October 2016 Let's Talk Informatics Presentation by Allscripts Vice-President Robert Leviton

THE POWER OF ALLSCRIPTS
Innovations that Inspire

Smarter Care
What Drives Allscripts
Our Vision Our Mission
Allscripts solutions enable

smarter care, delivered with
Building Open, Connected
greater precision, for
Communities of Health
healthier populations and
communities
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 2

INDUSTRY
Trends
Industry Challenges
Aging population Service demand increasing Need to improve

with increasing • Access to care already an issue quality while
chronic disease • Can’t sustain cost trajectory lowering costs

Strategic Imperative for Health Care
Shift from reactive care to proactively and predictably managing populations
Note: Data excludes the uninsured and VA populations, year = 2012. | Source: Oliver Wyman analysis, Kaiser, CMS, Census Bureau, CDC.

WHO WE ARE
A Global Leader in Healthcare

Technology
Our Vision
PRECISION MEDICINE/ POPULATION HEALTH

CONSUMER SOLUTIONS MANAGEMENT
ELECTRONIC FINANCIAL
HEALTH RECORDS MANAGEMENT

45K+
12M+ PHYSICIAN
PRACTICES
7.2M+ REFERRALS
PATIENTS
USE PORTAL
180K
Building Open, PHYSICIANS
2,500
Connected Communities HOSPITALS 19K
POST-ACUTE
FACILITIES
of Health™
CareInMotion Differentiators
Population Health
Management
• Aggregates community data to create a
True Harmonized View of the patient
CARE
ANALYTICS COORDINATION
• Puts care plans and interventions Into Action
• Patient-Centric engagement across all

settings of care
• Enables Full Enterprise Financial Performance

Mgmt.
CONNECTIVITY & PATIENT
DATA AGGREGATION ENGAGEMENT

POSITION AND STRATEGY
How We Help Drive Change

Execute across the healthcare continuum
Ambulatory Acute Post Acute Community Consumer
Physician Practices Hospitals Home Health Pharmacies Patient Engagement

Clinics Health Systems Long-Term Care Labs Technologies
… … Hospice Specialists Portals
Private Duty In- and out-of-network Wearable Tech
… physicians Personalized Medicine
YMCA’s …
…

Enabling smarter care delivery
Building a Bridge
to Our Future
Connecting Deliver new capabilities
Your Community to enable precision
Elevating Align patients and care
medicine and consumer-
centered care
Your Success providers to foster population
Strengthening Partner to develop and
health through care
coordination, analytics and
Your Foundation execute your strategy to patient engagement
meet your unique
Continue investment in clinical, operational and
community-aware systems financial needs
across the continuum of care

Innovations that Inspire

Smarter Care
Enhance Care with Orders-At-A-Touch
• DVT Assessment is required on
Admission
• Simply identifying the patient’s
Risk Factor auto-selects age
specific order sets.
• The clinician then quickly answers
three questions:
• Is there Pharmacologic
Contraindication?
• Is there High Bleeding Risk?
• Is there Mechanical
Prophylaxis
Contraindication?

Enhance Care with Orders-At-A-Touch
• The evidence based

medications appear
for the clinician to
select.
• Without requiring
an order form or
order set, on SAVE
of the document, the
order items are
automatically
submitted.

Enhance Care with
Auto-Display Medication Specific Instructions
• Many regulatory requirements and evidence based care recommend
specific instructions for certain diagnoses or medications.
• On opening discharge instructions, the system automatically identifies a
specific medication has been prescribed and is auto-selected

Enhance Care
Auto-Display Medication Specific Instructions
The medication specific

instructions auto-populate
assuring safe prescribing
information and clinician
efficiency

Improve Efficiency, Care, and Outcomes
Sepsis Initiative
Surveillance
Early
Warning
System

Improve Efficiency, Care and Outcomes
Sepsis Initiative
Sepsis Actionable Alert
• End of Life
• Not Septic Shock,
Severe Sepsis
• Patient / Care Giver
Refuses Protocol
• Launch Sepsis Protocol

Sepsis Initiative
Sepsis Protocol
Aware Note
• Auto-Selects
Options
• Single Select
Launches
succeeding
order sets

Sepsis Initiative
Severe Sepsis Initiate
Protocol OS
• Preselected items
• Physician
Intelligence
• Quality Performance

Sepsis Initiative
Organ System Antibiotic
Order Sets
• Infectious Disease
• Pharmacy
• Critical Care
• Drives Evidence
Based Care,
Outcomes, Cost

Drive Performance, Identify Gaps
CLABSI Initiative
Tracking Board – Quickly identifies outliers within the
organization

CLABSI Initiative
Advanced Patient Lists – actionable items directly launch
patient document

CLABSI Initiative
Scatter Charts – rapidly identify outliers and provide quick
launch to details

CLABSI Initiative
Dashboard View
• Immediately
accessible
information
• Drives care
initiatives
• Focus on
outcome
• Link to cost and
decision making
Clinical Summary- Discrete Data Single View
Single Summary View compiles days of admission data in one discrete location
– provides immediate review of pertinent information….and is configurable.

• Tiles display configured content
– Care Provider and Diagnosis & Procedure tiles
– Vital Sign and Daily I&O’s tiles

• Progress Note by Assessment, Plan, Author and Date
– Discrete immediately available intelligible information to review daily plans of care





• Radiology and Cardiology Results

• Current Daily Orders and Current Medications
• Nursing Admission and Patient Profile Summary

• CBC and Metabolic Profile Trending Tiles
• Cardiac and Coagulation Profile Trending Tiles
• Macro and Microscopic Urinalysis Trending Tiles

• Blood Gas and Blood Bank Trending Tiles
• Toxicology Abuse and Medication Trending Tiles
• Endocrinology and Daily Weight Trending Tiles

• Microbiology Tiles
• Endless Potentials for Clinical Summary Tiles

• Mechanical Ventilator Weaning Tiles
• Infectious Disease Titers Tiles
• Prenatal Care Management Tiles
• Hand Off / Care Transition Tiles

Interdisciplinary Plan of Care - IPOC
• Quality Care intuitively prescribes acknowledging the IPOC
• The Allscripts solution provides an efficient, quick method to rapidly
review all team member plan of care.
• By selecting the team member, their plan of care is displayed

In this instance the

“Team Plan of Care,
Last Note is displayed
in chronologic order

• All Team members last charted
note is displayed in one view
• Plan of Care notes for all team
members are displayed
• Nursing
• Social Work /Case Management
• Nutrition
• Pharmacy
• Physical / Occupational Therapy
• Speech Language
• Respiratory
• Physician Notes

Actionable Alerts – Drive Safe Care
• Physicians and clinical staff are
incredibly busy while numerous
regulatory requirements may
take a clinician from their usual
workflow
• Actionable Alerts place the required
actions to fulfill requirements efficiently
for the clinician to respond.
• Here, the patient is admitted
with AMI and requires an Aspirin
on Admission.
• A single click, provides the
required information to
meet the standard of care
Open Connected Communities

of Health
Allscripts Strategy
Community Population Health Precision Medicine /
Aware EHR Management Consumer Solutions
CARE
PHARMACY CLINICAL MOBILITY AND
ANALYTICS COORDINATION
OMICS WEARABLES
Allscripts Community Architecture
SPECIALIST
HOSPITAL &
HEALTH SYSTEMS
POST ACUTE
INTELLIGENT
INTERVENTION
PHYSICIAN
PRACTICE CONNECTIVITY & RESEARCH
PATIENT
DATA AGGREGATION ENGAGEMENT

Insights to Population Health Dashboard

Focused Review by Clinician and Patient

Care Navigator Referral

Patient Engagement – Health Summary

Conditions - Medications

Patient Directed Goals

Population Health Analytics

Precision Medicine
Precision Medicine - Moving The Needle
Proactive Preventive
Reactive Predictive
• Trial and error • Precise matched therapy

• “Average Patient” • Avoid toxicity
• Iterative treatment • Improve treatment adherence

Precise Stratification
Toxic but Toxicity with

beneficial NO effectiveness
Same diagnosis,
same drug
Effective with NOT toxic,

NO toxicity NOT beneficial
Potential Disease Packages - Examples
Family Phenotype Description
Colon cancer (Lynch Syndrome) 1 of 20 colon cancer cases
Cancer
Breast cancer (Tamoxifen low cetabolizers) 1 of 10 breast cancer cases
Diabetes Maturity Onset Diabetes of the Young (MODY) 1 of 50 from all diabetes cases
Hyperlipidemia Familial Hypercholesterolemia (FH) 1 of 500
Monogenic Persistent Isolated Microscopic 1 of 100 of all renal diseases

Renal disease
Hematuria (MPIMH)
Neurodevelopmental
Neurodevelopmental monogenic disorders 1 of 30
disorders

The Vision of Precision Medicine - Providers
• Put the power of next generation sequencing into the hands of
doctors
• Detection and prevention of Individual health risk
• Faster, more accurate diagnosis – cost avoidance
• Tailored, optimized (first) line of treatment
Precise action at point-of-care

Genomics and Precision Medicine High Level Architecture
Cloud Based
Rule Rules Knowledge Base

EMPI
Engine Authoring
Clinical Subset
Data Genomics Data Insights Cloud
Repository Repository Rules Genomics
Tenants
(CDR) Rules Ontology
(GDR) Orgs Rules dictionary
Users
Precision Medicine API
AHS
Cerner EPIC dbMotion HIE FMH Genetic lab
EHRs
adapter adapter adapter adapter adapter adapter
adapter
States, Genetic
HIEs Labs 3rd party apps
3rd party Precision Medicine web app
applications 60
Copyright © 2016 Allscripts Healthcare Solutions, Inc.
Familial Hypercholesterolemia (FH)
• More than 80M adults have high cholesterol in the
US
• This double the risk for heart disease
• ~ 25% of adults over 40 are taking drugs to lower
their LDL (e.g., statin)
• Only a third of them will get it under control
• 1:500 (1:50 in early CVD ) have FH (~2 Million)
• 20x risk for CHD, 50% chance of a coronary
event before 50
• Only 50k of them are diagnosed correctly
• FH mutations (LDLR, APO-B, PCSK9)
• More likely to be resistant to common therapy
Premature CHD in
High LDL in family family 1st degree PCSK9
1st degree APO-B New
member Pathogenic
member
mutation Premature CHD in
LDLR family 1st degree
tendon xanthoma member
and\or comeal
arcus in family 1st Genes
degree member personal &
environmental LDL = 320
Hypercholesterole factors Gene Mutations
mia mutations in
family member
age
Influence on risk
New
gender Knowledge pathogenic
mutation
ethnicity
Sources
LDL Tests for
Hypercholesterolemia Variates of
Blood Lab tests Tests for LDLR unknown
significance
TC Identified
Related conditions
Variations
First line therapy
May treat
Conditions
Medications
Biological
medications
Genetic
Other lipid-
Laboratory
Statins Early onset Early onset tendon xanthoma
lowering therapies CVD CHD and\or comeal arcus
Familial Hypercholesterolemia (FH)
Doubled risk for cardiovascular disease (CVD)
• High cholesterol detected
Precision Medicine
• Life style changes
• Low dose statins • Identify individuals
• High dose statins • Genetic tests (and Life style Change)
• High potent statins Side effects • Clini-Omics prediction
• Second drug (Fibrate • Propose new class of drugs
etc….)
• New drugs (expensive)
6 Months to 2 Years Weeks

The Closed Loop Single Healthcare Platform

Thank You!

October 2016 Let's Talk Informatics Presentation by Allscripts Vice-President Robert Leviton

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THE POWER OF ALLSCRIPTS

Innovations that Inspire

Our Vision Our Mission

Allscripts solutions enable

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 2

Aging population Service demand increasing Need to improve

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 4

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 5

A Global Leader in Healthcare

PRECISION MEDICINE/ POPULATION HEALTH

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 7

• Patient-Centric engagement across all

• Enables Full Enterprise Financial Performance

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 9

How We Help Drive Change

Ambulatory Acute Post Acute Community Consumer

Physician Practices Hospitals Home Health Pharmacies Patient Engagement

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 11

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 12

Innovations that Inspire

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 17

• The evidence based

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 18

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 19

The medication specific

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 20

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Copyright © 2016 Allscripts Healthcare Solutions, Inc. 28

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 30

– Vital Sign and Daily I&O’s tiles

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 31

– Discrete immediately available intelligible information to review daily plans of care

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 32

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 33

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 34

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 35

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 36

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• Nursing Admission and Patient Profile Summary

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 38

• Cardiac and Coagulation Profile Trending Tiles

• Macro and Microscopic Urinalysis Trending Tiles

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 39

• Toxicology Abuse and Medication Trending Tiles

• Endocrinology and Daily Weight Trending Tiles

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 40

• Endless Potentials for Clinical Summary Tiles

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 41

• By selecting the team member, their plan of care is displayed

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 42

In this instance the

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 43

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 44

Open Connected Communities

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 47

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 48

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 49