HealthBridge Appendix

HealthBridge CASE STUDY APPENDIX © Kelsey Jackson | April 17, 2024

ORIGINAL Compiled and cra昀琀ed in Secondary Research Project Empty Empty Program Empty Area Empty Due Date Empty Action Date Status Done 15 more properties Add Resources Kelsey Jackson | March 12, 2023 © Taking care of our providers through improved EHR systems Secondary Research The healthcare industry is constantly evolving with new standards, new diseases, new medications, new research studies, new medical technology, and, to top it off, new electronic Project Empty medical record systems (EHR/EMR). The best doctors and nurses are constantly fighting to stay Empty Program up-to-date on what’s new, all while dreaming of the day when charts aren’t demanding their attention. A 2021 study performed by the Journal of the American Medical Informatics Empty Area Association (JAMIA) found after-hours charting in EMR software “was significantly associated with physician burnout” ( JAMIA , 2021), and another study reported, “inefficient user interface Empty Due Date designs” requiring “too many clicks per task” or having to open “10 screens to do one task” Empty Action Date ( JAMIA , 2018). A poor relationship with one’s EHR is commonly “associated with intent to reduce clinical work hours and leave one’s current practice” ( JAMIA , 2019), so keeping providers Status Done satisfied with an EHR is critical for a practice to maintain its workforce. 15 more properties While the EHR greatly impacts provider job satisfaction, the pandemic brought the healthcare burnout crisis to the surface. With the rising demand and need for timely care, healthcare workers are being stretched far too thin, contributing to further rates of burnout. Providers that Add Resources fall into this category are often leaving the industry altogether to pursue a healthier lifestyle for Kelsey Jackson | March 12, 2023 © themselves. In total, the healthcare industry lost 30% of its workers during the pandemic ( Morning Consult , 2021), leading to less than satisfactory implications for accessible healthcare. Nearly 70% of all Americans have suffered delays from staffing shortages with “canceled Taking care of our providers through improved EHR systems appointments” and “delayed surgeries” ( Axios , 2022). The healthcare industry is constantly evolving with new standards, new diseases, new When reviewing the demographics of this short-staffed industry, it is reported that the average medications, new research studies, new medical technology, and, to top it off, new electronic age of the U.S. healthcare worker is 49 years old ( Zippia , 2023), with 45% of the workforce at medical record systems (EHR/EMR). The best doctors and nurses are constantly fighting to stay age 55 and older nearing “retirement age” ( Verywell Health , 2023). If almost half of the up-to-date on what’s new, all while dreaming of the day when charts aren’t demanding their healthcare workers are in their last ten years of service, where does that leave the US healthcare attention. A 2021 study performed by the Journal of the American Medical Informatics system in the future? Projections reveal that the US could face “a shortage of up to 124,000 Association (JAMIA) found after-hours charting in EMR software “was significantly associated physicians by 2034, including 48,000 primary care physicians” ( Healthcare Dive , 2023). Labor with physician burnout” ( JAMIA , 2021), and another study reported, “inefficient user interface shortages and burnout rates are jeopardizing the overall health of the US, and fewer students designs” requiring “too many clicks per task” or having to open “10 screens to do one task” want to enter the industry because of it. ( JAMIA , 2018). A poor relationship with one’s EHR is commonly “associated with intent to reduce clinical work hours and leave one’s current practice” ( JAMIA , 2019), so keeping providers Therefore, health organizations must now more than ever prioritize the quality of life for their satisfied with an EHR is critical for a practice to maintain its workforce. providers and find ways to make their job more efficient and sustainable. While a new EHR/EMR system can’t directly address the labor shortage, improving the tool healthcare providers use the While the EHR greatly impacts provider job satisfaction, the pandemic brought the healthcare most can be a great place to start. Better EHR/EMR experiences can reduce the threat of after- burnout crisis to the surface. With the rising demand and need for timely care, healthcare hours work while increasing overall clinical workflow efficiency. Charts, data entry, and workers are being stretched far too thin, contributing to further rates of burnout. Providers that Secondary Research administrative work can be less of a barrier to work/life balance issues for health care fall into this category are often leaving the industry altogether to pursue a healthier lifestyle for professionals, and their patient base can experience more accessible and higher quality health themselves. In total, the healthcare industry lost 30% of its workers during the pandemic care when they need it most. When EHRs provide an optimal experience to their users, the ( Morning Consult , 2021), leading to less than satisfactory implications for accessible healthcare. healthcare industry as a whole can have a greater chance of meeting the demand. Nearly 70% of all Americans have suffered delays from staffing shortages with “canceled appointments” and “delayed surgeries” ( Axios , 2022). When reviewing the demographics of this short-staffed industry, it is reported that the average age of the U.S. healthcare worker is 49 years old ( Zippia , 2023), with 45% of the workforce at Improving EHR’s patient portals with proactive symptom tracking age 55 and older nearing “retirement age” ( Verywell Health , 2023). If almost half of the and patient notifications healthcare workers are in their last ten years of service, where does that leave the US healthcare EHR systems and their respective patient portals provide a unique landscape for patients to system in the future? Projections reveal that the US could face “a shortage of up to 124,000 communicate with their providers. If patients had more ready access to their health data via physicians by 2034, including 48,000 primary care physicians” ( Healthcare Dive , 2023). Labor mobile view or app ( JAMIA Open , 2022), they could more conveniently report their day-to-day shortages and burnout rates are jeopardizing the overall health of the US, and fewer students symptoms and sync their smart device health data for providers to identify patterns. This extra want to enter the industry because of it. data would help provide a patient’s full wellness story rather than just simply seeing a snapshot Therefore, health organizations must now more than ever prioritize the quality of life for their in time from the data captured in their lab work. “Instead of a doctor measuring vital signs and providers and find ways to make their job more efficient and sustainable. While a new EHR/EMR asking questions, then typing away in an electronic health record, doctor and patient could sit system can’t directly address the labor shortage, improving the tool healthcare providers use the together and review the data the patient has collected” ( Forbes , 2021). This new feature can put most can be a great place to start. Better EHR/EMR experiences can reduce the threat of after- some of the administrative lift on the patients instead of the provider and present a more hours work while increasing overall clinical workflow efficiency. Charts, data entry, and collaborative environment for the doctor and patient. Patient portals can become centralized administrative work can be less of a barrier to work/life balance issues for health care hubs of a patient’s health data with higher adoption rates. With regular day-to-day use, patients professionals, and their patient base can experience more accessible and higher quality health will have less front-end paperwork before their next appointment. This introduces another care when they need it most. When EHRs provide an optimal experience to their users, the opportunity for a more efficient visit. healthcare industry as a whole can have a greater chance of meeting the demand. Improving EHR’s patient portals with proactive symptom tracking Competitive Landscape and patient notifications EHR systems and their respective patient portals provide a unique landscape for patients to Top Electronic Health Record Vendors communicate with their providers. If patients had more ready access to their health data via mobile view or app ( JAMIA Open , 2022), they could more conveniently report their day-to-day Rank Vendor % of Market symptoms and sync their smart device health data for providers to identify patterns. This extra data would help provide a patient’s full wellness story rather than just simply seeing a snapshot 1 Epic Systems Corporation (MyChart) 37% in time from the data captured in their lab work. “Instead of a doctor measuring vital signs and 2 Oracle Cerner 23% asking questions, then typing away in an electronic health record, doctor and patient could sit together and review the data the patient has collected” ( Forbes , 2021). This new feature can put 3 MEDITECH 15% some of the administrative lift on the patients instead of the provider and present a more 4 Evident 8% collaborative environment for the doctor and patient. Patient portals can become centralized hubs of a patient’s health data with higher adoption rates. With regular day-to-day use, patients 5 MEDHOST 5% will have less front-end paperwork before their next appointment. This introduces another 6 Altera Digital Health 4% opportunity for a more efficient visit. 7 Netsmart Technology 3% 8 Proprietary Software 2% 9 Aetna Health 2% Competitive Landscape 10 Allscripts 1% Top Electronic Health Record Vendors https://www.definitivehc.com/blog/most-common-inpatient-ehr-systems Rank Vendor % of Market Largest Health Systems in the US and Their Chosen EHR/EMR Software 1 Epic Systems Corporation (MyChart) 37% 2 Oracle Cerner 23% Health Network Hospitals EMR Sources 3 MEDITECH 15% HCA Healthcare 182 Commure PatientKeeper 4 Evident 8% Veterans Health 171 VistA to Oracle https://www.healthcareitnews.com/news/house-bill- 5 MEDHOST 5% Administration Cerner to VistA would-put-stop-va-ehr-modernization 6 Altera Digital Health 4% Encompass Health 143 Oracle Cerner 7 Netsmart Technology 3% Ascension Health 143 Oracle Cerner https://www.healthcaredive.com/news/ascension- expands-pilot-of-google-ehr-search-tool/595726/ 8 Proprietary Software 2% https://healthcarecouncil.com/cerner-ascension-execs- 9 Aetna Health 2% call-for-ehr-standardization/ 10 Allscripts 1% CommonSpirit 140 Epic MyChart Health https://www.definitivehc.com/blog/most-common-inpatient-ehr-systems Select Medical 134 Epic MyChart Corporation Trinity Health 92 Epic MyChart Largest Health Systems in the US and Their Chosen EHR/EMR Software Community Health 79 Oracle Cerner Health Network Hospitals EMR Sources Services HCA Healthcare 182 Commure Scion Health 79 ProTouch/NetSmart https://www.kindredhospitals.com/about-us/news/ PatientKeeper (LifePoint, & PinPoint 2018/12/18/kindred-healthcare-and-netsmart-partner- Cornerstone, to-create-next-generation-post-acute-platform Veterans Health 171 VistA to Oracle https://www.healthcareitnews.com/news/house-bill- Kindred) Administration Cerner to VistA would-put-stop-va-ehr-modernization https://lifepointhealth.net/news/lifepoint-health-and- kindred-healthcare-to-launch-new-company- Encompass Health 143 Oracle Cerner scionhealth#:~:text=LifePoint Health and Kindred Ascension Health 143 Oracle Cerner https://www.healthcaredive.com/news/ascension- Healthcare to Launch New Company ScionHealth | expands-pilot-of-google-ehr-search-tool/595726/ Lifepoint Health https://healthcarecouncil.com/cerner-ascension-execs- https://lifepointhealth.net/technology-and-operations- call-for-ehr-standardization/ tools#:~:text=Pinpoint,for a behavioral health facility . CommonSpirit 140 Epic MyChart Advocate Health 67 Cerner to Epic https://www.fiercehealthcare.com/ehr/advocate-health- Health MyChart care-aurora-healthcare-epic-ehr-merger-care- coordination Select Medical 134 Epic MyChart Corporation Tenet Healthcare 61 Oracle Cerner https://www.modernhealthcare.com/article/20190207/ NEWS/190209943/tenet-extends-long-term-contract- Trinity Health 92 Epic MyChart with-cerner Community Health 79 Oracle Cerner Christus Health 60 Epic MyChart Services Providence Health & 52 Epic MyChart Scion Health 79 ProTouch/NetSmart https://www.kindredhospitals.com/about-us/news/ Services (LifePoint, & PinPoint 2018/12/18/kindred-healthcare-and-netsmart-partner- Cornerstone, to-create-next-generation-post-acute-platform Kindred) https://www.hospitalmanagement.net/features/top-ten-largest-health-systems-in-the-us-by- https://lifepointhealth.net/news/lifepoint-health-and- number-of-hospitals-affiliated/ kindred-healthcare-to-launch-new-company- https://www.healthgrades.com/pro/the-10-largest-health-systems-in-the-us scionhealth#:~:text=LifePoint Health and Kindred Healthcare to Launch New Company ScionHealth | Lifepoint Health Competitive Analysis https://lifepointhealth.net/technology-and-operations- tools#:~:text=Pinpoint,for a behavioral health facility . Feature Epic Cerner MEDITECH MEDHOST VistA Advocate Health 67 Cerner to Epic https://www.fiercehealthcare.com/ehr/advocate-health- Clinical MyChart care-aurora-healthcare-epic-ehr-merger-care- ✔ ✔ ✔ ✔ Workflow coordination Management Tenet Healthcare 61 Oracle Cerner https://www.modernhealthcare.com/article/20190207/ Electronic NEWS/190209943/tenet-extends-long-term-contract- ✔ ✔ ✔ ✔ Prescriptions with-cerner Billing Christus Health 60 Epic MyChart ✔ ✔ ✔ ✔ ✔ Scheduling Providence Health & 52 Epic MyChart ✔ ✔ ✔ ✔ Services Specialty 24 50 Modules https://www.hospitalmanagement.net/features/top-ten-largest-health-systems-in-the-us-by- Mobile Access Coming Soon ✔ ✔ ✔ number-of-hospitals-affiliated/ Artificial ✔ ✔ ✔ https://www.healthgrades.com/pro/the-10-largest-health-systems-in-the-us Intelligence Pros Most used EHR, Secure, Simple and Simple Efficient and AI, Niche collaborative customizable secure Competitive Analysis Specialty and user friendly Feature Epic Cerner MEDITECH MEDHOST VistA Cons Expensive, no Slow technology, Not user- Old school More training ERP system, support and friendly, lacks in interface, required, old Clinical ✔ ✔ ✔ ✔ difficult updates features, old integrations school interface Workflow implementation school interface lacking Management and data migration Electronic ✔ ✔ ✔ ✔ Prescriptions https://digitalhealth.folio3.com/blog/cerner-vs-epic-pros-and-cons/ Billing ✔ ✔ ✔ ✔ ✔ #3_Things_You_Dont_Know_About_Cerner_And_Epic Scheduling ✔ ✔ ✔ ✔ https://hitconsultant.net/2014/07/24/physicians-prefer-the-vas-ehr/ Specialty 24 50 https://www.wired.com/story/va-vista-medical-records-flaw/ Modules Mobile Access Coming Soon ✔ ✔ ✔ Artificial ✔ ✔ ✔ Intelligence Sources Pros Most used EHR, Secure, Simple and Simple Efficient and AI, Niche collaborative customizable secure H. C Eschenroeder, Jr, Lauren C Manzione, Julia Adler-Milstein, Connor Bice, Robert Cash, Specialty and user friendly Cole Duda, Craig Joseph, John S Lee, Amy Maneker, Karl A Poterack, Sarah B Rahman, Jacob Jeppson, Christopher Longhurst, Associations of physician burnout with Cons Expensive, no Slow technology, Not user- Old school More training organizational electronic health record support and after-hours charting , Journal of the ERP system, support and friendly, lacks in interface, required, old difficult updates features, old integrations school interface American Medical Informatics Association , Volume 28, Issue 5, May 2021, Pages 960– implementation school interface lacking 966, https://doi.org/10.1093/jamia/ocab053 and data Philip J Kroth, Nancy Morioka-Douglas, Sharry Veres, Katherine Pollock, Stewart Babbott, migration Sara Poplau, Katherine Corrigan, Mark Linzer, The electronic elephant in the room: Physicians and the electronic health record , JAMIA Open , Volume 1, Issue 1, July 2018, https://digitalhealth.folio3.com/blog/cerner-vs-epic-pros-and-cons/ Pages 49–56, https://doi.org/10.1093/jamiaopen/ooy016 #3_Things_You_Dont_Know_About_Cerner_And_Epic Rebekah L Gardner, Emily Cooper, Jacqueline Haskell, Daniel A Harris, Sara Poplau, Philip J https://hitconsultant.net/2014/07/24/physicians-prefer-the-vas-ehr/ Kroth, Mark Linzer, Physician stress and burnout: the impact of health information https://www.wired.com/story/va-vista-medical-records-flaw/ technology , Journal of the American Medical Informatics Association , Volume 26, Issue 2, February 2019, Pages 106—114, https://doi.org/10.1093/jamia/ocy145 Dennis Thompson, The 'Great Resignation' Is Taking a Toll on U.S. Health Care, HealthDay News via U.S. News & World Report , December 1, 2022, https://www.usnews.com/news/ health-news/articles/2022-12-01/the-great-resignation-is-taking-a-toll-on-u-s-health-care Sources Gabby Galvin, Nearly 1 in 5 Health Care Workers Have Quit Their Jobs During the H. C Eschenroeder, Jr, Lauren C Manzione, Julia Adler-Milstein, Connor Bice, Robert Cash, Pandemic, Morning Consult , October 4, 2021, https://morningconsult.com/2021/10/04/ Cole Duda, Craig Joseph, John S Lee, Amy Maneker, Karl A Poterack, Sarah B Rahman, health-care-workers-series-part-2-workforce/ Jacob Jeppson, Christopher Longhurst, Associations of physician burnout with Tina Reed, The health worker shortage is starting to get real for Americans, Axios , March organizational electronic health record support and after-hours charting , Journal of the 7, 2022, https://www.axios.com/2022/03/07/the-health-worker-shortage-is-starting-to-get- American Medical Informatics Association , Volume 28, Issue 5, May 2021, Pages 960– real-for-americans 966, https://doi.org/10.1093/jamia/ocab053 Tina Reed, Health workforce shortages begin to weigh on patient safety, Axios , March 28, Philip J Kroth, Nancy Morioka-Douglas, Sharry Veres, Katherine Pollock, Stewart Babbott, 2022, https://www.axios.com/2022/03/28/health-workforce-shortages-begin-to-weigh-on- Sara Poplau, Katherine Corrigan, Mark Linzer, The electronic elephant in the room: patient-safety Physicians and the electronic health record , JAMIA Open , Volume 1, Issue 1, July 2018, Pages 49–56, https://doi.org/10.1093/jamiaopen/ooy016 Hailey Mensik, Lawmakers stress urgency of healthcare worker shortage, Healthcare Dive , February 16, 2023, https://www.healthcaredive.com/news/lawmakers-fixes-healthcare- Rebekah L Gardner, Emily Cooper, Jacqueline Haskell, Daniel A Harris, Sara Poplau, Philip J workforce-shortages/642994/#:~:text=The country faces a shortage,drive them to other Kroth, Mark Linzer, Physician stress and burnout: the impact of health information roles technology , Journal of the American Medical Informatics Association , Volume 26, Issue 2, February 2019, Pages 106—114, https://doi.org/10.1093/jamia/ocy145 Health Care Provider Demographics & Statistics in the US, Zippia , 2023, https:// www.zippia.com/health-care-provider-jobs/demographics/ Dennis Thompson, The 'Great Resignation' Is Taking a Toll on U.S. Health Care, HealthDay News via U.S. News & World Report , December 1, 2022, https://www.usnews.com/news/ Rachel Murphy, Why Does It Take So Long to Schedule a Doctor's Appointment?, Verywell health-news/articles/2022-12-01/the-great-resignation-is-taking-a-toll-on-u-s-health-care Health, March 8, 2023, https://www.verywellhealth.com/why-is-the-wait-so-long-for- doctors-appointments-7113418 Gabby Galvin, Nearly 1 in 5 Health Care Workers Have Quit Their Jobs During the Pandemic, Morning Consult , October 4, 2021, https://morningconsult.com/2021/10/04/ Dani Zoorob, Yasmin Hasbini, Katherine Chen, Victoria Wangia-Anderson, Hind Moussa, health-care-workers-series-part-2-workforce/ Brian Miller, Debi Brobst, Ageism in healthcare technology: the older patients’ aspirations for improved online accessibility , JAMIA Open Tina Reed, The health worker shortage is starting to get real for Americans, Axios , March , Volume 5, Issue 3, October 2022, ooac061, https://doi.org/10.1093/jamiaopen/ooac061 7, 2022, https://www.axios.com/2022/03/07/the-health-worker-shortage-is-starting-to-get- real-for-americans Adnan Asar, How Digital Symptom Tracking Is Remaking Medicine For The Better , Forbes , January 21, 2021, https://www.forbes.com/sites/forbestechcouncil/2021/01/21/how-digital- Tina Reed, Health workforce shortages begin to weigh on patient safety, Axios , March 28, symptom-tracking-is-remaking-medicine-for-the-better/?sh=64fc6f881655 2022, https://www.axios.com/2022/03/28/health-workforce-shortages-begin-to-weigh-on- patient-safety Hailey Mensik, Lawmakers stress urgency of healthcare worker shortage, Healthcare Dive , February 16, 2023, https://www.healthcaredive.com/news/lawmakers-fixes-healthcare- workforce-shortages/642994/#:~:text=The country faces a shortage,drive them to other roles Health Care Provider Demographics & Statistics in the US, Zippia , 2023, https:// www.zippia.com/health-care-provider-jobs/demographics/ Rachel Murphy, Why Does It Take So Long to Schedule a Doctor's Appointment?, Verywell Health, March 8, 2023, https://www.verywellhealth.com/why-is-the-wait-so-long-for- doctors-appointments-7113418 Dani Zoorob, Yasmin Hasbini, Katherine Chen, Victoria Wangia-Anderson, Hind Moussa, Brian Miller, Debi Brobst, Ageism in healthcare technology: the older patients’ aspirations for improved online accessibility , JAMIA Open , Volume 5, Issue 3, October 2022, ooac061, https://doi.org/10.1093/jamiaopen/ooac061 Adnan Asar, How Digital Symptom Tracking Is Remaking Medicine For The Better , Forbes , January 21, 2021, https://www.forbes.com/sites/forbestechcouncil/2021/01/21/how-digital- symptom-tracking-is-remaking-medicine-for-the-better/?sh=64fc6f881655

Taking care of our providers through improved EHR systems The healthcare industry is constantly evolving with When reviewing the demographics of this new standards, new diseases, new medications, short-sta昀昀ed industry, it is reported that the new research studies, new medical technology, average age of the U.S. healthcare worker and, to top it o昀昀, new electronic medical record is 49 years old (Zippia, 2023), with 45% of systems (EHR/EMR). The best doctors and nurses the workforce at age 55 and older nearing are constantly 昀椀ghting to stay up-to-date on what’s “retirement age” (Verywell Health, 2023). If new, all while dreaming of the day when charts almost half of the healthcare workers are in aren’t demanding their attention. A 2021 study their last ten years of service, where does performed by the *Journal of the American Medical that leave the US healthcare system in the Informatics Association (JAMIA) found a昀琀er- future? Projections reveal that the US could hours charting in EMR so昀琀ware “was signi昀椀cantly face “a shortage of up to 124,000 physicians associated with physician burnout” (JAMIA, 2021), by 2034, including 48,000 primary care and another study reported, “ine昀케cient user physicians” (Healthcare Dive, 2023). Labor interface designs” requiring “too many clicks per shortages and burnout rates are jeopardizing task” or having to open “10 screens to do one the overall health of the US, and fewer task” (JAMIA, 2018). A poor relationship with students want to enter the industry because one’s EHR is commonly “associated with intent to of it. reduce clinical work hours and leave one’s current Therefore, health organizations must now practice” (JAMIA, 2019), so keeping providers more than ever prioritize the quality of life satis昀椀ed with an EHR is critical for a practice to maintain its workforce. for their providers and 昀椀nd ways to make their job more e昀케cient and sustainable. While the EHR greatly impacts provider job While a new EHR/EMR system can’t directly satisfaction, the pandemic brought the healthcare address the labor shortage, improving the burnout crisis to the surface. With the rising tool healthcare providers use the most can demand and need for timely care, healthcare be a great place to start. Better EHR/EMR workers are being stretched far too thin, experiences can reduce the threat of a昀琀er- contributing to further rates of burnout. Providers hours work while increasing overall clinical that fall into this category are o昀琀en leaving the work昀氀ow e昀케ciency. Charts, data entry, and industry altogether to pursue a healthier lifestyle administrative work can be less of a barrier for themselves. In total, the healthcare industry lost to work/life balance issues for health care 30% of its workers during the pandemic (*Morning professionals, and their patient base can Consult*, 2021), leading to less than satisfactory experience more accessible and higher implications for accessible healthcare. Nearly quality health care when they need it most. 70% of all Americans have su昀昀ered delays from When EHRs provide an optimal experience sta昀케ng shortages with “canceled appointments” to their users, the healthcare industry as a and “delayed surgeries” (Axios, 2022). whole can have a greater chance of meeting the demand.

Improving EHR’s patient portals with proactive symptom tracking and patient noti昀椀cations EHR systems and their respective patient portals provide a unique landscape for patients to communicate with their providers. If patients had more ready access to their health data via mobile view or app (*JAMIA Open*, 2022), they could more conveniently report their day- to-day symptoms and sync their smart device health data for providers to identify patterns. This extra data would help provide a patient’s full wellness story rather than just simply seeing a snapshot in time from the data captured in their lab work. “Instead of a doctor measuring vital signs and asking questions, then typing away in an electronic health record, doctor and patient could sit together and review the data the patient has collected” (*Forbes*, 2021). This new feature can put some of the administrative li昀琀 on the patients instead of the provider and present a more collaborative environment for the doctor and patient. Patient portals can become centralized hubs of a patient’s health data with higher adoption rates. With regular day-to-day use, patients will have less front-end paperwork before their next appointment. This introduces another opportunity for a more e昀케cient visit.

ORIGINAL Compiled and cra昀琀ed in Competitive Analysis

Top U.S. Electronic Health Largest U.S. Health Systems Record (EHR) Vendors and Chosen EHR Platform RANK VENDOR % OF MARKET HEALTH NETWORK # OF HOSPITALS CHOSEN EHR 1 Epic Systems Corporation (MyChart) 37% HCA Healthcare 182 Commure PatientKeeper Veterans Health Administration 171 VistA to Oracle Cerner to 2 Oracle Cerner 23% VistA 3 MEDITECH 15% Encompass Health 143 Oracle Cerner 4 Evident 8% Ascension Health 143 Oracle Cerner CommonSpirit Health 140 Epic MyChart 5 MEDHOST 5% Select Medical Corporation 134 Epic MyChart 6 Altera Digital Health 4% Trinity Health 92 Epic MyChart 7 Netsmart Technology 3% Community Health Services 79 Oracle Cerner 8 Proprietary So昀琀ware 2% Scion Health 79 ProTouch/NetSmart & 9 Aetna Health 2% (LifePoint, Cornerstone, Kindred) PinPoint Advocate Health 67 Cerner to Epic MyChart 10 Allscripts 1% Tenet Healthcare 61 Oracle Cerner Christus Health 60 Epic MyChart Providence Health & Services 52 Epic MyChart

Competitive Analysis FEATURE CLINICAL WORKFLOW MANAGEMENT ✓ ✓ ✓ ✓ ELECTRONIC PRESCRIPTIONS ✓ ✓ ✓ ✓ BILLING ✓ ✓ ✓ ✓ ✓ SCHEDULING ✓ ✓ ✓ ✓ SPECIALTY MODULES 24 50 MOBILE ACCESS ✓ Coming Soon ✓ ✓ ARTIFICIAL INTELLIGENCE ✓ ✓ ✓ PROS Most used EHR, AI, Secure, collaborative Simple and customizable Simple E昀케cient and secure Niche Specialty and user friendly Expensive, no ERP system, Slow technology, support Not user-friendly, lacks in Old school interface, More training required, CONS di昀케cult implementation and and updates features, old school interface integrations lacking old school interface data migration

ORIGINAL Compiled and cra昀琀ed in Avana Diaz ARCHETYPE Fatigued patient with suspected thyroid disease and Crohnʼs disease BIOGRAPHY Avana, has been a frequent patient and goes to the doctor more often than the average individual to seek treatment and further assess the state of her chronic conditions. She leaves the doctor with a QUOTE long list of tasks in her care plan from tracking symptoms and picking up prescriptions to scheduling image studies, “I am losing hope as I lab work, and specialist appointments. After leave appointments with calling the specialist office, the earliest more questions than appointment wasnʼt for another four months answers and given a Shelly Morrison, NP down the road meaning she would have to endure her symptoms until the next chance care plan that is met at finding answers and relief. She then with roadblocks and makes the call to schedule her imaging long wait times.ˮ ARCHETYPE study, only to find the doctor order was missing the required diagnostic code and Ambitious nurse practitioner and couldnʼt therefore book until she got it attentive mother corrected. The amount of administrative BIOGRAPHY Avana Diaz 1 Shelly, 32, is a high-performing individual with a carefully curated schedule. She works part-time at the urgent care which allows her to remain involved in her daughterʼs lives. As a nurse, she cares for User Personas every patient that comes to the practice and hopes to help make them feel better, even if itʼs only for the brief time she can provide care for them. After each appointment, QUOTE Shelly works quickly clicking through the pre-built EHR templates and sending prescriptions within 5 minutes. While she “I hope I can help believes the EHR system her practice uses people receive timely is outdated and cumbersome compared to care so they can start to Dr. Charles P. Thurston, MD others she used during residency, it provides enough stability and simplicity to feel better faster and allow her to leave her work at work. She can return to the healthiest end her day with peace of mind knowing version of themselves.ˮ ARCHETYPE Experienced physician and sacrificial friend Shelly Morrison, NP 1 BIOGRAPHY Charles, 64, is an experienced physician with over 35 years as a family doctor. Nearly the last third of his career has been a struggle to transition from paper to digital patient charting in EHR systems. While he QUOTE sees younger doctors left and right who have easily adapted, he is left doing over “Iʼm a better doctor double the work to keep up. Everyone loves Doctor Thurston, and he actively cares for using a pen and paper.ˮ his patients despite the extra work. In order to maintain the relationship and trust he brings to each patient interaction, he proactively makes notes from the EHR system on his legal pad before entering the room to provide full attention to the patient and avoid wrestling the EHR system in real time. He works on his patientsʼ charts up until he goes to bed, and even though he will miss caring for his patients, he looks Dr. Charles P. Thurston, MD 1

Dr. Charles P. Shelly Thurston, MD Morrison, NP Experienced physician and Ambitious nurse practitioner and sacri昀椀cial friend attentive mother BIOGRAPHY BIOGRAPHY Charles, 64, is an experienced physician with over Shelly, 32, is a high-performing individual with a 35 years as a family doctor. Nearly the last third of his carefully curated schedule. She works part-time at career has been a struggle to transition from paper the urgent care which allows her to remain involved to digital patient charting in EHR systems. While he in her daughter’s lives. As a nurse, she cares for sees younger doctors le昀琀 and right who have easily every patient that comes to the practice and hopes adapted, he is le昀琀 doing over double the work to to help make them feel better, even if it’s only for keep up. Everyone loves Doctor Thurston, and he the brief time she can provide care for them. A昀琀er actively cares for his patients despite the extra work. each appointment, Shelly works quickly clicking In order to maintain the relationship and trust he through the pre-built EHR templates and sending brings to each patient interaction, he proactively prescriptions within 5 minutes. While she believes QUOTE makes notes from the EHR system on his legal pad the EHR system her practice uses is outdated and “I hope I can help people receive before entering the room to provide full attention to QUOTE cumbersome compared to others she used during the patient and avoid wrestling the EHR system in real “I’m a better doctor using a residency, it provides enough stability and simplicity timely care so they can start to time. He works on his patients’ charts up until he goes pen and paper.” to allow her to leave her work at work. She can end feel better faster and return to to bed, and even though he will miss caring for his her day with peace of mind knowing her work and the healthiest version patients, he looks forward to the day where he can home life are both under control. of themselves.” retire and escape from the demands an EHR adds to his life. NEEDS & GOALS CHALLENGES & CONSIDERATIONS NEEDS & GOALS CHALLENGES & CONSIDERATIONS • Maintaining high-quality care standards despite • Multi-tasking during an appointment presents risk • Integrating with other systems to reference • Frequently starting from scratch with patient high patient volume to delivering high-quality care historical medication lists and 昀氀ag potential charts coming for urgent care means a lot of data • Simple, one-click actions to access current • Low aptitude with computers and technology interactions for future prescriptions entry before, during and a昀琀er the appointment. patient medical data means longer time to complete tasks • A less busy and updated look-and-feel to improve • New practitioners are overwhelmed with the • Preserved focus on patient instead of • Sitting and typing behind a computer screen EHR perceptions busyness and number of acronyms used. transcription and data entry into EHR during during an appointment is contrary to empathetic • Serving up data onscreen at the right time (and • With quick data capture, comes more regular appointments bedside manner removing the number of clicks to access data) will grammatical mistakes. • Visibility options to accommodate older eyes and • Scribes aren’t always available to doctors and allow for more attention on the patient prevent eye strain depends upon the practice • E昀케cient support for post-visit documentation • A昀琀er-hours work to complete administrative tasks tasks like a昀琀er visit summaries, prescriptions, brings increased threat of burnout and medical lab requests and results, imaging requests and error referral notes • Internal communication and chats from services • Less disruptive internal notes and messaging like Microso昀琀 Teams add more work and introduce controls to collaborate with others in the practice a way for doctors to be exploited by patients • Straightforward, customizable template builders heckling nurses that allow for personal notes regarding the patient

Avana Diaz Fatigued patient with suspected thyroid disease and Crohn’s disease BIOGRAPHY Avana, has been a frequent patient and goes to the doctor more o昀琀en than the average individual to seek treatment and further assess the state of her chronic conditions. She leaves the doctor with a long list of tasks in her care plan from tracking symptoms and picking up prescriptions to scheduling image studies, lab work, and specialist appointments. A昀琀er calling the specialist o昀케ce, the earliest appointment wasn’t for another four months down the road meaning she would have to endure her symptoms until the next chance at 昀椀nding answers and relief. She then makes the call to schedule her imaging study, only QUOTE to 昀椀nd the doctor order was missing the required “I am losing hope as I leave diagnostic code and couldn’t therefore book until she got it corrected. The amount of administrative appointments with more and scheduling roadblocks like these are not only questions than answers and discouraging but also take her time and energy away given a care plan that is met with from her job. She is losing hope and trust in the roadblocks and long wait times.” medical system with the extra work it takes to receive the care she needs. The more appointments with new doctors, the more forms to complete and the harder it is to keep her medical data up-to-date with multiple patient portals. NEEDS & GOALS CHALLENGES & CONSIDERATIONS • Virtual visits to allow for greater 昀氀exibility • Paperwork forms are redundant and data is • More e昀케cient request systems for prescriptions, seemingly never captured in the record. referrals, etc. • The same questions are asked multiple times • Access to enter personal medical data like during the same appointment. symptom tracking system to share daily health • Online scheduling systems are unreliable and challenges phone scheduling requires long wait times. • Online scheduling with more transparent waitlists • Patient portals only become useful once they for sooner appointments contain multiple lab test results and appointment • Universal access with integrated data to analyze notes and are accessible to other providers. and compare historical records • Dashboard to monitor trends and gain insights • An easy sign-in experience to encourage more frequent access

ORIGINAL Compiled and cra昀琀ed in Brainstorming & Prioritization

Brainstorm Analogous Inspiration 1 Bridging EHR systems together for a more comprehensive patient record 2 Providing doctors with a patient summary to easily digest full-picture of patient’s medical history and not “dig” for information 3 Determining ways to dictate appointment using AI, so doctors can focus on their bedside manner 4 Customizing a doctor’s preferences using an introductory intake form to build a system that best works for their preferences and skillset 5 Providing patients with scheduling that’s more transparent and includes waitlist WHO? for more urgent appointments The 昀椀nancial industry has found ways to bridge and aggregate sensitive information (like someone’s bank account information) to digest overall trends. Personal Capital, an investing and budgeting Simpler logins and mobile accessibility app, provides its 昀椀nancially savvy users with a free tool that compiles their 昀椀nancial institutions into 6 one macro-level view. This streamlined product allows people to digest their full 昀椀nancial picture and see their net worth. Connecting EHR systems to exterior health devices like an Apple Watch for HOW? 7 more detailed analytics Personal Capital brings in users who want to manage their 昀椀nances themselves. They have built relationships with 昀椀nancial institutions like banks, credit card companies, mortgage lenders, etc. to securely pull in their users’ transaction history, earnings, etc. A user can then add their account 8 Dashboards and trends with better visualizations for both patient and doctor credentials and see a compiled set of 昀椀nancial data. This solves the issue of managing more than one 昀椀nancial account and with more than one 昀椀nancial institution. In fact, it encourages the use of more than one account per person in its essence, and it allows people to take control of their 昀椀nancial independence. 9 Having customized views based on the provider’s typical appointment 昀氀ow to give them the information they need at the right time NEW IDEAS We’re seeing the overburden of patient medical record upkeep being put onto doctors, but what if we pushed the responsibility on to the patient? Financial institutions have largely outsourced a lot of 10 Setting up a veri昀椀cation process for patients to not have to redundantly answer their work to computers and programs that is supposed to be reviewed by account holders. What if the same information each year when they go in for an appointment we proactively had patients record and track their medical symptoms or healthy habits, and it was brought in for the doctor to simply review and provide guidance? Patients can come to doctors more collaboratively.

Feature Prioritization NICE TO HAVE FEATURE DESCRIPTION SUPPORTING RESEARCH Sync health devices Like Apple Watch, Oura Ring, FitBit, Secondary research: Equipping doctors with 1 and apps blood pressure monitor, diabetes more data points to help assess conditions MUST HAVE monitor FEATURE DESCRIPTION SUPPORTING RESEARCH Patients can upload old records and User interviews: Since EHRs are still rather 2 Upload documents new, paper records are still needing to be Patient Account Registration and sign in with Secondary research: Securing and 昀椀ling 昀椀le them documented for historical reference. 1 Creation account recovery patient data is foundational to EHR Track food to identify potential gut Secondary research: Tracking food could help 3 Food tracking sync sensitivities and allergies using with weight issues or digestion issues Patient User interviews: Graphically evaluating common apps like MyFitnessPal 2 Dashboard Health timeline, recent activity compiled data for trends Female health See what part of your cycle you’re Secondary research: Female tracking can help 4 tracking in and connect with other popular with more e昀케cient evaluation of symptoms. New Patient User Figure out the features they will User interviews: Further securing patient safety female cycle tracking apps 3 Form & HIPPA want activated and proactive HIPAA with HIPAA disclosures and reducing annual Consent consent to sharing medical data paperwork Secondary research: Moods are another form 5 Mood tracker Track moods for behavioral health of symptom tracking but with mental health Patient Accounts being a large issue, it should be included. 4 Database Linked to all major EHR systems User interviews: Universal EHR Connect with your pharmacy for User interviews: Connecting to pharmacies 6 Pharmacy link prescription requests could eliminate pre-appointment paperwork View previous appointment User interviews: Patients will see appointment and doctors needing to enter it. 5 Appointment and documentation including A昀琀er Visit records and providers will see other doctor Providers can have access to this Competitor analysis: Companies have third- visits cards Summaries and care plans notes and 昀椀ndings bridge to sync with their record for party so昀琀ware contracts with EHRs and these 7 EHR Plugins viewing on their machine (like QR plugins could help doctors to see into other Tests, labs and Connect with lab providers and see User interviews: Helping doctors to have code for Venmo) EHRs at di昀昀erent practices 6 imaging studies the list of historical testing access to testing results Advanced reports Share speci昀椀c metrics with other 8 and sharing and providers with “unlinkable” EHR User interviews: Universal EHR viewer options systems and family members Change contact information User interviews: Patients can reduce pre- 7 Pro昀椀le editor and insurance appointment paperwork SURPRISE & DELIGHT Historical medications list, report User research: Patients are historically FEATURE DESCRIPTION SUPPORTING RESEARCH 8 Medications list undisciplined in remembering their concern, request re昀椀ll medications Secondary research: Premium features could Appointment scheduling priority support those experiencing chronic symptoms User research: Doctors need a baseline of 1 Premium members and support and sharing with by acting as their health advocate and helping View all historical diagnoses along information before they can start to treat caretakers 9 Diagnoses list with doctor who diagnosed their patients. This view would provide that to 昀椀nd and secure appointments background. Caretaker Create a plan to share with User interviews: Caring for children or parents 2 management caretakers (premium) means more than one person needs access to List of doctors Have a list of doctors with their Secondary research: Equipping patients with advocate for the patient 10 (current and practice contact information and easier access to their doctors Outsource the pain of scheduling Secondary research: Long waits for previous) their access status Scheduling an appointment and pay for appointments given the shortage means 3 assistant with extra assistance to get a sooner patients aren’t receiving care. Transparency and waitlist feature User interviews: To eliminate this form 昀椀eld in appointment (premium) further support can help in times of need. 11 Family history Capture and share family history paperwork, patients can keep more up-to-date family health when they control it Enter previous reports that aren’t Secondary research: More collaborative 4 Manual entry logged in the EHR systems approach

Sources 1. Eschenroeder, H. C., Jr, Manzione, L. C., Adler-Milstein, J., Bice, C., Cash, R., Duda, C., Joseph, C., Lee, J. S., Maneker, A., Poterack, K. A., Rahman, S. B., Jeppson, J., & Longhurst, C. (2021). Associations of physician burnout with organizational electronic health record support and a昀琀er-hours charting. Journal of the American Medical Informatics Association, 28(5), 960–966. https://doi.org/10.1093/jamia/ocab053 2. Kroth, P. J., Morioka-Douglas, N., Veres, S., Pollock, K., Babbott, S., Poplau, S., Corrigan, K., & Linzer, M. (2018). The electronic elephant in the room: Physicians and the electronic health record. JAMIA Open, 1(1), 49–56. https://doi. org/10.1093/jamiaopen/ooy016 3. Gardner, R. L., Cooper, E., Haskell, J., Harris, D. A., Poplau, S., Kroth, P. J., & Linzer, M. (2019). Physician stress and burnout: The impact of health information technology. Journal of the American Medical Informatics Association, 26(2), 106–114. https://doi.org/10.1093/jamia/ocy145 4. Thompson, D. (2022, December 1). The ‘Great Resignation’ Is Taking a Toll on U.S. Health Care. HealthDay News via U.S. News & World Report. https://www.usnews.com/news/health-news/articles/2022-12-01/the-great-resignation-is- taking-a-toll-on-u-s-health-care 5. Galvin, G. (2021, October 4). Nearly 1 in 5 Health Care Workers Have Quit Their Jobs During the Pandemic. Morning Consult. https://morningconsult.com/2021/10/04/health-care-workers-series-part-2-workforce/ 6. Reed, T. (2022, March 7). The health worker shortage is starting to get real for Americans. Axios. https://www.axios. com/2022/03/07/the-health-worker-shortage-is-starting-to-get-real-for-americans 7. Reed, T. (2022, March 28). Health workforce shortages begin to weigh on patient safety. Axios. https://www.axios. com/2022/03/28/health-workforce-shortages-begin-to-weigh-on-patient-safety 8. Mensik, H. (2023, February 16). Lawmakers stress urgency of healthcare worker shortage. Healthcare Dive. https:// www.healthcaredive.com/news/lawmakers-昀椀xes-healthcare-workforce-shortages/642994/#:~:text=The country faces a shortage,drive them to other roles 9. Zippia. (2023). Health Care Provider Demographics & Statistics in the US. https://www.zippia.com/health-care- provider-jobs/demographics/ 10. Murphy, R. (2023, March 8). Why Does It Take So Long to Schedule a Doctor’s Appointment? Verywell Health. https://www.verywellhealth.com/why-is-the-wait-so-long-for-doctors-appointments-7113418 11. Zoorob, D., Hasbini, Y., Chen, K., Wangia-Anderson, V., Moussa, H., Miller, B., & Brobst, D. (2022). Ageism in healthcare technology: The older patients’ aspirations for improved online accessibility. JAMIA Open, 5(3), ooac061. https://doi.org/10.1093/jamiaopen/ooac061 12. Asar, A. (2021, January 21). How Digital Symptom Tracking Is Remaking Medicine For The Better. Forbes. https:// www.forbes.com/sites/forbestechcouncil/2021/01/21/how-digital-symptom-tracking-is-remaking-medicine-for-the- better/?sh=64fc6f881655 13. Folio3 Digital Health. (n.d.). Cerner vs Epic: Pros and Cons. https://digitalhealth.folio3.com/blog/cerner-vs-epic-pros- and-cons/#3_Things_You_Dont_Know_About_Cerner_And_Epic 14. Castellucci, M. (2014, July 24). Physicians Prefer the VA’s EHR. HIT Consultant. https://hitconsultant.net/2014/07/24/ physicians-prefer-the-vas-ehr/ 15. Greenberg, A. (2019, July 1). The Medical Records Flaw That Could Hurt Thousands of Veterans. Wired. https://www. wired.com/story/va-vista-medical-records-昀氀aw/ 16. Hospital Management. (n.d.). Top Ten Largest Health Systems in the US by Number of Hospitals A昀케liated. https:// www.hospitalmanagement.net/features/top-ten-largest-health-systems-in-the-us-by-number-of-hospitals-a昀케liated/ 17. Healthgrades. (n.d.). The 10 Largest Health Systems in the US. https://www.healthgrades.com/pro/the-10-largest- health-systems-in-the-us 18. De昀椀nitive Healthcare. (n.d.). Most Common Inpatient EHR Systems. https://www.de昀椀nitivehc.com/blog/most- common-inpatient-ehr-systems