The event was held in Bedminster, NJ, and was sponsored by ACHE-NJ and Cegedim Dendrite. It brought together experts from around the globe to help attendees better understand practical issues, benefits and challenges of EHR adoption, including interoperability, reimbursement, and more. Dr. Kennedy Ganti, the New Jersey Health IT Commissioner, was a keynote presenter as well as one of the guest panelists. I have received many emails from people unable to attend this event due to time, date or location who wanted access to this presentation - so here it is! The keynote presentations and introduction by the panel moderator, Michael Fossel, are presented in this slide deck. (NOTE: A link to the recorded event - including the infamous panel of experts who received major applause and kudos at the conclusion of the event - will be available soon!)

1. EMRgency Medicine – Are You Ready?
December 10th, 2009

2. Agenda
Opening Remarks Dr. Michael Fossel
Understanding the HITECH Act Dr. Kennedy Ganti
and the EMR Mandate
Lessons Learned: A European Jean-Michel Van
Perspective on EMR’s effect on
savings costs, lives & time
Increasing Your Chances for Paul Roemer
Success: What are the Critical
Success Factors for EHR/EMR
Break
Thought Leadership Panelists
Discussion
Open Q&A
Networking & Dessert
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3. Dr. Michael Fossel | Cerner Corporation
OPENING REMARKS
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4. Sometimes,
your EMR can be a
―PICNIC‖
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5. Reality:
not always a
PICNIC
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6. People will never laugh at
anything that is not based on
truth.
- Will Rogers
I feel like I’m working for the
computer, rather than it working
for me.
 MD, Iowa, 2007
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7. | 7

8. Sound like your EMR?
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9. Extormity and ARRA’s meaningful use
"Our legal team is expending incalculable billable hours to develop a
carefully worded statement that will depict in illustrative terms our
commitment to helping customers and prospects move toward the
eventual demonstration of meaningful use," explained Extormity chief
financial officer Samantha James in a carefully worded statement.
"It is common knowledge that meaningful use criteria are not fully
defined, so Extormity is taking great care not to issue an ironclad, no
exceptions guarantee," added James. "However, we plan to provide
the market with a vague impression of intent designed to inspire a
tinge of confidence and an indication of some degree of willingness to
comply at some future point, all without creating a legal obligation or
definitive pledge to deliver an actionable event."
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10. Who said…
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11. Nothing new under the sun...
Who and when?
Florence Nightingale
1863
―Notes on Hospitals‖
Source: London: Longman, et al.
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12. Potential Benefits
Reduce errors
More ―intelligent‖ care
Real-time data
Better communication & documentation
Secure (and HIPAA compliant) data
Reduced labor costs
Reduced litigation
Automated workflows
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13. Costs of doing nothing…
• 33 cents/dollar spent is non-clinical
Consider:
>90% of ~30 billion transactions/year by phone, fax, or mail
Physicians spend an estimated:
20-30% searching for information
38% documenting (nurses 50%)
Records misplaced in 30% of visits
Patients average 13 pieces of paper/visit
Offices average $10/visit on paper records
Patient records average 3.3 kg
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14. Deadlines are nearing, penalties are looming
Why hesitate?
Ill-defined requirements
Unanswered questions
The opportunity to learn from others
Successes in the EU and US
How do we achieve success?
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15. THANK
THANK
YOU
YOU
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16. Dr. Kennedy Ganti | NJ Health IT Commission Chair
UNDERSTANDING THE HITECH ACT AND THE
EMR MANDATE
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17. Stimulus, Software and Sense
Understanding the Fundamentals of Electronic
Health Data Use and Exchange:
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18. The Case for Health IT Adoption
Computerized health data: nothing new
Since the 1970s
At centers like Boston, Indianapolis and Salt Lake City
Electronic medical records such as VA Vista were created
Central data repositories
Enter the Electronic Medical Record
Collection of related pieces of health data on a person's health and
disease
Electronic version of the standard medical charge
Data can be structured
Data can be shared
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19. The Case for Health IT Adoption
Making better decisions- clinical decision support
Drug-drug interactions
clinical reminders for preventative services
'red flags' on structured lab data
ePrescribing- tracking meds better
Know if patient actually filled a script
Track prescribers tendencies
Connecting the dots
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20. HITECH: Adding fuel to the fire
Health Information Technology for Economic and Clinical
Health Act
Makes federal funding and planning resources to build an
interconnected, interoperable national health data exchange
network
Provisions:
$18 billion for CMS to promote "meaningful use" of EMR systems
$2 billion for ONC for infrastructural upgrades in HHS, education of health IT professionals,
promotion of interoperable clinical data repositories
$1 billion to Federally Qualified Health Centers (FQHC) for renovation and acquisition of
health IT systems
$550 million for Health IT and other uses for Indian Health Services
$300 million to support regional and sub-national efforts for HIEs
$40 million to be used by Social Security Admin to use EMRs to submit disability claims
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21. Meaningful Use
Policies, standards and metrics that guide clinical usefulness of
EMRs
Specifies goals by policy, patient setting and time (every two years
starting in 2011)
Guide for CMS for promoting incentive payments and eventually
non-use penalties
Has harmonized goals between ambulatory and inpatient care
Pro- grounded in sound clinical and health policy principle
Con- Not very helpful in other care settings (Long term care,
physical therapy, etc)
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22. Jean-Michel Van | Cegedim Healthcare Software (CHS)
LESSONS LEARNED: A EUROPEAN
PERSPECTIVE ON EMR’S EFFECT ON SAVING
COSTS, LIVES AND TIME
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23. Group’s Expertise
Cegedim Group
2008 : €849 million with 8,200 employees (80 countries)
Cegedim Healthcare Software (CHS)
29% of group’s activity
Main market in western Europe
a) Healthcare provider
b) #1 in France, #2 in the UK, #1 in Italy, #1 in Spain, #2 in Belgium
Definition of EHR:
Data exchange, e-prescribing, CPOE, e-claim
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24. Adoption Rate Across Top Countries
1. Early starters
Fig 1- Use of EHR Systems in Hospitals Fig 2 - Use of EHR Systems by Primary Care Physicians
Percentage of Hospitals Using Percent of Primary Care Physicians
Country EHR Systems Country Using EHR systems
DENMARK 65 DENMARK 95
FINLAND 100 FINLAND 95
SWEDEN 88 GERMANY 42
France 40 France 70
SPAIN 70 NETHERLANDS 98
US 8 SWEDEN 100
UK 89
US 28
Sources: Castro, D. ITIF, Sept 2009
a) European initiatives earlier than US (Northern Europe): early 1980’ 90’
with e-claims submission, e-referral, e-clinical record
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25. US and EU: Similar Barriers
1. Privacy issues
a) Danish Web portal Sundhed.dk= privacy functions! Thru Digital Signature, access tracking (40%
healthcare related Internet traffic)
b) Sweden: Good Policy - government-run database (4 to 5 % opt out)
c) Netherlands: stored in healthcare providers. Privacy control (2% opt-out)
2. Data ownership
a) Patients do not manage their data but own them and decide who can view/modify them
3. Cost of IT adoption
Fig 3 – Cost of IT Adoption and % of total cost
Denmark Small subsidies (30%)
Netherlands Tax deductible and incentive payments for every patient (50%)
UK Financial incentives (75%)
France Subsidies (75%)
Spain Financial incentives (90%)
Source: Gartner, Ministry of Health Sweden and Sécurité Sociale Report France | 25

26. Benefits of e-Health
(France, Spain, Holland, UK, Denmark, Czech Republic )
1. ROI ?  Yes
2. Benefits for Patient Safety (2005-2008)
15% reduction in prescription errors/year = Electronic Transfer of
Prescription
France: 200,000 reduction of prescription errors
Czech Republic: 75,000 reduction of prescription errors
Netherlands: 26,000 medication errors through CPOE and CDS
Six States: potential reductions of 5 million outpatient prescription
errors across the studied states
Source: Gartner, Ministry of Health Sweden and Sécurité Sociale Report France
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27. Benefits of e-Health
(France, Spain, Holland, UK, Denmark, Czech Republic )
3. Benefits for Quality of Care
UK: over 250,000 surplus laboratory tests were avoided since 2005
France : 11,000 readmissions to hospital for CHF were avoided
through EMR (an additional 26,000  savings of over €110 million,
if full elec.)
4. Increasing Physician Availability
UK: Over 90,000 appointments covered through “Did Not Attends”
option enabled by Electronic Appointment Booking (600,000)
Czech Republic: Almost 560,000 bed-days were become available
every year through Telemedicine, direct saving of €32 million
Sweden: Over 92,500 GP appointments/year were made available
alone through the use of web-portal
Source: Gartner, Ministry of Health Sweden and Sécurité Sociale Report France
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28. Mid + Long-term Costs & Benefits
(France, Spain, Holland, UK, Denmark, Czech Republic)
1. Benefits on Annual basis
Average HPOs : annual benefits = annual costs  year 3
Fig 4 - Annual Costs And Benefits Of E-Health 60 Sites From 1994 To 2008, In € Mill
Present value of annual costs Present value of annual benefits
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Source: European Commission « Economic Impact of eHealth Report » 2008

29. Mid + Long-term Costs & Benefits
(France, Spain, Holland, UK, Denmark, Czech Republic)
2. Benefits on Cumulative basis
Average HPOs: annual benefits > annual costs  year 5
Cumulative benefit by 2008: € 330 million
Cumulative investment costs (incl. operating expenditure): €155 million
Fig 5 - Cumulative Costs And Benefits Of E-Health 60 Sites From 1994 To 2008, In € Mill
2500
1500
500
Present value of cumulative costs Present value of cumulative benefits
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Source: European Commission « Economic Impact of eHealth Report » 2008

30. Future of the US e-Health
Each country is different
There is no one best practice!
Same strong signals as in Europe
a) National leadership groups, CCHIT
b) Set of Standards, HL7, SNOMED
c) Incentives
d) Top-down communication
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31. Thank You for Your Attention
« Yes, you can!!! »
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32. Paul Roemer | Managing Principal, Healthcare IT Strategy
INCREASING YOUR CHANCES FOR SUCCESS:
WHAT ARE THE CRITICAL SUCCESS FACTORS
FOR EHR/EMR
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33. EMR—What Should I Know?
What is the elephant in the room?
What does this mean—EMRs must be interoperable
& interconnected?
Know before you buy—what connects to what?
If EMRs aren’t connected, doctors will still need electronic and
paper files
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34. EMR—Where Does that leave you?
Focus on yourself, on what you control
Don’t let Washington drive your decision
ARRA
Certification
Meaningful Use
Decide why EMR is right for you
Figure out what your team should include
Define your requirements
Set a budget
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35. EMR—Fail Safe Points
What are the EMR Fail Safe Points (FSPs)?
EMR is healthcare’s Y2K time bomb.
There a is concurrent national rollout of EMR; standards not
available until 2010.
The costs are very high, so are the penalties
1/3rd to 2/3rd of EMRs implemented have failed
There may not be time to earn the incentives
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36. EMR—Ambulatory Practices
A good argument can be made for waiting. Within 12-18
months they will likely have the opportunity to acquire a
plug-and-play EMR in-house or SaaS, including:
Project management
Selection
Implementation
Adapting workflows
Training
Support
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37. EMR is Wide Open
New England Journal of Medicine (NEJM) received
responses from 63.1% of hospitals surveyed:
Only 1.5% of U.S. hospitals have a comprehensive electronic-
records system present in all clinical units.
7.6% have a basic system present in at least one clinical unit.
Computerized provider-order entry for medications has been
implemented in only 17% of hospitals.
Respondents cited capital and maintenance
costs as the primary barriers to implementation
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38. EMR
if it doesn’t connect…
Just because EMR’s have been implemented,
doesn’t mean they’re of much value.
“I've witnessed more serious errors with the EMR than in my
previous 25 years as a physician.”
Christine A. Sinsky, MD
"...our system for delivering medical care is clearly in crisis...At
the heart of the problem is the fragmented nature of the way
health information is created and collected,"
Bill Gates
Most EMRs don’t operate beyond the walls of the
building in which they were implemented
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39. EMR
Are you ready?
Enterprise
Readiness
Assessment
Federal funding
EMR Incentives, Implementation
grants Playbook
Readiness And penalties
Methodology
has a 6 phase
scorecard.
Implementation Risk
Management Assessment
Cost
Benefit/Funding
Analysis
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40. Enterprise Readiness Assessment
The Enterprise Readiness Assessment identifies gaps in:
Change Management Readiness
Technology Readiness
Risk Management
Standards Readiness
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41. EMR Implementation Playbook
The Implementation Playbook defines a program or set
of projects the enterprise needs to execute in order to
implement EMR. Potential projects may include:
Requirements
SW selection
Change Management
Integration
Policy, Procedure or Process
Training
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42. Enterprise Risk Assessment
The Enterprise Risk Assessment should help you
identify potentially fatal EMR implementation risks:
Staffing
Program management
Readiness
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43. EMR Cost Benefit/Funding Analysis
The Cost Benefit Analysis identifies:
The cost of implementation and the level of funding
necessary to successfully implement EMR
Funding sources such as grants or federal government
loans
The short term costs and the long term benefits
ROI development and monitoring
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44. EMR Implementation Management
Implementation Management oversees projects to
successfully implement each EMR project managing:
Project task management
Budget, Schedule, & ROI
Issues tracking and resolution
Staffing and skill requirements
Project accountability and visibility
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45. In Summary
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46. THOUGHT LEADERSHIP PANEL DISCUSSION
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47. Overview
Panel:
What is an EMR? Dr. Naomi Grobstein
Meaningful use Dr. Kennedy Ganti
Implementation Dr. Ganti/Dr. Fossel
Interoperability Paul Roemer
Which vendor? Dr. Spencer Kroll
Are EMR’s good? Jean-Michel Van
Getting reimbursed Dr. Kennedy Ganti
Who owns the data? Dr. David Memel
Q&A
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48. QUESTIONS & ANSWERS
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49. NETWORKING & DESSERT
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