© 2011 PeriGen – Proprietary and Confidential 1

Committed to Improving OB Patient Safety Through Clinical & Operational

Improvement Discussions with PinnacleHealthOctober 13, 2011

© 2011 PeriGen – Proprietary and Confidential 2

• Tina Armstrong, RN – Clinical System Specialist

• Doug Masiel - SVP Business Development

• Richard Henley, FACHE FHFMA – Executive Advisor

PeriGen Participants

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Our Agenda Today

• Overview of PinnacleHealth Goals and Objectives

• Overview of PeriGen’s Suite of Obstetrical Solutions and Services

What makes PeriGen unique?

• Discussion of Possible Next Steps and Actions

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PinnacleHealthObjectives

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PeriGen Company Profile

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• Founded in 1995

• More than 100 Employees, Including Physicians and OB Nurses & Midwives

• Serving Hospitals and Physicians in the US and Canada

• Over 400,000 Births in Our Database

• FDA Cleared & ARRA Certified

OB Knowledge & Research

Professional Services

Proprietary Technology

PeriGen Highlights

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PeriGen Solutions

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The PeriGen Solution

• OB Specific Content• Real-Time Clinical Guidance• Data & Analytics• Professional Services• Risk Reduction and ROI

What Makes it Unique?

Experts in OB Risk Reduction

© 2011 PeriGen – Proprietary and Confidential 9

The OB Continuum Solution

PrenatalTriage

AntepartumIntrapartum OR /

RecoveryPostpartumWell Baby

• Fetal Surveillance & Archiving

• Fetal Heart Rate Interpretation Tools

• Labor Progress Assessment Tools

• Complete OB Documentation

• Decision Support

• Reporting & Analytics

• Implementation Services

• On-going Support Services

Demonstration

© 2011 PeriGen – Proprietary and Confidential 10

Building an OB SolutionA Staged Approach

Stage 2Surveillance & Archiving

Stage 3Nursing Charting

Stage 4Nursing

Protocols

Stage 5Physician Orders & Protocols

Stage 1Fetal

Monitoring

Begin and Grow as Appropriate

© 2011 PeriGen – Proprietary and Confidential 11

Data & Analytics

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PeriTrack™- Performance Improvement Through MetricsStandard Aggregation Reports Available

• Can be set up for automatic email distribution to selected personnel

• Can be generated “on demand” by customer

Accreditation Organizations Focused on

Measuring Clinical Performance & Visibility of

DataReport Name Default ScheduleDelivery Log DailyTriage Log DailyEvents Report DailySummary Report WeeklyProvider Stats Report WeeklyDelivery Breakdown Report MonthlyDone Sequence Report DailyPain Scale Report WeeklyUnsigned Reports Log WeeklyUnsigned Orders Log WeeklyHIPAA – Chart Activity Report No Schedule – Run on demand

HIPAA – User Activity Report No Schedule – Run on demand

Standard User Security Audit Trail Report WeeklyFailed Login Attempt Report Daily

© 2011 PeriGen – Proprietary and Confidential 13

Performance Profile – Striving for 100%

Hospital XX – Q3 ‘10

Results# measures in the last

quarter ≥ 90% (# with 100%)

TrendAny meaningful new statistically significant change in last 4 Qs in green (+) or red (-) .

Indicators with n>20 included.

Compare# of measures > PeriGen client

average

CommentHighest % achieved among all clients this Q: All 100%

11 of 15 measuresat ≥90%

(2 of 15 measures at

100%)

•Preterm Labor 24-33 wks - Glucocorticosteroids Administered 11 of 15

measures above average

•Overall results better than Q2 (Q2: 10/15≥90%; 3/15 at 100%; Q1: 11/15≥90%; 4/15 at 100%)•CMK Active Labor protocol upgrade installed 02/22/2010, consistent with slight increase in EFW documentation.•Consistently, Labor induction measures are all documented well, except Labor Induction- Indication. Advise looking at Oxytocin Notes card to continue trend. •Cesarean Delivery Indication is below PeriGen average. Advise looking at CMK Indication documentation update.•Negative trend in Preterm Labor 24-33 wks-Glucocorticosteroids Administered continued from last quarter, however achieved 100% of Preterm Delivery 24-32 wks – Glucocorticosteroids Administered. Suggest review of preterm labor cases. Steroid documentation added in med v.13.1, in production 07/09

The colored bars for each indicator represent rolling four (4) quarters of comparative data, with the most recent quarter shown in orange. The green and red dots represent PeriGen averages: green ≥ PeriGen avg.; red: < PeriGen avg. A (-) notation indicates the event was not measured in that quarter; “nm” indicates that this indicator is not monitored at the client site.

Active Labor - EFW

Documented within last

weekQ3 n=685

Macrosomia/ DM/ GDM -

EFW Documented within last 3

weeksQ3 n=53

Labor Abnormality -

Pelvic Adequacy

DocumentedQ3 n=141

Cesarean Delivery

Indication Documented

Q3 n=368

Shoulder Dystocia - Length of

Dystocia (head to body

delivery time) Documented

Q3 n=5

Shoulder Dystocia - Fetal

Position Documented

Q3 n=5

Operative Vaginal

Delivery - Fetal Station

DocumentedQ3 n=37

Labor Induction - Indication

DocumentedQ3 n=336

Labor Induction - EFW

Documented within last

weekQ3 n=336

Labor Induction - Presentation Documented

Q3 n=336

Labor Induction - Pelvic

Adequacy Documented

Q3 n=336

Labor Induction - Bishop Score Documented

Q3 n=336

BP > 180 systolic or 110

diastolic - Antihypertensiv

es Administered

Q3 n=4

Preterm Labor 24-33 wks –

Glucocortico-steroids

AdministeredQ3 n=22

Preterm Delivery 24-32

wks – Glucocortico-

steroids Administered

Q3 n=8

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

_ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _

© 2011 PeriGen – Proprietary and Confidential 14

14

Outcome MonitorX Hospital – Q4 ‘09

0.8%

0.0% 0.0%0.4%

3.5%

1.9%

0.8%

0.0%0.6%

3.1%

1.7%

0.5%0.0%

0.6%

3.1%

1.6%

0.1% 0.0%

1.1%

4.3%

Apgar 5 minutes < 7 Apgar 5 minutes < 4 Near term or term Intrapartum or neonatal death (in immediate post

delivery period)

Blood Transfusion 3rd or 4th degree perineal lacerations

Apgar 5 minutes < 7*Nat’l Avg./PeriGen Avg./Tertiary Avg.

Apgar 5 minutes < 4**Nat’l Avg./PeriGen Avg./Tertiary Avg.

Near term or term Intrapartum or neonatal

deathPeriGen Avg./Tertiary Avg.

Blood Transfusion

PeriGen Avg./Tertiary Avg.

3rd or 4th degree perineal lacerations

PeriGen Avg./Tertiary Avg.

1.6% 1.0 % 1.6% 0.5% 0.1% 0.2% 0.0% 0.0% 1.4% 1.2% 3.0% 2.9%

Compare (red if > 2x avg.) Comment

Above National Avg. Above PeriGen Client Avg. Above PeriGen Client Tertiary Avg.

•None •Apgar 5 minutes < 7•3rd or 4th degree perineal lacerations

•3rd or 4th degree perineal lacerations •Recommend evaluation of substantial spike in perineal lacerations

The colored bars for each indicator represent rolling four (4) quarters of comparative data, with the most recent quarter shown in orange. A (-) notation indicates the indicator was not measured during that quarter. National averages obtained from National Vital Statistics Report – Birth for 2006* and 2005** [the most recently published data available].

© 2011 PeriGen – Proprietary and Confidential 15

15

Perinatal PracticesX Hospital – Q4 ‘09

0.4%

6.8%

20.2%

44.3%

5.7%

27.8%

0.0%

5.6%

31.0%34.3%

22.6%

11.7%

1.9%

25.9%

0.4%4.2%

22.4%

35.1%

20.3%14.9%

3.6%

25.5%

0.0%

7.6%

18.6%

33.6%

18.8%14.8%

4.4%

30.1%

Elective Singleton Induction <39 wks

Deliveries with Episiotomy

Excessive Uterine Activity on Oxytocin

Cesarean Delivery Rate

Primary Cesarean Delivery Rate

Repeat Cesarean Delivery Rate

Operative Vaginal Delivery Rate

Induction Rate

Elective Singleton Induction <39 Wks

PeriGen Avg./Tertiary Avg.

Deliveries w/EpisiotomyPeriGen Avg./Tertiary Avg.

Excessive Uterine Activity/Oxytocin

PeriGen Avg./Tertiary Avg.

Cesarean Delivery Rate*Nat’l Avg./PeriGen Avg./

Tertiary Avg.

Primary Cesarean Delivery RatePeriGen Avg./Tertiary Avg.

Repeat Cesarean Delivery RatePeriGen Avg./Tertiary Avg.

Operative Vaginal Delivery Rate**Nat’l Avg./PeriGen Avg./

Tertiary Avg.

Induction Rate**Nat’l Avg./PeriGen Avg./

Tertiary Avg.

0.6% 0.3% 17.7% 13.1% 26.0% 25.7% 31.8% 34.4% 34.3% 20.1% 20.6% 14.3% 13.7% 4.5% 5.0% 4.7% 22.5% 35.5% 32.6%

Compare (red if > 2x avg.) CommentAbove National Avg. Above PeriGen Client Avg. Above PeriGen Tertiary Client

Avg.

•Cesarean Delivery Rate•Induction Rate

•Repeat Cesarean Delivery Rate •Repeat Cesarean Delivery Rate •Improved Cesarean rate although repeat cesareans continue to be higher than peer group

The colored bars for each indicator represent rolling four (4) quarters of comparative data, with the most recent quarter shown in orange. A (-) notation indicates the event was not measured in that quarter; the notation “n/m” indicates the indicator is not monitored at the client site. National averages obtained from National Vital Statistics Report – Birth: Preliminary Data for 2007* and final data for 2006** [the most recently published data available].

--

© 2011 PeriGen – Proprietary and Confidential 16

Contraindications ReportHospital X – Q4 ‘09

Not OrderedPotential errors avoided when first ordered and not completed

(% of births)

Type% events by category

Q209 Q309 Q409 Q409

73 of 261 births(27.97%)

107of 541 births(19.78%)

57of 492 births(11.59%)

Cancelled/DiscontinuedPotential errors avoided when first ordered and not completed

(% of births)

Type% events by category

Q209 Q309 Q409 Q409

30 of 261 births(11.49%)

39 of 541 births(7.21%)

27 of 492 births(5.49%)

Oxytocin7%

Dinoprostone2%

All Others51%

Basic Drug & Allergy

40%

Near Misses During Order

Near Misses During Δ Condition

© 2011 PeriGen – Proprietary and Confidential 17

OB Med Mal Reduction Experience

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20 02 200 3 20 04 20 05 200 6 200 7 20 08 20 09 20 10 (thro ug h 3/31 /10 )

0

5

10

15

20

25

30

35

40

45

50

$0 .0 0

$2 .0 0

$4 .0 0

$6 .0 0

$8 .0 0

$1 0.0 0

$1 2.0 0

$1 4.0 0

10

1613

97 7

3 40

$4.2 7

$1 0 .4 0$11 .46

$1 1.7 8

$7.1 8

$9 .45

$1 .31 $2

$0 .0 0

Obstetric Claims - Frequency and SeverityValued thru 12/31/09

Cla im Co unt To ta l Inc urred $ (Mi l li o ns )

Los s Yea r (Policy Ye ar )

Claim Count

Total Incurred $ (Millions)

All Obstetric C ases

Due to the uniquely non-obst etr ic lit igat ion f acts, t wo cases have b ee n om itt ed f ro m t his analysis: 13113, 12648

Post PeriBirth®Pre PeriBirth®

Driving Down OB Claim Frequency and SeverityMedstar’s Latest OB Med Mal Results

© 2011 PeriGen – Proprietary and Confidential 19

Documented Reduction in Med Mal CostsSignificant Reduction in All OB Claims Categories

*Comparing the periods 2001-2005 and 2006-2010 (YTD)*PeriBirth implementation began in 2006

• 18-Hospital System• Avg. ~30,000

births/year

© 2011 PeriGen – Proprietary and Confidential 20

Improving Charge Capture Overview

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Documented Increase in OB Triage Charge CaptureImmediate Revenue Increase of 10 – 15%

Improved Charge Capture

NYC Academic Medical Center

Substantial shift in Triage Level III and

IV acuity and reimbursement

PeriBirth investment recaptured

within 3 years

9.2% Volume Increase in

Charge CaptureFlagship Hospital

$98.00 improvement per Triage Visit

$857,206 annual impact

Service Unit Capture- $960,000

annual impact

18-hospital Health System

$32.00 improvement per Triage visit; 33% cost/charge ratio

ROI in less than 3 years

© 2011 PeriGen – Proprietary and Confidential 22

Technology Integration

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HIS VendorsEclipsysMcKessonSiemensCernerEPICMeditechMisys

Fetal Surveillance

Typical PeriGen IntegrationUni- and Bi-Directional

PeriBirth

Pre-NatalADT

Pharmacy

Interfaces• Fetal Monitoring• Prenatal• A/D/T• RX Order• RX Change Order• Pyxis Connect• Allergy• Bar Code Med

Admin• Lab Order• Lab Result• Radiology Order• Radiology Result• EMR – Data/xml• EMR – Reports• Transcribed

Reports• Charges

Lab

Radiology

EMRTranscriptionBilling

© 2011 PeriGen – Proprietary and Confidential 24

ARRA ONC CertificationPeriGen - PeriBirth 4.5.1

General Criteria (170.302) (a) Drug-drug, drug-allergy interaction checks (b) Drug formulary checks (c) Maintain up-to-date problem list (d) Maintain active medication list (e) Maintain active medication allergy list (f) Record and chart vital signs (g) Smoking status (h) Incorporate laboratory test results (i) Generate patient lists (j) Medication reconciliation (k) Submission to immunization registries (l) Public health surveillance (m) Patient specific education resources (n) Automated measure calculation (o) Access control (p) Emergency access (q) Automatic log-off (r) Audit log (s) Integrity (t) Authentication (u) General encryption (v) Encryption when exchanging electronic health information (w) Accounting of disclosures (optional)

Criteria (170.306) (a) Computerized provider order entry (b) Record demographics (c) Clinical decision support (d) Electronic copy of health information (e) Electronic copy of discharge instructions (f) Exchange clinical information and patient summary record (g) Reportable lab results (h) Advance directives (i) Calculate and submit clinical quality measures

Certifying ATCB: CCHIT  |  CHPL Product Number: CC-1112-586750-2Classification: Modular EHR  |  Practice Setting:Inpatienthttp://onc-chpl.force.com/ehrcert/EHRProductDetail?id=a0X300000025FGOEA2&retURL=%2Fehrcert%2FEHRProductSearch&setting=Inpatient

© 2011 PeriGen – Proprietary and Confidential 25

Services Overview

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PeriGen’s Consulting ServicesAligning Our Solutions to Client Needs

• Perinatal Safety Assessment• Protocol Development• Clinical Education Programs• Team Communication and Effectiveness

PATIENT SAFETY

• Maximizing Charge Capture and Billing• Clinical Workflow Design• OB Triage Redesign

OB SERVICE LINE EFFECTIVENESS

• Bad Outcome / “Near Miss” Medical Record Review• Litigation Defense Support

REDUCING RISK AND LIABILITY

© 2011 PeriGen – Proprietary and Confidential 27

Our OB Knowledge Driven By Leading AuthoritiesPhysician Council & Senior Consultants

Emily Hamilton, MD Chief Clinical Research, PeriGenFormer OB/Gyn Professor, McGill University

Eric Knox, MD Senior OB Consultant, PeriGenOB/Gyn Faculty, University of Minnesota

Tom Garite, MD Senior OB Consultant, PeriGenProfessor Emeritus, University of California, IrvineEditor-in-Chief, Am J. of Obstetrics & Gynecology

Arnie Cohen, MD OB Chair, Einstein Medical Center

Glenn Markenson, MD Chief of OB and MFM, Baystate Medical Center

Yoni Barnhard, MD OB Chair, Norwalk Hospital

Samuel Smith, MD OB Chair, Franklin Square Hospital

George Neubert, MD OB Chair, The Reading Hospital

© 2011 PeriGen – Proprietary and Confidential 28

Comprehensive Services Support our Clients

Implementation Services Through “Go Live”

• Governance Structure & Project Management

• Site Assessment

• Technical Configuration & Installation

• Clinical Configuration

• Testing: Integration and User Acceptance

• Train-the-Trainer and End User Training

• Communication Program

• Go Live Support

© 2011 PeriGen – Proprietary and Confidential 29

Building an OB Service Line

© 2011 PeriGen – Proprietary and Confidential 30

Growing an OB Service LineA Case Study

• Community Hospital in Southern Connecticut• Competitive Market• Technology & Safety as the Centerpiece of Strategic Plan to

Grow the OB Service Line• Media Campaign Planned• Goal of 20% Growth

© 2011 PeriGen – Proprietary and Confidential 31

PeriGen Solutions -

Clinical Scenario

© 2011 PeriGen – Proprietary and Confidential 32

Discussion

© 2011 PeriGen – Proprietary and Confidential 33

PeriCALM Patterns and PeriContractility Index

Baseline

Accelerations

Labels and Measurements

Decelerations

Window Summary