
bullQuest and LCA investing significant $$ in EMR interfacing and have a head start over hospitals
bull2009 Health Information Technology for Economic and Clinical Health Act (ldquoHITECHrdquo) will spur significant increases in EMR utilization in the outpatient setting
bullSignificant challenges will be placed on independent laboratories and hospital laboratories to integrate with all manner of outpatient EMR systems
bullCurrently over 350 EMRs are available in North America
bull32 new EMR vendors have been certified over the past 12 months
bullQuest and LCA investing significant $$ in EMR interfacing and have a head start over hospitals
bull2009 Health Information Technology for Economic and Clinical Health Act (ldquoHITECHrdquo) will spur significant increases in EMR utilization in the outpatient setting
bullSignificant challenges will be placed on independent laboratories and hospital laboratories to integrate with all manner of outpatient EMR systems
EMR Vendor Snapshot
Top 10 EMR Vendors (smaller 1-10 Physician practices) (largest growth sector)
bullNextGen bullAllscriptsMisys (Merger Completed 1008) (Allscripts purchased A4 Health in 2006)bullMcKesson (puchase Practice Partner 207) (PMSI name change to Practice Partner in 2006)bulle-MDsbulle-ClinicalWorksbulliMedica bullSagebullEmdeon Intergy EMR (WebMD) bullGE CentricitybullMedinotes
Top 10 EMR Vendors (smaller 1-10 Physician practices) (largest growth sector)
bullNextGen bullAllscriptsMisys (Merger Completed 1008) (Allscripts purchased A4 Health in 2006)bullMcKesson (puchase Practice Partner 207) (PMSI name change to Practice Partner in 2006)bulle-MDsbulle-ClinicalWorksbulliMedica bullSagebullEmdeon Intergy EMR (WebMD) bullGE CentricitybullMedinotes
EMR Market Adoption
020000400006000080000
100000120000140000160000180000200000
2005 2007 2009E 2011E
EMR Adoption
EMR Penetration Docs
total 2005 2006 2007 2008E 2009E 2010E 2011E
Solo 181500 33 9075 10391 11898 13623 15607 17898 20556
2-9 220000 40 22000 26840 32754 40000 48911 59899 73470
10-20 55000 10 9020 11095 13642 16763 20592 25295 31078
21-49 38500 7 7816 9691 12021 14921 18512 22929 28361
50+ 38500 7 10203 12855 16129 20063 24600 29567 34982
Total penetration 58114 70872 86444 105370 128222 155588 188477
Total Docs 550000 106 129 157 192 233 283 343
Source CDC Health Affairs AC Group MGMA SFG ResearchCompiled Susquehanna Financial Group investor report on Allscripts published 32207
Physician EMR Adoption ProfileIn
ves
tme
nt
(tim
e t
oo
ls e
tc hellip
)
EMR Implementation Timeline
Minimal workflow impactPopulates chart with clinical data lab results and transcription usually via scanned documentsChart review from home
Phone notesVirtual ldquoto dordquo listOffice efficiencies
Script legibilityInteraction checksFormulary compliance
Face sheet documentationEampM ComplianceBilling efficienciesDisease management
CPOE requirementComplete EMR workflow
View andSign
OfficeCommunication
MedicationManagement
Full EncounterDocumentationLab Results are
required in 90 ofEMR go-lives
Lab Orders areadopted whengeneral ordersare adopted
Orders
2006 ndash Uncle Sam Gets Involved
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT Certification Chronology
CCHIT interoperability requirements that impact laboratoryCurrently itrsquos a Low Bar 32 EMR vendors have been certified
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20091048633Transmit the Lab Test Order Electronically
20091048633Transmit the Lab Test Order Electronically
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
HITECH Begins in 2009
CCHIT expected to be go forward certification body for healthcare IT
$19 billion in incentives and funding
$17 billion in physician incentives
$2 billion in HHS ldquodiscretionary fundsrdquo
Aims to dramatically drive interoperability standards across healthcare IT
90 physician EMR adoption by 2020
2009 Congressional Budget Office2009 Congressional Budget Office
What Physicians Want for Lab
All orders originate from within the physicianrsquos EMR
Must be easy to use Want the fewest ldquoclicksrdquo to order and view lab
Dynamically update physiciansrsquo ordering information
Make it part of physiciansrsquo normal EMR workflow
All results returned to physiciansrsquo EMR and matched to their patientsrsquo record (IPOPOR)
Inform the ordering provider of pending results
EMR Integration
Physician Office Perception
EMR LIS
IntegrationhellipNot the Other ldquoIrdquo Word
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Benefits of EMR Integration Platform
Improve customer service and client satisfactionMake it easier for your customers to order within their EMR
Consolidates inpatient outpatient outreach results
Perform test and bill correctly the first time avoid calling for missing clinical and billing information
Creates another exit barrier with physician
Increase revenue improve efficiency reduce operational costs
Decrease billing and clinical errors
Eliminate data entry at the lab and PSC
Reduce costly data correctionretrieval activities
Reduce medical necessity denials and write-offs
Healthcare EMR Emergence and Laboratory EMR Strategies for 2009
Thank You
Questions
EMR Vendor Snapshot
Top 10 EMR Vendors (smaller 1-10 Physician practices) (largest growth sector)
bullNextGen bullAllscriptsMisys (Merger Completed 1008) (Allscripts purchased A4 Health in 2006)bullMcKesson (puchase Practice Partner 207) (PMSI name change to Practice Partner in 2006)bulle-MDsbulle-ClinicalWorksbulliMedica bullSagebullEmdeon Intergy EMR (WebMD) bullGE CentricitybullMedinotes
Top 10 EMR Vendors (smaller 1-10 Physician practices) (largest growth sector)
bullNextGen bullAllscriptsMisys (Merger Completed 1008) (Allscripts purchased A4 Health in 2006)bullMcKesson (puchase Practice Partner 207) (PMSI name change to Practice Partner in 2006)bulle-MDsbulle-ClinicalWorksbulliMedica bullSagebullEmdeon Intergy EMR (WebMD) bullGE CentricitybullMedinotes
EMR Market Adoption
020000400006000080000
100000120000140000160000180000200000
2005 2007 2009E 2011E
EMR Adoption
EMR Penetration Docs
total 2005 2006 2007 2008E 2009E 2010E 2011E
Solo 181500 33 9075 10391 11898 13623 15607 17898 20556
2-9 220000 40 22000 26840 32754 40000 48911 59899 73470
10-20 55000 10 9020 11095 13642 16763 20592 25295 31078
21-49 38500 7 7816 9691 12021 14921 18512 22929 28361
50+ 38500 7 10203 12855 16129 20063 24600 29567 34982
Total penetration 58114 70872 86444 105370 128222 155588 188477
Total Docs 550000 106 129 157 192 233 283 343
Source CDC Health Affairs AC Group MGMA SFG ResearchCompiled Susquehanna Financial Group investor report on Allscripts published 32207
Physician EMR Adoption ProfileIn
ves
tme
nt
(tim
e t
oo
ls e
tc hellip
)
EMR Implementation Timeline
Minimal workflow impactPopulates chart with clinical data lab results and transcription usually via scanned documentsChart review from home
Phone notesVirtual ldquoto dordquo listOffice efficiencies
Script legibilityInteraction checksFormulary compliance
Face sheet documentationEampM ComplianceBilling efficienciesDisease management
CPOE requirementComplete EMR workflow
View andSign
OfficeCommunication
MedicationManagement
Full EncounterDocumentationLab Results are
required in 90 ofEMR go-lives
Lab Orders areadopted whengeneral ordersare adopted
Orders
2006 ndash Uncle Sam Gets Involved
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT Certification Chronology
CCHIT interoperability requirements that impact laboratoryCurrently itrsquos a Low Bar 32 EMR vendors have been certified
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20091048633Transmit the Lab Test Order Electronically
20091048633Transmit the Lab Test Order Electronically
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
HITECH Begins in 2009
CCHIT expected to be go forward certification body for healthcare IT
$19 billion in incentives and funding
$17 billion in physician incentives
$2 billion in HHS ldquodiscretionary fundsrdquo
Aims to dramatically drive interoperability standards across healthcare IT
90 physician EMR adoption by 2020
2009 Congressional Budget Office2009 Congressional Budget Office
What Physicians Want for Lab
All orders originate from within the physicianrsquos EMR
Must be easy to use Want the fewest ldquoclicksrdquo to order and view lab
Dynamically update physiciansrsquo ordering information
Make it part of physiciansrsquo normal EMR workflow
All results returned to physiciansrsquo EMR and matched to their patientsrsquo record (IPOPOR)
Inform the ordering provider of pending results
EMR Integration
Physician Office Perception
EMR LIS
IntegrationhellipNot the Other ldquoIrdquo Word
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Benefits of EMR Integration Platform
Improve customer service and client satisfactionMake it easier for your customers to order within their EMR
Consolidates inpatient outpatient outreach results
Perform test and bill correctly the first time avoid calling for missing clinical and billing information
Creates another exit barrier with physician
Increase revenue improve efficiency reduce operational costs
Decrease billing and clinical errors
Eliminate data entry at the lab and PSC
Reduce costly data correctionretrieval activities
Reduce medical necessity denials and write-offs
Healthcare EMR Emergence and Laboratory EMR Strategies for 2009
Thank You
Questions
EMR Market Adoption
020000400006000080000
100000120000140000160000180000200000
2005 2007 2009E 2011E
EMR Adoption
EMR Penetration Docs
total 2005 2006 2007 2008E 2009E 2010E 2011E
Solo 181500 33 9075 10391 11898 13623 15607 17898 20556
2-9 220000 40 22000 26840 32754 40000 48911 59899 73470
10-20 55000 10 9020 11095 13642 16763 20592 25295 31078
21-49 38500 7 7816 9691 12021 14921 18512 22929 28361
50+ 38500 7 10203 12855 16129 20063 24600 29567 34982
Total penetration 58114 70872 86444 105370 128222 155588 188477
Total Docs 550000 106 129 157 192 233 283 343
Source CDC Health Affairs AC Group MGMA SFG ResearchCompiled Susquehanna Financial Group investor report on Allscripts published 32207
Physician EMR Adoption ProfileIn
ves
tme
nt
(tim
e t
oo
ls e
tc hellip
)
EMR Implementation Timeline
Minimal workflow impactPopulates chart with clinical data lab results and transcription usually via scanned documentsChart review from home
Phone notesVirtual ldquoto dordquo listOffice efficiencies
Script legibilityInteraction checksFormulary compliance
Face sheet documentationEampM ComplianceBilling efficienciesDisease management
CPOE requirementComplete EMR workflow
View andSign
OfficeCommunication
MedicationManagement
Full EncounterDocumentationLab Results are
required in 90 ofEMR go-lives
Lab Orders areadopted whengeneral ordersare adopted
Orders
2006 ndash Uncle Sam Gets Involved
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT Certification Chronology
CCHIT interoperability requirements that impact laboratoryCurrently itrsquos a Low Bar 32 EMR vendors have been certified
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20091048633Transmit the Lab Test Order Electronically
20091048633Transmit the Lab Test Order Electronically
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
HITECH Begins in 2009
CCHIT expected to be go forward certification body for healthcare IT
$19 billion in incentives and funding
$17 billion in physician incentives
$2 billion in HHS ldquodiscretionary fundsrdquo
Aims to dramatically drive interoperability standards across healthcare IT
90 physician EMR adoption by 2020
2009 Congressional Budget Office2009 Congressional Budget Office
What Physicians Want for Lab
All orders originate from within the physicianrsquos EMR
Must be easy to use Want the fewest ldquoclicksrdquo to order and view lab
Dynamically update physiciansrsquo ordering information
Make it part of physiciansrsquo normal EMR workflow
All results returned to physiciansrsquo EMR and matched to their patientsrsquo record (IPOPOR)
Inform the ordering provider of pending results
EMR Integration
Physician Office Perception
EMR LIS
IntegrationhellipNot the Other ldquoIrdquo Word
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Benefits of EMR Integration Platform
Improve customer service and client satisfactionMake it easier for your customers to order within their EMR
Consolidates inpatient outpatient outreach results
Perform test and bill correctly the first time avoid calling for missing clinical and billing information
Creates another exit barrier with physician
Increase revenue improve efficiency reduce operational costs
Decrease billing and clinical errors
Eliminate data entry at the lab and PSC
Reduce costly data correctionretrieval activities
Reduce medical necessity denials and write-offs
Healthcare EMR Emergence and Laboratory EMR Strategies for 2009
Thank You
Questions
Physician EMR Adoption ProfileIn
ves
tme
nt
(tim
e t
oo
ls e
tc hellip
)
EMR Implementation Timeline
Minimal workflow impactPopulates chart with clinical data lab results and transcription usually via scanned documentsChart review from home
Phone notesVirtual ldquoto dordquo listOffice efficiencies
Script legibilityInteraction checksFormulary compliance
Face sheet documentationEampM ComplianceBilling efficienciesDisease management
CPOE requirementComplete EMR workflow
View andSign
OfficeCommunication
MedicationManagement
Full EncounterDocumentationLab Results are
required in 90 ofEMR go-lives
Lab Orders areadopted whengeneral ordersare adopted
Orders
2006 ndash Uncle Sam Gets Involved
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT Certification Chronology
CCHIT interoperability requirements that impact laboratoryCurrently itrsquos a Low Bar 32 EMR vendors have been certified
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20091048633Transmit the Lab Test Order Electronically
20091048633Transmit the Lab Test Order Electronically
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
HITECH Begins in 2009
CCHIT expected to be go forward certification body for healthcare IT
$19 billion in incentives and funding
$17 billion in physician incentives
$2 billion in HHS ldquodiscretionary fundsrdquo
Aims to dramatically drive interoperability standards across healthcare IT
90 physician EMR adoption by 2020
2009 Congressional Budget Office2009 Congressional Budget Office
What Physicians Want for Lab
All orders originate from within the physicianrsquos EMR
Must be easy to use Want the fewest ldquoclicksrdquo to order and view lab
Dynamically update physiciansrsquo ordering information
Make it part of physiciansrsquo normal EMR workflow
All results returned to physiciansrsquo EMR and matched to their patientsrsquo record (IPOPOR)
Inform the ordering provider of pending results
EMR Integration
Physician Office Perception
EMR LIS
IntegrationhellipNot the Other ldquoIrdquo Word
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Benefits of EMR Integration Platform
Improve customer service and client satisfactionMake it easier for your customers to order within their EMR
Consolidates inpatient outpatient outreach results
Perform test and bill correctly the first time avoid calling for missing clinical and billing information
Creates another exit barrier with physician
Increase revenue improve efficiency reduce operational costs
Decrease billing and clinical errors
Eliminate data entry at the lab and PSC
Reduce costly data correctionretrieval activities
Reduce medical necessity denials and write-offs
Healthcare EMR Emergence and Laboratory EMR Strategies for 2009
Thank You
Questions
2006 ndash Uncle Sam Gets Involved
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
In August 2006 the Department of Health and Human Services (HHS)published rules that provide an exception under the physician self-referralprohibition law (Stark) as well as safe harbor under the anti-kickback act
(AKA) for the donation of interoperable EHR technology to physicians andother health care practitioners or entities
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
EHR software is ldquodeemed to be interoperable if a certifying body recognizedby the Secretary has certified the software no more than 12 months prior to
the date it is provided to the physicianrecipientrdquo
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT is an officially recognized certifying bodyCCHIT = Certification Committee for Healthcare Information Technology
CCHIT Certification Chronology
CCHIT interoperability requirements that impact laboratoryCurrently itrsquos a Low Bar 32 EMR vendors have been certified
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20091048633Transmit the Lab Test Order Electronically
20091048633Transmit the Lab Test Order Electronically
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
HITECH Begins in 2009
CCHIT expected to be go forward certification body for healthcare IT
$19 billion in incentives and funding
$17 billion in physician incentives
$2 billion in HHS ldquodiscretionary fundsrdquo
Aims to dramatically drive interoperability standards across healthcare IT
90 physician EMR adoption by 2020
2009 Congressional Budget Office2009 Congressional Budget Office
What Physicians Want for Lab
All orders originate from within the physicianrsquos EMR
Must be easy to use Want the fewest ldquoclicksrdquo to order and view lab
Dynamically update physiciansrsquo ordering information
Make it part of physiciansrsquo normal EMR workflow
All results returned to physiciansrsquo EMR and matched to their patientsrsquo record (IPOPOR)
Inform the ordering provider of pending results
EMR Integration
Physician Office Perception
EMR LIS
IntegrationhellipNot the Other ldquoIrdquo Word
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Benefits of EMR Integration Platform
Improve customer service and client satisfactionMake it easier for your customers to order within their EMR
Consolidates inpatient outpatient outreach results
Perform test and bill correctly the first time avoid calling for missing clinical and billing information
Creates another exit barrier with physician
Increase revenue improve efficiency reduce operational costs
Decrease billing and clinical errors
Eliminate data entry at the lab and PSC
Reduce costly data correctionretrieval activities
Reduce medical necessity denials and write-offs
Healthcare EMR Emergence and Laboratory EMR Strategies for 2009
Thank You
Questions
CCHIT Certification Chronology
CCHIT interoperability requirements that impact laboratoryCurrently itrsquos a Low Bar 32 EMR vendors have been certified
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20071048633Receive General Text Reports1048633Display normal versus abnormal results1048633Display flow sheets1048633Provider results notification1048633Order lab diagnostic tests1048633Associate a diagnosis with a test1048633Test specific AOE prompts1048633Transmit the lab order ndash ONLY ON PAPER 1048633Group or panel ordering
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20081048633Receive Microbiology lab results1048633Capture co-signatures for orders1048633Associated Images with result
20091048633Transmit the Lab Test Order Electronically
20091048633Transmit the Lab Test Order Electronically
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
Still Missing Today1048633Electronic Orders1048633Auto-update of Orders1048633Rules based Routing
HITECH Begins in 2009
CCHIT expected to be go forward certification body for healthcare IT
$19 billion in incentives and funding
$17 billion in physician incentives
$2 billion in HHS ldquodiscretionary fundsrdquo
Aims to dramatically drive interoperability standards across healthcare IT
90 physician EMR adoption by 2020
2009 Congressional Budget Office2009 Congressional Budget Office
What Physicians Want for Lab
All orders originate from within the physicianrsquos EMR
Must be easy to use Want the fewest ldquoclicksrdquo to order and view lab
Dynamically update physiciansrsquo ordering information
Make it part of physiciansrsquo normal EMR workflow
All results returned to physiciansrsquo EMR and matched to their patientsrsquo record (IPOPOR)
Inform the ordering provider of pending results
EMR Integration
Physician Office Perception
EMR LIS
IntegrationhellipNot the Other ldquoIrdquo Word
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Benefits of EMR Integration Platform
Improve customer service and client satisfactionMake it easier for your customers to order within their EMR
Consolidates inpatient outpatient outreach results
Perform test and bill correctly the first time avoid calling for missing clinical and billing information
Creates another exit barrier with physician
Increase revenue improve efficiency reduce operational costs
Decrease billing and clinical errors
Eliminate data entry at the lab and PSC
Reduce costly data correctionretrieval activities
Reduce medical necessity denials and write-offs
Healthcare EMR Emergence and Laboratory EMR Strategies for 2009
Thank You
Questions
HITECH Begins in 2009
CCHIT expected to be go forward certification body for healthcare IT
$19 billion in incentives and funding
$17 billion in physician incentives
$2 billion in HHS ldquodiscretionary fundsrdquo
Aims to dramatically drive interoperability standards across healthcare IT
90 physician EMR adoption by 2020
2009 Congressional Budget Office2009 Congressional Budget Office
What Physicians Want for Lab
All orders originate from within the physicianrsquos EMR
Must be easy to use Want the fewest ldquoclicksrdquo to order and view lab
Dynamically update physiciansrsquo ordering information
Make it part of physiciansrsquo normal EMR workflow
All results returned to physiciansrsquo EMR and matched to their patientsrsquo record (IPOPOR)
Inform the ordering provider of pending results
EMR Integration
Physician Office Perception
EMR LIS
IntegrationhellipNot the Other ldquoIrdquo Word
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Benefits of EMR Integration Platform
Improve customer service and client satisfactionMake it easier for your customers to order within their EMR
Consolidates inpatient outpatient outreach results
Perform test and bill correctly the first time avoid calling for missing clinical and billing information
Creates another exit barrier with physician
Increase revenue improve efficiency reduce operational costs
Decrease billing and clinical errors
Eliminate data entry at the lab and PSC
Reduce costly data correctionretrieval activities
Reduce medical necessity denials and write-offs
Healthcare EMR Emergence and Laboratory EMR Strategies for 2009
Thank You
Questions
What Physicians Want for Lab
All orders originate from within the physicianrsquos EMR
Must be easy to use Want the fewest ldquoclicksrdquo to order and view lab
Dynamically update physiciansrsquo ordering information
Make it part of physiciansrsquo normal EMR workflow
All results returned to physiciansrsquo EMR and matched to their patientsrsquo record (IPOPOR)
Inform the ordering provider of pending results
EMR Integration
Physician Office Perception
EMR LIS
IntegrationhellipNot the Other ldquoIrdquo Word
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Benefits of EMR Integration Platform
Improve customer service and client satisfactionMake it easier for your customers to order within their EMR
Consolidates inpatient outpatient outreach results
Perform test and bill correctly the first time avoid calling for missing clinical and billing information
Creates another exit barrier with physician
Increase revenue improve efficiency reduce operational costs
Decrease billing and clinical errors
Eliminate data entry at the lab and PSC
Reduce costly data correctionretrieval activities
Reduce medical necessity denials and write-offs
Healthcare EMR Emergence and Laboratory EMR Strategies for 2009
Thank You
Questions
EMR Integration
Physician Office Perception
EMR LIS
IntegrationhellipNot the Other ldquoIrdquo Word
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Benefits of EMR Integration Platform
Improve customer service and client satisfactionMake it easier for your customers to order within their EMR
Consolidates inpatient outpatient outreach results
Perform test and bill correctly the first time avoid calling for missing clinical and billing information
Creates another exit barrier with physician
Increase revenue improve efficiency reduce operational costs
Decrease billing and clinical errors
Eliminate data entry at the lab and PSC
Reduce costly data correctionretrieval activities
Reduce medical necessity denials and write-offs
Healthcare EMR Emergence and Laboratory EMR Strategies for 2009
Thank You
Questions
IntegrationhellipNot the Other ldquoIrdquo Word
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Integration vs ldquoOne-offrdquo Interfacing
bullEliminates costly burden of building maintaining and supporting ldquoone offrdquo interfaces from hospital IT dept
bullEliminates incomplete lab orders ex) missing clinical billing and business information
bullTest and result codes correctly mapped and updated
bullAutomatic standardized laboratory requisition and label printing
bullOrder routing based on insurance plan
bullEnables EMR to accept unsolicited andor partial results
Benefits of EMR Integration Platform
Improve customer service and client satisfactionMake it easier for your customers to order within their EMR
Consolidates inpatient outpatient outreach results
Perform test and bill correctly the first time avoid calling for missing clinical and billing information
Creates another exit barrier with physician
Increase revenue improve efficiency reduce operational costs
Decrease billing and clinical errors
Eliminate data entry at the lab and PSC
Reduce costly data correctionretrieval activities
Reduce medical necessity denials and write-offs
Healthcare EMR Emergence and Laboratory EMR Strategies for 2009
Thank You
Questions
Benefits of EMR Integration Platform
Improve customer service and client satisfactionMake it easier for your customers to order within their EMR
Consolidates inpatient outpatient outreach results
Perform test and bill correctly the first time avoid calling for missing clinical and billing information
Creates another exit barrier with physician
Increase revenue improve efficiency reduce operational costs
Decrease billing and clinical errors
Eliminate data entry at the lab and PSC
Reduce costly data correctionretrieval activities
Reduce medical necessity denials and write-offs
Healthcare EMR Emergence and Laboratory EMR Strategies for 2009
Thank You
Questions
Healthcare EMR Emergence and Laboratory EMR Strategies for 2009
Thank You
Questions
