Proposed Product Road Map forPresented by Judson P. Bruno

Outline

• TactusMD’s Strategic Guiding Principles• TactusMD’s EMR Development Principles

– Governance– Customer Engagement– Standardization– Interoperability– Security and Privacy– Improved Health Status– Education of Clinical and Administrative Users– System Performance– Financial Oversight– Continuous Process Improvement– ARRA requirements and wish list for development

Strategic Guiding Principles

• Reclaim the enjoyment of clinical care for the clinicians we serve

• Create a flexible, authoritative, interoperable electronic medical record platform

• Build the foundation for increased efficiency & effectiveness in healthcare decisions

• Maintain a financially sustainable system for our customers

• Decrease the administrative & clerical burden on providers whenever possible (and in no case further compromise provider time)

Create a governance structure to assure the broadest possible adoption of the TactusMD’s ambulatory electronic medical record (EMR) for the Family Practice and Internal Medicine provider community across the nation.

Governance

Governance

• Marketing structure with effective representation of our product, service and goals for providers.

• Create an appropriate number of distribution channels to guide use of TactusMD’s EMR; using process focused approaches to consider strategic, clinical, operational and technical issues for potential customers

• In the future engage providers by specialty to validate clinical content in the TactusMD’s EMR and better meet specific practice needs.

• Assure transparency and fairness in decision making and economic obligations for the investors we represent and support.

Leverage an effective governance structure and marketing / communications plan to assure broad based practice support for our TactusMD’s EMR system.

Customer Engagement

Customer Engagement

• Assure “user buy in” (physician, mid-level, and office staff).• All providers in Practice will adopt TactusMD’s EMR.• Customer engagement and cooperation to determine readiness and

sequencing.• Commitment to practice redesign, training and implementation

efforts, including the preload of necessary clinical and demographic information.

• Agreement to participate in a community master patient index (MPI) when connected to a hospital or Health Information Exchange.

• Agreement to use TactusMD’s EMR as the authoritative secure messaging mechanism.

• Agreement that, if the practice allows patient access to the record, ALL practices that care for that patient agree (does not include emails to nurses, docs, etc.).

Customer Engagement

• Agreement to support and embrace appropriate standardization.

• Agreement to appropriately utilize the TactusMD’s EMR so that information is readily available to clinicians and accessible for purposes of back end data aggregation.

• Agreement to participate in the development of a robust ambulatory informatics capability to improve the quality of information available for patient care.

• Create the necessary tools (Bluetooth, automated E&M coding, text converting dictation software and intuitive interface) for all parties workflow enhancements.

TactusMD’s EMR will be standardized to the greatest extent possible across practices to allow for efficient implementation, standard workflows, outcomes analysis, economic efficiencies and quality reporting. The differences in specialty and individual practice preferences will be respected and balanced with standardization.

Standardization

Standardization

• Standardization will be mandatory around Meta-Data - the name of reports, sections of the chart, definitions of data elements, etc.

• Standardization will be mandatory around the basic layout of the user interface; including how and where allergies, problem list, medications, etc. are displayed.

• Whatever content standardization is necessary will be deployed to create a single interface to Clinical Information Repository (CIR), 3rd parties (Dr. First, Labcorp, etc.,) and a reasonable set of interfaces to various billing systems.

• Templates, user screens, smart screens and best practice flags will be standardized. In future projects they will be standardized by specialty and across specialties to the greatest extend possible.

• Enough workflow standardization will be mandated to ensure that the practices are supportable and the system can be implemented with economies of scale.

Over time TactusMD’s EMR will be interfaced or integrated with practice management systems and other 3rd party systems to provide a consistent presentation layer to users and support the care of patients.

Interoperability

Interoperability

• Initial deployment will assure minimum necessary interfaces are in place (lab results, MRIs, etc…).

• Initial deployment will include an approach to assure the efficient pre-load of existing health record information into the TactusMD’s EMR (demographics, problem lists, allergies, medications, etc…).

• A process to develop long term system integration will be incorporated into the governance structure and EMR development plans utilizing Pervasive Software’s middleware application.

• Initial deployment will meet ARRA’s meaningful use requirements for physician stimulus reimbursement.

The security and privacy of protected health information (PHI) will be a priority of the TactusMD’s EMR development.

Security and Privacy

Security and Privacy

• A process will exist to assure appropriate practice and patient consent.• A process will exist to appropriately define roles, responsibilities and

levels of security.• Access to all necessary clinical information for providers and other users

will be assured, with effective audit trails and retrospective review of EMR use.

• A set of clearly defined rules for "who owns the data," and what usage rights the clinicians and patients have to this information will be in place.

• A set of clearly defined rules will be developed to allow the aggregation of clinical information across a broad population to identify unwanted variation in care for the purpose of improving the health of the patients served.

• Follow and integrate all current HIPAA and Red Flag rules

The requirements of and coordination with existing community initiatives for improved health status will be evaluated and supported to the fullest degree possible.

Improved Health Status

Improved Health Status

• The EMR system design will incorporate metrics, best practice flags and quality measurements required to support population health status initiatives.

• The EMR will identify unwanted variation in care delivery and encourage the coalescing of care to demonstrated best practice.

• Robust Informatics capability will be developed to provide clinically relevant information to improve patient care.

• It will be the responsibility of our clients to act on and effectively implement care improvement strategies. The EMR governance process will create a framework through which client’s directed efforts are organized.

The implementation will provide initial and on-going training and change management support to assure the effective and broad use of the TactusMD’s EMR system.

Education of Clinical and Administrative Users

Education of Clinical and Administrative Users

• Metrics will be in place to monitor utilization of the TactusMD’s EMR system.

• Re-training as necessary will be provided through our reseller and distributor networks.

• A dedicated user training and help desk structure will be in place through iTivity.

• On-line training videos will be created to assist with new hires on understanding our product.

• On-line update videos will be created for new product releases.

The consistent and reliable availability of the TactusMD’s EMR to the broad provider community will be a priority of the development.

System Performance

System Performance

• Metrics will be created to determine the requirements for system availability, performance and disaster recovery.

• Processes will be created to monitor these metrics and assure a timely remediation of problems through iTivity

Adherence to the project budget and fairness in allocation of costs to project stakeholders will be a priority.

Financial Oversight

Financial Oversight

• Effective financial reporting will be in place and shared with stakeholders understanding development costs.

• The Project Management Team will be effective stewards of resources.

• Group purchasing of hardware and software will be implemented to assure the lowest delivered cost of products to all stakeholders.

The development and adoption of TactusMD’s EMR will bemeasured using rigorous process improvement tools to continuously assure a financially sustainable model and improve the effectiveness of the system.

Continuous Process Improvement

Continuous Process Improvement

• Baseline assessments and regular, periodic reviews of cost changes to the budget against the financial plan will be performed to assure financial targets are met.

• A process to measure and determine Return on Investment to all stakeholders will be in place.

• A process to measure and monitor clinical metrics will be created to determine the EMR’s impact on patient care and improve outcomes for our clients.

• A process to review Practice workflow re-design and adherence to best practice will be in place to assist the Practices in the continuous improvement of workflows.

These requirements and requests are necessary to achieve certification and to show our customers that we are going to continue to provide a quality solution.

ARRA requirements and wish list for development

ARRA Meaningful use requirements

• Computer physician order entry

• Drug decision support• Problem list• Electronic prescribing• Medication list• Medication allergy list• Demographics• Advance directives• Vital signs• Smoking status• Lab test results• Patient Lists• CMS quality reporting• Patient reminders• Clinical decision rule

• Progress note• Insurance eligibility• Electronic claims submission• Patient electronic copy of health

information• Patient electronic access of health

information• Patient specific educational

resources• Patient clinical summary• Exchange clinical information• Medication reconciliation• Immunization registries• Reportable lab submission• Electronic syndromic surveillance

Wish list

• Free text written in any language to seamlessly create, store, and share any clinical data, enabling unlimited query of discrete data within free text

• Active sync with mobile devices• Create a mobile application with ARRA meaningful use requirements.• Have the system accept information that patients can fill out on a

clinics website and then import into our system. • Have patient’s personal information available on their cell phone and

for patient’s to incorporate the PHR with our system.