Presentation on preparing for Meaningful Use of EHRs.

1. Helping Georgia Hospitals Prepare for Meaningful Use and Improved Quality Kent Giles, MPPMEric Bartholet December 9, 2009

2. Agenda Welcome and Introductions Review Meaningful Use Requirements Review “where we are” in GHA Facilities Keys to Success Q&A

3. Introductions Kent Giles, MPPM, Partner, CSC Healthcare 25 years of Hospital Administration, Physician Practice, Payor and Consulting GHA Account Partner and Advisor to C-Level Executives across the SE US Subject Matter expertise in strategy, planning, IT and Margin/Operations Improvement Eric Bartholet, Partner, CSC Healthcare IT Strategy & Planning Over 25 years working with healthcare systems Subject Matter Expertise in It Strategy, Systems Implementation and Architecture

4. Adoption of Clinical IT in Hospitals is Low and Even Lower Among Physicians Background Transforming the health system will require hospitals and physicians to dramatically increase their use of HIT The latest data from HIMSS Analytics suggests that just over 40 percent of hospitals have basic clinical (nursing) documentation but less than2 percent have physician documentation(HIMSS Analytics, 2009) The level of current EMR adoption will be a major factor in how much investment will be necessary to satisfy the Meaningful Use requirements

5. EHR Meaningful Use Timetable Meaningful Use and HIT-Enabled Health Reform Targets The “meaningful use” criteria to be phased in, with the criteria building from year to year. 2015 2011 2009 2013 HIT-Enabled Health Reform HITECH Policies Capture & Share Data Advanced Care Processes with Clinical Decision Support Improved Outcomes Source: Meaningful Use Work Group Presentation at the HIT Policy Committee Meeting on June 16, 2009

7. Payments start based on when you achieve the Meaningful Use requirements

8. Compression of incentive payments begins if you don’t achieve Meaningful Use by 2013

10. EHR Meaningful Use Requirements Summary

11. EHR Meaningful Use Requirements Summary

12. What CEO’s Want to Know Meaningful Use Can my application vendor make my hospital ARRA compliant? Can we just accept the penalties and not achieve meaningful use? Isn’t this an issue that I should delegate to my CIO? 4. How do we achieve MU and keep our medical staff and clinicians happy? What is the financial impact on my organization? What are the major CEO risks that I face?

13. HITECH Framework HITECH Scorecard: Results Of 17 GHA Hospitals Overall readiness can be determined by totaling the scores of all the categories, 80 is “likely to achieve MU”. To have a good probability of readiness, a hospital needs to score 80 percent or better in a given category. Dimensions of Healthcare Delivery

15. HF on arrival/within 24 hr

16. Shock on arrival/within 24 hr

17. Bradycardia day of/before disc

18. Heart transplant during stay

19. LVAD during hospital stay

20. Patient has pacemaker

21. 2nd or 3rd degree block on ECG

22. Allergy to beta blocker

23. Other contraindication to beta blocker

24. Arrival date/time

25. Beta blocker administered (date/time)

26. Birth date

27. Admission date

28. Discharge date

29. Transfer from hospital/ED

30. Transfer out soon after arr.

31. Receiving CMO only

32. Involved in clinical trial

33. Discharged to hospice

34. Expired

35. Left against medical adviceAcute myocardial infarction (AMI) patients without beta-blocker contraindications who received a beta blocker within 24 hr after hospital arrival REG/ADT FACE SHEET (4 data elements) EDDOCUMENTATION (6 data elements MD DOCUMENTATION (7 data elements) RNDOCUMENTATION(1 data element) DISCHARGE SUMMARY (8 data elements) UB-04 (3 data elements) SOURCES OF DATA ELEMENTS

37. High level of user satisfaction

38. Expectations are fulfilled

40. Project milestones not met

41. Expectations unfulfilled

43. No Project Rigor

44. Low User Satisfaction

45. Non-achievementClinical Change Management

46. ARRA Costs vs. Incentives (350 bed facility w. limited CIS) ARRA costs (capital vs operating) Capital: $ 2.75 million License and Installation – $1,550,000 Project Management - $450,000 Training - $150,000 Clinical Adoption - $450,000 Order Sets (250), Reports (50), Interfaces - $150,000 Operating: $3.24 million / year Hosting and Application Management - $850,000/year Help Desk - $90,000 Additional FTEs in IT, Departments- $1,500,000/year Back Up and Recovery - $ 800,000 ARRA Revenues Incentive Payments of $6,200,000 Impact Analysis Initial need to fund $2,750,000 with cash or financing Additional Operating Budget of $3.24 million / ongoing $3,670,000 in annual penalties if MU not achieved

47. Recommendations for Hospitals and Participating Providers Recommendations Educate - Your Leadership Understand the regulations, rewards, risks and costs. Proforma incentives and ongoing deductions. Form - Steering Committee Chaired by a C-Level Executive (CEO preferred) MU is a major impact on clinical, business office, IT and medical staff Include key clinical, IT, operational and financial leaders (Big Team) Maximize quality improvement, patient safety and cost reduction opportunities Reduce the number of initiatives across the Hospital to provide focus on MU Assess - Current State Assessment w. Road Map (GHA offers one) Determine where you are currently using HITECH Framework Develop overall timelines, major milestones, operational and capital budget Develop measures and accountabilities with responsible parties Implement – CIS and Revise Clinical Processes and Work Flow System Selection based upon criteria not vendor demos Build a detailed project plan with PMO Be honest about your internal capabilities and needs Engage partners (application vendor (s), consulting resources, internal hires) Focus on clinical adoption and implementation in a combined methodology with PMO Focus on best practices and maximize opportunities for improvement Improve – Improve Performance Receive Stimulus Dollars Constant improvement of quality, service and process improvement / cost reduction

48. Elements of Meaningful Use of EHRs Meaningful Use RIGHTOUTCOME RIGHTADOPTION RIGHT IMPLEMENTATION RIGHT PRODUCT

49. Q & A

50. Questions or Comments?Thank you! Kent Giles, MPPM 404-483-7000 kgiles4@csc.com