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4. EMR: The levels: Private and Confidential EMR Adoption Model – EMRAM Stage Cumulative Capabilities 7 Complete EMR; Continuity of Care Document (CCD) transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 6 Physician documentation (structured templates), full CDSS (Clinical Decision Support Systems) with variance & compliance, full R-PACS (Radiology Picture Archiving and Communication System) 5 Closed loop medication administration 4 CPOE (Computerized Provider Order Entry), Clinical Decision Support (clinical protocols) 3 Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology 2 CDR (Clinical Data Repository), Controlled Medical Vocabulary, CDS (Clinical Decision Support), may have Document Imaging; HIE (Health Information Exchange) capable 1 Ancillaries - Lab, Rad, Pharmacy - All Installed 0 The hospital has not yet installed all of the three key ancillary department systems (Laboratory, Pharmacy, and Radiology).

5. INTEGRATED DATA VIEW OF MULTIPLE HOSPITAL SYSTEMS FLEXIBLE TO CREATE, EASY TO USE MULTI DATA INPUT METHODS SECURE AND ACCESSIBLE, ANYWHERE

6. EMR: How has the US faired? Private and Confidential Only 1.1% of 5,000+ hospitals surveyed in the US have achieved level 7 “Complete EMR”. EMR Adoption Model – EMRAM Stage Cumulative Capabilities 2011 7 Complete EMR; Continuity of Care Document (CCD) transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 1.1% 6 Physician documentation (structured templates), full CDSS (Clinical Decision Support Systems) with variance & compliance, full R-PACS (Radiology Picture Archiving and Communication System) 4% 5 Closed loop medication administration 6.1% 4 CPOE (Computerized Provider Order Entry), Clinical Decision Support (clinical protocols) 12.3% 3 Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology 46.6% 2 CDR (Clinical Data Repository), Controlled Medical Vocabulary, CDS (Clinical Decision Support), may have Document Imaging; HIE (Health Information Exchange) capable 13.7% 1 Ancillaries - Lab, Rad, Pharmacy - All Installed 6.6% 0 The hospital has not yet installed all of the three key ancillary department systems (Laboratory, Pharmacy, and Radiology). 10%

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13. EMR: Is there a divide? Private and Confidential Segmenting by hospital type (Table 2) shows that Rural, Critical Access, Independents, and Non-Academic hospitals have most catching up to do in Health IT (EMR scores of 3 or less), whereas Acadamic/Teaching hospitals are most advanced, scoring 4 or higher. The divide widens based on how funding is allocated. Leading to a future issue regarding inability to achieving an EMR based on the type of hospital you operate… Table 2: EMR scores by Hospital Type Hospital Type Segment Mean Min Max Median Number Rural 2.24 0.00 7 2.16 1246 Critical Access 2.25 0.00 6 2.23 1304 Others 2.61 0.00 7 3.10 2115 Independent Hospital 2.75 0.00 7 3.15 2014 NonAcademic 3.01 0.00 7 3.23 5088 IDS 3.24 0.00 7 3.29 3296 Urban 3.30 0.00 7 3.30 4064 General Medical/Surgical 3.34 0.00 7 3.32 3193 Academic/Teaching 4.12 0.48 7 4.24 220

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21. EMR: Is big better? Private and Confidential While no hospital with more than 400 beds has scored less than 2, at least some hospitals in all segments with 400 or fewer beds have no EMR at all (i.e. Min = 0). On that basis smaller hospitals have more catching up to do in terms of Health IT adoption. These figures are based on a survey of 5,300 hospitals, so it gives quite a complete picture given that total number of US hospitals is around 6,000. In a situation where data can’t be shared, what is the impact on decision making and planning in smaller hospitals? Table 1: EMR Scores by Bed Size Bed Segment Mean Min Max Median Number 0-100 Beds 2.53 0.00 7.06 3.08 2,769 101-200 Beds 3.33 0.00 7.07 3.30 973 201-300 Beds 3.70 0.01 7.07 3.40 608 301-400 Beds 3.74 0.19 7.07 3.40 407 401-500 Beds 3.72 2.02 7.04 3.42 213 501-600 Beds 4.03 2.17 7.07 3.45 150 600+ Beds 4.16 2.07 7.07 4.18 190

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