Healthcare Executive Forum

2. Healthcare Executive Forum Dr. Steve HesterChief Medical Information Officer Joseph DeVenuto Chief Information Officer

3. Who Is Norton Healthcare? Integrated Delivery Network of Five Not-for-Profit Facilities 1.2 Million yearly patient encounters 35 Employed Physician Practices 5 Immediate Care Centers 10,000 Employees 2,000 Physician Medical Staff 2,000 Licensed Beds 60,000 Admissions/year

4. Norton HealthcareA vision for technology • Improve patient safety and quality • Measure and communicate quality, safe, efficient patient care and supporting services • Utilize technology to facilitate patient centered care • Provide a comprehensive continuity of care which is patient centered through clinical systems and appropriate integration • Provide tools to patients, physicians and staff to achieve safe and efficient patient care through a systematic transformation of the clinical care process • Provide tools and support for managing compliance and regulatory standards

5. Portals Provide Infrastructure For Improved Business Processes And Quality Outcomes Strategy: Provide the standard of care through a systematic transformation of the clinical care process to improve Quality Outcome based results (best practices) Improved Decision Support Process Excellence Portal Management CareLINK Information Access InformationExchange PracticeLINK ImageLINK Information Presentation InformationStorage/Processing

6. Physician Portal Marketing Portal Nursing Portal Support Services Portal Admin.Portal Learning Mgt Portal ResearchPortal Patient Portal EmployeePortal HR Portal Portals Support Integration And Cross Organization Collaboration • Single entry point for personalized information • Access from multiple systems integrated and tailored by role Compliance Information Electronic Forms Policies and Procedures EMR ERP Scheduling ADT Lab System

7. Collaboration And IntegrationPulling the puzzle together TransparentQuality Reporting ImprovedCorporateCollaboration Patient, Physician & Employee Portal Learning Management Portal WirelessEnvironment & Mobility Ease of Use Improved Interoperability Clinical Portal Policy and Procedures Order Set Standardization HR Portal

8. Norton HealthcareClinical quality • Norton Healthcare Quality Initiative • Quality drives strategy • Public Reporting • Strong Senior Leadership • Physician and Staff Collaboration for Clinical Quality Improvement • Create an environment focused on improving business, workflow and clinical process • Portals provide foundation for improving clinical quality • Go Green Initiative • Collaborative effort across the organization • Long Range Clinical Quality Plan • Approach Quality like Long Range Financial Plan • Quality is a measurable entity

9. Key Success Measures Providers Must • Track and Measure Results • Analyze their results, to find their strong and weak points • Compare their results with those of other hospitals… • Welcome publicity not only for their successes, but for their errors… Providers Must Track and Measure Results Analyze their results, to find their strong and weak points Compare their results with those of other hospitals… Welcome publicity not only for their successes, but for their errors… “Such opinions will not be eccentric a few years hence.” Dr. Ernest A. Codman, 1917 Quote from: The Role of Clinical Data and Risk Adjustment in Public Reporting of Hospital Performance. Massachusetts Health Data Consortium, December 10, 2003. RS Johannes, MS, MD, Vice President for Medical Affairs, Data & Clinical Information – Cardinal Health. http://www.mahealthdata.org/forums/data/2003/DMUF_20031210_Johannes.pdf

10. Norton Healthcare Quality Report • 244 Quality Measures on the Internet available for public evaluation • Plan for Ambulatory Metrics in first quarter of 2006 • Side-by-side, hospital-specific numbers • Highlight red or green based on 99% confidence limits around the U.S. average • We say “worse” and “better” • Popup boxes give indicator definitions and any hospital-specific response • We show state average when available

12. Long Range Quality Plan People Process ImprovementMethodology Implementation Process Improve Collaboration for QualityImprovementsGo-Green Planning Finalized 12/05 Technology Go-Green Planning Finalized 12/05 Mobility for Point of Care Clinical Decision SupportQuality Bundle Implementation 7/06CPOE 7/07

17. Patient Satisfaction Report

18. Financial Stewardship Report

19. Physician Portals For Quality Improvement • Central access for provider specific information • Reference materials • Group specific quality information • Central location for quality indicator collaboration

23. Norton Healthcare Collaboration And Portals Initiatives PHASE I – Administrative portals • Employee Portal (EmployeeLINK) • Organizational Policies and Procedures management • Ongoing Education and CME (Learning Management System) • Guest Services • Clinical Quality Collaboration • Create Easy to Use Collaboration Tools • Hurricane Katrina Collaboration Site and Patient Tracking • Mobile Solutions for physician documentation and access PHASE II –Clinical portals and Mobility Solutions • Clinical portals – integration with Electronic Medical Record • Physician Peer Review • Patient Portal with Disease Management Focus (GuestLINK) • Wireless infrastructure for patient satisfaction and education • Increased mobility for information retrieval and workflow integration at time of delivery • DOCLINK – Norton Healthcare’s version of Virtual Physician Office

24. Employee Portal Employee Portal • Employee Portal (EmployeeLINK) • Problem • Limited and disjointed access to personalized employee and benefits information • Solution description • Integration to People Soft HR system • HR Forms access – future online forms completion • IHDN System Communication Tool • Integration with existing applications • Offer employees online Over the Counter Medication Discount program • Benefits/ROI • Online Open Enrollment • $100,000 savings each year • Online Benefits Management and Pay Stub • $50,000 savings each year

28. Policies And Procedures Portals • Problem • Document management needed for policies and procedures • Solution description • Portal to provide a central location and standardized process for storing and revising documents to ensure regulatory compliance and ease of workflow • Benefits/ROI • Central Universal Location • Version Control • Central Updates • Risk Management Control • Improved Patient Safety • Standardization Policy & Procedure

31. Learning Management Portal • Problem • Training documents, courses and internal documents spread out across organization • Solution description • Single point of access to training documents, courses and internal documents for employee training personalized to user • Integration with People Soft • CME and CEU Opportunities • Norton Healthcare is the largest provider of CME in the state of Kentucky • Real Time access and testing for Web Based Training • Benefits/ROI • $3 Million savings for recent Hospital EMR Go-Live • At home training opportunities for employees Learning Management Portal

35. Other Administrative Portals • Problem • Need flexible and easy to use tools to create collaboration and portals as needed • Solution description • Leverage portals to provide easy to use collaboration tools • Benefits/ROI • Example - Hurricane Katrina Site • Central Location for Information • 10 minute setup time • Extremely flexible • Excellent use of technology to augment workflow

38. Clinical Portals And Mobility Benefits • Instant, Real Time Information Access • Enables caregivers to access patient information where they need it most—at the point of care • Improved Patient Safety • Electronic capture of patient data reduces errors that inevitably occur with paper-based forms • Streamlined Compliance and Enhanced Security • Reduced reliance on paper, increased control over information, and digital signature capabilities can improve both regulatory compliance and overallinformation security Clinical Portals and Mobility

39. Clinical Portals And Mobility Current initiatives • Outpatient Oncology unit with Tablet PC clinical documentation • Problem • Need to access and document clinical results at the bedside and other locations • Solution Description • Display digital images on the Tablet PC to consult with patients and families • Collect patient documentation at the bedside • Benefits • Improved patient care and satisfaction Clinical Portals and Mobility

40. Mobility and WirelessCurrent initiatives • Nurse and Respiratory Therapy with access to clinical information system and EmployeeLINK • Problem • Nurse and respiratory highly mobile • Solutions description • Therapists and nurses access clinical and employee information • Benefits • Improved patient care and satisfaction, nurse satisfaction • Patient access to Patient Portal via wireless network • Problem • Patients and families want overall access to the Internet as well as disease reference information in the hospital • Solution Description • Patient education, disease management, personal email available for patients in the hospital • Benefits • Patient Satisfaction Clinical Portals and Mobility

41. Clinical Portals, Mobility and WirelessSolutions - Phase II Initiatives • Neonatal Intensive Care Unit online documentation utilizing Tablet PC • Hospital based Cardiologists with access to Cath and Echo films for viewing via wireless tablet • ED online documentation via wireless tablet • Physician utilization of tablet devices for patient care management • EMR Utilization of Tablet PCs Mobility and Wireless

42. Why Microsoft? • Familiar and easy to use • Adaptive • Supports multiple platforms, devices,and mobility • Low cost of ownership • Works with existing technology investments • Interoperable by design

43. Process excellence Improved Decision Making Data integrity and integration Return on investment Improving workflow and collaboration Access at point of care through mobility solutions Collaborative team behaviors Norton Healthcare Summary • Technology enabling a collaborative relationship between care givers and administrative employees • How Portals and Technology Supports Norton Healthcare Quality Initiatives Quality Outcomes Based results Standardization Patient satisfaction

44. Norton Healthcare Takeaways • Pilot Groups – Start Small and Grow • Strong Strategic Partners • Adequate Support Structure for growth • Legal involvement with wireless technology • Changes in Workflow Management • Multiple opportunities for return oninvestment with collaborative technologies