Information Technology & Services2011 – 2012 Annual Performance Report

Delivering Value.

TABLE OF CONTENTS

Section 1: Executive Introduction 2

Section 2: Business Efficiency 8

Section 3: Business Growth 13

Section 4: Moving Forward 17

SECTION 1: EXECUTIVE INTRODUCTION

Barnabas Health Thinks DifferentlyAbout the Value of InformationTechnology & Services (IT&S)

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Welcome to the first edition of the IT&SPerformance Report. When we as an IT&Sorganization excel, our Barnabas Healthservice lines are positioned to excel. It is notabout what we make; it is about what wemake possible.

Trends in the health care and IT&S industriesare reshaping our market as we continue tofocus on the most important business processesand fostering enterprise agility to respond tonew payment and care managementprocesses.

IT&S will be further essential as we manage,evaluate and transform health care deliveryunder radically evolving market conditions. Everimportant will be the need for enterprise-wideintelligence capabilities and timely, pervasiveadoption of new care management processes,regulatory requirements and business initiatives.

We deliver business value in numerous ways.We use IT&S to enhance employeeproductivity, facilitate business growth, anddrive business efficiency and bottom lineresults. We also deploy next generation IT&Scapabilities to improve the efficiency of ourown IT&S operations — and in doing so,deliver value back into Barnabas Health.

I hope that you find this publication helpful as we strengthen our business partnering,inform broadly, engage locally and provideIT&S transparency.

Who We Support

Barnabas Health Employees: 18,200

Physicians: 5,370 (670 employed and 4,700 affiliated)

Barnabas Health networked sites: 52

IT&S by the NumbersAs of Q1 2012

“I believe in the ability of information technology and services to enable andtransform business. While progress has been made, there is much more to do.The challenges ahead are many and complex, and require an agile IT&Sorganization to enable, support and execute. Our IT&S family is passionateabout our health care system and the communities we serve to deliver clinicalexcellence.”

Thomas M. BartiromoSenior Vice PresidentChief Technology OfficerInterim Chief Information OfficerBarnabas Health

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Office of the Chief Information Officer Leadership Team (pictured left to right): Michael McTigue,System Vice President, Deputy Chief Information Officer-North; Anthony R. Macaluso, SystemAssistant Vice President, Enterprise Architecture; Chris Butler, System Vice President, Deputy ChiefInformation Officer-South; Tom Bartiromo; Rama Govinda, System Director, Enterprise BusinessInformation Services; Bonnie Geissler, System Vice President, Enterprise Clinical Information Systems;John Novak, System Director, Project Management Office; not pictured: Angelo Schittone, System Vice President, Technology Resources Division.

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93 millionThe total number of email messages sent tothe health care system in 2011, of which84 million were blocked as SPAM.

15,472The number of Enterprise Service Desk (ESD)interactions per month, of which more than1,800 are CIS- and physician-generated,with 96.6% of the service requests resolvedwithin the service-level objective (SLO).

Current Projects: 160

Planned Projects: 8

Idea/Requested: 17

On Hold: 80

Total: 265

Project Management Office (PMO)

Client Environment

Number of interactions/month:15,472

First call resolution: 58.6%

Service requests resolved within SLO: 96.6%

Customer service rating above “Very Good”: 93.0%

Enterprise Service Desk

Corporate Data Centers: 2

Corporate Data Center Servers: 758

Affiliate-based Server Rooms: 298

Total System Servers: 1,056

Desktop/Laptop Devices: 11,927

Storage Capacity Resources: 1.2 petabytes (PB)

NetworkSupported users in 52 networked locations: 20,000

Local Area Network connections: 12,000+

Managed data circuits: 100+

Managed vendor connections: 150

Network connected sites: 52

Messages (email)Email accounts: 11,000+

Internal email: 28.8 million/year

Technology Infrastructure Environment

The IT&S investment Barnabas Healthhas made is significant, and

requirements from our businesspartners continue to evolve.

937 millionThe number of interface transactionsprocessed annually through our 1,325production system interfaces.

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Suspicious access attempts blocked by firewall: 55,000,000

Device risks detected: 20,000

Intrusion to Devices blocked: 3,600

Network service disruption attempts blocked: 130,682

Security

Telephone Calls: 36.4 million/year

Inbound: 18.5 million/year

Outbound: 17.8 million/year

Voice Mails: 2.2 million/year

Mobile devices: 2,238 devices

Telecommunications

48% of the servers in the CorporateData Centers are virtualized, acarbon reduction of 370,597 lbs. of CO2, the equivalent of taking 288 cars off the road per year.

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Disaster RecoverabilityCorporate Data Center-based Servers

% of servers backed up andreplicated for disaster

recoverability (DR)

30% of servers backed up and data stored offsite

Electronic data storage capacity of 1 petabyte is about half of all theU. S. academic research libraries or

20 million 4-drawer filing cabinetsfilled with text, with average annual

growth rate of 63%.

13% of the more than 8 millionexternal web pages accessed

contained malicious software andwere successfully blocked, and

98% of the 20,000 end point riskswere automatically remediated.

2,383 The number of care providers at Monmouth Medical Center (MMC),Saint Barnabas Medical Center (SBMC) and Community MedicalCenter (CMC) now entering orders directly, known as ComputerizedPhysician Order Entry (CPOE), into our Enterprise Clinical InformationSystem, representing about a 90% compliance rate.

265The number of ProjectManagement Office (PMO)projects, 46 of which relatedirectly to the ClinicalTransformation initiative.

138The number of employed providersnow using the PowerWorks ElectronicHealth Record (EHR) in their officepractices.

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The Pace of Innovation in Health Care and Information Technology & Services (IT&S)

The pace of innovation in health care and IT&Sand their impact on Barnabas Health are bothexciting and fast-paced and over the past yearwe have made significant progress in manykey multi-year initiatives. Our Enterprise ClinicalInformation System initiative is now live inMonmouth Medical Center (MMC), SaintBarnabas Medical Center (SBMC) andCommunity Medical Center (CMC).Currently,149 independent providers — and149 employed providers, excluding residents —are now using our Electronic Health Record(EHR) offering in their office practices. OurHealth Information Exchange (HIE) initiative

allows the transfer and exchange of healthinformation among physicians’ offices andBarnabas Health network hospitals, andpositions us to exchange information withsanctioned New Jersey Health Informationexchanges. Our clinical transformation,physician practice EHR, Health InformationExchange and interoperability initiatives are keyfoundational enablers to our connected strategy.

On the service management front, transitioningto a centralized operating and optimizedservice support and delivery model —consolidating all IT&S resources into one

operating unit and organizing the resourcesinto a shared service delivery model —resulted in improved operational performanceand a reduced cost structure. Creating theProject Management Office identified,standardized and organized IT&S-related projects across the health caresystem for the purposes of business projectvaluation, benefits realization andprioritization. Implementing and transitioning toa centralized Enterprise Service Desk improvedand standardized system-wide customer servicesupport levels for both the new clinicalinitiatives as well as the existing service supportneeds into one consolidated framework.

Building on the foundation from theseinitiatives, we are launching a strategicinitiative evaluating the further use of dataanalytics and business intelligence tools and frameworks to expedite decision-makingand turn the abundance of clinical, operationaland financial data into meaningful information.IT&S, working with key internal partners toestablish an analytics oversight team tofacilitate our data analytics initiativesemphasizing the role of information inperformance management targeted to currentoperations and population-based care.

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“Our Information Technology & Services organization strengthensnearly every business aspect of Barnabas Health to help meet ourcore objectives. While their efforts aren’t always visible on thesurface, their positive impact is seen every day by the thousands ofcolleagues and millions of patients who benefit from their relentlesspursuit of providing information technology and servicesexcellence.”

Barry H. OstrowskyPresident and Chief Executive OfficerBarnabas Health

1,574 “Point of Care” devices

(in the form of PCs, laptops,

work stations on wheels & tablets)

have been installed at the three

Go-Live sites (MMC, SBMC,

CMC) to improve access to

clinical information.

• Created Barnabas Health ProjectManagement Office, initially identifyingand documenting 363 projects.

• Implemented centralized Enterprise ServiceDesk, improving and standardizing system-wide customer service support levels byconsolidating, then transitioning, the existingBarnabas Health help desks into a singlepoint-of-contact enterprise-level service desk,adding Clinical Transformation customersupport to the existing customer supportactivities. The ESD handles almost 16,000contacts per month with a more than 93%customer satisfaction rating of “very good”or above.

• Created ECIS Facility Operations Manager(FOM) positions to provide clinicalleadership, to resolve and direct educationand workflow issues on a daily basis, andto manage education and physicianinformation system assistance at the facilitylevel. The FOM also works closely with thePerformance Improvement and Quality

Operational EfficiencyIT&S accomplished four major goals in the pastyear key to achieving its objective to transition toa centralized operating and optimized servicedelivery model. First, IT&S consolidated all of itsresources into one centralized operating unit andorganized the resources into a shared servicedelivery model. Second, it created the ProjectManagement Office to identify, standardize andorganize IT&S project and portfolio managementacross the health care system. Third, IT&Simplemented and transitioned to an EnterpriseService Desk to improve and standardize system-wide customer service support levels. Finally, itestablished key foundational elements enablingEnterprise Clinical Information System to integrateclinical systems and streamline patient care.

• Implemented centralized shared servicedelivery and operating models overseeingthe transition and consolidation of IT&Sresources, reducing operating expense bymore than $250,000 while meeting orexceeding pre-centralization service levels.

SECTION 2: BUSINESS EFF ICIENCY

Achieving OperationalExcellence

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Service excellence relies on process excellence and a

shared commitment to desired outcomes built on a foundation of performance-based management.

IT&S continually seeks ways to increase theefficiency of our infrastructure and systems tosupport business requirements while minimizingoperating and capital expenditures. In doing so,this allows us to direct more budget towardprojects that grow or transform our business.Implementation of our shared services modeland framework enables us to optimize IT&Sservice support and delivery while enhancingthe quality, capacity and velocity of IT&Sservices. We focused on key initiativesincluding transforming service management,consolidating our Enterprise Service Desk(ESD), establishing an enterprise ProjectManagement Office (PMO), and optimizingtechnology resource infrastructure assets.

While operations and financial managementremain a strong focus, our commitment tobusiness growth and transformation, quality,execution, sustainability and customersatisfaction is integrated in our direction andmanagement decisions. These core values alsorepresent a significant portion of our overallperformance and accountability.

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departments to ensure core measures andbest practice are being addressed in theelectronic record.

• Began implementing Cerner’s FirstNet, anEmergency Department application builtwith input from physicians and nurses atBarnabas Health’s six hospitals, focusing on clinical and operational efficiency. Thesystem features a comprehensive workflowand an electronic white board that providesreal-time information on ED patients. InOctober 2012, Community Medical Center(CMC) was the first hospital to Go-Live withFirstNet, which fully integrates with ourECIS. All past patient information will bereadily available to the ED staff, increasingcare delivery agility when time is critical.

• Upgraded the clinical labs at MonmouthMedical Center (MMC) and SaintBarnabas Medical Center (SBMC), andbegan implementing Cerner’s PharmNet

application in Barnabas Health’s PharmacyDepartments. This allows for globalizationof the pharmacy program — from order setsand billing standardization to nursing staffto physicians. Streamlining the processallows for workflow changes across thehealth care system, increasing ease in fillingorders and covering departments.

• Configured and installed more than 1,500new ECIS assets to date, including desktopcomputers, wall-mounted units, scanners,workstations on wheels and other devices.

• The System Integration team is responsiblefor more than 1,300 interfaces, processingmore than 937 million transactionsthroughout BH. Most notably, CernerPowerWorks interfaces supported theemployed physician EHR implementations;KMC SoftMed interfaces supported HIMimplementation; eMPI interfaces facilitatedthe transition to “1 patient, 1 medicalrecord number,” which is fundamental to our ECIS implementation.

The implementation of the Enterprise MasterPatient Index (eMPI) in 2012 has positionedthe health system to track a patient through ourorganization, allowing a single record to beviewed by all clinicians sharing in the care.The eMPI ensures one accurate clinical recordis retained per patient, regardless of the datasource or facility visited. Currently, the eMPIcontains more than 3.2m patient records andservices 195 requests for patient informationevery minute.

In 2011 virtualization of 75 serversin the Data Center resulted in acarbon reduction of 75,942 lbs. of CO2, the equivalent of taking 59 cars off the road per year.* According to Gartner Research

“All of our Information Technology & Services colleagues at BarnabasHealth play a critical part in the execution of our strategy and plans byproviding high levels of service and creating value for our facilities tosupport their mission to service patients. Their focus on driving towardtrue business and service partnerships contributes to the greater goodof caring for the sick, improving the health of our communities andcreating one of the best health care systems in the country.”

John MonahanSenior Vice President – Corporate Services Barnabas Health

In 2011 the Enterprise Imaging Systems (EIS)group implemented a significant replacementPicture Archiving and Communication Systems(PACS). It included Monmouth Medical Center(MMC), Clara Maass Medical Center(CMMC) and Saint Barnabas Medical Center(SBMC) and three imaging systems ProgressiveImaging Center (PIC), Ambulatory Care Center(ACC) and Jacqueline M. WilentzComprehensive Breast Center (JBC),representing more than 100 modalities and155 workstations, and migrated more than2.5m studies, equating to more than 450mimages. This was a joint effort betweenRadiology and IT&S to make this one of thesmoothest migrations of an existing system.

• EIS implemented an electronic auto-distribution for cardiac reports to referringordering physicians. This eliminated the

manual faxing of more than 40,000 reports,representing 6-8 hours per week at each site,improving operational efficiency 18.5% aweek in the cardiac non-invasive department.

• The Enterprise Business Information Systemsgroup successfully transformed the HR/Payrollsystem from an unsupported, decentralizedplatform to an upgraded, state-of-the-art, fully supported and centralized PeopleSoftHR/Payroll platform for all of BarnabasHealth. The team successfully implemented a centralized time and attendance trackingsystem throughout Barnabas Health. Duringboth implementations, the Business and EBISteams worked together to assess, reengineerand standardize the existing businessprocesses to come up with standardizedprocesses consistent with the best practices in the industry.

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“The growth of Information Technology & Services at Saint BarnabasMedical Center has been extraordinary in the last year. Going livewith our new Clinical Information System in June has significantlyadvanced our commitment to patient safety and quality. More than90% of patient orders for care and medications are entered into thecomputerized record by our physicians, increasing patient andmedication safety. Electronic medication and patient scanning at thetime of medication administration eliminates errors at the bedside.These technology advances have helped us to deliver on ourcommitment to patient safety.”

John Bonamo, MD, MS President and CEO, Saint Barnabas Medical Center

Currently, the eMPI contains more than 3.2m patient records and

services 195 requests for patientinformation every minute.

2011 Financial PerformanceIT&S achieved $2.9m in direct cost savings and$5.4m in cost avoidance for a total of $8.3m of direct cost savings and cost avoidance. The$2.9m in direct cost savings represents thelargest cost savings amount since 2005. IT&Shas used these savings to both return direct valueto Barnabas Health by reducing expenses andreinvesting savings in the IT&S infrastructure,service delivery and operating environments. The net result enables new business capabilitiesfocusing on efficiency and operational excellenceto meet strategic and tactical business initiatives.

• Refresh of Network Storage Environmentreduced expense by 44%, while providingadditional growth capacity, functionalityand disaster recovery capabilities.

• Data Center virtualization initiatives resultedin $241,000 cost avoidance over theacquisition cost of physical hardware.

• Reduced Wide Area Network data servicesoperating expense by $350,000 throughreengineering.

The 2012 amount of IT&S spendingper employee: $5,165 (the 2011

health care industry average is $5,768).

* According to Gartner Research

• Local Area Network upgrades at MonmouthMedical Center and Kimball MedicalCenter (KMC) increased functionality whilereducing acquisition cost by 45%.

• Reengineering supply chain and finance,server infrastructure environment, reducedoperating expense by $1.1m over a 3-year term.

• The Information Technology AssetManagement (ITAM) Program exceededdesktop asset cost avoidance goal by morethan $813,000 (82%) avoiding $1.8M indesktop asset expenses, moving to the nextgeneration of workstations while keepingpricing flat and increasing technology.

• Telephone bill reviews and inventorymanagement allowed Barnabas Health tocost avoid $466,202 and a $305,381direct cost savings in telecom-relatedexpenses.

• Avoided $1.8M in software license fees byincreasing Software Asset Managementawareness, and negotiating an enterpriselicense agreement with an 80% discount.

• Employed physicians’ offices have received Meaningful Use payments, totaling $668,750.

• Barnabas Health has received $8.3m fromthe Centers for Medicare and MedicaidServices (CMS) in Meaningful Use (MU)funding as a direct result of our ClinicalTransformation initiative.

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66%: Percentage of POs processed annually via EDI, resulting in real-time efficiency improvements. For example, EDI-ordered supplies are delivered

within 3 hours to our facilities versus doublethat time for manual processing.

“Our Information Technology & Services colleagues are the strategicarchitects behind the scenes that provide the support, expertise, andinnovative technology to place life-saving products at a patient’s bedsideor in the hands of a surgeon. This degree of solutions-based expertiseallows us to deliver the highest level of patient care and customer service.As health care continues to transform and IT&S continues to keep pace, I am confident we have the resources needed to continue as a nationallyrecognized leader in the health care system.”

Angela RiccoSenior Vice President, Supply ChainBarnabas Health

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Attesting to and managing our

MU performance thresholds

maintains maximum payout

eligibility for Barnabas Health.

Barnabas Health MU: $60.1M

28%

72%

■ Medicare

■ Medicaid

Barnabas Health has made a commitment toimplement its next generation ClinicalInformation System and new health informationtechnology in all six acute care facilities andBarnabas Health Behavioral Health Center. Thiscommitment and investment brings new safetytools to the system and further facilitatesimproved and more efficient patient care.

We have made a significant investment in thisnew environment, providing the opportunity for BH to redefine how we deliver health care.Partnering with physicians, nurses and other care providers to enable them to see health caredifferently is a critical aspect of achieving this goal.

Clinical Transformation (ECIS)Barnabas Health has partnered with Cerner toprovide electronic health record technology forphysician practices, a clinical information systemfor Barnabas hospitals and a health informationexchange to provide a connection between thehospitals and physician offices. The AmbulatoryCare Center currently uses Cerner for resultsreviewing in its Ambulatory Surgery Center.

Goals of the project include:

• Patient Safety and Quality Improvement• Standardization of Care and Tools• Clinical Decision Support (CDS)• Physician/Clinician Engagement and

Participation• End-User Devices• Training and Support.

Our Clinical Transformation initiative brings themost up-to-date clinical information technologyto our entire health care team. Clinical andtechnical staff from each facility and manydisciplines — medical staff, nursing, pharmacy,laboratory, respiratory, quality and standards,and information technology — havecollaborated to design our integrated system.

To date, Barnabas Health has trained more than7,158 physicians, nurses and technicians, whohave joined BH in its tremendous commitmentto continuing education.

See more online athttp://transformation.barnabashealth.org.

CPOE and Physician Documentationand Standardization of CareComputerized Physician Order Entry (CPOE)provides system-wide standardized orders andorder sets and provider documentationtemplates. By building an environment wherephysicians enter their own orders — eliminatingnurses or other staff members as intermediaries— the health care system is creating a safer,more efficient hospital setting. The threefacilities that have gone live with the newsystem — Monmouth Medical Center (MMC),Saint Barnabas Medical Center (SBMC) andCommunity Medical Center (CMC) — havereached CPOE numbers that run between 80% and 91% on a daily basis.

Within days of going live with the new ClinicalInformation System, Saint Barnabas MedicalCenter (SBMC) reached 91% computerizedphysician order entry of the 427 physicians,residents and other CPOE-eligible personnel at that facility.

SECTION 3: BUSINESS GROWTH

Improving Health CareDelivery Using IT&S

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“The increased use of technology has made our nursing practice muchmore efficient. But its potential to go beyond efficiency has increaseddramatically by enhancing not only nursing practice and processes butalso the point-of-care between nurses and patients. The InformationTechnology & Services organization is truly valued as an integral partof Barnabas Health’s redesign of how we are delivering extraordinaryhealth care rather than simply the automation of existing processes.”

Nancy E. HolecekSenior Vice President and CNO, Patient Care Services Barnabas Health

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Over the 10-day Command Center Go-Live period, an average amount of18,000 – 20,000 hours of support is provided to ensure a quality

implementation and Go-Live experience.

CareNetCareNet is an application that physicians andmid-level practitioners, nurses, rehabilitationprofessionals, respiratory therapists and othercare professionals use as an inpatient clinicaldocumentation system, to document, sendorders, and receive orders. CareNet has gonelive at Monmouth Medical Center (MMC), Saint Barnabas Medical Center (SBMC) andCommunity Medical Center (CMC), and theteam continues to validate the system forupcoming Go-Lives, such as Kimball MedicalCenter (KMC) and Barnabas Health BehavioralHealth Center (BHBC) in February 2013,Newark Beth Israel Medical Center (NBIMC) in April 2013 and Clara Maass Medical Center(CMMC) in June 2013.

Electronic Health Records (EHR)In October 2010, Barnabas Health introduced itsBarnabas Health Physician Community ConnectProgram, which offered physician practices an85% subsidy toward the purchase of the CernerPowerWorks EHR. The program also offered asimilar subsidy to those with existing, non-CernerEHRs, which provided a connection to BHfacilities, as well as paid the lower of 85% of theinterface fees up to $5,000 per eligible physicianfor such health information exchange capability.

The Medicare and Medicaid EHR IncentivePrograms provide a financial incentive for the“meaningful use” of certified EHR technology toachieve health and efficiency goals. By puttinginto action and meaningfully using an EHR

DEFINITIONS

The Clinical Information System (CIS)is a standardized inpatient electronichealth record to be used by all patientcare providers for clinical documentationand partial charge capture. It also willintegrate laboratory and radiologyresults into patients’ electronic records.

Computerized Physician Order Entry(CPOE) provides physicians with theability to enter their own patient orderselectronically. Because CPOE aims toeliminate handwritten orders, it helps to increase order accuracy and patient safety.

The Health Information Exchange (HIE)supports the secure exchange of selectpatient information to provider offices,including demographic information,allergies, problems, medications andclinical results.

The Electronic Health Record (EHR)is the software used by physician officesto capture clinical information collectedduring patients’ visits.

Enterprise Master Patient Index (eMPI)An EMPI maintains unique listing ofpatients and medical records acrossmultiple facilities and hospitals to ensurestaff can find the complete and correctpatient record and avoid creatingduplicate records.

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138 employed providers, excludingresidents, and 149 independent

providers have implemented CernerPowerWorks, our electronic health

record (EHR).

system, providers will accrue benefits beyondfinancial incentives — such as reduction inerrors, availability of records and data,reminders and alerts, clinical decision support,and e-prescribing/refill automation and a number of safety tools to the patients.

Health Information Exchange (HIE)This system allows the transfer of healthinformation among physicians’ offices andhospitals within the Barnabas Healthorganization; and within other organizations andthe state to build health information exchanges.

Barnabas Health maintains the need for thisinformation exchange not just within the BHsystem, but throughout other groups toencourage the secure exchange of patientinformation nationally. These various systemsused within Barnabas Health are connected tothe CIS in a seamless secure view of importantdata gathered from different systems.

Our EHR and HIE initiatives form the foundationthat enables our connected strategy.

Quality at Barnabas HealthWith the implementation of Barnabas Health’snew Clinical Information System, including theFirstNet system for the Emergency Department andthe pharmacy system upgrade, patients are ableto receive better care from their clinicians acrossthe continuum of care. Clinicians now have fullaccess to review and work in patients’ electronichealth records (EHR) throughout their hospital stay.

Beginning with the review of patients’ homemedication on admission, physicians now are ableto order or discontinue these medications, whichthen initiates the medication process. This processfollows the patients until their discharge. Ondischarge or a transition in care, physicians can e-prescribe medications for home administrationthrough our new Clinical Information System. IT&Scontinues working in physician offices to install EHRsand connect our patients, physicians and hospitals,which adds value to patients’ ongoing care.

Clinical alerts in the system, the ability to requestspecific ordering information, medicationadministration that uses bar coding technology,and access to the EHR for all clinicians throughoutpatients’ hospital stay all help drive patient safety.

5 Quality Priorities:• Medication Safety • Serious Event Reporting• Mortality Reduction• Length of Stay• Readmissions

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These checks and balances increase medicationsafety for all patients in the system, whichdecreases both length of stay and mortality ratesfor patients.

IT&S also helps Barnabas Health physicians staymobile. We are working to more broadlyprovide physicians with the ability to receivereal-time patient information wherever they arelocated, so they can review patient data andresults as soon as they are posted and makequicker decisions about patient care andmedication administration.

As they care for patients throughout the system,clinicians are able to use this new technology tobetter manage issues, facilitate processes andimprove performance. The new ClinicalInformation System supports clinicians in providinga quality patient experience and achieving clinicalexcellence.

“At Barnabas Health, we aim to maintain and restore health. Our Information Technology and Services (IT&S) organizationprovides us with the necessary technology and tools that enable our clinical teams to deliver high quality care with improved patientoutcomes across the full continuum of care. Whether assuring safemedication delivery for our most vulnerable hospitalized patients orproviding a reminder to a physician about preventive care during a routine follow-up appointment, our IT&S colleagues work to assurethat our providers have access to patient information where and when they need it to assist with clinical decision making.”

Anthony Slonim, MD, DrPHExecutive Vice President of Medical Affairs and Chief Medical OfficerBarnabas Health

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Enterprise Clinical Information System As noted in the report, outstanding work hasbeen accomplished to date in the design, buildand implementation phase of our clinicalinformation system. The emphasis on theimplementation phase will re-distribute to bothmaintain our ability to execute while providingthe required emphasis on support andoptimization.

Meeting the demand for continuedimplementation, support and optimizationrequires a sound support model and skilledresources to both help our care managementteams get better at doing what they’ve alwaysdone in delivering clinical excellence, and helpthem do things they’ve never been able to dobefore, advancing clinical best practice.

• Training and implementation continue atMonmouth Medical Center (MMC), Saint Barnabas Medical Center (SBMC)and Community Medical Center (CMC). At each facility, Transformation staffmembers offer further education sessions to

ensure clinical documentation improvement,including the introduction of a DragonSpeak software option, providing dictationcapability through voice recognition.Another addition is Cerner’s PowerNoteapplication, providing the means forelectronic documentation of history andphysicals, progress notes and proceduralnotes. Next in line for Go-Live are KimballMedical Center (KMC) and BarnabasHealth Behavioral Health Center (BHBHC),targeted for February 2013. Preparationsfor this facility — as well as for NewarkBeth Israel Medical Center (NBI) and ClaraMaass Medical Center (CMMC) — hasalready begun.

• After going live at Community MedicalCenter (CMC) in October 2012, FirstNetwill be implemented in all EmergencyDepartments — including KMC, NBI,CMMC, SBMC and MMC — within the next year.

Physician Mobility• Review of the Cerner solutions to provide

physician access to clinical information frommobile devices. The maturity, security,reliability and device agnostic capabilitieswill be reviewed for considered adoption.

Strategic Planning and Roadmap Development• While there is much focus and attention

required on the tactics to deliver thecommitted projects and workload, we willprioritize more time to further shape the IT&Sagenda with inputs from our internal leadersto accelerate, execute, enable and supportthe evolving needs of our health care system.One of the components being our ConnectedStrategy, in support of Population HealthManagement providing the fabric by whichto connect, exchange, report and analyzebetween and amongst the care managementteams. Additionally, the continuation ofenterprise road-mapping of committed andproposed strategic initiatives.

SECTION 4: MOVING FORWARD

What’s Next ...

Physician/Patient Portal

EMPI

Patient Scheduling SCI Picis Picis Picis SCI Picis Cerner Quadramed

Registration/ADT Siemens, C&S Siemens Siemens Siemens Quadramed Quadramed Quadramed

HIM SoftMed SoftMed SoftMed SoftMed SoftMed SoftMed SoftMed

ED EDIMS EDIMS EDIMS EDIMS EDIMS EDIMS

Inpatient EMR Siemens Eclipsys Siemens Cerner Eclipsys Eclipsys

Ambulatory EMR

Case Management MIDAS MIDAS MIDAS MIDAS MIDAS MIDAS

OR Picis Picis Picis Picis SIS SIS Picis

PACS McKesson McKesson McKesson Merge/Amicas McKesson GE/IDX GE/IDX

Hospital Billing Siemens Siemens Siemens Quadramed Quadramed Quadramed

Professional Billing C&S GE (IDX) GE (IDX) GE (IDX) GE (IDX) GE (IDX) GE (IDX)

GL/AP/SCP

HR/Payroll

Application Current State – 2011 ACC CMMC SBMC NBI MMC CMC KMC

In-house MDPortal(in progress)

PeopleSoft – locally hosted

HealthInformationExchange

(Relay Healthand Cerner;NJ Connect;Health-e-Citi;

MOHIE)

Relay Health

PeopleSoft – locally hosted

The following charts show our overall 3-year strategic road map to an integrated care environment.*

In 2013, we are focusing our integration strategy activities in areas such as Legal Medical Record, Patient Accounting, Patient Management,Midas, Lumedx – a central cardiovascular information data repository. *additional charts on following pages.

Meaningful Use Stage 2 (MU2)A byproduct of our clinical transformationinitiative is accomplishing MU2 reportingrequirements. Attesting to these requirementswill maintain Barnabas Health’s eligibility tomaximize available subsidies.

Data Center• Barnabas Health has experienced a natural

and continual growth of its InformationSystems and underlying infrastructure deliverycapacity. Our two existing data centerslocated in Oceanport and West Orangeeach constructed 14 years ago, haveexceeded their planned life cycle limits. We will finalize our Data Center strategy of rightsizing the environment, hosting,outsourcing and consolidation of services.

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Barnabas Health has

trained more than

7,158 physicians,

nurses and technicians.

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Physician/Patient Portal

EMPI

Patient Scheduling SCI, Picis Picis Picis SCL Picis Cerner Quadramed

Registration/ADT Siemens, C&S Siemens Siemens Siemens Quadramed Quadramed Quadramed

HIM SoftMed SoftMed SoftMed SoftMed SoftMed SoftMed SoftMed

ED

Inpatient EMR

Ambulatory EMR

Case Management MIDAS MIDAS MIDAS MIDAS MIDAS MIDAS

OR Picis Picis Picis Picis SIS SIS Picis

PACS McKesson McKesson McKesson Merge/Amicas McKesson GE/IDX GE/IDX

Hospital Billing Siemens Siemens Siemens Quadramed Quadramed Quadramed

Professional Billing C&S GE (IDX) GE (IDX) GE (IDX) GE (IDX) GE (IDX) GE (IDX)

GL/AP/SCP

HR/Payroll

Interim State – 2013 ACC CMMC SBMC NBI MMC CMC KMC

PeopleSoft – remote hosted

PeopleSoft – remote hosted

Cerner + TBD?

Quadramed

Cerner

Cerner

Cerner

HealthInformationExchange

(Cerner; NJConnect;

Health-e-Citi)

CareAware CareAware solutions enable any area of ahospital to create an environment where alldevices are integrated and contextually awareto ensure the right data is presented in the rightformat at the right time to improve healthoutcomes. CareAware is the foundation neededto get this critical information from medicaldevices directly into the electronic health record.

Enabling an automatic flow of information fromthe medical devices directly to the medicalrecord allows health care providers to consultthe medical record as the single source of truthfor each patient. Our 2013 approach is toplan and design our device integration solutionand develop our roadmap.

Electronic Health Record• In the next year, Barnabas Health intends

to install 200 additional EMR licenses in independent physician practices.

• Barnabas Health is working to bring up 600 Barnabas Health physicians on an EHR.

Health InformationExchange/Interoperability• Through the Barnabas Health Information

Exchange, we’re building a network. The BH HIE allows physicians access to patient’slab results, radiology reports and otherimportant transcribed reports via a web-based inbox, or directly into a physician’selectronic health record system. Barnabas isbuilding a network that will connect themedical community, share patient data andenable physicians to access and use real-timeevidence-based standards. TheHIE/Interoperability team is working onestablishing and branding the Barnabas

Physician/Patient Portal

EMPI

Patient Scheduling

Registration/ADT

HIM

ED

Inpatient EMR

Ambulatory EMR

Case Management

OR

PACS

Hospital Billing

Professional Billing

GL/AP/SCP

HR/Payroll

Future State – 2015 ACC CMMC SBMC NBI MMC CMC KMC

Health HIE, in support of the BarnabasHealth “Connected” approach.

Accountable Care Organization• In July 2012, the Barnabas Health

Accountable Care Organization – Northwas established as one of 89 ACOsselected to participate in the MedicareShared Savings Program (MSSP)Accountable Care Organization.

• Through the shared savings program the BH ACO – North will provide high-qualityservice and care to Medicare beneficiariesin return for the opportunity to share in

savings realized through this high-quality, well-coordinated care. To ensure that savings areachieved through improving carecoordination and providing care that isappropriate, safe, and timely, an ACO must meet quality standards. For 2012, CMShas established 33 quality measures relatingto care coordination and patient safety,appropriate use of preventive health services,improved care for at-risk populations, andpatient and caregiver experience of care. TheClinical Transformation, physician practiceEHR, Health Information Exchange andinteroperability initiatives are enablers to ACO success.

Cerner

Quadramed

PeopleSoft – remote hosted

Cerner

Cerner

Cerner

TBD

TBD

SoftMed?

TBD

TBD

Cerner

Single RIS/PACS?

MIDAS?

PeopleSoft – remote hosted

HealthInformationExchange

(Cerner; NJConnect;

Health-e-Citi)

SoftMed

20

21

Business Intelligence and Data Analytics• As we continue to deploy and optimize our

EHR and Clinical Transformation initiatives,the data collected creates other opportunities,including spawning analysis of EHR data andprovider-directed care management andpopulation health applications. Analysis ofthis data allows a richer understanding andability to correlate data and turn it intomeaningful information, and orchestrates amore seamless care process across multipleoperating entities within the continuum ofcare. Inevitably and appropriately, health

care is catching up with other industries in its demand for more timely and robustperformance analytics and dashboarding to turn this data into meaningful insights. The availability of rich data from the EHRsystems and ancillaries, coupled withincreased internal and external demands forinformation to facilitate care standards andbusiness best practices, requires integratedclinical, operational and financial businessintelligence. IT&S with business leaders willbe piloting a data analytics initiativeemphasizing the role of information inperformance management and targeted tocurrent operations and ACO-related activities.

... building a network

that will connect the

medical community,

share patient data and

enable physicians

to access and

use real-time

evidence-based

standards.

* According to Gartner Research

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