“Using information to deliver world-class care at lower cost”

Simon HillHead of Corporate Affairs, Cerner

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 2

Biography

CurrentlyHead of Corporate Affairs, Cerner

Health PolicyGovernment/KOL EngagementStrategyInvestor RelationsCommunications

PreviouslyGraduate of the University of Durham & the Royal Military College SandhurstArmy officerChief of Staff & policy advisor to the then ‘shadow,’ now current UK Health MinisterSenior Counsel with a leading UK healthcare consultancy

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 3

The cost implications of ageing

Dutch study• A 90 year old consumes 10x as much healthcare as a 50 year old• Cost increases over just 4 years is much greater, the older the age group

UK Implications• Ageing population• Very elderly group growing the fastest• 75+ costs 5x as much per annum as a 40 year old

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 4

Fuente: Informe INE (http://www.ine.es/daco/daco42/sociales/infosoc_envej.pdf )

The cost implications of ageing

Spain implications• Ageing population• Severe and moderate physical disabilities appear more frequently in people from 65-79 years-old•People from 80 years-old above, are subjected to higher chances of full disability (50 % present with total disability).

Fuente: EUROSTAT, Base de Datos Newcronos

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 5

Budget pressures everywhere ...

CANADA: From 2012–13 to 2017–18, the

Ontario government will attempt to hold

health-care spending increases to just 3 per

cent per year. Over the last five years, health-

care spending has risen by an annual average

of 6.5 per cent. (March 2010)German Health Care Spending Cut, Fees

Raised (July 2010)

DANISH healthcare spending cuts (June 2010)

ITALY: EUR24bn Austerity Package Contains

Healthcare Spending Cuts (June 2010)

SPAIN’s budget for healthcare has been

decreased by 2.8 billion euros through a 19

billion dollar austerity plan. (WHO, June

2010)

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 6

We know there is a great deal of variation

0

10

20

30

40

50

606 fold variance of your chances of surviving an aneurism across London

4 fold variance of your chances of surviving a stroke across London

0

5

10

15

20

25

30

3510 fold variance of your chances of surviving a heart attack across London

Despite 15 years of evidence based standardisation there is still wide variation in outcomes across the NHS

Data 2005/06

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 7

Outcome against cost of intensive care

No evidence that shows spending more creates better outcomes or spending less creates worse outcomes

Data 2005/06

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 8

Relationship between quality of care and Medicare spending, by US State, 2004

Composite measurement of quality of care100 = maximum

Source: Congressional Budget Office based on data from the Centers for Medicare and Medicaid Services and the Agency for Healthcare Research and Quality

The evidence does not indicate that higher Medicare spending is associated with better care for Medicare beneficiaries. In fact, it suggests the opposite: After adjusting for other factors, areas with higher Medicare spending tend to score substantially worse on a composite indicator of the quality of care provided to Medicare beneficiaries

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 9

Cost Effectiveness of Evidence-Based Treatment Guidelines for the Treatment of Non–Small-Cell Lung

Cancer in the Community Setting12-month cumulative cost by Pathway status.

Neubauer M A et al. JOP 2010;6:12-18

©2010 by American Society of Clinical Oncology

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 10

Reducing cost through the use of evidence

“Finish medical school and residency knowing

everything…read and retain 2 articles every single night…at the end of 1 year you’re only

1,225 years behind.”

W Stead. JAMIA 2005;12:113-20Alper BS, Hand JA, Elliott SG, et al.

J Med Lib Assoc 2004;92:429-37

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 11

Slow Innovation Adoption

From time new knowledge discovered until ½ of physicians act on that knowledge = 15 - 17 years

Everett Rogers, Diffusion of Innovations, 1995

% o

f p

op

ula

tion

time

Adoption Half-life = 17y

Knowledge Half-life = 10y

Balas, Boren. Managing Clinical Knowledge for Health Care Improvement.

Yearbook of Medical Informatics 2000

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 12

How to drive cost reduction

Make the institutions more productive Make the system more productive

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 13

Driving cost reduction by being better

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 14

Integrating The UK Health System

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 15

Reducing costs system-wide (Spain)

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 16

Rural Hospital ClinicLocal Hospital

Satellite Campus

Pharmacy

Rehab

Surgery

ImagingCenter

Nursing Home

Government

Physician Office

Laboratory

Healthcare System/Hospital(main campus)

HUB AND SPOKE CONNECTIVITY MODEL

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 17

eHealth Path

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 18

Reducing cost through process efficiency

Managing discharge to reduce readmissions

Managing nurse time effectively

Automated infusion management

Integrated information availability

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 19

Readmission Risk Algorithm: Daily assessment

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 20

Managing LTCs – Individual support with technology

Personal Health RecordClinical, financial, self-entry

Personal Plan for HealthManaging health goalsCan tie incentives

Managing a family’s whole healthConvenient patient services

SchedulingMessagingBill PayeVisits

Community Integration

Device integration

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 21

Engaging the patient in managing their own health

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 22

Molecular Diagnostics

Pharmacogenomic Alerts

•Registries•Safety reporting•Late phase

Translational Research Cycle

Integrated Data Capture in EMRTrials

© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 23

Finally – Redesign to improve the serviceComputerisation of poor process solves nothing