THE REAL FACTS ABOUT EMR Any fact that

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THE REAL FACTS ABOUT EMR “Any fact that needs to be disclosed should be put out now or as quickly as possible, because otherwise the bleeding will not end. ” Henry Kissinger “There are in fact two things, fact and opinion; the former begets knowledge, the later ignorance” Hippocrates "Practical politics consists of ignoring facts. " Henry Adams

Terms and Acronyms MRI - Medical Records Institute, which sets many of the definitions frequently used today in reference to information technology, as explained below. CCHIT - stands for a voluntary, private-sector organization to certify HIT products. It was initially founded by three leading HIT industry associations – the American Health Information Management Association (“AHIMA”), the Healthcare Information and Management Systems Society (“HIMSS”) and The National Alliance for Health Information Technology (“Alliance”). CPOE - computerized physician order entry. C-EHR - stands for “certified electronic health record”. EHR – electronic health record, which is a computer-accessible, interoperable resource of clinical and administrative information pertinent to the health of an individual. The information, drawn from multiple clinical and administrative resources, is used by a broad spectrum of clinical personnel. This enables them to coordinate the patient's care and promote wellness. EMR – electronic medical record, which is a computer-accessible resource of medical and administrative information available on an individual collected from and accessible by health care professionals involved in the patient's care within a single care setting. HHS - Health and Human Services, currently chaired by Secretary Michael Leavitt. HIMSS EHRVA is a trade association of EHR vendors which functions as an advocacy and lobbying group founded to fight for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare. Founded in 1961 it has offices in Chicago, Washington D. C. , Brussels, and other locations across the United States and Europe. Slide 2

FACTS ABOUT CCHIT

DID YOU KNOW? On 7/2006 CCHIT began certifying EMR software systems… And now the average cost of the typical “certified” EMR is about twice as expensive as those that aren’t certified. The uptake of “certified” EMR software systems has stagnated while those that aren’t certified have seen the overall prevalence in the market grow to almost 30%. The failed installation rates are estimated at up to 50% in the c-EHR software systems industry; the deinstallation rate is reported to be another 8%. Only 10% of those that buy c-EHR software systems actually use all the features that Medicare wants to eventually force onto physicians. The special “features” that government and Insurance companies want to implement have more to do withholding payment to providers than in actually improving patient care. • http: //www. healthcareinformatics. com/ME 2/dirmod. asp? sid=349 DF 6 BB 879446 A 1886 B 65 F 332 AC 487 F&nm=&ty pe=Blog&mod+View+Topic&mid=67 D 6564029914 AD 3 B 204 AD 35 D 8 F 5 F 780&tier=7&id= EDE 4 B 65 E 6 FA 344 C 286 C 02 EFB 2 CD 4 D 223 • http: //www. ihealthbeat. org/articles/2007/10/31/Survey-Finds-Health-Care-Providers-Often. Backtrack-on-EHRs. aspx? topic. ID=54 Slide # 5

Reason for the High Failed Installation Rates An artistic depiction of what a typical CCHIT certified “enterprise” EHR chaotic installation could look like in “real time”. Slide 6

DID YOU KNOW? In 2006 CCHIT began certifying EMR software systems, offering “assurance”… Since 2006 approximately 100 EHR software systems have been CCHIT certified. Of these, 3 of which have declared bankruptcy, and at least 2 dozen other certified EMR software systems have seen their stocks fall in the past year alone over 30%. And these are just the ones that are publicly traded. Little is known of the majority of EHR software systems that are privately owned. On several blog sites on the ‘net there are several discussions of EHR software system vendors that leave their users angry, and on one occasion holding patient records hostage waiting for more fees. Here are the most recent discussions: ü ü ü e. CW (https: //md. sermo. com/medical/ticket/details? nav=on&id=23060) Cerner (https: //md. sermo. com/medical/ticket/details? nav=on&id=18593) Next. Gen- discussion still active after more than a year! (http: //www. emrupdate. com/forums/t/12000. aspx? Page. Index=1 ) http: //www. youtube. com/watch? v=c. L 9 Wu 2 k. Ww. SY Slide # 7

DID YOU KNOW? The Medicare P 4 P and e-prescribing rules show that the government has conspired with HIMSS “enterprise” EMR vendors to try to force physicians to purchase a CCHIT-certified EMR in the future if they wish to be paid a fair wage for services rendered when they see those elderly patients in their practices. This could be illegal, but… There exists a situation, "extortionate extensions of credit" which can apply to CCHIT-related activity: ü ü For vendors: The purported CCHIT "buy-in" certification costs of $30000 if you wish to stay in business within the HIT industry. Physicians: The department of HHS P 4 P payout of money only if you purchase a CCHIT-certified EMR. Legalese: "By its very nature, however, extortion causes the victim to consent to the taking of property. Extortion does not necessarily involve the use of force or the threat of the use of force. For example, the victim storeowner voluntarily pays a Mafia enforcer $1000 per month because the Mafia enforcer said, ‘pay us $1000 per month of we'll break your legs’”. http: //www. emrupdate. com/forums/p/7953/60493. aspx#60493 Slide # 8

DID YOU KNOW? The Medicare P 4 P and e-prescribing rules show that the government has conspired with HIMSS “enterprise” EMR vendors to try to force physicians to purchase a CCHIT-certified EMR in the future if they wish to be paid a fair wage for services rendered when they see those elderly patients in their practices. This could be illegal, but… In Summary: "Governmental power, by its nature, is legalized extortion, i. e. “unless you buy a CCHIT certified EMR you won't be able to make a decent living in the practice medicine in the USA anymore…” You only have 2 options- ü ü Don’t vote for elected officials that don’t understand the implications of their representation. Don’t consent to forced HIT rules which may pay you an extra pittance for “consent” or participation which legitimizes the process further. http: //www. emrupdate. com/forums/p/7953/60493. aspx#60493 Slide # 9

DID YOU KNOW? Occasionally a Physician May Claim: “It would however be more positive and productive if doctors as a profession would actually accept the challenge and work with CCHIT to design appropriately suitable standards. ” If you try to work with CCHIT, all you end up doing is giving this politically contrived public/private company more validity. Its whole premise is wrong and flaunts the Clayton and Sherman antitrust acts simply because of the backing of the Department of Health and Human Services. CCHIT functions not unlike the mafia, providing a method of racketeering in which if you didn't pay their $30000. 00 a year, your business dies. This decreases competition, leading to increased prices that impacts every physician office in the USA. On top of this they through massive donations which are usually poorly known, they have been able to get bipartisan support to force doctors into purchasing their bloated, costly, difficult to use EMR software. “An Antitrust Primer”http: //www. emrupdate. com/forums/p/7196/56269. aspx#56269 Slide # 10

DID YOU KNOW? Occasionally a Physician May Claim: “It would however be more positive and productive if doctors as a profession would actually accept the challenge and work with CCHIT to design appropriately suitable standards. ” (continued) When I first began looking into this, I found that CCHIT itself, a “nonprofit” organization, had planned on making a million dollars in the first 6 months of existence in 2006, then divide the profits at the end of the year. I exposed that, and subsequently they reorganized on 11/2006. Subsequently, an article stated that Cerner spent $180, 000 in its lobbying efforts in Q 1 of 2008 in Congress to forward the agenda of the "enterprise" EHR. So those that are contemplating on working with this process- don’t! URL for the CCHIT original charter and minutes demonstrating how not-for-profit CCHIT was going to make a profit in 2006: http: //msofficeemrproject. com/Page 3. htm Slide # 11

DID YOU KNOW? CCHIT Facts According to Histalk: Incorporated as an LLC in 2004, reincorporated as a non-profit C -corporation in 2006. CCHIT’s address on the tax form is 200 S. Wacker Drive, Chicago, IL 60606. CCHIT took in $4. 7 million in FY 2007, spent $3. 6 million of that, and banked $1. 1 million, bringing its fund balance up to $2. 7 million and total assets of $3. 4 million. Of the $4. 7 million in income, $2 million was from certification fees, $2. 7 million was from government contracts. CCHIT reported $866 K transferred to AHIMA (the “enterprise” EHR vendor lobbying group) in a category that includes sharing of equipment, facilities, or employees. HIMSS received $196 K for a category that includes performance of membership services. http: //histalk 2. com/2009/02/21/monday-morning-update-22309/ Slide # 12

DID YOU KNOW? CCHIT Facts According to Histalk: The tax records indicate that CCHIT chair Mark Leavitt is still a HIMSS employee, "on leave from his position as HIMSS’ Chief Medical Officer while serving as Chair of CCHIT pays HIMSS an hourly rate for Dr. Leavitt’s services that is intended to cover the portion of his salary and benefits allocable to those hours. " That’s at odds with both his CCHIT bio and his Linked. In write-up, which say he’s finished with HIMSS and working full-time for CCHIT (he put on Linked. In that he left HIMSS in September 2005), although on tax forms he is shown as being paid $164 K for 40 hours a week at CCHIT, possibly more. http: //histalk 2. com/2009/02/21/monday-morning-update-22309/ Slide # 13

FACTS: THE ECONOMICS ABOUT BUYING A c -EMR SOFTWARE SYSTEM

DID YOU KNOW? If you try to take advantage of the Stark Law Relaxation to allow hospitals to buy you an EMR… First you have to find a hospital willing to donate money to your cause. By law, the most that the hospital can buy is 85% of the initial outlay of the EMR. The hospital will not cover the training, which can cost as much as the EMR itself. You still have to pay forü The yearly ongoing fees, usually costing about 15% of the initial cost. ü The cost of the hardware which can handle an SQL server backend, plus the technical assistance to make it work. You still have the loss of productivity associated with workflow disruption that in many cases does not improve with time. The response to date has been lukewarm due to both hospital and physician reluctance to enter into binding agreements, costs, and problems related to patient confidentiality. http: //www. hschange. com/CONTENT/1015/ Slide # 15

DID YOU KNOW? Multiple Vendors Claim: “Physicians need to understand that this is an investment, so they will not only make their initial costs back, but in the next five years, they could make an extra $125, 000!” As stated in the previous slide, the initial and ongoing costs provide a large hurdle to overcome before a provider begins to “make money”. Just the 50% failed installation rate, the 8% deinstallation rate, and for those that do install the EMR, the 90% less-than-full use, and lastly the loss of productive workflow, alone will kill any possible increased income using an expensive CCHIT-certified EHR. In 2 case studies published at the www. aafp. com site, the total outlay just for the technology was reported to cost anywhere between $125, 000. 00 to as much as a $250, 000. 00 for 2 doctors over the first 5 years (2002 dollars). • The two aafp website articles referenced above: http: //www. aafp. org/fpm/20020400/57 howm. html and http: //www. aafp. org/fpm/20030500/37 impl. html) • http: //www. emrupdate. com/blogs/ducknet/archive/2008/10/01/ehradoption-remains-off-in-the-distance-getting-way-to-complicated. aspx Slide # 16

DID YOU KNOW? The 2/13/2009 stimulus bill’s $44, 000. 00 incentive payment for “significant use” of a c-EHR may seem like a lot, but not really… The current (2009) estimated average cost of purchasing an EHR system is $33, 000 for each physician, with an additional cost of $1, 500 per doctor per month for maintenance. So if you do the math, $33000. 00 plus $1500 x 60 months = $123000. 00 (http: //blog. case. edu/case-news/2008/10/30/ehrregulation) Add to that 1/3 of a full-time employee to follow the trail of the reporting and documentation, and it comes out to another $10000. 00/year x 5 years = $50, 000. 00 Workflow losses: The costs of P 4 P with the added extra data input needed to capture the “granular data” is an estimate, as the specifics haven’t been posted yet, but say it takes an extra 5 minutes per encounter. An office grossing $100, 000. 00 a year in Medicare funds, at $100. 00 per encounter, equals to 1000 encounters. Do the math again- 1000 x 5 min/encounter = 5000 minutes; 5000/20 min per encounter = 250 “lost” encounters, or another $25000. 00/year x 5 years = $125, 000. 00 Total losses over 5 years: $298, 000. 00 http: //www. hcplive. com/mdnglive/articles/PC_Medicare_HIT_mandate Slide # 17

FACTS ABOUT EEHR SOFTWARE SYSTEMS AND QUALITY

DID YOU KNOW? Big government, EHR vendors, health insurers, and Presidents Bush & Obama all believe that EHR software systems improve quality & save lives… But there is not one prospective study demonstrating this fact. There are several showing the opposite, s. a. ü ü In one study published in 2005 involved a pediatrics ICU using EHR and CPOE systems. The final result was that more children died using HIT- “Univariate analysis revealed that mortality rate significantly increased from 2. 80% (39 of 1394) before CPOE implementation to 6. 57% (36 of 548) after CPOE implementation. ” In another study, the CPOE system was so bad that physicians could not put in the orders in a timely manner, and after only 3 months the whole project was discontinued. See “Cedars-Sinai Doctors Cling to Pen and Paper” URL below. • Pediatrics, Vol. 116, No. 6. (December 2005), pp. 1506 -1512, http: //www. citeulike. org/user/scheufele/article/505501 • http: //www. washingtonpost. com/wp-dyn/articles/A 52384 -2005 Mar 20. html? sub=AR Slide # 19

DID YOU KNOW? Big government, EHR vendors, health insurers, and Presidents Bush & Obama all believe that EHR software systems improve quality & save lives… (continued) In 2007 one study, published in the Archives of Internal Medicine, showed that for 14 of the 17 quality indicators, there was no significant difference in performance between visits with vs. without EHR use. In 2008 a study performed at the Richmond, VA MCV/University of Richmond Medical Center they concluded that for 10 quality indicators, “… there is limited evidence of the relationship between hospital EMR use and quality. ” • http: //archinte. ama-assn. org/cgi/content/abstract/167/13/1400 • http: //mcr. sagepub. com/cgi/content/abstract/65/4/496 Slide # 20

DID YOU KNOW? One study “finally showed” that EMR software systems might lower malpractice risk… But this was a retrospective study which involved varied amounts of EMR use by practitioners. The survey response rate was only 71. 4% (1345 of 1884), and only 1140 respondents of these had significant data on the presence of EHR. The purported 40% reduction was not statistically significant: “ In logistic regression analysis controlling for sex, race, year of medical school graduation, specialty, and practice size, the relationship between EHR adoption and paid malpractice settlements was of smaller magnitude and no longer statistically significant (adjusted odds ratio, 0. 69; 95% confidence interval, 0. 40 -1. 20; P =. 18). ” A subgroup analysis revealed that although only 5. 7% of frequent EMR users had paid malpractice claims, compared to 10. 8% of those not using an EMR, those that infrequently/partially used an EMR (s. a. "hybrid systems") faired WORSE than those using only paper records (12. 1%). The facts remain that despite the cheerleading for EMR software systems there’s still not a shred of evidence they have a significant impact on outcomes that matter. http: //archinte. ama-assn. org/cgi/content/abstract/168/21/2362 Slide # 21

DID YOU KNOW? On the contrary, another more recent study showed the opposite- that “EMR software systems pose new legal risks” “For one thing, an overarching concern is that Federal Rules of Civil Procedure, approved by the U. S. Supreme Court in December 2006, make any electronically-stored data discoverable in a trial--and those details can catch doctors off guard. ” Doctors may run into problems if the EMR software systems’ metadata (the time stamp indicating who entered what and when) conflicts with his or her version of events. “Perhaps even more vexing, it's still not clear what the legal status of an EMR is. At present, it's still in question whether all EMR software systems meet the legal definition of being medical records, a concern that could become important in some forms of legal disputes over patient care. ” http: //www. fiercehealthit. com/story/emrs-pose-new-legal-risks/2008 -10 -06 Slide # 22

DID YOU KNOW? On 7/2008 Congress passed a bill forcing doctors to use e-prescribing or suffer a cut in reimbursement… This bill was pure politics at its worse. For most practitioners, e-prescribing is a workflow slowing tedious procedure. Allscripts claims that they offer a “free” system, but it’s a marketing ploy. Its database is not “open source” and no plans are in the works to make it accessible to most EMR software systems so as to prevent double entry. This "free" e-prescribing is what convinced Congress to put eprescribing on their recent 7/2008 HR 6331 bill. Although on 7/2008 there were up to 10% of physicians capable of eprescribing, only 2% of prescriptions actually were legitimately sent by eprescribing as described by law. It was meant to make a transition from handwritten prescriptions to a format that was more legible overall, but what is not known is why they prohibited the faxing or simple printing of prescriptions from an EMR? https: //md. sermo. com/medical/ticket/details? nav=on&id=21117 Slide # 23

FACT: C-EHR SOFTWARE SYSTEM AGENDAS HAVE MORE TO DO WITH POWER, MONEY, AND GREED

DID YOU KNOW? There is a dark side to the certified EHR software systems currently being pushed by President Obama- a World Where Money Buys Power, Greed, and the Ability to Manipulate the President of the United States: You have to follow the money. The internet first mentions a relationship that Obama has had with a technology guy call Robert Blackwell who kept him, a newly minted lawyer, on retainer. Blackwell seemed to later get quid pro quo payments where his company, EKI (“Electronic Knowledge Interchange”) profited. EKI is a business and technology consulting firm that specializes in delivering measurable business value to mid to large size corporate and government organizations, which is something that Obama wants to bring to health care through the use of c-EHR systems. Obama’s presidential campaign website reported that Blackwell in 2008 committed to raise between $100, 000 and $200, 000 for Obama’s White House run that year. I'm sure that eventually we'll be hearing more of this Blackwell relationship. • http: //citizenwells. wordpress. com/2008/04/29/robert-blackwell-obama-moneylaundering-eki-consulting-rod-blagojevich-illinois-tony-rezko/ • http: //news. lavenderliberal. com/2008/04/27/obama-supporters-how-do-you-justifybarrys-blackwell-eki-killerspin-wheeling-and-dealing/ Slide # 25

DID YOU KNOW? There is a dark side to the certified EHR software systems currently being pushed by President Obama- a World Where Money Buys Power, Greed, and the Ability to Manipulate the President of the United States: TULLMAN: Shortly after Obama gets elected, he makes Glen Tullman, CEO of Allscripts, his personal IT advisor. Mr. Tullman personally gave President Obama at least $144300. 00 in donations in the 2 years prior to his election. His employees gave $20662 during the same period. His company, Allscripts/Misys also gave the possible future HHS Secretary Daschle $12000 speaking fees on 8/2008 for a lecture. This lobbying put him into the unusual position where he can influence legislation which can ultimately enrich himself by forcing the use of eprescribing and c-EHR systems while the American taxpayer, and especially doctors have to foot the bill. • http: //histalk 2. com/2009/02/05/histalk-interviews-glen-tullman-ceo-of-allscripts 2509/ • http: //hotair. com/archives/2008/04/27/an-obama-payoff/ • http: //www. talkleft. com/story/2008/4/27/145012/154 • http: //www. obamamustgo. com/ • http: //www. discoverthenetworks. org/Articles/blackwell 5. html • http: //www. campaignmoney. com/political/contributions/glen-tullman. asp? cycle=08 • http: //fundrace. huffingtonpost. com/neighbors. php? type=emp&employer=ALLSCRIPTS • http: //www. democraticunderground. com/discuss/duboard. php? az=view_all&address=389 x 4968435 Slide # 26

DID YOU KNOW? There is a dark side to the certified EHR software systems currently being pushed by President Obama- a World Where Money Buys Power, Greed, and the Ability to Manipulate the President of the United States: On a more recent note, several of Obama's health information technology related appointees have been found to be "problematic" (I'm trying to be kind here): DASCHLE: Allscripts/Misys (CEO Glen Tullman's company) also gave the possible future HHS Secretary Daschle $12, 000. 00 speaking fees on 8/2008 for a lecture. Fortunately "buy me out" Daschle failed to pay his taxes, so he had to resign. KUNDRA: On 3/10/2009 the FBI raided the former office of one of President Obama's appointees, Vivek Kundra. An employee of the D. C. Office of the Chief Technology Officer and a private contractor were charged with corruption, including bribery of a public official, money laundering, wire fraud and conflict of interest. As the raid took place, Obama's appointee, Kundra, was giving a speech at FOSE - an annual government technology expo - about changing the way the government purchases materials from vendors. Kundra is on leave from his White House job until further details of the case become known, a White House source told the Associated Press. He was at the job only 7 days before this occurred; if he stays on, he would be an integral part of the push to c-EHRs. §http: //www. democraticunderground. com/discuss/duboard. php? az=view_all&address=389 x 4968435 §http: //voices. washingtonpost. com/posttech/2009/03/vivek_kundra_to_be_obamas_chie. html http: //voices. washingtonpost. com/posttech/2009/03/vivek_kundra_to_be_obamas_ chie. html §http: //www. huffingtonpost. com/2009/03/12/fbi-raids-obama-technolog_n_174265. html §http: //groups. google. com/group/alt. politics. democrats. d/browse_thread/6 c 3 ddc 4 a 3 f 4 bee 10 Slide # 27

DID YOU KNOW? There is a dark side to the certified EHR software systems currently being pushed by President Obama- a World Where Money Buys Power, Greed, and the Ability to Manipulate the President of the United States: Other lobbyists include: DEPARLE: President Obama's health technology "czar", Nancy-Ann De. Parle, has some deep financial ties to the healthcare industry she’s supposed to reform. Among them is the fact that she served as a Cerner board member since 2001 and that she was paid $195 K in stock and cash and held around $1 million of CERN shares at the end of 2007. She donated $39, 400. 00 to various Democratic party officials. On 3/6/2009 she resigned from Cerner's board. BLUMENTHAL: President Obama recently selected David Blumenthal M. D. , to serve as national coordinator within the U. S. Department of Health and Human Services. Blumenthal was director of the Institute for Health Policy at Massachusetts General Hospital in Boston, part of Partners. An interesting disclosure: he is receiving grant support from GE Healthcare. §http: //content. nejm. org/cgi/content/full/NEJMp 0901592 §http: //www. chicagotribune. com/news/nationworld/chi-deparlemar 29, 0, 7090806. story §http: //www. histalkpractice. com/2009/03/02/news-3309/ §http: //www. campaignmoney. com/finance. asp? type=in&cycle=08&criteria=De. Parle Slide # 28

DID YOU KNOW? There is a dark side to the certified EHR software systems currently being pushed by President Obama- a World Where Money Buys Power, Greed, and the Ability to Manipulate the President of the United States: An editor from the Chicago Tribune questions how De. Parle and others in this administration can avoid conflicts of interest, particularly given the size and market share of some of the firms they have served. "What the administration is going to have to guard against is this perception that there is some benefit given to companies who know people in the administration. " http: //www. chicagotribune. com/news/nationworld/chi-deparlemar 29, 0, 7090806. story Slide # 29

DID YOU KNOW? There is a dark side to the certified EHR software systems currently being pushed by President Obama- a World Where Money Buys Power, Greed, and the Ability to Manipulate the President of the United States: FRIEDEN: Dr. Thomas Frieden, M. D. , an infectious disease specialist, who worked at the CDC from 1990 to 2002 as an Epidemiologic Intelligence Service Officer investigating a range of issues include the spread of multidrug-resistant tuberculosis, who served as the former Chairman of the New York City Department of Health and Mental Hygiene since January 2002, has been named by President Obama as the director of the Centers for Disease Control and Prevention. Frieden has been a strong advocate of electronic health records, and as such his department two years ago signed a $19. 8 million contract to fund deployment in underserved areas of integrated practice management/electronic records software from e. Clinical. Works Inc. (e. CW), Westborough, Mass. I suspect that he will be the fourth c-EHR system lobbyist surrounding Obama, representing e. CW. To date I was not able to find the exact behind the scenes reason for his strong patronage of this particular EMR… but I’m still looking. http: //www. healthdatamanagement. com/news/CDC-282101. html? ET=healthdatamanagement: e 872: 555 a: &st=email&channel=disease_management Slide # 30

DID YOU KNOW? There is a dark side to the certified EHR software systems currently being pushed by President Obama- a World Where Money Buys Power, Greed, and the Ability to Manipulate the President of the United States: GLASER: Mr. John Glaser, VP & CIO Partners Healthcare in Boston was appointed to a 6 month stint as an adviser to David Blumenthal, the recently appointed national coordinator for HIT. Glaser will spend 4 days/week for 6 months working with ONC. Blumenthal, a practicing physician and Harvard Medical School professor most recently worked for Partners Health. Care as director of the Institute for Health Policy at Massachusetts General Hospital. Glaser is a fellow of HIMSS, CHIME and the American College of Medical Informatics. He also serves on the editorial board of Healthcare IT News and is a regular columnist at www. histalk. com. http: //www. healthcareitnews. com/news/glaser-advise-onc-chief-hitech Slide # 31

DID YOU KNOW? There is a dark side to the certified EHR software systems currently being pushed by President Obama- a World Where Money Buys Power, Greed, and the Ability to Manipulate the President of the United States: PARK: On 8/3/2009 Mr. Todd Park, co-founder and board member of Athenahealth, has been named CTO of the US Department of Health and Human Services. He resigned from Athenahealth’s board on 8/10/2009 and had promised to divest his Athenahealth stock position. Park will report to Deputy HHS Secretary William. Athenahealth (Nasdaq: ATHN), another “enterprise” level EHR vendor is a leading provider of internet based business services for physician practices, and received the 2008 Certification Commission for Healthcare Information Technology (CCHIT) for its Athena. Clinicals. SM Version 9. 15. 1. http: //histalk 2. com/2009/08/03/todd-park-athenahealth-co-founder-named-cto-of-hhs/ Slide # 32

SUMMARY FACT STATEMENTS

EMR FACT SUMMARY List of quick facts about EMR: Physicians do NOT like c-EHR systems. EMR does NOT save time. EMR does NOT improve workflow, and most likely will make it worse. EMR does NOT save money, especially for the doctor. EMR does NOT make a physician money and will NOT offer a ROI. EMR has NOT been demonstrated to improve quality of care over paper in prospective studies when looking at the same quality measures. EMR does NOT prevent redundant testing. EMR does NOT lessen your risk of malpractice litigation. • https: //md. sermo. com/medical/ticket/details? nav=on&id=24242 • https: //md. sermo. com/medical/ticket/details? nav=on&id=31562 Slide 34

EMR FACT SUMMARY More of the list of quick facts about EMR: EMR does NOT save paper. EMR CAN bring organization to an office. EMR WILL print out a hell of a 3 page consultation on an OV for a sore throat, whether or not the patient was seen. EMR WILL erode the patient privacy and make everyone's file available to government, insurance companies, and anyone else who wants to see it. The c-EHR agenda has more to do with power, money, and greed than with issues of quality, errors, and ROI. https: //md. sermo. com/medical/ticket/details? nav=on&id=31562 Slide 35

EMR FACT SUMMARY Finally, quotes from David C. Kibbe: "One has to question whether or not a vendorfounded, vendor-funded and vendor-driven organization should have the exclusive right to determine what software will be bought by federal taxpayer dollars. “ "It's important that the people who determine how this money is spent are disinterested and unbiased. . . Even the appearance of a conflict of interest could poison the whole process. " http: //www. washingtonpost. com/wpdyn/content/article/2009/05/20/AR 2009052003600. html Dr. Borges in his organized office using his EMR! Slide 36

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