An EMR Specifically Designed for the Cardiovascular Practice

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1 An EMR Specifically Designed for the Cardiovascular Practice Gary Chaisson RTR, RCSA Co-Founder Objective Medical Systems May 30, 2017

2 Disclosure Major Shareholder Objective Medical Systems

3 EMR History Dishwasher King 1972 Regenstrief Institute 1 st EMR 1990 s PC s, Internet, Affordability 2000 s National Health Information Coordinator, mandated industry-wide adoption of EHR s by 2014 (Meaningful Use)

4 Meaningful Use

5 The Promise Minimize Errors Maximize Cost-Efficiency Better Coordination between Healthcare Providers

6 State of Current Cardiology Practice Most guideline oriented specialty in medicine Current number of recommendations exceed 7100 Ranging from medications, multi-modality diagnostics, to timing of therapeutic interventions, etc.

7 Typical Cardiology Patient MB is 74 yo male, Hx of CAD with a CABG 11 years ago. He has DM, HTN, Cholesterol. Moderate Aortic Stenosis, and CVD with a CEA 8 years ago. Episode of CHF 4 years ago. Presented with a new onset of chest pain that he stated was not his typical angina but Studies included a Stress Perfusion and echocardiogram, US doppler of Carotids, along with labs

8 Results of Diagnostic Test Nuclear MPI - Scar anterior wall and an ischemic zone in the lateral wall EF 23% Echo- Anterior wall Akinesis, EF 20% Aortic valve 1.2 cm2 LA 5.1cm,- Aortic Root 3.9 cm Wall thickness 1.5cm, +2AI, + 2MR Carotid % RICA, 40-59% LICA Labs Mildly Anemic with a slight decrease in Renal function

9 Analyzing Study Results ACC/AHA Recommendations that may apply? 612 This should ideally be accomplished in 5 minutes or less

10

11 Basic Database Design Traditional EHR vs. OMS CVIS (Document Centric) (DATA Centric)

12 Traditional Document Centric Design Unit of Storage = File

13 Data Centric Design Unit of Storage = Discrete Data

14 Data Centric Design Unit of Storage = Discrete Data CDS Trigger

15 Comprehensive Cardiovascular Solution CRM /HF Vascular Ultrasound Exercise Treadmill Stress Echocardiogram Coronary / Peripheral Angiography &Interventions Myocardial Perfusion Imaging Exercise Chemical Coronary / Peripheral CTA Echocardiography TEE TTE OMS Unified Data Repository Cardiology EHR > 6000 discreet data elements per patient

16 Charting the Course Diagnostic Studies

17 OMS s 17 Cardiovascular Diagnostic/Theraputic Modules

18 Comprehensive Cardiovascular Modules Comprehensive Cardiovascular Solution Carotid Vascular Ultrasound Echocardiography Ambulatory EKG Monitoring Nuclear Perfusion Imaging

19 Comprehensive Cardiovascular Modules Comprehensive Cardiovascular Solution Exercise Stress Echocardiography Trans-Esophageal Echocardiography Dobutamine Stress Echocardiography Chemical MPI

20 Comprehensive Cardiovascular Modules Comprehensive Cardiovascular Solution Coronary Angiography & Interventions Cardiac CTA Lower Extremity Venous Ultrasound Lower Extremity Arterial Ultrasound

21 Echocardiography - Structured Reporting

22 Echocardiography - Structured Reporting

23 Echocardiography - Structured Reporting

24

25 Echocardiography - Structured Reporting

26 Text

27 Text

28 CDS rules Imbedded within Report schedule clinic appointment

29 Charting the Course EHR Diagnostic Studies

30 OMS Electronic Health Record Confidential Information - Objective Medical Systems LLC - All Rights Reserved

31 Charting the Course Clinical Decision Support Engine EHR Diagnostic Studies

32 Clinical Decision Support Rules

33 Clinical Decision Support

34 Clinical Decision Support

35 Clinical Decision Support

36 Charting the Course Population Health Management Analytics Clinical Decision Support Engine EHR Diagnostic Studies

37 Data Centric Design Experience - Single Center ( 5 years) 733,752 Diagnostic Studies 527,108 Clinic Visits (EHR) 351 Million Discrete Data Elements

38 LDL Risk Stratification PCSK9 Inhibitors?

39 Hypertension Risk Stratification John Doe 200 mm Hg MR#

40 EHR and Patient Satisfaction

41 Patient Frustration with Wait Times

42 Top Strategies for Minimizing Patient Wait Time Frustration

43 Real Time Patient Wait Times Automated Patient Notification of Delay can be initiated

44 Patient Wait Times

45 CHF Mortality Hospital Variability Mortality Rate Objective Medical Systems LLC Confidential Information

46 Remote Patient Monitoring Implantable diagnostic sensors Remote Monitoring Patch >6000 Discreet Data Elements

47 Chronic Disease Management - HF OMS HF Readmission Dashboard Baseline Intervention 100 Survival 1 yr 2 yr 5 yr 1 yr 2 yr 5 yr 80% 63% 28% 80% 63% 28% 50 Mortality Mean Life Expectancy 20% 37% 72% 3.6 years 20% 37% 72% 3.6 years Clinical Medication Diuretics Labs Devices Age 65 ACEI Furosemide Hgb 65 None Gender Male Beta-Blocker Bumetanide Lymphocyte Male BiV Pacer NYHA 4 ARB Torsemide Uric Acid 4 ICD Weight (kg) 89 Statin Metolazone TC 89 BiV ICD EF 30 Allopurinol HCTZ NA 130 SBP 120 Aldosterone Blocker Chlorthalidone QRSD > 150 LBBB Interventions ACEI Beta-Blocker ARB Aldosterone Blocker Devices None BiV Pacer ICD BiV ICD Objective Medical Systems LLC Confidential Information

48 Chronic Disease Management - HF OMS HF Readmission Dashboard Baseline Intervention 100 Survival 1 yr 2 yr 5 yr 1 yr 2 yr 5 yr 80% 63% 28% 86% 74% 43% 50 Mortality Mean Life Expectancy 20% 37% 72% 3.6 years 14% 26% 57% 5.0 years Clinical Medication Diuretics Labs Devices Age 65 ACEI Furosemide Hgb 65 None Gender Male Beta-Blocker Bumetanide Lymphocyte Male BiV Pacer NYHA 4 ARB Torsemide Uric Acid 4 ICD Weight (kg) 89 Statin Metolazone TC 89 BiV ICD EF 30 Allopurinol HCTZ NA 130 SBP 120 Aldosterone Blocker Chlorthalidone QRSD > 150 LBBB Interventions ACEI Beta-Blocker ARB Aldosterone Blocker Devices None BiV Pacer ICD BiV ICD Objective Medical Systems LLC Confidential Information

49 Chronic Disease Management - HF OMS HF Readmission Dashboard Baseline Intervention 100 Survival 1 yr 2 yr 5 yr 1 yr 2 yr 5 yr 80% 63% 28% 86% 74% 43% 50 Mortality Mean Life Expectancy 20% 37% 72% 3.6 years 14% 26% 57% 5.0 years Clinical Medication Diuretics Labs Devices Age 65 ACEI Furosemide Hgb 65 None Gender Male Beta-Blocker Bumetanide Lymphocyte Male BiV Pacer NYHA 4 ARB Torsemide Uric Acid 4 ICD Weight (kg) 89 Statin Metolazone TC 89 BiV ICD EF 30 Allopurinol HCTZ NA 130 SBP 120 Aldosterone Blocker Chlorthalidone QRSD > 150 LBBB Interventions ACEI Beta-Blocker ARB Aldosterone Blocker Devices None BiV Pacer ICD BiV ICD Objective Medical Systems LLC Confidential Information

50 Chronic Disease Management - HF OMS HF Readmission Dashboard Baseline Intervention 100 Survival 1 yr 2 yr 5 yr 1 yr 2 yr 5 yr 80% 63% 28% 89% 79% 51% 50 Mortality Mean Life Expectancy 20% 37% 72% 3.6 years 11% 21% 49% 5.9 years Clinical Medication Diuretics Labs Devices Age 65 ACEI Furosemide Hgb 65 None Gender Male Beta-Blocker Bumetanide Lymphocyte Male BiV Pacer NYHA 4 ARB Torsemide Uric Acid 4 ICD Weight (kg) 89 Statin Metolazone TC 89 BiV ICD EF 30 Allopurinol HCTZ NA 130 SBP 120 Aldosterone Blocker Chlorthalidone QRSD > 150 LBBB Interventions ACEI Beta-Blocker ARB Aldosterone Blocker Devices None BiV Pacer ICD BiV ICD Objective Medical Systems LLC Confidential Information

51 Appropriate Use Criteria Inappropriate Appropriate Uncertain Rarely Appropriate Maybe Appropriate 19% 5% 1% 17% 76% 82% CIS 2014 CIS 2016

52 Appropriate Use Criteria Inappropriate Appropriate Uncertain Rarely Appropriate Maybe Appropriate 1% 17% 15% 14% 82% 71% CIS National Average

53 Redefining Cardiovascular Care One Data Element at a Time

54 An EMR Specifically Designed for the Cardiovascular Practice Gary Chaisson RTR, RCSA Co-Founder Objective Medical Systems May 30, 2017

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