9 th Global Information Technology Association (GITMA) World Conference June 22 - 24, 2008 Tim Rice, CEO

1. 9th Global Information Technology Association (GITMA) World Conference June 22 - 24, 2008 Tim Rice, CEO

3. Today • U.S. and Global Healthcare Industry Broad comments • Intro to Moses Cone Health System • Information Technology at Moses Cone Health System – The Good, the Bad and the Potential

4. Global and U.S. Healthcare Industry

5. 1 4. $ TRILLION

6. World Health Organization (WHO) Composition of world health payors www.who.int, May 2008

7. 2007 Life Expectancy Source: CIA World Factbook, September 2007

8. 2006 Infant Mortality Rates Source: CIA World Factbook, September 2007

9. Maternal Mortality Maternal mortality ratio per 100,000 live births Legend Less than 10 deaths per 100,000 10 - 199 deaths per 100,000 200 - 499 deaths per 100,000 500 - 999 deaths per 100,000 Greater than or equal to 1,000 deaths per 100,000 Data not available www.who.int, June 2008

10. 10 Million Children Die Annuallyfrom Lack of Healthcare •Nearly all in third world countries. •200 million under the age of five get no healthcare. •#1 Killer: Pneumonia 30 cents antibiotics = treatment. •#2 Killer: Diarrhea – no oral rehydration. • Large disparities within own countries between well-off children and poor children. • Immunizations. http://news.yahoo.com: May 6, 2008

11. Comprehensive Solution VS. Country by Country Solution VS. Philanthropist’s Solution

12. World Health Organization (WHO) Six Point Agenda •Promote Development – access for poor, disadvantaged, vulnerable populations • Health Security – defend against outbreaks • Strengthen health systems • Harnessing research, information and evidence – monitor and measure evolving global health situation • Enhancing partnerships – international organizations, donors, civil society and the private sector • Improving performance

13. Bi-modal Problem Chronic diseases chief causes of death globally World Economies Developing Countries Sub Sahara Africa Preventable & treatable diseases (malaria and tb) United StatesChronic Diseases (Lifestyle) More people dying from heart disease than infectious diseases. (TB, malaria, HIV/AIDS) World Health Organization, June 2008

14. Bill and Melinda Gates Foundation Primary Aims •Largest, transparent charitable foundation in the world. •Founded in 2000. •Doubled in size by Warren Buffet in 2006. •$38.7 Billion endowment. To globally enhance healthcare and reduce extreme poverty, and, in the United States, to expand educational opportunities and access to information technology. www.gatesfoundation.org; June 2008

15. Cost Trends Increasing Globally www.who.int, May 2008

16. U.S. Compared to Other Countries International Comparison of Spending on Health 1980 - 2004 Average spending on health per capita ($US PPP) Total expenditures on health as percent of GDP Data: OECD Health Data 2005 and 2006. Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.

17. U.S. GDP Comparison to Other Sectors United States = $1.9 Trillion per Year • Clothing - 2.7% •Energy - 2.7% • Defense - 4.8% • Food - 9.8% • Housing - 10.2% • Healthcare - 15.6%

18. Moses Cone Health System

19. Moses Cone Health System Not-For-Profit • Community Based Five Hospitals • 1057 Licensed Acute-Care Beds • 200 Employed Physicians The Moses H. Cone Memorial Hospital Wesley Long Community Hospital The Women’s Hospital of Greensboro Annie Penn Hospital Behavioral Health Center

20. Moses Cone Health System Not-For-Profit • Community Based Five Hospitals • 1057 Licensed Beds • 200 Employed Physicians •168,000 Emergency Visits •35,600 Surgeries •239,000 Inpatient Days •906 Medical Staff •$767M Revenue •18 Joint Venture Operations Fiscal Year 2007

21. Where is Moses Cone Health System? • 26 miles east of Winston-Salem • 50 miles west of Chapel-Hill, Durham, Raleigh

22. Information Technology at Moses Cone

23. Information Systems 95 FTE’s $6,151,245 in Salary $2,059,044 Fringes

24. Capital Budget

25. Technology Examples Purchases and Installations in Five Years • Picture Archiving Communication System ($10.2M) - CR and DR Readers • MD Data - PDA Project ($300K) •IDX CareCast ($5.7M) - Nurse Documentation - Medication Reconciliation • IDX FlowCast ($1.8M) • Electronic Medical Record • Safety Zone Portal ($75K) •elink Critical Care ($6.4M) • Diligent – Safe Patient Handling ($1.9M) • Smart IV Pumps ($4.5M) •Enterprise Master Patient • Index ($1M) •Data Repository ($3.4M)

26. Picture Archiving Communication System (PACS)

27. Picture Archiving Communication System (PACS) • > $6.5 million system. • GE System. • Necessity in this digital age. • 21 Diagnostic Quality Monitors ($24,000 each). • Communicates with other systems. • ~ 450 internal and external log-ins.

28. Picture Archiving Communication System (PACS) Computed Radiography vs. Direct Radiography • Computed Radiography (CR) Readers - Digital plates in portable units - the plate is removed to download into PACS. - Analogy: take the disk into Target to print pictures. • Direct Radiography (DR) Readers - Direct capture and downloads into PACS. - Four in System at $390,000 each.

29. PACS Benefits • Images instantly available – real time. • Radiologist and Physician can review same image at the same time. • Immediate magnification. • No film processing. • Burn images to a CD and take to referring hospital. • Radiologist can review from anywhere; offshore? • ED “Digital” Sticky Note - Radiologist can type note right on image telephone call is not required.

30. PACS Drawbacks • Different PACS that do not communicate with one another. • Archived images may be off-site from where images are taken. eg. Compare year-to-year mammograms • Hardware requirements, Storage, Transmission.

31. MD Data – PDA Project • Created by two Duke neurosurgeons. • First hospital pilot – The Moses H. Cone Memorial Hospital • PDA / Smartphone: now wireless syncing. • Allows physicians to view clinical documentation anywhere at anytime. • More than 300 physicians use it while industry average is 10% utilization.

32. Registration System Includes scheduling and billing • Five hospitals: all had different systems. • 24 outpatient clinics. • Outpatient formerly different from inpatient.

33. Electronic Medical Record • GE product – interface someday with clinical documentation and registration systems? • All hospital outpatient clinics. • 200 licenses for community physicians.

34. Safety Zone Portal On-line, web-based occurrence/incident reporting system Average 220 incidents reported per week. Report near misses - opportunities.

35. Safety Zone Portal • Top 10 Occurrences

36. elink Critical Care Continuous Monitoring Via Cameras and Remote Computers • 11 intensivists and 12 critical nurses. • $4.2 million initial cost. • 107 beds, six critical care departments, two EDs. • Appropriate interventions sooner. • 38 hospitals in the country – only one in NC. • Becoming the standard of care.

37. The Bad

38. Globally Sanitation, Nutrition, Basic Healthcare or Information Technology

39. United States • Fragmented medical record except for the military system. • Soldier’s medical information whether in United States, Iraq or on a submarine. • 47 million uninsured.

40. Moses Cone Health System • Quality of vendor code and functionality. eg. customization, reliability, shortfalls • Ability to keep up with technology requests and/or requirements. • $2 million lab mistake. • Staff burnout due to pace of installations.

41. From Patient Perspective • No common ID in System. • Medical history, allergies multiple times. • Manual progress notes, physician orders. PATIENT WAS ORDERED 4 mg MSO4, ENTERED INTO CLINICAL INFORMATION SYSTEM AS 4 gm MAGNESIUM. INTERCEPTED PRIOR TO REACHING PATIENT.

42. The Potential

43. Globally • Healthcare without borders. • Best practice adoption at a faster pace. • As part of global economy - Radiology reading - Transcription - Medical Tourism

44. • Computerized physician order entry. • Document imaging. • Interoperability of non-core vendor systems. • Personal health records. • National initiatives for patient information sharing. U.S. Healthcare

45. IT to Leverage Quality Improvement Since 2006 • Over Sedation Task Force. • Tracheotomy Care Task Force. • Pathology Specimen-PDCA. • First Dose Antibiotic-PDCA. • Peri-operative Antibiotic-PDCA. • Reducing Surgical Site Infections-Six Sigma Project. • Behavioral Health Center Admission Process-Six Sigma Project. • Medication Reconciliation-Six Sigma Project. • Falls Reduction-Six Sigma Project. • National Patient Safety Goals Compliance Monitoring. • Patient Handling Initiatives to Decrease Employee Injury.

46. The Potential Congestive Heart Failure Wireless sensor

47. Bar coded Meds Administration • Reduces ADEs 25% – 85%. • Patient bar coded for two years already. • 15% of all medications we individually barcode on-site. • $834,000: cost of IT to barcode, manage inventory, electronic ordering from departments to the pharmacy, electronic invoice payment, electronic receiving and picking of items. • Elapsed time to get technology into productive use eg. Barcode on patients throughout system = 15 months. Still not managing medication administration using bar codes.

48. Moses Cone Health System Nosocomial HAI MRSA Transmission Rate Overall Rate (with SSIs) Number of VAPs by Quarter in ICUs MONTH FY QTRs

49. “This film cost $31 million. With that kind of money I could have invaded some country.” - Clint Eastwood

50. 50MILLION Clint, I Feel Your Pain $ in five years, andwe’ve got a ways to go!