1. Legacy 2 Inland Northwest Health Services INHS Formed - May - PDF document

INNW State of Reform September 12, 2013 Moderator: Steve Akins, INHS Administrative Director Panelists: Fred Galusha, INHS CIO/COO John Copeland, Nuvodia CEO Brett Crown, Tiani-Spirit, Chief of Strategy 1. Legacy 2

Inland Northwest Health Services • INHS Formed - May 30, 1994 (19 yrs) • Deaconess Medical Center (DMC) - 1990 (23 yrs) • Valley Hospital Medical Center (VHMC) - 1990 (23 yrs) • St Luke’s Rehabilitation Institute (SLRI) - 1994 (19 yrs) • Sacred Heart Medical Center (SHMC) - 1997 (15 yrs) • Holy Family Hospital (HFH) - 1997 (15 yrs) • Regional Hospitals Added - 1997 - 2013+ (15 yrs) 3 INHS%&%Hospital%Customers%&%Aug%2013 4

Inland Northwest Health Services • 34 Hospital HIT systems operated & hosted (60) • Facility size: 25 bed to 700 bed • 1,100+ Physician EMR systems hosted (1 to 173 MDs) • Number of supported users: 47,000 • MU Stage 1 = 22 + Hospitals and Growing, MU Stage 2+ • Nationally recognized programs (Beacon, VLER, SSA, CDC, 17 of 100 Most Wired Hospitals (2013), 15 HIMSS Level 6 and 7 Hospitals) • 275+ IT Professionals (Platform for Growth!) 5 2. Present (Adoption & Use) 6

Transaction Per Day - Estimated 12,738,506 Transactions Per Day Spokane & Region 7 Ambulatory EMR (A-EMR) Adoption Rate by Group INHS/IRM - EMR Growth - Fully Paid by Practice - #MD + 4x Title 70 53 35 18 Group “C” 24% 0 National 38% INHS 69% NAMCC - A EMR Adoption Rates - Aug 2009/Jun2013 (40 % ONC - Dec 2012) 8

Patient Portal - Live Oct/Nov 2013 9 3. Future - Bright! 10

INHS%&%Data%Sharing%Models 11 INHS - Data Sharing Model Where we’ve Where we’re Where we are come from going ABC RHS RHS XYZ INHS Shared PHS Shared “Federated” Technology Technology Data Sharing PHS Other Hubs INHS INHS Environment: Environment: Environment: Collaboration based on New business relationships Population-based approach community relationships with decision-making to care delivery in a and individual leaders occurring outside the competitive health system community Technology: Technology: Technology: Shared information HIT components interacting systems with Disparate information with federated information standardized data systems relying on health hubs that supports common information exchange to standards of data exchange conduct business 12

Projected Cost Index and Data Sharing Ratio Core HIT Cost HIE Cost Data Sharing Ratio 300 225 150 75 0 Legacy Current Propensity Future 13 Spokane and Regional - Data Sharing Ratio - September 2013 Thank-You! 14

A Digital Medical Imagining Health Information Exchange (HIE) Before the Term Even Existed … September 12, 2013 Jon Copeland History • May 1, 1996 – Inland Imaging, a Spokane based medical imaging company had an IT FTE Department of One. Me … • By 1999 we scaled up on staffing and we were starting to implement Stentor PACS (Picture Archive Communication System). • We started working closely with INHS on regional information sharing. They did Meditech HIS. We did Medical Imaging (Stentor - PACS). We integrated these systems so we had a single point of access of all medical images via Meditech PCI.

! History • 2000 - We formed INCHIP – Inland Northwest Community Health Information Partnership. • We helped lead the selection of a community EMR (Logician) which became the Centricity EMR Hosted by INHS Today. • Today - INHS still implements and supports Meditech and the IT Division of Inland Imaging (now called Nuvodia) continues to implement PACS but now on a national scale. Nuvodia has 110 employees today in Spokane, Seattle, and St. Louis, MO. The Regional Collaboration ! Today ! • 1999-2013 – Our PACS volumes grew from 50K to 2.0+ million patient exams (digital imaging and reports) / Year. • Over 100+ sites and 3,000 di ff erent imaging devices are connected (MRI, CT, etc.) to our servers. • We are a big-data management company. • How did this happen? • It took a lot of work and willingness to collaborate.

! PRESENT - Nuvodia Northwest P PRESENT - Nuvodia Northwest PACS Footprint ACS Footprint ! !! PACS!Full!Archive!Sites! A Patient Centric Horizontal Connection A Patient Centric Horizontal Connection ! !! Image!Distribu7on!HIE!Sites! Tonasket Bonners Ferry Colville Republic Newport Omak Chewelah Sandpoint Brewster Grand Coulee Deer Park Bothell Davenport Leavenworth Coeur d � Alene Kellogg Plummer Quincy Odessa St. Maries Moses Lake Ritzville Great Falls, Colfax Othello Missoula, Helena South Bend Orofino Clarkston Buena Ilwaco Helena Cottonwood Goldendale Hermiston Phoenix Confidential Phoenix The Impact of Technology on Radiology… ! • 1999 – We started with the Providence Hospitals and then extended into the Region. • We were able to implement quickly and cost e ff ectively. We received volume discounts from Stentor that we were able to pass thru to our growing consortium. • We allowed for free image exchange from other parties on other systems. (Deaconess and Valley Hospitals). • We encouraged competing entities to join the consortium and they did. • KMC, Northwest Ortho, Inland Neuro, Columbia Medical Associates, others (The High Road)

! ! Less than 25 bed Hospitals in the USA An Opportunity to Share Critical Access Hospitals (<25 bed) in dark blue Nuvodia customers highlighted in light blue and red The Future of Diagnostic Imaging – have we been there? ! • The � OLOGIES � and � Scopies � go digital. • Radiology – Cardiology – Pathology – Gastroenterology - Ophthalmology - Dermatology • Arthroscopy - Laparoscopy – etc. • Other eHealth is emerging and needing Video, Image Management and / or Workflow Technologies • TelePharmecy, TeleHospitalists, TelePsych • eHealth centers popping up across the USA – furthering the need horizontal integration of information for the PATIENT centric record. • Mercy Health System in St Louis, MO has a 40,000+ eHealth Center (all ePatients)

Thank You Jon Copeland CEO – Nuvodia Jcopeland@nuvodia.com 509-363-7300 HEALTH INFORMATION EXCHANGE ITS MORE THEN EXCHANGING INFORMATION ITS A VIBRANT BUSINESS RELATED ECOSYSTEM

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AN INFORMATION EXCHANGE ECOSYSTEM TECHNOLOGY MODELS USED (FULLY INTEGRATED) A"PATIENT"QUERY"TO"THE"GLOBAL"ECOSYSTEM END"USER"KNOWLEDGE"IS"NOT"NEEDED POLICY,"PATIENT"CONSENT"AND"GOVERNANCE"FILTER"RETURNS Thank-You! 32