How Picis Solutions Help You Achieve Meaningful Results and Meaningful

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How Picis Solutions Help You Achieve Meaningful Results and Meaningful Use www.picis.com/HIT-Stimulus cWe had a five-year strategic plan to invest over $100 million in IT and that was ambulatory systems, acute care systems, and emergency department systems. I think our investment is going to pay off well in that achieving 8meaningful use 9 should be within our reach& if you get started and get started quickly, you 9ll be rewarded more than if you postpone it. d David Pecoraro , CIO, Exempla Healthcare October 2009 Dear Colleague: At Picis, we are committed to helping our hospital partners achieve cmeaningful use d under the American Recovery and Reinvestment Act (ARRA). We believe demonstrating cmeaningful use d is only attainable with health information technology (HIT) that includes full functionality and clinically-rich data for reporting on quality initiatives, ultimately driving quality and reimbursement from the high-acuity care areas of hospitals.

Just as important, we have specialized for the past 15 years in these areas, and have demonstrated meaningful results in surgery, emergency departments and intensive care units, well before ARRA HITECH entered the scene. Picis executives are helping to influence the development and refinement of regulations by actively participating in ARRA HITECH discussions with ... more. less.

the Department of Health and Human Services (HHS). These deliberations will ultimately shape policy and strategy around how hospitals implement healthcare reform, bring HIT into productive use, and reap the rewards of federal stimulus funding. We also continue to communicate to regulators what we have learned from conversations with many of our customers and customer advisory board members, offering recommendations where relevant. According to our 2009/2010 product roadmap, we expect to align to recommended HHS timelines and certification criteria that will be used for ARRA stimulus funding. Our market-leading EDIS, Picis ED PulseCheck ® versions 4.0 and 4.1 have already achieved Certification Commission for Health Information Technology (CCHIT ® ) Certified ® 08 Emergency Department Electronic Health Records (EHR). While there are currently no certifications available for surgery and ICU applications, we, like the Office of the National Coordinator for Health Information Technology (ONC), believe all systems should be certified to identical certification criteria, including those which support high-acuity, high-cost specialties like surgery. Picis has reviewed the meaningful use criteria, and we have aligned our product roadmaps to the 2011 objectives and believe many of our customers are already deriving meaningful results. More information about Picis 9 position can be found in the enclosed position paper and by visiting www.picis.com/HIT-Stimulus. Many leading medical centers with Picis solutions have leveraged HIT to drive rapid financial and clinical success, including using data to help guide clinicians 9 course of care. These health systems are reaping the benefits of our technology to demonstrate meaningful results as well as meaningful use. In conclusion, you can have confidence that Picis will be your partner in achieving not just meaningful use but meaningful results. As for the future, I look forward to establishing and growing productive partnerships with each of you. Please contact me if you have any questions. Best regards, Todd Cozzens Chief Executive Officer, Picis 100 Quannapowitt Parkway, Suite 405 Wakefield, MA 01880 Tel: 781 557 3000 Fax: 781 557 3140 picis.com Position Paper How Picis Solutions Help You Achieve Meaningful Results and Meaningful Use Picis is committed to helping its customers achieve cmeaningful use d of healthcare information technology (HIT) under the American Recovery and Reinvestment Act (ARRA). As regulators work to finalize the definition of cmeaningful use d and guidelines for reimbursement, Picis is reviewing information on cmeaningful use d closely, and assessing how our solutions meet the applicable requirements in 2011 through 2015. The information provided in this document is intended to outline our general product direction, is for informational purposes o nly, and may not be included in any contract. Although it is Picis 9 intent to use every reasonable effort to meet the ARRA guidelines as described above, the development, release, and timing of any features remain solely at our discretion. 6 How Picis Solutions Help You Achieve Meaningful Results and Meaningful Use Introduction To show our commitment, a Picis Task Force consisting of executives and clinicians has taken an active role in helping to influence the development and refinement of regulations. Members of the Picis staff are actively participating in the Administrative and Congressional groups who are driving the ARRA HITECH discussions, as well as delivering thoughtful comments on definitions that will ultimately shape policy and strategy. While we have our cear to the ground d during this period, we also continue to communicate what we have learned and heard from many of our customers and customer advisory board members, offering recommendations where relevant. A leading HIT provider since 1994, Picis focuses entirely on the high-acuity care areas of hospitals: the emergency department (ED), the operating room (OR) and the intensive care unit (ICU). Picis CareSuite ® family of high acuity solutions are designed specifically to address these acute care areas where patients are most vulnerable and costs and revenues are greatest. These areas consume as much as 60% of hospital resources, and can drive as much as 70% of revenues for a U.S. hospital, having a significant impact on the success or failure of the entire organization. These high-impact areas of the hospital demand the highest priority for information technology, in part because of their impact on driving costs, revenues and quality outcomes. Not all hospital specialties are created equal, in terms of their contribution to the nation 9s healthcare bill. In particular, surgery by far accounts for the largest proportion of hospital revenue, and thus payer cost (payers including the Federal and state governments, in addition to private insurance and patient self-pay). We recommend that hospitals focus on automation, optimization and transformation of these high-acuity care areas early as a key component of achieving not just meaningful use, but meaningful clinical, financial, and operational results. Picis solutions are targeted not just to the initial ARRA 2011 certification levels, but take a comprehensive approach to allow hospitals to continuously ramp as the certification levels are established through 2015. Picis has a history of focusing on driving quality and continuity of care, and has shown leadership in developing cross-departmental applications based on the adoption of standards. This platform allows us to easily align to the ARRA requirements, as demonstrated by our seamless integration with various hospital information systems including the demanding requirements of the Veteran 9s Administration (VA) VistA platform 4 the gold standard for interoperability. Our customers can expect that as one of their key healthcare IT vendors, we intend to adapt to the regulations as they develop. This document states our intent to align with the initiatives as defined by the Health and Human Services (HHS) Policy and Standards committees. Position Paper 7 Achieving cMeaningful Use d Product Roadmap According to our 2009/2010 product roadmap, we expect to deliver the capabilities to align to the Office of the National Coordinator for Health Information Technology (ONC)- recommended cHHS Certification criteria, d which will be used for certification in 2009/2010. We are watching, with the rest of the industry, the CMS rules-making process, which will drive the final certification and reimbursement processes beginning early in 2010. Having already achieved product certification from the Certification Commission for Healthcare Information Technology (CCHIT ® ), 2010 releases and later of Picis ED PulseCheck ® are expected to continue to align with the anticipated HHS certification criteria as they develop. While there are no applicable functional certifications for our other CareSuite solutions, we intend to align with the anticipated HHS certification criteria, including those for ARRA compliance, as they develop. This plan should allow clients to demonstrate cmeaningful use d in the areas addressed by ONC; e.g. continuity of care, interoperability, medication management, e-prescribing, and quality reporting. We also have the ability to capture data that will be required for the applicable quality measures recommended by ONC. We are able to provide sample report content, rules, and consulting services to assist customers in demonstrating meaningful use by reporting the required quality measures with the requisite data from their Picis application(s). Certification Today, Picis is among a small group of healthcare technology providers offering a certified emergency department solution. ED PulseCheck versions 4.0 and 4.1, part of the CareSuite family of high-acuity solutions are Certification Commission for Health Information Technology (CCHIT ® ) Certified ® 08 Emergency Department Electronic Health Records (EHR). We see this certification as validation that our solutions meet and exceed the criteria that hospitals need now and will need in the future to obtain the full amount of stimulus funds available to them. The certification also provides an objective set of criteria for measuring HIT products, enabling many buyers to narrow their focus on emergency department information systems (EDIS) worthy of selection, as well as those eligible for EHR stimulus money under ARRA. CCHIT product certification designates that a HIT product has been tested for functionality, interoperability and security and has passed inspection of 100 percent of the criteria. In recent tests, ED PulseCheck version 4.0 and 4.1 met all of nearly 200 rigorous requirements for functionality, interoperability and security for CCHIT certification. Looking forward, we intend to pursue ARRA-related certification for each of our care areas. Functional, or ccomprehensive, d certifications are not currently available for surgery 8 How Picis Solutions Help You Achieve Meaningful Results and Meaningful Use and ICU applications. However, ONC has indicated that all systems should be certified to cidentical certification criteria d and has endorsed the notion of systems comprised of dcomponents d from various vendors, including those which support specialties such as surgery. The test will be the ability of the component product to meet the cmeaningful use d criteria that is applicable to each product. Picis has reviewed the cmeaningful use d criteria and we have aligned our product roadmaps to the 2011 objectives. CCHIT has formed a variety of workgroups comprised of industry experts in order to further their mission to accelerate the adoption of robust, interoperable health information technology. Mark Crockett, MD, FACEP, President of the Emergency Care Division at Picis, participates in the CCHIT Privacy and Compliance Work Group, charged with recommending criteria and test scripts to all work groups for certification of EHRs and Health Information Exchanges (HIE). Interoperability and Health Information Exchange The focus on interoperability within ARRA is to ensure that patient records can be communicated easily and securely to the patients 9 personal health record (such as Google" Health and Microsoft ® HealthVault), to providers outside the hospital, and to Health Information Exchanges. As a specialist in high-acuity automation, Picis is already delivering interoperable HIT solutions on a daily basis. We work through industry citizenship to help develop standards that will further enable interoperability across care entities with systems of all kinds. Picis is committed to continuing to provide technology that conforms to industry standards for data content, format, terminology, and communication, as required for meaningful use per the HIT Standards Committee. Continuity of Care Document One particular element of enhanced interoperability, designed to foster care continuity among healthcare institutions, is the Continuity of Care Document, or CCD, part of the Integrating the Healthcare Enterprise (IHE) interoperability set of standards. Among our high-acuity care areas, we believe this document is most applicable to the emergency department, from which most patients are treated and released, often with discharge instructions to consult their primary care physician as follow-up. (In surgery and critical care, we believe care summaries will more often be part of a larger record to be made available outside the hospital, and thus will be combined with other care records before publication.) As one of the cmeaningful use d criteria, we have aligned our product roadmap to the 2011 objectives in this area. cThe government will not hold organizations chostage d to high standards. It will be more of a carrot than a stick. They are looking to reward hospitals that are making moves 4 reporting quality and using some type of CPOE& They are also looking for information exchange. Everyone wants to see an integrated system where all documents are visible and useful to everyone in the hospital. d Mark D. Crockett, MD, FACEP Attending Physician at Advocate Good Samaritan Hospital and President of Picis Emergency Care Division Position Paper 9 Quality Reporting The vast amount of clinical data documented in the Picis CareSuite high-acuity product suite provides clinicians and administrators unprecedented visibility into the operation of the most life-critical areas of the hospital. In addition to the prominent place these high- acuity care areas hold in the delivery of acute care services, they also represent the areas where much of the data that HHS in general, and CMS and others in particular, require quality measures reporting and documentation. Once documented, the data is available for reporting and analytics via an open and non-proprietary database schema. This provides clinicians and hospitals with a window into the clinical, operational and financial details of care delivery in these critical areas. Multiple mechanisms already exist within the various Picis solutions for capturing and reporting applicable quality measures and to ensure that time-based quality measures are documented in an appropriate and timely manner. CPOE Hospitals that implement Picis 9 EDIS, ED PulseCheck, are virtually guaranteed to meet the 10% computerized physician order entry (CPOE) threshold established in the final definition of cmeaningful use d objectives for 2011. Given that an estimated 20-50% of physician orders within a hospital originate in the ED, and combined with our high rate of physician adoption, implementation of ED PulseCheck can help assure that the 10% threshold can be met for the entire hospital. 10 How Picis Solutions Help You Achieve Meaningful Results and Meaningful Use Clinicians also use Picis perioperative and critical care solutions to issue orders for lab tests, medications and drug infusions, radiology, and procedures. Through the use of one or more of Picis high-acuity solutions, your institution could potentially meet the 2011 meaningful use criteria of >10% CPOE without the time and expense of attempting to implement a house-wide CPOE system and the adoption headaches that would involve. Clinical Decision Support Picis has established a standard for information access and analytics that allows our clients to do more than simply replace paper processes with computer screens. The volume of high-quality clinical data documented by Picis high-acuity solutions provides clinicians and administrators unprecedented visibility into the operation of the most life-critical areas of the hospital. Clinical decision support tools are currently available throughout Picis solutions. These tools range from care beacons 4 a visual screen notification that tells the clinician that a rule, pre-defined by the clinician, has been met and/or a notification is pending 4 to Picis InSight for ED, critical care, and anesthesia. Picis InSight is a clinical rules solution that allows clinicians and administrators to create rules that trigger notifications when specified criteria are met, facilitating communication and supporting clinical decisions. These tools enable caregivers to use clinical documentation beyond simple record keeping, extending the usefulness of the electronic record to help hospitals identify and report best practices for care. HIPAA Privacy and Security Picis is committed to patient privacy and data security and to full HIPAA compliance. To date, we have put considerable effort into providing the capability to protect and audit access to patient personal health information (PHI) in our products. Picis solutions already support configurations that will permit authorized users to restrict access to certain features and functions, to allow view-only rights to protected information, and to define editing rights. Also, native audit features and reports can be utilized by our customers periodically in order to monitor changes or particular instances of access to data. We intend to continue to ensure our software products maintain the features necessary to allow you to be HIPAA-compliant and to meet new security and privacy standards under ARRA. As part of our implementations, Picis Professional Services staff works with your staff to ensure that full advantage is taken of Picis capabilities in this critical area. Position Paper 11 Going Beyond cMeaningful Use d The cmeaningful use d criteria set a minimum cbar d for software functionality, and we believe that will drive useful baseline capabilities for hospital IT. However, Picis has never been a believer in, or provider of, minimal functionality in any of its high-acuity care areas. Areas of differentiation beyond cmeaningful use d: 1. Getting to > 10% overall CPOE in one or two care areas (ED and ICU) . 2. Decision support tools in all care areas 3. Deep expertise in interoperability leads to care continuity, which is a key goal of ARRA HITECH 4. Analytics 4 beyond quality reporting, the ability to optimize and transform clinical documentation, financial, and operational functions 5. Proven implementation and support offerings and methodologies that ensure shorter time-to-benefit and long-term productive use of our solutions When evaluating vendors and their solutions, Picis recommends strongly that hospitals look beyond cmeaningful use, d and also demand meaningful results. Picis 9 proven track record in helping hospitals realize financial, operational and clinical improvements through HIT is unparalleled, and directly related to our solutions, specifically designed for the hard-to-automate care areas. We remain confident that the value we deliver goes well beyond cmeaningful use d and stimulus funds reimbursement, as do our more than 1,700 customer hospitals worldwide. Summary The complex array of factors shaping ARRA and the definition of cmeaningful use d could change before the final regulations are promulgated and approved. Staying informed and up-to-date can also be challenging. Through active participation in organizations that influence requirements for ARRA funding, Picis experts gain valuable insights that we share with customers on a regular basis. These insights also continue to inform the planning and delivery of our solutions. You are welcome to browse the Picis HIT Stimulus section of our web site, known as the Picis Healthcare IT Stimulus Resource Center , offering a library of resources and up-to-date information. You 9ll find links to our position papers, communications, customer case studies, and other useful information. Visit www.picis.com/HIT-Stimulus 12 How Picis Solutions Help You Achieve Meaningful Results and Meaningful Use Delivering Results in High Acuity ® Positioning Paper ARRA HITECH 092009-2.0 100 Quannapowitt Parkway, Suite 405 Wakefield , MA 01880 Tel: 781 557 3000 Fax: 781 557 3140 www.picis.com © Picis, Inc. All rights reserved. cPicis d, the Picis logo and the Picis tagline may be trademarks or registered trademarks of Picis, Inc. in the United States and/or other countries. All other trademarks used herein are the property of their respective owners. About Picis Picis is a global provider of information solutions that enable rapid and sustained delivery of clinical, financial and operational results in the acute care areas of the hospital. These high-acuity areas include the emergency department, operating and recovery rooms, and intensive care units. Picis offers an advanced suite of integrated products focused on these life-critical areas of the hospital where the patients are the most vulnerable, the care process is the most complex, and an increasing majority of hospital costs are concentrated. Headquartered in Wakefield, Massachusetts, Picis has licensed systems for use in more than 1,700 hospitals. More information is available at www.picis.com .

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