Enabling Enabling EMR/EHREMR/EHR –– Best Practices in Best Practices in IntegrationIntegrationWebinar, February 14, 2008Marc Holland, Program Director, Healthcare Provider ITSponsored by WIPRO Technologies and Sun Microsystems
© Health Industry Insights, an IDC company Page 2
Agenda
� U.S. Healthcare IT mega-trends
� EMRs vs. EHRs: similar but not the same
� The HIT Maturity Model: a framework for assessing progress
� So where are we now?
� So what’s HOTHOT in HIT?
� System Integration: the tie that binds
� Essential Guidance
� Sun Microsystems and WIPRO speakers
� Combined Q & A
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US Healthcare IT Mega TrendsUS Healthcare IT Mega Trends
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Healthcare IT: Poised for Growth� Healthcare costs are growing
– Medical technology, particularly in the US, is state of the art
– Population growth and longevity are taxing the system
� Healthcare has historically lagged other industries in using information technology
– That is changing, dramatically –and worldwide
� Healthcare IT seen as a tool to reduce healthcare costs and improve quality and safety
� CAGR for healthcare providers in the US > 6%
� CAGR for healthcare providers worldwide ~ 7%
– The tortoise and the hare?– US Hospital Provider IT annual
budget growth now roughly 10%
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U.S. Provider Spend
Source: HII Worldwide Healthcare IT Spending Guide, 2006
0
5,000
10,000
15,000
20,000
25,000
30,000
2006 2007 2008 2009 2010
(%)
(M)
Hardware
Software
IT Services
01
234
567
89
%
About 85% of the total is About 85% of the total is spent by hospitalsspent by hospitals
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Mega Trends: Industry Environment
� Focus on cost containment, quality of care and patient safety across the health ecosystem.
� Aging infrastructure, new technologies, and regulatory pressures are fueling a significant upgrade cycle.
� Innovation is essential but it is currently under funded.
� Analytics allow new insights into improving the quality and cost of care; essential for compliance (P4P, CMS Core Measures, personalized medicine, performance management, etc).
� Increased focus on collaborative IT investment. New tension andcompetition emerges for the investment funding between internal/legacy and external/collaborative business relationships, processes and investments.
� The lines between the life sciences, provider and payer sectors are continuing to blur as each sector is driven to improve quality and patient safety, and reduce healthcare costs.
© Health Industry Insights, an IDC company Page 7
Mega Trends: Industry Environment
� Focus on cost containment, quality of care and patient safety across the health ecosystem.
� Aging infrastructure, new technologies, and regulatory pressures are fueling a significant upgrade cycle.
� Innovation is essential but it is currently under funded.
� Analytics allow new insights into improving the quality and cost of care; essential for compliance (P4P, CMS Core Measures, personalized medicine, performance management, etc).
� Increased focus on collaborative IT investment. New tension andcompetition emerges for the investment funding between internal/legacy and external/collaborative business relationships, processes and investments.
� The lines between the life sciences, provider and payer sectors are continuing to blur as each sector is driven to improve quality and patient safety, and reduce healthcare costs.
= Increased automation, data collection = Increased automation, data collection and integration across the ecosystemand integration across the ecosystem
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Healthcare is rapidly becoming an inter-connected ecosystem, with IT as its circulatory system
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� Offering EHR/EMR technology and PBHRs to provider constituents
� Balancing internal projects vs. external collaborative projects such as RHIO and HIE initiatives
� Providing revenue cycle mgt tools� Reimbursing for outcomes (P4P)� Reimbursing for remote home health
monitoring
� Identifying patients for clinical trials
� Utilizing EMRs to supplement electronic data capture (EDC) systems
� Exploring pharmacogenomics
� Identifying research sites and populations
� Drug safety and tracking
� Enabling consumers to get involved in managing their health
� Understanding increasing patient liability
� Improving quality of care (and of life) through remote home health monitoring �����������������
� Information connectivity� Translational medicine� Reducing costs and
improving patient outcomes
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HIT Maturity Model:HIT Maturity Model:A Framework for Assessing ProgressA Framework for Assessing Progress
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IDC-HII Hospital IT Maturity Model
Stage 1Basic HIS
• Patient Registration / Inpatient Admission Discharge & Transfer
• Patient Billing and Accounts Receivable
• HRIS / Payroll• General Ledger /
Financial Reporting• Purchasing /
Accounts Payable
Stage 2Advanced HIS
• Electronic Claims Submission (Discharge Summaries, Coding and Abstracting)
• Electronic Payment Processing
• Inventory, Supply Requisitioning and Distribution
• Basic Order Communications
• Email• Internet Access• Intranet
Stage 3Advanced HIS Core Clinicals
• Laboratory Information System
• RIS/Radiology Results Reporting
• PACS• Pharmacy• Operating Room
Scheduling and Management
Stage 4Digital
Hospital
• Patient Appointment Scheduling
• Computerized Physician Order Entry
• Nursing Documentation
• Emergency Department Management
• Physician Portal• Patient Portal• Wireless
Infrastructure
• Inpatient Electronic Medical Record (EMR)
• Ambulatory EMR
• Enterprise Master Patient Index
• Location-based services
Stage 5Digital Virtual
Enterprise
• Secure messaging (Provider-Provider/ Provider-Patient)
• Clinical Data Repository/ Data Warehouse
• Participation in Regionalized Patient CDR
• Home Health Case Management
• Remote Patient Monitoring/ Telemedicine
The key prerequisites The key prerequisites for an for an EMREMR
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EMREMR vs. vs. EHREHR::Coming to TermsComing to Terms
Similar, but Not the SameSimilar, but Not the Same
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Electronic Medical Records Defined
Clinical Data
Repository(CDR)
Clinical Decision Support
Workflow
Orders Results
Documentation
Controlled Medical Vocabulary
Enterprise Master Patient Index
Laboratory
Transcription
Electronic Data
Digitized Images
Patient: Jane Doe
General Hospital
Physician
X-ray
Nursing
Pharmacy
Admitting
Surgery
Emergency
Source: Health Industry Insights
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Electronic Health Records Defined
Hospitals
Summarized Health Information
Electronic Medical
Recordsfor patient Jane Doe
Electronic Health Record� Table of contents/indexing� Viewer � Key diagnoses and procedures summaries � Labs and results� Medication history� Analytics, search & reporting tools� Security
$ Payer data
Patient provided data
Prescription data
Primary Care Providers Specialists Other Providers
Source: Health Industry Insights
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HIT Maturity:HIT Maturity:So where are we now?So where are we now?
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Hospital Adoption of EMRs is Increasing
� Only 23% of hospitals over 500 beds reported a “fully” operational EMRs based on an objective, 15-function point scale
� Only 13% of hospitals between 100 – 200 beds were “fully” implemented – 21% had no clinical IT deployed
� Only 7% of hospitals between 50 – 100 beds were “fully” implemented – 37% had no clinical IT deployed at all
� Urban higher than rural; teaching higher than non-teaching;
� But the trend is clearly favorable
0102030405060708090
100
<50 50-99 100-299 300-499 >500
(Bed Size)
(%)
Full (12 – 15 functions)
Partial (1 - 11)
Source: AHA 2nd Annual HIT Survey 2007
Vendor Market Notes• Fragmentation by solution set, geography and market segment.• Major hospital information system vendors dominate the EMR market.• CCHIT begins certifying inpatient EMRs, 9 certified between Nov. 2007 and Jan. 2008.• Market players: Cerner, CPSI, Dairyland, Eclipsys, Epic, GE Healthcare,
McKesson, MEDITECH, Siemens, QuadraMed
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Physician Adoption of EMR is Increasing
� Overall, nearly 30% of physicians use an EMR system [comprehensive (14.5%) and partial (14.7%)] in their office-based practices.
� This represents a 22% increase since 2005 and a 60% increase since 2001.
� Adoption will continue. In 2006, 23.9% of office-based physicians surveyed reported that they planned to install a new EMR systems or replace their current systems within the next 3 years.
05
101520253035404550
Solo Partner 3 - 5 MDs 6 - 10 MDs 11 or moreMDs
(%)
Any EMRComprehensive EMR System
Source: CDC/NCHS, National Ambulatory Medical Care Survey, 2006 – published October 2007.
Vendor Market Notes• Continues to be a fragmented market. The market is wide open, and will remain so.• Approximately 100 ambulatory EMR products have been certified by CCHIT.• Buying “cooperatives” are emerging, sponsored by payers and local medical associations.• Web-based hosting services and SaaS gaining traction in the market place.• Major Market players: Allscripts, eClinicalWorks, GE (IDX), McKesson
(Practice Partner), Misys, NextGen, Sage (Emdeon/Med Mgr)
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A Landmark 2004 Study Showed EMR Adoption in US Lagged Badly and Times Haven’t Changed Dramatically – EMEA is Far Ahead
Source: "European Physicians Lead U.S. in Use of Electronic Medical Records." Harris Interactive Health Care News 2(16). Reproduced from a presentation by Dr. David Bates, Mass General Hospital to the ACMI, 2004
EMR Rates of Adoption by Country (2002)
0102030405060708090
100
Sweden
Nether
lands
Denmar
k UKFin
land
Austria
Germ
any
Belgiu
m
Luxem
bourgIre
land
Greece US
Spain
France
Portugal
Country
% M
D P
ract
ices
with
O
pera
tion
al E
MR
s
Adoption %
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Provider Initiatives Involving EHRs�������������� ������������ ����� ������ ������� ��� ��������� �������� ��� ��������������� ��������������������� ������ ��������� �������� ����������
0 5 10 15 20 25 30 35 40
No, but active discussion to participate in a proprietary RHIO or HIE
Community-based RHIO; Info exchange operational
Proprietary RHIO; Info exchange operational
Proprietary RHIO; Info exchange planned
Community-based RHIO; Info exchange planned
No, and no plans to participate in any form of RHIO/HIE
No, but active discussion to participate in a community-based RHIO/HIE
N = 34Source: Health Industry Insights, Sept 2007
Vendor Market Notes
� Most are SOA-portal type architectures.
� Not all vendors offer a complete solution; but not all RHIOs want (or can afford) one.
� The market is wide open, but will likely bifurcate along public and private lines. It will also remain risky ….
� Market players: InterSystems (HealthShare), Oracle, Wellogic, Misys, Cerner, dbMotion, Quovadx, Carefx, Initiate Systems, Medicity, MEDSEEK, IBM, Orion Health Systems, Open Source Vendors (BrowserSoft and Tolven Health), Sun
� Operational health information exchange is not widespread. Less than 3% of respondents belong to a community-based RHIO and actively exchange health information. And only 8.8% of respondents are exchanging health information among related entities.
� More are in the planning phase; 17.7% participate in a community-based RHIO and 8.8% in a proprietary RHIO in the planning stages. Approximately 35% are in discussions to participate in a community-based RHIO.
© Health Industry Insights, an IDC company Page 19
Payer Initiatives Involving EHRs
0 10 20 30 40 50
Provider electronichealth record
systems
Provider electronicmedical record
systems
Consumerpersonal health
records
(%)
N = 62
Source: IDC Health Industry Insights Survey, 2007
� 43% of healthcare payers report planned investment in PHRs in 2008.
� EHRs (58.1) and PHRs (50.0) were among the top three external transparency initiatives driving business intelligence investment through 2010.
� In an informal study of health plan CMOs, 66% of respondents that deploying a PBHR was important or very important.
Consumerism (69.4%) and provider demands (37.1%) were the top two drivers for payer investment in collaborative healthcare initiatives. Interestingly, compliance with federal government mandates or regulations was less frequently cited (27.4%).
Vendor Market Notes• Attributes: Multiple models, no clear winners.• Challenges: Integration, adoption, information exchange• Major Market players: Active Health Management, Availity, HealthTrio, RelayHealth,
MEDecision, Medem, TriZetto, WebMD
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WhatWhat’’s s HOTHOT in HIT?:in HIT?:Market Shaping Technologies for 2008Market Shaping Technologies for 2008
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So What’s “Hot” in U.S. HIT?� EMRs, EHRs
– CPOE – Health Information Networks– The emergence of EMR Gen 2
� Business and clinical intelligence– Performance analysis– Evidence-based medicine– Personalized health
� Wireless– Wireless point of care devices (Gen 2)– Location-based services (RFID, Ultrasonic)
� Virtualization of servers, storage and desktops
� SOA, Integration platforms & portals
� Web 2.0
� SaaS
� Security
� Disaster Recovery /Biz Continuity
© Health Industry Insights, an IDC company Page 22
So What’s “Hot” in U.S. HIT?� EMRs, EHRs
– CPOE – Health Information Networks– The emergence of EMR Gen 2
� Business and clinical intelligence– Performance analysis– Evidence-based medicine– Personalized health
� Wireless– Wireless point of care devices (Gen 2)– Location-based services (RFID, Ultrasonic)
� Virtualization of servers, storage and desktops
� SOA, Integration platforms & portals
� Web 2.0
� SaaS
� Security
� Disaster Recovery /Biz Continuity
Systems integration technology is a critical element for unleashing the potential in most of these.
© Health Industry Insights, an IDC company Page 23
Systems Integration:Systems Integration:The Tie That BindsThe Tie That Binds
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CIS Platforms: The Myth of the Single Source
Which of the following clinical information system (CIS) platform philosophies best describes your organization's current and future architectural approach?
Best-of-breed (20.6%)
Hybrid (52.9%)
Single suite (26.5%)
n=34
Best-of-breed (5.9%)
Hybrid (55.9%)
Single suite (38.2%)
n=34
Source: Health Industry Insights, 2007
Current Future
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Data Integration in HIT: an Old but New Concept� HL7 introduced more than 20 yrs ago;
pioneered by Libra Health Technologies
� The HL7 organization (www.HL7.org) has become one of the most influential forces in the area of HIT standards definition and adoption
� But integration remains a complex issue as information sharing requirements increase in their diversity and complexity
� Different forms of integration requirements exist at different levels of business processes--
– Transaction – Document– Application – Enterprise– Platform
� Integration remains a major growth market
© Health Industry Insights, an IDC company Page 26
Data Integration: It’s Not Just About Messaging Systems Anymore� No longer a technology for just big hospitals
� No longer just HL7, but all of its variants and complementary technologies
– HL7 2.5, 3.0 (transaction format & data stds)– CDA and CCR (“translucent” attachments)– XML (web-page integration)– CCOW (application synchronization)
� Eight vendors now dominate the market for integration messaging platforms
– Eclipsys, InterSystems, Oracle, Orion, Quovadx, Siemens, Sun Microsystems, Sybase
� But also consider the need for products that provide integration at the context level, as well as single sign-on
– Carefx, Encentuate, Novell, Sentillion
� Think “virtually”; the “virtual healthcare enterprise” will drive demand for integration across all market segments
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Selecting an Integration Platform: What to Look For
� Ease of implementation
� Technology
� Ease of development across all types of interfaces
� Upward migration
� Performance
� Backup and recovery
� Audit, monitoring, error mgt and security
� Service and support
� Application experience
� Testing and development
� Documentation
� Total cost of ownership
© Health Industry Insights, an IDC company Page 28
Essential Guidance
�� An EMR is a journey, not a An EMR is a journey, not a destinationdestination
� Make a clear business case
� Learn from the leaders
� Partner with your vendors
� It’s less about technology than it is about process
� Partner with your clinical leadership; you cannot succeed without their commitment
� Your competitors are also your colleagues – we all have the same goals in common – a healthier populace and improved access to quality care at affordable cost
� Ask questions, lots of questions; share your experiences
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Questions
Marc HollandProgram DirectorHealthcare Provider IT Research
Please feel free to email me [email protected]
© Health Industry Insights, an IDC company Page 30
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Sun Proprietary Do Not Reproduce Without Explicit Written Permission
Sun and Healthcare
Nancy Abell, RNSun Global Software Healthcare
February 14, 2008
Solutions to Bridge the Digital Divide
Sun Proprietary Do Not Reproduce Without Explicit Written Permission
The Vision
Everyone and Everything Participating on the Network
Sun Proprietary Do Not Reproduce Without Explicit Written Permission
Sun’s Solution
• Product: JavaTM
Composite Application Platform Suite – the industry’s most complete, unified and secure platform for SOA and composite applications
• Services: Life-cycle professional servicesand learning curriculumto augment yourin-house skills
Sun Proprietary Do Not Reproduce Without Explicit Written Permission
AccessManager
ServicesRegistry(RegrepUDDI)
34
Reusable Services
HIS
EMPILabInquiry RAD
CDR
RLS
Enterprise Network
OrdersResults
EnterprisePatientView
ExecutiveDashboards
IncreasedAgility
Imaging Sched
Scheduling RAD / LAB
CompositeApplications
Pharm
Sun Java™ Composite Application Platform Suite
Composite Applications via Service-Oriented Architecture
Presentation Services
John Doe
TranscriptionRegistration EMPIImagingRadiology Pharmacy Laboratory
Sun Proprietary Do Not Reproduce Without Explicit Written Permission
Sun JAVA™ Composite Application Platform Suite (CAPS)
eViewStudio
eBAMStudio
eVisionStudio
Sun Portal Server PE
View Generation
Composite Applications
eInsight Business Process ManagerOrchestration
eWayAdapters
eXchangeIntegrator
eXpressway
IntegratoreTL
Integrator
Repository
eGate Integrator
Enterprise M
anager
Enterprise D
esigner
Integration
Sun Directory Server
Sun Application Server
Sun Access Manager
Core Services
Sun Java StudioSun Java Creator
eIndex / eView Studio provides Patient information / Record
Locator Svs, cleansing, probabilistic matching, indexing,
and linking
eGate unlocks and exposes the data in your
existing applications
eInsight BPM also provides a rules engine to ensure security, and privileges are adhered
too
eInsight BPM orchestrates steps
necessary to satisfy generate Patient View
Executive / OperationsDashboards
Custom Patient Views
eWay adapters provide connection points between systems
eXchange automates B2B interactions
Sun Proprietary Do Not Reproduce Without Explicit Written Permission
Solutions
…combining all integration technologies in one easy-to-use environment.
Built on a foundation of integration with unified capabilities for SOA, BPM, BAM, Single Entity View”…
Sun Proprietary Do Not Reproduce Without Explicit Written Permission
Use Case: UK National Health Service • 50+ million patients with life-long healthcare records
• Linking with 250 hospitals
• 1.4m providers (doctors, nurses, scientists)
• 10,000 systems
• 40,000 sites
• For the National Service Provider (NASP) “Spine”> 2005 – 2 billion transactions per year> 2010 - 6 billion transactions per year> Due to peak usage approximately 420 messages per second
(4–6x hourly average)> Response SLA – 0.2 seconds> Available 99.9% (44 minutes per month downtime)> Failover in 30 minutes
• For the Local Service Providers (LSP’s)> Each has a lot of local messages (10bn to 12bn per year) and shares some
with the NASP
• There are 5 LSP and therefore the total volumes of messages per year is:> 56 billion to 66 billion messages per year
• Initially using eGate, eInsight, eView and eXchange
����NewcastleNewcastle
BristolBristol
NameNHS No.Address
Broken Leg
Chest infection
Back Pain
Back Pain
Broken Leg
Chest Infection
Name
NHS No.Address
Back Pain
Broken Leg
Chest Infection
Name
NHS No.
Back Pain
Broken Leg
Chest Infection
Name
NHS No.Address
Emergency
Emergency
Sun Proprietary Do Not Reproduce Without Explicit Written Permission
Enterprise Master Patient Index – Active Mode
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Solution: Provide unique patient indexing across systems. Replace all patient search and registration functionality on top of existing applications via overlays and screen scraping. Eliminate duplicate patient records.
Use Case: Multi-hospital health system has dozens of systems and requires a single patient identifier.
In order to prevent future duplicates, eIndex with Active Integrationgenerates popup windows that overlays existing applications.
EMPI Validates whether or not patient exists before trying to add as a new record.
Sun Proprietary Do Not Reproduce Without Explicit Written Permission
Colorado RHIO
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Solution: Portal that integrates to sites via web services and interfaces.Leverages existing systems instead of rip and replace. eIndex, RLS and IDM
Use Case: State initiative to link multiple data sources to a single portal for view by any authorized providers. Data must be retained in its original location but be available for view in an aggregated manner for providers---data such as lab results, radiology exam results, medications, problems, allergies and immunizations.
Use Case Phase 2: State initiative to apply patient data to accepted Clinical Guidelines/Protocols for feedback to treating physician.
Sun Proprietary Do Not Reproduce Without Explicit Written Permission
Cleveland Clinic
Challenge • Eliminate errors in filling handwritten prescriptions
• Enable e-prescription functionality between clinic and pharmacies
• Increase patient satisfaction
• Using Sun integration software, the medical center was able to synch up communications between its internal prescription system and those existing at retail pharmacies
• Enabled communications between clinic and pharmacies systems
• Ensured accurate filling of e-prescriptions• Enhanced patient safety and care
Solution
Benefits
Sun Proprietary Do Not Reproduce Without Explicit Written Permission
Sun – Your eHealth Partner• Interoperability through 16+ year history in HIT• Indexing through a proven master patient index• Commitment to ongoing standards development
through presence on HL7 committees• Sun Java Composite Application Platform Suite
enables all integration initiatives
Sun Proprietary Do Not Reproduce Without Explicit Written Permission
Sun’s 360°Health Info Exchange Architecture
AcademicMedical Center
PublicHealth
SpecialtyClinic
Hospital
ReferenceLaboratory
MedicalSupplier
Long-TermCare
DiagnosticImaging Center
Finance Researchand Education
EmergencyServices
Physicians
Home Health
PrivateInsurance
GovernmentInsurance
Pharmacy BenefitManagement
Employer
Single-Patient View
Ambulatory Centers
Payers
Pharmacy
ClinicalDocuments
ScreeningRegisters
Sun Proprietary Do Not Reproduce Without Explicit Written Permission
The Sun Prescription
• An interoperable and highly extensible healthcare solution
• Solutions and infrastructure to transform the way healthcare records, tracks, and accesses critical business information
• Sun is the remedy for healthcare information exchange initiatives that need to find a more cost-effective way to standardize and exchange critical information between their entities.
Enabling EMR/EHR – Best Practices in Integration
Wipro Technologies
© 2007, Wipro Technologies
Healthcare Provider Organization Context
• Between 44,000 and 98,000 Americans die each year from medical errors. • Many more die or have permanent disability because of inappropriate treatments,
mistreatments, or missed treatments in ambulatory settings. • $300 billion is spent each year on healthcare does not improve patient outcomes –
treatment that is unnecessary, inappropriate, inefficient, or ineffective.• Patients with medical emergencies too often are seen by doctors with no access to
their critical medical information, such as allergies, current treatments or medications, and prior diagnoses
Source: Institute of Medicine
Well Designed Application Integration with Industry Standard tools and Services can help to reduce some of these instances
• Prescribing Error Rates and Quality Issues– More than 3B prescriptions are written per year (AHRQ)– Pharmacists make 150M calls to physicians each year to discuss possible errors or
clarify prescriptions (ISMP) – 8.8M ADE’s occur each year in ambulatory care, of which more than 3M are
preventable (CITL)– Medication errors account for 1 out of 131 ambulatory care deaths (CITL)
© 2007, Wipro Technologies
Integration Best Practices Help the Achieve Objectives
Improved Quality of Care and Patient Satisfaction
Greater ROI
Seamless Integration
Enhanced Risk Management
Increased Efficiency
© 2007, Wipro Technologies
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© 2007, Wipro Technologies
Facts & Figures• Largest Integration Practice in APAC• Largest Pool of HL7 Certified Professionals having 10+
years of collective experience in healthcare interface• Extensive Product Expertise • Extensive functional expertise in many vertical domains
such as healthcare, manufacturing, retail, automotive, energy and utilities
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Wipro Technologies
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360 degree services for Providers
R & D
• EPIC, Cerner, IDX, Eclipsys, MEDITECH, Siemens
• Application Management services• Integration Services – HL7Care
Management Portals • Healthcare Analytics• Paperless office solutions• Identity and access management
Healthcare IT Services
• Remote Network Monitoring• Remote desktop support• Service desk and Help desk• ITIL compliance • Security & Risk Management: HIPAA
Infrastructure Services
Global Compliance Center - HIPAA ComplianceAHA certified partner, Fixed fee HIPAA compliance
IT and Non IT Asset Management for HospitalsManagement of Medical Devices from a command center
Clinical Reporting with Business ObjectsMEDTECH NPR reporting alternative
Clinical Process OutsourcingRemote Radiology Services
• Revenue cycle management• Medical coding and billing• Remote radiology services• Procurement, F&A and HR services
BPO Services
Innovation and Value Accelerators
Consult Develop & Deploy Manage & Evolve
Application on Network ServicesAON on Medical Grade Networks - Cisco
Managed Integration Services Shared SUN JCAPS (e*Gate) Integration Factory
© 2007, Wipro Technologies
Thank You !
You can Interact with Raj Ranganath face to face at HIMSS Booth #2235 (Feb 24- 28)
Raj Ranganath is presenting on the Topic “Enabling EMR/EHR a Unique Pay per Request
Approach”at Booth 581 on Date: 2/25/2008
Time: 5:15 PM - 6:00 PM
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