Artisan HealthCare
Bariatric Informatics Company

Crafting a better way to practice Medicine

Rex Osborn
June 2011
In 2006 the Center for Medicare & Medicaid Services agreed
with the NIH (National Institute of Health) that morbid obesity...
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Artisan HealthCare
Who We Are
Bariatric Informatic Market

What We Do

Market Differentiation

Our Develop...
Artisan HealthCare (AH) is a Bariatric Medicine** Informatic
Solution Company. AH is an independent innovator
organization...
PHR: Combining AH’s Patient Advocacy Navigation (PAN) and Personal Health Record (PHR) AH aids the patient through their a...
Artisan HealthCare (AH) is a Bariatric Medicine Informatic Solution Company; Development based in Deventer, Netherlands, a...
Artisan HealthCare has a technical & collaborative relationship
with Topicus HealthCare of Deventer, Netherlands. The Dutc...
Topicus HealthCare is a leading provider of web-based services for the
HealthCare market, with a special focus on patient-...
All Rights Reserved ©2010 Artisan HealthCare, Inc.
BOLD captures real-time information on each patient during
pre-, intra- and all postoperative visits. BOLD also obtains
in...
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Artisan HealthCare

Bariatric Informatic Market
Customers
Market Differentiation

Market Data

Patient Adv...
Metabolic & Bariatric Surgeon Practices, Weight Loss Clinics, Hospitals opening
Gastric Bypass Centers / Practices & Indep...
The Patient is responsible for surgical procedure bill.
Therefore the bariatric surgeon has to offer a competitive
array o...
Primary Target Market: The US has the largest
HealthCare Information Technology (HCIT) market
in the World (estimates 2009...
US bariatric market growth has gone
up over 600% from 1993 – 2008;

600% Growth
Surgeries
Performed

Source AMA, American ...
Average Morbidly Obese Patient;
275 Pounds
42 Year Old, Caucasian Woman
BMI of 45

All Rights Reserved ©2010 Artisan Healt...
The average gastric band surgery cost
between $17,000 and $30,000.
The average cost of gastric bypass surgery
is $20,000 t...
There are 3060 licensed Bariatric Surgeons in
the US.
These Bariatric Surgeons work in a little over
1000 specialty center...
Crafting a better way to practice Medicine

AH improves access, overall care, mitigates risk & liability for both
the pati...
Bariatric Practices & Centers are losing money & potential patients from denied claims that
would not be denied with a com...
Artisan HealthCare’s Vermeer EMR solution (vEMR) will meet all criteria outlined by the latest legislation from the US
gov...
There are generic EMR & PMS solutions, none of which are focused or organically
designed to support Bariatric Medicine.
Th...
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Artisan HealthCare
Bariatric Informatic Market

Market Differentiation
Patient Advocacy Navigation
Vermeer...
Prior to rounds Bariatric Surgeon will have a patient list;
“Data Gathering” prior to examination; By Acuity Level
Laborat...
Medical Necessity
Case Scheduling
 Resource Allocation
 Inventory Management

Post-Operative

Pre-Operative
DATA GATHE...
AH benefits both the surgeon as well as the patient.
We lower the surgeon’s current denial rate by raising the amount of
p...
The patient can follow their own medical necessity progress; from pre-registration, through scheduling, on-line
education,...


Outsourcing Bariatric Medical Necessity / Navigating
Patients Leveraging The Latest HealthCare Technology:
o Pre-certif...
We improve the communication between patients and their surgeons
via a Personal Health & Wellness Record (PHR+); OUTCOMES
...
Thought Leadership
Present, Publish & Conference
Participation
Patient Advocacy
Standards Adherence
Interoperability in Ba...
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Artisan HealthCare
Bariatric Informatic Market
Market Differentiation

Patient Advocacy Navigation
Vermeer...
Medical Necessity is a set of rules used by the US to
determine what is medically justified as reasonable,
appropriate & o...
PAN & PHR
Pre-Surgery - Patient Advocacy Navigation (PAN)
is an innovative service that AH provides via
subscription to ai...
Patient Advocacy Navigation

To qualify for a GB, you must
meet “Medical Necessity”
 ECG - Cardiologist
 Diabetes Manage...
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Artisan HealthCare
1
2 Bariatric Informatic Market
3 Market Differentiation
4 Patient Advocacy Navigation
5 Vermeer EMR...
EMR
An EMR is electronically
stored & distributed medical
information about an
individual’s health status &
healthcare tra...
EMR

The EMR enables Continuity of
Care; the availability of
information, clinician constancy
with a goal of seamlessness ...
Core Functionality is the basic functionality contained in
Vermeer EMR, primarily supporting data capture & retrieval.


...
The presence of “Enhanced Functionality” indicates
that our Vermeer EMR will support & improve
clinical workflow. Via mess...
“Leading Edge” functionality is designed to support both prospective
& retrospective analysis; manage clinical processes a...
All Rights Reserved ©2010 Artisan HealthCare, Inc.
PMS
A PMS (Practice Management
System) is a business tool to
support registration of patients,
scheduling of events, billi...
Subscription based partner, leveraging X12 EDI transactions as
well as HL7 feeds for integration to and from EMR & PHR
sol...
All Rights Reserved ©2010 Artisan HealthCare, Inc.
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Artisan HealthCare
Bariatric Informatic Market
Market Differentiation
Patient Advocacy Navigation
Vermeer ...
PHR+
Personal Health Record; Our Personal Health
Record (PHR) is a web-based personalized wellness
application that functi...
Personal Health & Wellness Record
After Surgery Wellness Programme:
 Morbid Condition Trending (weakening of diseases)
 ...
All Rights Reserved ©2010 Artisan HealthCare, Inc.
Crafting a better way to practice Medicine

Personal Health &
Wellness Record

All Rights Reserved ©2010 Artisan HealthCar...
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  • Mission Statement: All men at one time or another find themselves contemplating how they might turn their thoughts into a business, or make their avocation their vocation, or their passion their profession. Artisan HealthCare is founded on seeking ways to make intelligent ideas reality. Artisan HealthCare innovates & has crafted a better way for specialized clinicians to practice medicine, engage their patients and deliver better quality care.
  • Obesity Statistics Below are public health agencies and organizations monitoring and researching the epidemic of obesity and related diseases. Centers for Disease Control and Prevention The Centers for Disease Control and Prevention (CDC) is the nation’s top agency that works to prevent and control disease including obesity. On its website, the CDC has the latest statistics on obesity trends among adults, children and adolescents in the United States. It also provides a state-by-state breakdown of Obesity’s economic impact on the U.S. health care system as well as an interactive map illustrating the growth of obesity in the U.S. since 1985. Weight-control Information NetworkWeight-control Information Network (WIN) is a national information service of the National Institute of Diabetes and Digestive Kidney Diseases (NIDDK) – the primary organization for research on obesity within the National Institutes of Health (NIH). WIN provides up-to-date, science-based information on weight control, obesity, physical activity, and related nutritional issues, including statistical information on the prevalence of obesity as well as the latest figures on the economic costs of the disease.National Center for Health StatisticsThe National Center for Health Statistics (NCHS) is the United States’ principal health statistics agency. A part of the CDC, NCHS collects and produces data related to obesity, and its website lists recent studies that include data on the connection between sleep and obesity, the prevalence of obesity among adults and among children and adolescents. NCHS also has a statistics section on Obesity and Overweight conditions.World Health OrganizationThe World Health Organization (WHO) is working to prevent and monitor the global epidemic of overweight and obesity. WHO’s website has the most recent statistics and facts regarding the global spread of obesity. Their site also has a database that provides the BMI for each country around the world and a link to WHO’s latest studies and publications on obesity and related chronic diseases.The Hormone FoundationThe Hormone Foundation is the public education affiliate of The Endocrine Society. The Foundation's website provides information about emerging hormone-related endocrine system diseases, including obesity.American Obesity AssociationThe American Obesity Association (AOA) is one of the nation's premier public policy advocates for combating and curing obesity. AOA's website is filled with the latest data and figures on a myriad of obesity-related topics, including obesity trends in the U.S., morbid obesity, and statistics regarding obesity in minority populations and women. The AOA also has information about consumer protection issues and health effects related to obesity.International Obesity TaskforceThe International Obesity Taskforce (ITF) is the research and advocacy arm of the International Association for the Study of Obesity (IASO) – an umbrella organization for national obesity associations which represent 56 countries around the world. IOTF's website provides statistical data on the global study of obesity, including information on global obesity prevalence in adults and global childhood obesity.
  • With over 220,000 bariatric surgical procedures performed in the US in 2008, doctors and patients need to know if the procedures are safe and effective. A federally-funded, multicenter consortium was created to answer that question. Approximately 15 million people in the US are morbidly obese with a body mass index (BMI) of over 40. Sixty-four percent of Americans are overweight or obese. More than 25 percent of adults are considered obese (BMI greater than 30). Obesity leads to a myriad of diseases and complications. Increasingly doctors and patients have been turning to bariatric surgical procedures (various surgical procedures to shrink or bypass the stomach to reduce food intake) to improve diabetes and life expectancy and reduce cancer rates and coronary artery disease. Do the short-term and long-term benefits outweigh the risks of surgery? The National Institutes of Health (NIH) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) funded a study called Longitudinal Assessment of Bariatric Surgery (LABS). This study involved a clinical consortium that was awarded $3 million dollars a year for five years starting in 2003. The consortium includes University of Washington /Virginia Mason, Oregon Health and Science University/Legacy Good Samaritan Hospital, Sacramento Bariatric, Neuropsychiatric Research Institute, University of Pittsburgh Medical Center, University of Pittsburgh Graduate School of Public Health, Columbia/Cornell University Medical Center/ Valley Hospital, NIDDK, and East Carolina University.
  • Bariatric Informatics: Automating the clinical & business operations including integration of associated & satellite clinical information systems. Supports the bariatric practice end-to-end as well as complex integrated delivery networks, and surgery centers. Promotes remote leveraging of web-based applications by the clinician as well as their patient population. Subscription based, so operational cost can be incremental rather than a large initial investment. Access and services associated with the pre and post surgical requirements for patients means that the PHR and EMR share relevant clinical information, allowing collaborative communications for colleagues and patients.
  • Artisan HealthCare’s trinity of applications / solutions and services: PAN / PHR for pre-surgical navigation & medical necessity guidance, EMR for clinical connectivity (integration) and compliance as well as PHR+ for post-surgical management, wellness and outcomes measurement.Artisan HealthCare’s (AH) EMR & PHR solution that has been developed and is being adapted by a European 3rd party development partner. AH’s solution portfolio will focus on the fastest growing market in HealthCare: Bariatric Medicine. AH is an independent HCIT marketing organization capable of managing, selling, distributing, implementing, outsourcing & supporting Bariatric sites.  AH will be comprised of a HealthCare IT solution group (Vermeer EMR / vEMR), a billing / credentialed management team for consulting & outsourced management of bariatric services & centers. Future co-development will include templates for bariatric medicine related clinical disciplines; endoscopy (complete), general surgery, chiropractic, dietary / nutrition, exercise physiology, radiation oncology, plastic surgery, exercise physiology, occupational therapy & sleep disorder clinics.
  • BOLD™ Surgical Review Corporation expects more than 100,000 patients to be entered annually into its Bariatric Outcomes Longitudinal Database™ (BOLD™), thus making it the largest bariatric surgery database registry in the world. Each participant in the BSCOE program is required to submit detailed patient information on every patient that has bariatric surgery. Bariatric Outcomes Longitudinal Database (BOLD™)BOLD is an efficient, user-friendly, Internet-based patient outcomes tracking and reporting database that is IRB approved and fully compliant with HIPAAA and other patient privacy requirements. Click here to view an online presentation of BOLD. Purpose of BOLDBOLD captures real-time information on each patient during pre-, intra- and all postoperative visits. BOLD also obtains information on intraoperative, pre- and post-discharge adverse events. BOLD captures detailed information regarding each patient’s co-morbidities before and after surgery using a severity scale. Users of BOLD have access to all of their information at no additional charge and will be able to compare their results against national aggregates. BOLD provides the ability to establish criteria for best practices. BOLD has three primary goals:To offer Centers a real-time tool to monitor their compliance with the Bariatric Surgery Centers of Excellence (BSCOE) requirements.To provide SRC with credible data that can be used to demonstrate to consumers, employers, medical professionals and payors of the value and efficacy of bariatric surgery. Clinical series, although helpful, represent only selective data. Claims data collected by payors is often inaccurate due to the nature of billing codes. To collect the information needed to improve patient outcomes. The data will guide surgeons in choosing the right operation for patients. BOLD is a unique platform for evidence-based medicine, tracking complications and improvement or resolution of co-morbidities longitudinally in an effort to develop risk stratification guidelines that will promote improved patient care and outcomes.BOLD Design The development of BOLD was guided by SRC's Research Advisory Committee (RAC) and began during the fourth quarter of 2005. All software development was performed by SRC. Efforts were made to keep data elements and data definitions common with the NIH Longitudinal Assessment of Bariatric Surgery (LABS) program and other national databases. Initial data elements were posted for review and comment by all BSCOE program applicants. Beta testing was done by SRC's Bariatric Surgery Review Committee and RAC. Access to BOLD As of February 1, 2008, all Provisional Status designees are required to participate in BOLD and compliance is required within 90 days of the Provisional Status designation. After receiving BOLD access, Provisional Status designees must begin entering all new bariatric surgery patients. BOLD compliance is required to be able to receive Full Approval designation as a BSCOE. Participants are required to enter their information in the BOLD format. Accuracy is required and the data is audited and verified. Inaccurate reporting can mean loss of BSCOE status. Interface with Third-party Software SRC developed an interface designed to import data from interested third-party software systems. Participants currently using a participating third-party software system may transmit their data directly into BOLD to minimize or eliminate duplicate data entry. SRC has shared the data elements and integration instructions with several vendors and hospitals interested in developing an interface with BOLD. (Vendors are listed in order of interface completion date.) SRC is pleased to announce that the following vendors have been approved as a third-party provider source that will transmit outcomes data into BOLD. RemedyEHRExemplo MedicalPatientHub™Patient Relationship Management, LLCRaintree Systems, Inc./MDnetSolutions, LLCDigital BariatricsBariatric Office ProductsProNex, Inc.Healthwise Technologies, Inc.EZ Healthcare, Inc.TransMed NetworkOCERIS, Inc.CureTrac LLCBOLD Fees Effective February 18, 2008, SRC changed the fee structure for BOLD as follows:All surgical groups — Provisional Status and Full Approval designees — will pay a one-time BOLD activation fee of $875 with the submission of the BOLD Participation Agreement. Payments for the initial block of 100 patients from designees already signed up to use BOLD will be credited as the BOLD activation fee.Provisional Status Centers (hospitals and freestanding outpatient centers) will be billed an annual BOLD data submission fee of $875, regardless of the number of patients entered into BOLD.Fully Approved BSCOE Centers (hospitals and freestanding outpatient centers) designated before January 1, 2008, will be billed an annual BOLD data submission fee of $1,250 until they enter their renewal year, regardless of the number of patients entered into BOLD. Starting in 2008, Centers renewing their BSCOE designation will not be charged a separate BOLD fee as it is included in the annual BSCOE Participation Fee. BOLD does not require a software purchase. The fee specifically covers costs for program activation, data management, storage and security, as well as compilation, analysis, reporting and dissemination of data. These fees are charged even if a third-party software system is used to transmit data to BOLD. IRB ApprovalBOLD utilizes information on living patients from the preoperative stage through five years or more following surgery. It also asks for some information which is considered Protected Health Information under HIPAAA. For these reasons, the BOLD research study is considered human subject research and subject to various federal laws, including the requirement to receive Institutional Review Board (IRB) approval. The University and Medical Center Institutional Review Board (UMCIRB) at East Carolina University approved SRC’s IRB application, along with a short-form protocol and informed consent document. BOLD users will receive a package with the IRB approval letter, the approved patient informed consent form, study protocol and consent to have UMCIRB provide oversight for the BOLD research study. Institutions that are required or elect to have a local IRB provide oversight will be permitted to do so with appropriate documentation. IRB approval is required before users can enter data. Purpose of the BOLD Co-morbidity Scale The co-morbidity scale used in BOLD was created by the RAC and is based upon a schema originally published by noted bariatric surgeons, Bruce Wolfe, M.D. and Mohamed Ali, M.D., in consultation with others such as NIH/NIDDK/LABS co-investigators and representatives from national health plans. The co-morbidity scale provides a quantifiable measure of the effect of bariatric surgery on co-morbidities over time. The scale will be used to guide SRC in setting new standards for its BSCOE program. It will also be used to demonstrate the value and efficacy of bariatric surgery. Purpose of the Participation Agreement The Participant Agreement was prepared by legal counsel in consultation with other industry experts. The Agreement covers all areas and is intended to protect surgeons, hospitals and patients, as well as meet the various requirements of HIPAAA and privacy of human subjects. Once the agreement is completed, signed and returned to SRC (along with the other required documentation), users will be given access to BOLD. Future Changes to BOLD BOLD is expected to grow in a modular design with additional modules to enhance and supplement SRC’s research initiatives. While the current data collected in BOLD is required for all BSCOE participants, the supplemental data collected in the additional modules will be optional for Research Consortium participants. Constructive input from users is important to the continued evolution of BOLD. Suggestions for changes to improve BOLD are considered by SRC’s research staff and RAC. Your input is valuable. Please feel free to send comments or suggestions regarding BOLD to Support.
  • Their system is fairly simple, everyone is required to purchase insurance from highly-regulated private providers. They describe it as "private health insurance with social conditions". Insurers are tightly regulated for quality, provision of basic services, and to prevent discrimination, as they are required to accept everyone in their coverage area at a flat rate, no matter what their health status. To prevent loss of profitability from chronically-ill patients, they have a risk equalization system so that rather than losing profits from recruiting sicker patients, insurance companies are compensated for providing service to those patients who need it most. And if a citizen wants to change companies, or buy additional insurance they are free to. It's a system that encourages competition, but is regulated to prevent the companies from selecting only healthy patients, or otherwise abusing the system to prevent health care provision to sick people. The incentives are designed to provide excellent care to as many people as possible, cheaply and efficiently no matter what their health status, rather than the perverse US system in which the incentives are to deny care and only sign on the healthy. The government even runs a website allowing patients to comparison shop among the different insurance companies and hospitals based upon their ratings for quality, outcomes and performance indicators.
  • BOLD™ Surgical Review Corporation expects more than 100,000 patients to be entered annually into its Bariatric Outcomes Longitudinal Database™ (BOLD™), thus making it the largest bariatric surgery database registry in the world. Each participant in the BSCOE program is required to submit detailed patient information on every patient that has bariatric surgery. Bariatric Outcomes Longitudinal Database (BOLD™)BOLD is an efficient, user-friendly, Internet-based patient outcomes tracking and reporting database that is IRB approved and fully compliant with HIPAAA and other patient privacy requirements. Click here to view an online presentation of BOLD. Purpose of BOLDBOLD captures real-time information on each patient during pre-, intra- and all postoperative visits. BOLD also obtains information on intra-operative, pre- and post-discharge adverse events. BOLD captures detailed information regarding each patient’s co-morbidities before and after surgery using a severity scale. Users of BOLD have access to all of their information at no additional charge and will be able to compare their results against national aggregates. BOLD provides the ability to establish criteria for best practices. BOLD has three primary goals:To offer Centers a real-time tool to monitor their compliance with the Bariatric Surgery Centers of Excellence (BSCOE) requirements.To provide SRC with credible data that can be used to demonstrate to consumers, employers, medical professionals and payors of the value and efficacy of bariatric surgery. Clinical series, although helpful, represent only selective data. Claims data collected by payors is often inaccurate due to the nature of billing codes. To collect the information needed to improve patient outcomes. The data will guide surgeons in choosing the right operation for patients. BOLD is a unique platform for evidence-based medicine, tracking complications and improvement or resolution of co-morbidities longitudinally in an effort to develop risk stratification guidelines that will promote improved patient care and outcomes.BOLD Design The development of BOLD was guided by SRC's Research Advisory Committee (RAC) and began during the fourth quarter of 2005. All software development was performed by SRC. Efforts were made to keep data elements and data definitions common with the NIH Longitudinal Assessment of Bariatric Surgery (LABS) program and other national databases. Initial data elements were posted for review and comment by all BSCOE program applicants. Beta testing was done by SRC's Bariatric Surgery Review Committee and RAC. Access to BOLD As of February 1, 2008, all Provisional Status designees are required to participate in BOLD and compliance is required within 90 days of the Provisional Status designation. After receiving BOLD access, Provisional Status designees must begin entering all new bariatric surgery patients. BOLD compliance is required to be able to receive Full Approval designation as a BSCOE. Participants are required to enter their information in the BOLD format. Accuracy is required and the data is audited and verified. Inaccurate reporting can mean loss of BSCOE status. Interface with Third-party Software SRC developed an interface designed to import data from interested third-party software systems. Participants currently using a participating third-party software system may transmit their data directly into BOLD to minimize or eliminate duplicate data entry. SRC has shared the data elements and integration instructions with several vendors and hospitals interested in developing an interface with BOLD. (Vendors are listed in order of interface completion date.) SRC is pleased to announce that the following vendors have been approved as a third-party provider source that will transmit outcomes data into BOLD. RemedyEHRExemplo MedicalPatientHub™Patient Relationship Management, LLCRaintree Systems, Inc./MDnetSolutions, LLCDigital BariatricsBariatric Office ProductsProNex, Inc.Healthwise Technologies, Inc.EZ Healthcare, Inc.TransMed NetworkOCERIS, Inc.CureTrac LLCBOLD Fees Effective February 18, 2008, SRC changed the fee structure for BOLD as follows:All surgical groups — Provisional Status and Full Approval designees — will pay a one-time BOLD activation fee of $875 with the submission of the BOLD Participation Agreement. Payments for the initial block of 100 patients from designees already signed up to use BOLD will be credited as the BOLD activation fee.Provisional Status Centers (hospitals and freestanding outpatient centers) will be billed an annual BOLD data submission fee of $875, regardless of the number of patients entered into BOLD.Fully Approved BSCOE Centers (hospitals and freestanding outpatient centers) designated before January 1, 2008, will be billed an annual BOLD data submission fee of $1,250 until they enter their renewal year, regardless of the number of patients entered into BOLD. Starting in 2008, Centers renewing their BSCOE designation will not be charged a separate BOLD fee as it is included in the annual BSCOE Participation Fee. BOLD does not require a software purchase. The fee specifically covers costs for program activation, data management, storage and security, as well as compilation, analysis, reporting and dissemination of data. These fees are charged even if a third-party software system is used to transmit data to BOLD. IRB ApprovalBOLD utilizes information on living patients from the preoperative stage through five years or more following surgery. It also asks for some information which is considered Protected Health Information under HIPAAA. For these reasons, the BOLD research study is considered human subject research and subject to various federal laws, including the requirement to receive Institutional Review Board (IRB) approval. The University and Medical Center Institutional Review Board (UMCIRB) at East Carolina University approved SRC’s IRB application, along with a short-form protocol and informed consent document. BOLD users will receive a package with the IRB approval letter, the approved patient informed consent form, study protocol and consent to have UMCIRB provide oversight for the BOLD research study. Institutions that are required or elect to have a local IRB provide oversight will be permitted to do so with appropriate documentation. IRB approval is required before users can enter data. Purpose of the BOLD Co-morbidity Scale The co-morbidity scale used in BOLD was created by the RAC and is based upon a schema originally published by noted bariatric surgeons, Bruce Wolfe, M.D. and Mohamed Ali, M.D., in consultation with others such as NIH/NIDDK/LABS co-investigators and representatives from national health plans. The co-morbidity scale provides a quantifiable measure of the effect of bariatric surgery on co-morbidities over time. The scale will be used to guide SRC in setting new standards for its BSCOE program. It will also be used to demonstrate the value and efficacy of bariatric surgery. Purpose of the Participation Agreement The Participant Agreement was prepared by legal counsel in consultation with other industry experts. The Agreement covers all areas and is intended to protect surgeons, hospitals and patients, as well as meet the various requirements of HIPAAA and privacy of human subjects. Once the agreement is completed, signed and returned to SRC (along with the other required documentation), users will be given access to BOLD. Future Changes to BOLD BOLD is expected to grow in a modular design with additional modules to enhance and supplement SRC’s research initiatives. While the current data collected in BOLD is required for all BSCOE participants, the supplemental data collected in the additional modules will be optional for Research Consortium participants. Constructive input from users is important to the continued evolution of BOLD. Suggestions for changes to improve BOLD are considered by SRC’s research staff and RAC. Your input is valuable. Please feel free to send comments or suggestions regarding BOLD to Support.
  • Financing bariatric surgery makes the treatment possible for the more than one-third of bariatric-eligible patients who are either uninsured or underinsured. But the wrong decisions could cause you to spend thousands more than necessary.  This page will help you make sure that doesn't happen.Overview of who pays for bariatric surgery in the U.S.Tax considerationsPrivate insurance, Medicare, Medicaid and disability insurance8 bariatric surgery financing options without insurance (or if insurance won't cover some or all of the costs)BLISPayment Plan Through Your Bariatric SurgeonFriends & FamilySecured LoanRetirement Plan LoansPermanent Life Insurance LoansBrokers, Direct Lenders and Credit Cards (Unsecured Loans)One final worthy consideration
  • Weight loss (or “bariatric”) surgery: It’s one of the few procedures that is profitable for hospitals. Because it is elective surgery, hospitals have time to verify insurance coverage. And each patient can turn into an income stream, with extra surgeries such as the removal of excess folds of skin.Operating rooms are expensive to maintain, and hospitals often get stuck with the bill from uninsured patients. But weight loss surgery has been a boon to hospital finances, and most hospitals are jumping on the bandwagon.
  • Artisan HealthCare’s solution will focus on the fastest growing market in healthcare: Bariatric Medicine. AH will be an independent HealthCare Information Technology (HCIT) solution provider capable of marketing, selling, distributing, implementing, outsourcing a certified integrated EMR & PMS solution. The EMR solution that AH markets and distributes will be certified by the US Office of the National Coordinator for Health Information Technology (ONCHIT). ARRA HITECH Legislation: The certification program: Certification Commission for HealthCare Information Technology for HealthCare Information Technology (CCHIT) makes our solution eligible for funds granted by the American Reconstruction Recovery Act of 2009, under a provision called HITECH: Health Information Technology for Economic and Clinical Health. Funds totaling more than $19.2 Billion have been allocated by the US government for EMR solutions that are certified. Additionally the AH solution suite will meet and exceed all ARRA HITECH “meaningful use” requirements, including the latest version of HIPAAA (Health Insurance Portability and Accountability Act).
  • Patient Advocacy Navigation (PAN - Includes PHR, Telephone Call Center & Shares RDBMS with vEMR) Vermeer EMR (vEMR - Includes Clinical System with Clinical Connectivity “integration” as well as EMR+ for the business office applications) Personal Health & Wellness Record “PHR+” (PHR+ - Includes limited call center and PHR sharing RDBMS with vEMR or existing EMR for outcomes management & post-operative wellness programmes (referrals & condition management))
  • Bariatric practices and centers rely upon clinical and business data being managed, this can only be done in today’s competitive environment with patient communication enablement. This allows the record to be interactive, and resonates with real-time cooperation; the patient needs a relationship with their provider of care, and have few opportunities couple innovative services with informatics. Artisan HealthCare does exactly that, we merge the medical staff that supports the surgeon with what the surgeon needs, while supporting the theory that patients what to be involved in their care, and not just a passive participant. Empowering the clinician to practice medicine is not innovative, it is common sense!
  • On February 17, 2009 a $787 Billion, the American Recovery and Reinvestment Act of (ARRA) 2009 aka “the Stimulus Bill,” was signed into law by the US federal government.  Included in this law is $19.2 Billion which is intended to be used to increase the use of Electronic Health Records (EHR) by physicians and hospitals; this portion of the bill is called, the “Health Information Technology for Economic and Clinical Health Act”, or HITECH Act.  The US government believes in the benefits of using electronic health records and is ready to invest federal resources to proliferate its use.  Title XIII in Division A, pages112 through 165 and Title IV in Division B, pages 353 through 398, cover the HITECH portion of this economic recovery act. The AH EMR solution will qualify for funds.
  • The differentiation is that both of our top competitors today focus on the features and functions of the EMR, rather than place an emphasis on medical necessity management and outcomes based measurement and consumer / patient involvement. The Artisan / Topicus difference is our approach to incorporate in a common shared database that provides a dynamic EMR application coupled with the consumer / patient access portal / Personal Health Record (PHR). This patient record allows Artisan Healthcare to interact with the patient by assisting their navigation of the difficult steps involved with medical necessity. This electronic component of our “Patient Navigation” has no competition in the US or international market TODAY: Nobody in the industry offers a Patient Advocacy Navigation service that guides patients through the nuances of medical necessity for the gastric bypass surgical procedure; the standard path to approval--- Endoscopy Procedure (Upper), Exercise Physiologist (3 – 6 MOs), Nutritionist Counseling (3 MOs), Patient Psychological Evaluation, Cardiology Assessment, Respiratory Therapy ABG , Sleep Study (Apnea) & Patient Physical (recommendation and referrals can also come from Endocrinologist – Diabetes of General Practitioner / Cardiologist Hypertension / Coronary Heart Disease).  Secondarily Topicus has a patient health record (patient portal) that AH will re-sell to enhance management of the credential requirement of maintaining a patient post operative history for five fiscal years. TODAY, there is not a single solution that combines an EMR and PHR to record and manage the post operative attenuation of co-existing morbid conditions of a gastric bypass patient. The differentiation is clear; Patient Navigation and automation of the medical necessity stages prior to surgery are un-equaled. Second the competition does not provide an online mechanism to measure post operative morbid condition attenuation***. This service solution combination will provide new revenue for the Bariatric Surgeon & will improve the % of patients eligible for the surgical procedure, and can improve outcomes. Our wellness program is a post-operative tool where patient scan continue to communicate with their clinician coupled with several management programs; After Surgery Wellness Programme, Medical Condition Management & Interactive Scheduling Referral System (Insurance specific)***Patients that qualify for bariatric medicine procedures have to have a medical history or a proven medical necessity for the procedure i.e. “morbid co-existing conditions include: Diabetes, Sleep Apnea, Congestive Heart Failure, COPD, Hypertension.: The attenuation of many if not all of these conditions are common post operative, and the monitoring and status update of these pre-existing condition require a 5 year post management programme. Today this is done manually, the records are required to mitigate risk for patients, clinicians and are used as research for outcome qualitative and quantitative reporting. National Quality Measures Clearinghouse™ (NQMC) & Agency for Healthcare Research & Quality (AHRQ)
  • TODAY: Nobody in the industry offers a Patient Advocacy Navigation service that guides patients through the nuances of medical necessity for the gastric bypass surgical procedure; the standard path to approval--- Endoscopy Procedure (Upper), Exercise Physiologist (3 – 6 MOs), Nutritionist Counseling (3 MOs), Patient Psychological Evaluation, Cardiology Assessment, Respiratory Therapy ABG , Sleep Study (Apnea) & Patient Physical (recommendation and referrals can also come from Endocrinologist – Diabetes of General Practitioner / Cardiologist Hypertension / Coronary Heart Disease).  Secondarily Topicus has a patient health record (patient portal) that AH will re-sell to enhance management of the credential requirement of maintaining a patient post operative history for five fiscal years. TODAY, there is not a single solution that combines an EMR and PHR to record and manage the post operative attenuation of co-existing morbid conditions of a gastric bypass patient. The differentiation is clear; Patient Navigation and automation of the medical necessity stages prior to surgery are un-equaled. Second the competition does not provide an online mechanism to measure post operative morbid condition attenuation***. This service solution combination will provide new revenue for the Bariatric Surgeon & will improve the % of patients eligible for the surgical procedure, and can improve outcomes. Our wellness program is a post-operative tool where patient scan continue to communicate with their clinician coupled with several management programs; After Surgery Wellness Programme, Medical Condition Management & Interactive Scheduling Referral System (Insurance specific)***Patients that qualify for bariatric medicine procedures have to have a medical history or a proven medical necessity for the procedure i.e. “morbid co-existing conditions include: Diabetes, Sleep Apnea, Congestive Heart Failure, COPD, Hypertension.: The attenuation of many if not all of these conditions are common post operative, and the monitoring and status update of these pre-existing condition require a 5 year post management programme. Today this is done manually, the records are required to mitigate risk for patients, clinicians and are used as research for outcome qualitative and quantitative reporting. National Quality Measures Clearinghouse™ (NQMC) & Agency for Healthcare Research & Quality (AHRQ)
  • Adverse Event Reporting System (AERS)Prior to rounds how do you receive and collect patient information / status, by acuity?Can you access VSIO, Nurse charting , flowcharts, H&P as well as Round Reports from your home & office?How do you receive medication information?How do you manage Adverse Events?How can you access ancillary results from home & office?How do you manage surgery suite scheduling from home & office?Can you enter orders form the Hospital @ your home or office?Are you involved with a Clinical Effectiveness Data System (CEDS)
  • Rounds management incorporates in all of the data gathering needed for a comprehensive post surgical – recovery to floor – to discharge experience. The surgeon needs flexibility and they need relevant clinical data, even the most technologically advanced systems tend to believe in the “one size fits all approach” to medicine. Artisan HealthCare understands what the bariatric professional needs, and that is a personalized view with intelligent filtered data so they can assess and maintain quality as they ensure positive outcomes. Managing adverse events can be timely, and reviewing multiple high acuity patients each round can be exhausting, so we want to help with spreading those patients out across a tenable surgical schedule. Placing an emphasis on acuity and co-existing conditions to keep quality up while also pushing patients through the hoops necessary to discharge them with confidence. Managing the patient is more than re-assuring them it means crossing the T’s and dotting the I’s this affirms credentialing, and complies with Health Information Management (HIM) guidelines. Improving the delivery of care in our eyes means starting with the patients journey and assisting the surgeon along their acute experience as well; then we merge the two once again post-operative so outcomes and wellness can become as predictable as the sunset.
  • Differentiation is more than just marketing, and verbosity it is the quality of service and the ability to execute on a plan. Artisan HealthCare is adapting the best of Europe to compete in an environment in the US where competition is fierce but where focus and dedication to innovation is weak. We are innovators & purveyors of patient advocacy, and believe that clinicians should practice medicine, not administration! We have to enable both, so we decided to craft a foundation that supports a clinical as well as a patient friendly user experience. Our hopes are to realize that which many companies simply cannot change, and that is the nature of their technology. When you start with the end in mind you discover quickly that data is data but it still has to be orchestrated in an intelligent and logical manner. The challenge is not abstracting the information as much as validating the value of a flexible tool that can easily adopt to workflow and to proactive intervention. Clinicians want a smart case summary, so they can assess the situation quickly, and then interact with a system that will notify the care team to execute. Patients are no longer relegated to the sidelines, instead they are a component of care, and are responsible for the long term success of the surgical procedure. Therefore post-operative wellness & outcomes is as logical as patient advocacy during medical necessity for pre-surgery approval; and that is why we kept the same PHR for both, to provide a continuity of care, using an interactive navigation dashboard that allows patients to be involved with their process. Imagine the value of a patient that knew exactly where they are in the medical necessity process, what results they have available and when their claim will actually be submitted. Denial reduction starts with educating the patient, and slides with continuity to positive outcomes. We take continuity of care seriously, however we place an emphasis on the patient as the surgeon is an independent entity / professional that can serve multiple institutions and have to diversify their services to remain competitive and relevant in an ever-changing discipline. The patient however is the common denominator and is at the base of what allows good medicine to be practiced, we measure outcomes to ensure the success of future patients, why not invoke enthusiasm with ones patients instead of sending out a post card with a lab order for follow up procedures. Improving business throughput while balancing quality care adds value and equates to long term patient dedication.
  • Insurance / Business Capabilities:Pre-certificationAuthorization On-line adjudicationSecondary coverageDenials & Appeals Referrals Document scanning & routingMulti-media scanning, downloading & routingPre-RegistrationPre vs Post Surgery SchedulingE-mail & Telephone Notes / ChartingReminder Letters
  • Obesity & Associated Conditions Symposium 60th Anniversary Celebration!New Orleans, LouisianaNovember 10-14, 2010 Registration begins July 2010. The 27th Annual Meeting will be held at the Aria Hotel at CityCenter in Las Vegas, NV on June 21-26, 2010. Aria Hotel at CityCenter 3730 Las Vegas Boulevard Las Vegas, NV 89109 1-866-359-7757 www.arialasvegas.com
  • Patient Advocacy Navigation is the flagship for a sustainable service as the PHR compliments a call service designed to assist the patient through the arduous task of medical necessity. Receiving approval is easier said than done, after you have confirmed with a selected surgeon than your journey begins, what is self pay, what is covered, what procedures need to be scheduled, what is the prep, what consent forms are needed, directions, hours of operation, what comes next, where are the results, what is the status of my claim…. what can a patient do to be more proactive without taking up their own precious time? Artisan HealthCare’s PAN (Patient Advocacy Navigation) simplifies and refines the patients journey.Balancing what is needed with education, using an interactive ability (web-based PHR) to go through the process step by step is not only a differentiation in the market place it is a diamond in the rough. You know exactly where you are in the process, and understand what is covered and what is not. We provide an invaluable service to the surgeon assisting their patients through a myriad of scheduling challenges, and do not attempt to broker patients from one surgeon to the next, we are a service that allows differentiation, and personalization. Our efforts are about the patient experience, not selling bodies to a surgeon, we are a clinical marketing & scheduling organization that optimizes the patients movement from procedure to procedure. We then offer personalized service to assist the patient, we are there 7X24 because we understand that some of your best questions are not coming to mind between the hours of 9AM - 5PM, people are individuals & should be treated as such.
  • AHs Patient Advocate Navigation provides an evolutionary staple in the way bariatric medicine will be practiced in the future; consumer based approach - focus on the Patient {Navigation to guide patients through medical necessity}Consulting services provide patient advocacy styled medical necessity & partner with the bariatric professional to improve access to clinically relevant information as well as reporting capabilities to validate evidence & outcomes based medicine best PracticesProfessional, private and public services can be enhanced by having a team that is sensitive & understands how Bariatric medicine is practiced Medical claims processing outsourcing has become one of the most common medical outsourcing processes today; AH will engage, schedule, monitor & accept results putting together the claim with appropriate annotations to increase the likelihood of coverage & as a collateral affect will lower denials.
  • Patient Advocacy Navigation is an innovative service that will enhance the quality of the patients experience, lower calls to the bariatric practice, improve the number of patients being approved by insurance, and provides the patient with an up to date status of their journey through medical necessity. The patient needs an advocate & the Bariatric Surgeon needs to offer a service that differentiates and improves the quality and approval rate today!AH will Navigate the Patients through Medical Necessity. Adhering to referral & insurance protocols that complicate the quality of the patient experience.
  • Vermeer is a famous Dutch painter that innovated the way light and color interact, born in Delph, Netherlands his creativity and zeal for capturing life in a “real light” inspired our desire to adapt a European EMR to the US healthcare IT market. As an innovator in one of the most exciting clinical disciplines “Bariatric & Metabolic Surgery” we are honored to serve our clinicians and their patients. Chronic Disease Management is one of the most expensive challenges we have in global healthcare, The US invests over 72% of all Medicare and Medicaid funds to fight these diseases. In 2006 the US healthcare system listed Morbid Obesity as a chronic disease, the debilitative nature of the disease is increasingly becoming an obstacle in peoples lives. It effects the way people live their lives, how they interact with other people and even how they view themselves.Bariatric Medicine is a discipline that demands a special solution that emphasizes a patient focused end-to-end solution and still provide collaborative capabilities so the surgeon can interact and gather data wherever they choose. We have to meet HIPAA requirements but why not make data available where and when the surgeon needs it, why can’t we provide them with real-time up to date information on the degree of pain a patient might be in (how often they touch the pain button post recovery room), why can’t we filter data by a patients acuity level, why not modify an order within an existing protocol. Patients are individuals as are the surgeons, why not craft a solution that can allow them to practice medicine, and not be beholden to ancient technology. We are innovators, and that is why we took the time to survey the competitive landscape, understand the way surgeons practice medicine and actually empathize with the path the patients have to take pre and post-operative for documenting outcomes. The proliferation and sustainable value of a solution is interdependent upon the services offered, as the world of PHR’s and EMRs are not turn key. We see the light, perhaps not the way Vermeer did but we certainly can appreciate it!
  • Electronic Medical Record description and benefits…. The EMR is HealthCare information based on an individual patient. It is created, gathered, managed, and consulted by licensed clinicians & staff from a single organization. Therefore the EMR enables ubiquitous critical clinical data availability for the clinician to execute on their care plan, designed and crafted for a single patient population. BENEFITs Patient Safety, Compliance, Collaboration, Communication, Referrals & Clinician Awareness
  • EMR standards offer a variety of features and functions, however the key area for EMR capabilities in the arena of Bariatric Medicine is actually are catalyst functions provided by a bi-directional interfaces. Surgery Information Systems and the Hospital HIS / EHR & or Surgery Center systems offer a wide variety of departments, clinical disciplines and therapies. Practical functionality coupled with registration, results, order management, charting and round management can enhance the way medicine is practiced. The desire to view and interact with real-time results, surgery scheduling, resource allocations, nutrition / dietary, exercise, sleep study, endoscopy, radiology, cardiovascular, respiratory therapy, physical therapy & endocrinologist collaboration are key to making the patient as well as the surgeons experience an uneventful one. Data is data but where and how you apply that data is clinical informatics, and is exactly what an EMR was designed to do.
  • Bariatric Surgeons & Centers are losing money & potential patients from denied claims that would not be denied with a comprehensive EMR & PMS solution coupled with our Patient Advocate Navigation (PAN) service. Today Bariatric Surgeons are forced to use expensive resources to acquire missing clinical documentation, un-signed documentation, un-corrected errors & claims appeal processes. With a Bariatric customized solution the delivery of care is improved & reimbursement is optimized. Estimates show annual savings of $360,000 (US Only) for a single Bariatric surgeon Practice, when denials are lowered a mere 20%; a standard EMR/PMS solution today can attain up to 40% denial claim attenuation.
  • Artisan HealthCare will develop a predictive & quantitative decision support mechanism. That application will leverage the evidence /outcomes gathered from over 4K + gastric bypass patients. The patients characteristic, medical status, co-existing morbid condition(s), medication history, stages of chronic disease & health factor(s) will algorithm a qualitative assist programme. Now the Bariatric Clinician will have a predictive, rules based logic reporting & practice tool for their medical discipline that no HCIT vendor has available today. - Patent -
  • Our Personal Health Record (PHR) is a web-based personalized wellness application that functions to capture, organize & display clinical information for the patient. This helps patients as well as surgeons to keep track of data, such as medications, laboratory / radiology results, illnesses, surgeries, allergies, referrals, condition management & other information pertaining to the patient’s medical history.
  • Georgia
  • PNDS = Perioperative Nursing Data Set
  • Transcript of "Artisan ehr-intro.2011"

    1. 1. Artisan HealthCare Bariatric Informatics Company Crafting a better way to practice Medicine Rex Osborn June 2011
    2. 2. In 2006 the Center for Medicare & Medicaid Services agreed with the NIH (National Institute of Health) that morbid obesity is a chronic disease, and is now classified as such. A shocking 33.3% of American adults are obese (63.6 million). In children, obesity is also prevalent, and around 17% of American children are overweight or obese. Lifestyle and behavior radically alter the chances of becoming obese. Obesity is estimated to cause about 300,000 deaths in the U.S. every year, according to the American Obesity Association. It also causes many other serious health conditions (morbid conditions) such as diabetes, heart disease, sleep apnea & high blood pressure (hypertension) Studies have shown that obesity not only effects individuals; it also drains the economy. According to the CDC, overweight and obese conditions cost a total of $117 billion per year in medical expenses. Imagine the cost if they included coexisting morbid conditions. All Rights Reserved ©2010 Artisan HealthCare, Inc.
    3. 3. ✓ 1 2 3 4 5 6 Artisan HealthCare Who We Are Bariatric Informatic Market What We Do Market Differentiation Our Development Collaborative Topicus HealthCare Patient Advocacy Navigation Vermeer EMR Functionality PHR+ Health & Wellness Why ”The Netherlands” BOLD ™ Artisan Management All Rights Reserved ©2010 Artisan HealthCare, Inc.
    4. 4. Artisan HealthCare (AH) is a Bariatric Medicine** Informatic Solution Company. AH is an independent innovator organization that markets, sells, implements & supports specialized software and patient services for Bariatric Surgeons. AH supports end-to-end bariatric informatics for the patient as well as the bariatric surgeon and their staff. AH re-sells the #1 Dutch EMR (Vermeer) / PHR (Patient Health & Wellness Record – PHR+) solutions. **Bariatric Medicine is the branch of medicine that deals with the causes, prevention & treatment of obesity. Weight loss is a significant financial investment in developed & developing countries. Now that morbid obesity has been classified as a disease, health authorities around the World are developing services to counteract the impact it has on co‐existing morbid condition like diabetes, sleep apnea, coronary heart disease and hypertension. The procedure that is widely performed is called a gastric bypass procedure, performed by bariatric surgeons. Our US team of product management, bariatric service specialist & HealthCare Informatic experts provide the functional, integration & certification requirements to provide a competitive and singularly unique end-to-end bariatric medicine stable of solutions. All Rights Reserved ©2010 Artisan HealthCare, Inc.
    5. 5. PHR: Combining AH’s Patient Advocacy Navigation (PAN) and Personal Health Record (PHR) AH aids the patient through their approval journey (pre-Surgery aka Medical Necessity) as well as their post surgery wellness endeavor to maintain health and weight. Pre-surgery - Patient Advocacy Navigation (PAN) utilizes an interactive PHR with a call center that has a trained staff of bariatric specialist to guide patient through approval Post-Surgery – Patient Health & Wellness Record (PHR+) allows tracking of co-existing morbid condition attenuation. EMR: The bariatric clinician and his staff will use AH’s Vermeer EMR , a dynamic EMR that provides clinical interoperability (connectivity to the Hospital / Surgery Center) and communication system that will improve the collaboration between clinicians, surgeons and patients. (via PAN / PHR & PHR+) Patient Advocacy Navigation (PAN) Assists patients through ”medical necessity” using Telephony & PHR (Pre-surgery for approval) & PHR+ for Post Surgery – Continuity of Record Vermeer Electronic Medical Record (vEMR) ARRA HITECH Funded EMR for Bariatric Practice. Provides clinical, administrative & financial tools for bariatric practice. Enables Hospital & Surgery Center interoperability & collaboration w/ patients pre & post surgery Aided Surgery Approval Assists patients in a sustainable Wellness program & provides Bariatric Practices a collaborative outcomes tool Post Operative PHR Patient Advocacy Navigation PHR Patient Health & Wellness Record (PHR+) Vermeer EMR (vEMR) PHR + Patient Health & Wellness Record All Rights Reserved ©2010 Artisan HealthCare, Inc.
    6. 6. Artisan HealthCare (AH) is a Bariatric Medicine Informatic Solution Company; Development based in Deventer, Netherlands, and Headquarters located in Reston, Virginia AH resell’s a European subscription based Clinical Electronic Medical Record (EMR)** solution that exceeds the needs of Bariatric Medicine: **Topicus Healthcare (based out of the Netherlands) is the #1 EMR solution in Holland & is the collaborative development partner AH will introduce the US HealthCare IT market a hybridization of a comprehensive clinical EMR & a consumer based Personal Health Record (PHR) AH provides a “single view” across disparate EMRs and or HIS solutions to enable collaboration with surgery center(s), Hospital(s) &referral clinicians (the Bariatric Surgeons domain) AH with Topicus Healthcare will design or partner with a Practice Management component (Billing, Claims, Insurance Management / or we integrate with existing billing solution) AH supports the Clinical Informatic component (EMR) and will also offer an array of Bariatric Business Management & Patient Advocacy Services; PHR based Patient Registration, pre-Registration, Scheduling & Education access Bariatric Medical Necessity Service; Patient Advocate Navigation (PAN)- Patient focused advocacy service that navigates the patient through Medical Necessity to qualify for the appropriate bariatric surgical procedure (Denial attenuation) All Rights Reserved ©2010 Artisan HealthCare, Inc.
    7. 7. Artisan HealthCare has a technical & collaborative relationship with Topicus HealthCare of Deventer, Netherlands. The Dutch preeminent leader in healthcare IT is also the market leader for EMR & PHR solutions in the Netherlands. Topicus & Artisan Healthcare are adapting US workflows, integration tools, HIE (Health Information Exchange) standards & proven 4GL tools to manage Bariatric patient(s) as well as clinician relevant data. Topicus & Artisan Healthcare are working together to provide end-to-end Bariatric Informatics that does not lose sight of the patient. Providing a tenable solution for clinicians means understanding the ARRA HITECH legislation, adopting “Meaningful Use” while meeting CCHIT certification criteria. With that being said, the most important fundamental differences in our approach is that we understand how the Bariatric professional works, who they have to communicate with & where are the interventions where they need to share critical data with the patient. Understanding Bariatric medicine and applying that knowledge to the IT solution that covers care from medical necessity to outcomes is the preeminent goal we have set for ourselves. Artisan Healthcare will leverage a Software as a Service model that allows EMR adoption via affordable circumstance; it fits within an operational budget rather than the standard capital expense of our competitor(s). Artisan HealthCare evaluated the US EMR market for ambulatory care & found that most are conformist, lack innovation and creative practical design. All Rights Reserved ©2010 Artisan HealthCare, Inc.
    8. 8. Topicus HealthCare is a leading provider of web-based services for the HealthCare market, with a special focus on patient-centered crosssector HealthCare services. Topicus improves HealthCare by focusing on the core participants in care-related processes: patients & HealthCare providers. By stimulating & supporting the multi-disciplinary cross-sector cooperation, Topicus aims to improve patient wellness, improve HealthCare quality & reduce costs across the HealthCare system. Thousands of general practitioners, millions of patients, hospitals, pharmacists, nursing homes & specialists are logging on to Topicus designed web-services day-in, day-out to manage their Electronic Medical Records, e-consults, medication prescriptions, appointments, referrals etc. Topicus enables a secure exchange of HealthCare information with a strong involvement of patients in their careprocesses . Topicus HealthCare solutions allow better coordination of care between HealthCare providers and patients. #1 EMR in Holland! All Rights Reserved ©2010 Artisan HealthCare, Inc.
    9. 9. All Rights Reserved ©2010 Artisan HealthCare, Inc.
    10. 10. BOLD captures real-time information on each patient during pre-, intra- and all postoperative visits. BOLD also obtains information on intra-operative, pre- and post-discharge adverse events. BOLD captures detailed information regarding each patient’s co-morbidities before and after surgery using a severity scale. Users of BOLD have access to all of their information at no additional charge and will be able to compare their results against national aggregates. BOLD provides the ability to establish criteria for best practices. Today there are 13 vendors that have active feeds to the Bariatric outcomes Longitudinal Database. Of these 2 vendors market and focus on the bariatric space, and provide features and functions in the arena of EMR. Bariatric Outcomes Longitudinal Database™ Artisan HealthCare’s Vermeer EMR will meet BOLD requirements in 2010. Click on SRC or BOLD All Rights Reserved ©2010 Artisan HealthCare, Inc.
    11. 11. ✓ 1 2 3 4 5 6 Artisan HealthCare Bariatric Informatic Market Customers Market Differentiation Market Data Patient Advocacy Navigation Procedural Costs Business Opportunity Vermeer EMR Functionality PHR+ Health & Wellness Denial Reduction EMR & ARRA HITECH Legislation Competition All Rights Reserved ©2010 Artisan HealthCare, Inc.
    12. 12. Metabolic & Bariatric Surgeon Practices, Weight Loss Clinics, Hospitals opening Gastric Bypass Centers / Practices & Independent Surgery Centers Medical sites & or regions that lack Bariatric Services can contract consulting & strategic planning. The emerging medical tourism vertical possesses clinics designed & credentialed to perform bariatric surgery and will also be included as potential clients Key motiviation for surgeons is the decrease in reimbursement (commercialization of procedure & necessity) as well as the competitive landscape. All Rights Reserved ©2010 Artisan HealthCare, Inc.
    13. 13. The Patient is responsible for surgical procedure bill. Therefore the bariatric surgeon has to offer a competitive array of services & has to simplify patients’ medical journey. AH wants to support patients by offering PAN / PHR+ “PreApproval to Surgery & Post-Surgery through 5 Year Outcomes Measurements” as these are currently not covered by any informatic vendor in the market today! AH will make an impact on the Patient Experience. The procedures that are required via Medical Necessity are COVERED; over 82% of pre-surgery procedures are covered under private insurance plans; Today patients have to tie up office staff & leverage insurance companies to guide their way through the system All Rights Reserved ©2010 Artisan HealthCare, Inc.
    14. 14. Primary Target Market: The US has the largest HealthCare Information Technology (HCIT) market in the World (estimates 2009 $39.5 Billion USD); The market vertical within the US where Bariatric Medicine (Office) is Practiced is valued at $6 Billion USD annually; Ambulatory Care Artisan Healthcare estimates the US Bariatric Informatics space est. $447 Million USD (Avg EMR $124K, 3060 Surgeons, 15% - 20% Annual SMA, Integration, Implementation & Consulting) All Rights Reserved ©2010 Artisan HealthCare, Inc.
    15. 15. US bariatric market growth has gone up over 600% from 1993 – 2008; 600% Growth Surgeries Performed Source AMA, American Society of Bariatric Surgery US bariatric surgery reimbursement has gone up over 700% in the past 3 years; Source AMA, American Society of Bariatric Surgery All Rights Reserved ©2010 Artisan HealthCare, Inc.
    16. 16. Average Morbidly Obese Patient; 275 Pounds 42 Year Old, Caucasian Woman BMI of 45 All Rights Reserved ©2010 Artisan HealthCare, Inc.
    17. 17. The average gastric band surgery cost between $17,000 and $30,000. The average cost of gastric bypass surgery is $20,000 to $35,000 Medical Tourism processes range from $6,000 to $12,000, with packages that cost up to $50,000. All Rights Reserved ©2010 Artisan HealthCare, Inc.
    18. 18. There are 3060 licensed Bariatric Surgeons in the US. These Bariatric Surgeons work in a little over 1000 specialty centers, clinics, & or practices. With an additional 300 clinics & practices due to become operations by the end of 2011. All Rights Reserved ©2010 Artisan HealthCare, Inc.
    19. 19. Crafting a better way to practice Medicine AH improves access, overall care, mitigates risk & liability for both the patient as well as the clinician. AH provides rapid access for the bariatric clinician to all relevant patient “clinical” information from a wide variety of Hospital(s), Medical Practices, Surgery Centers, Clinics & supporting Medical Institutions. AH handles all administrative, demographic & insurance data related to the bariatric patient & in parallel supports the financial components for the clinicians business. Personal Health & Wellness Record All Rights Reserved ©2010 Artisan HealthCare, Inc.
    20. 20. Bariatric Practices & Centers are losing money & potential patients from denied claims that would not be denied with a comprehensive EMR / PHR coupled with our Patient Advocacy Navigation service. Today managing a patient load as well as medical necessity requires automation, a call center and resources that rarely exist. With a Bariatric customized service & solutions the delivery of care is improved & reimbursement can be optimized. Diversification & Personalization of Services is a “bariatric imperative” Estimates show annual savings of $360,000 (US Only) for a single Bariatric surgeon Practice, when denials are lowered a mere 20% FACTOID: According to a HIMSS 2009 study “a standard EMR/PMS solution today can attain up to 40% - 55% denial claim attenuation for a single specialty physician / clinician.” All Rights Reserved ©2010 Artisan HealthCare, Inc.
    21. 21. Artisan HealthCare’s Vermeer EMR solution (vEMR) will meet all criteria outlined by the latest legislation from the US government (ARRA: HITECH Provision 2009 $19.2 B USD Funds for US EMR solutions) mandating the adoption of Electronic Medical Records for physicians (by 2014) AH will focus on Bariatric Surgeons, not only as a differentiation but because the sustained growth of that specialty market will rise with reimbursement predicated upon weight loss surgery to lower co-existing morbid conditions & improves patients’ quality of life (Preventive Medicine). Patient Experience enhancement. AH will also provide a Patient Advocacy Program that will help navigate the patient through the process of getting medically qualified for the surgical procedure (Medical Necessity). Physicians that do NOT adopt EMR technology by 2015 will have reduced Medicare Medicaid Reimbursement AH will offer a Personal Health & Wellness Record (PHR+) that will enable post-operative clinician & patient communication, allow automated referrals, trend the patients morbid conditions and track outcomes. All Rights Reserved ©2010 Artisan HealthCare, Inc.
    22. 22. There are generic EMR & PMS solutions, none of which are focused or organically designed to support Bariatric Medicine. There are 4 emerging bariatric styled system solutions in the US. Raintree is the pioneer, focused primarily on clients on the West Coast (California) & is privately held, designed for office management, lacks integration with surgery systems & PHR capabilities. (Lacks rounds management) Exemplo is a garden variety EMR that has a Bariatric styled solution, office dominance lacking PHR & integration to surgery & medication management. (Lacks rounds management & remote access) Remedy MD has a variety of specialized systems in multiple verticals, and is being managed by the venture capital group that provided the start up funds, an academic designed system, lacks PHR, integration & private Bariatric office applications. Pronex is a nutrition start-up with designs to move towards Bariatric management. We believe the growth & size of our market coupled with the lack of aggressive competition coupled with our patient advocacy navigation services equates to price point advantages, tangible ROI for our clients & predictable sustainable growth over the next 5 years. The differentiation is that our top two competitors today focus on the features & functions of the EMR, rather than place an emphasis on medical necessity management, rounds management, surgery integration & outcomes based measurement (i.e. consumer / patient involvement). All Rights Reserved ©2010 Artisan HealthCare, Inc.
    23. 23. ✓ 1 2 3 4 5 6 Artisan HealthCare Bariatric Informatic Market Market Differentiation Patient Advocacy Navigation Vermeer EMR Functionality PHR+ Vermeer EMR vEMR Patient Advocacy Navigation PAN PHR+ Health & Wellness All Rights Reserved ©2010 Artisan HealthCare, Inc.
    24. 24. Prior to rounds Bariatric Surgeon will have a patient list; “Data Gathering” prior to examination; By Acuity Level Laboratory / Radiology results, as well as progress notes & protocol status & nursing shift reports Auto signature for protocol notes & or order modifications Access to patient VSIO, Nurse charting , flowcharts, H&P as well as “Round Reports” eMAR updates Surgery scheduling bi-directional access Adverse Event Management Order entry or confirmation of pre-registration by patients Clinical Effectiveness Data System (CEDS) management All Rights Reserved ©2010 Artisan HealthCare, Inc.
    25. 25. Medical Necessity Case Scheduling  Resource Allocation  Inventory Management Post-Operative Pre-Operative DATA GATHERING: Flowsheet (lab), Notes, Clinical Documents & Surveillance / Monitors History & Physical Initiate Patient Alerts Case Cart Preparation POC Documentation  Patient Milestones Anesthesia Evaluation Patient Education Care Planning / Protocol Quality Assurance PATIENT Examination: Assess & Check Acuity Level COMMUNICATION: Collaborative Care Planning, Medication & Progress Status PLAN OF CARE: New Orders Existing Orders, Status Update Continuity of Care  Continuous Assessment Medication Reconciliation Initiate Patient Alerts Physiological Monitoring • Invasive & non-invasive Pain Management Post-Operative Plan Patient Adverse Event Management Dietary / Nutrition Management Condition Management Medication Management Wellness program Weight Management Lifestyle Management Chronic Disease Management Post-Operative Referrals Follow-Up All Rights Reserved ©2010 Artisan HealthCare, Inc.
    26. 26. AH benefits both the surgeon as well as the patient. We lower the surgeon’s current denial rate by raising the amount of patients that require medical necessity; NAVIGATION; We can enhance patient eligibility by leveraging our vast knowledge of medical necessity & insurance requirements to justify morbid obesity corrective surgery & We assist the patient through the complicated journey called medical necessity confirming co-existing morbid conditions & qualification criteria outlined per insurance payer. All Rights Reserved ©2010 Artisan HealthCare, Inc.
    27. 27. The patient can follow their own medical necessity progress; from pre-registration, through scheduling, on-line education, consent to layman results reporting & claim status notification. The patient becomes a proactive component rather than a reactive & under informed participant. Initial & Follow up appointment scheduling, reminders & monitors Allowing the patient to follow their progress post-surgery with a dashboard designed to trend / track their weight, morbid condition attenuation, program access (exercise, nutrition, supplements, counseling, relationship enhancement programmes etc.) Empowering patient for post operative procedures; Education Materials, Plastic Surgery References, Nutrition Counselors, Exercise Programmes, Medical Condition References (Diabetes, Sleep Apnea, Hypertension, Cardiovascular etc.) All Rights Reserved ©2010 Artisan HealthCare, Inc.
    28. 28.  Outsourcing Bariatric Medical Necessity / Navigating Patients Leveraging The Latest HealthCare Technology: o Pre-certification o Authorization o On-line adjudication o Secondary coverage o Denials & Appeals o Referrals o Document scanning & routing o Multi-media scanning, downloading & routing o Pre-Registration o Pre vs Post Surgery Scheduling o E-mail & Telephone Notes / Charting o Reminder Letters All Rights Reserved ©2010 Artisan HealthCare, Inc.
    29. 29. We improve the communication between patients and their surgeons via a Personal Health & Wellness Record (PHR+); OUTCOMES We lower the communication barriers between patients and their surgeon; We provide tools for wellness We measure the attenuation of morbid conditions Diabetes Management Nutrition & Vitamin Supplement Management We provide outcomes by integrating PHR+ & Vermeer EMR (or disparate EMR) Allow scheduling of procedures & a telephony advocacy program post-surgery All Rights Reserved ©2010 Artisan HealthCare, Inc.
    30. 30. Thought Leadership Present, Publish & Conference Participation Patient Advocacy Standards Adherence Interoperability in Bariatric Medicine Bariatric Informatics Leveraging ARRA HITECH Funds for the Surgeon Co-Existing Morbid Condition Management Bariatric Service Diversification Patient Experience Patient Advocacy Navigation / PHR Improving the delivery of care from inception to surgery approval & admission. AH blends PAN (telephony) & a PHR assisting patients by keeping them up to date with their process (results & claim status) in achieving medical necessity & ultimately approval Vermeer EMR & EMR+ Providing interoperability with existing surgery & clinical systems, enabling remote data gathering, collaboration with clinicians, medication management & charting + (Plus) includes business office management Personal Health & Wellness Record PHR+ Post-operative wellness, condition, referral management as well as personalized collaboration with bariatric team for outcomes measurement All Rights Reserved ©2010 Artisan HealthCare, Inc.
    31. 31. ✓ 1 2 3 4 5 6 Artisan HealthCare Bariatric Informatic Market Market Differentiation Patient Advocacy Navigation Vermeer EMR Functionality PHR+ Health & Wellness Medical Necessity PAN & PHR Patient Advocacy Navigation All Rights Reserved ©2010 Artisan HealthCare, Inc.
    32. 32. Medical Necessity is a set of rules used by the US to determine what is medically justified as reasonable, appropriate & or necessary. These rules are based upon Clinical Standards of Care. TODAY Patients’ are given a list or “required” procedures by the surgeon. Patients’ then have to logon to their own insurance sites to validate the requirements to achieve “medical necessity” All Rights Reserved ©2010 Artisan HealthCare, Inc.
    33. 33. PAN & PHR Pre-Surgery - Patient Advocacy Navigation (PAN) is an innovative service that AH provides via subscription to aid patients as they navigate through “Medical Necessity”. PAN is for pre-surgery blending of an interactive PHR and a call center. This combination allows patients to see their journey through a dashboard indicating the degree of completion, scheduled procedures / studies, results status, patient / procedure education & overview of medical claim status. PHR+ = Post-Surgery - Personal Health & Wellness Record (PHR+) is an interactive PHR that tracks weakening of morbid conditions, provides nutrition & sustainable ideas for weight normalcy. This is an outcomes based approach that provides the bariatric patient with a long-term interactive tool. All Rights Reserved ©2010 Artisan HealthCare, Inc.
    34. 34. Patient Advocacy Navigation To qualify for a GB, you must meet “Medical Necessity”  ECG - Cardiologist  Diabetes Management (Endocrinologist)  Physical Exam  CXR - Radiology  Laboratory  Psychological Evaluation  Endoscopy  Sleep Study  Nutritionist  Exercise Physiologist PAN is an innovative service that will enhance the quality of the patients experience, lower calls to the bariatric practice, improves the number of patients being approved by insurance & provides the patient with an up to date status of their journey through medical necessity. Avg GB Surgeon Has $1.8 M USD Worth of Denials Avg EMR Lowers Denials by Up to 50% Patient Advocate Navigation is a Patient Centric service provided via membership or as a part of the EMR focusing on navigating the patient through medical necessity (insurance qualification criteria) to lower surgery denials & grant qualified patients assistance from initial visit to surgery. (Blends PHR & Advocacy Call Center, sharing the EMR database) All Rights Reserved ©2010 Artisan HealthCare, Inc.
    35. 35. ✓ Artisan HealthCare 1 2 Bariatric Informatic Market 3 Market Differentiation 4 Patient Advocacy Navigation 5 Vermeer EMR Functionality 6 PHR+ Health & Wellness Vermeer EMR 101 vEMR Vermeer EMR Features & Functions PMS Practice Management System Standards & Adherence All Rights Reserved ©2010 Artisan HealthCare, Inc.
    36. 36. EMR An EMR is electronically stored & distributed medical information about an individual’s health status & healthcare transactions All Rights Reserved ©2010 Artisan HealthCare, Inc.
    37. 37. EMR The EMR enables Continuity of Care; the availability of information, clinician constancy with a goal of seamlessness in transitions from one medical setting to another. BENEFITs Patient Safety, Compliance, Collaboration, Surgery System Communication, Referrals & Clinician Awareness All Rights Reserved ©2010 Artisan HealthCare, Inc.
    38. 38. Core Functionality is the basic functionality contained in Vermeer EMR, primarily supporting data capture & retrieval.           H&P Discharge Summary Clinical Practice Guidelines (CPG) Problem List Medication List Transcription Results Management Master-Patient Index Advice Nurse Order Processing           Clinician Charting Coding Support Graphical Clinical Display Charting By Exception Structured Data & Aggregation Results Reporting E-Prescription (eRx) Nutrition / Dietary Planning Exercise Physiology Planning Remote Surgery (HL7 SU) Scheduling All Rights Reserved ©2010 Artisan HealthCare, Inc.
    39. 39. The presence of “Enhanced Functionality” indicates that our Vermeer EMR will support & improve clinical workflow. Via messaging, reminders, alerts, interaction checking, referral management & clinical decision support.          Diabetes Registry Proactive Health Maintenance EMPI Global Identifier Practice Analysis Tools Clinical Decision Support Access to Knowledge Tools Comprehensive Messaging QA/UR Reporting Evaluation & Management (E&M)        Advice Nurse Order Processing Medication Ordering Interaction Checking Alerts & Protocols Referral Management & Portal Website & Portal Access for Pre-Registration All Rights Reserved ©2010 Artisan HealthCare, Inc.
    40. 40. “Leading Edge” functionality is designed to support both prospective & retrospective analysis; manage clinical processes across disparate systems, provide quantitative vs. qualitative outcomes & support innovative data capture & communication methods.              Referral Management Multivariate Clinical Outcomes Analysis Diagnostic Quality Results Imaging Document Imaging Voice Storage Transcription Voice Recognition Transcription Disease Management and Care Planning Tailored Patient Education Materials Advanced Security Chronic Disease Management Referring Physician Portal / Collaboration Body Mass Index (BMI) Management *Highlight co-existing morbid condition attenuation Real-time post-op updates, interventions & monitoring via remote conduits (portal) All Rights Reserved ©2010 Artisan HealthCare, Inc.
    41. 41. All Rights Reserved ©2010 Artisan HealthCare, Inc.
    42. 42. PMS A PMS (Practice Management System) is a business tool to support registration of patients, scheduling of events, billing, claims management, remittance, eligibility verification & Insurance EDI transactions; All Rights Reserved ©2010 Artisan HealthCare, Inc.
    43. 43. Subscription based partner, leveraging X12 EDI transactions as well as HL7 feeds for integration to and from EMR & PHR solutions. PMS PMS focuses on Bottom Line… Profitability To continue to offer innovative services for patients. Beyond Medicine; Into the realm of Business Management BENEFITs Record Keeper, Reporting, Office Administrative Task Management, Patient Billing, Compliance All Rights Reserved ©2010 Artisan HealthCare, Inc.
    44. 44. All Rights Reserved ©2010 Artisan HealthCare, Inc.
    45. 45. ✓ 1 2 3 4 5 6 Artisan HealthCare Bariatric Informatic Market Market Differentiation Patient Advocacy Navigation Vermeer EMR Functionality PHR+ Health & Wellness Personal Health & Wellness Record Reference Material All Rights Reserved ©2010 Artisan HealthCare, Inc.
    46. 46. PHR+ Personal Health Record; Our Personal Health Record (PHR) is a web-based personalized wellness application that functions to capture, organize & display clinical information for the patient. This helps patients as well as surgeons to keep track of data, such as medications, laboratory / radiology results, illnesses, surgeries, allergies, referrals, condition management & other information pertaining to the patient’s medical history. PAN is for Pre-Surgery blending an interactive PHR & a call center. This combination allows patients to see their journey through a dashboard indicating the degree of completion, scheduled procedures / studies, results status, patient / procedure education & overview of medical claim status. Post-Surgery - Personal Health & Wellness Record (PHR+) is an interactive PHR that trends the attenuation (weakening) of morbid conditions, provides nutrition & sustainable ideas for weight normalcy & offers condition management programmes. This is an outcomes based approach that provides the bariatric patient with a long-term interactive tool for overall wellness. All Rights Reserved ©2010 Artisan HealthCare, Inc.
    47. 47. Personal Health & Wellness Record After Surgery Wellness Programme:  Morbid Condition Trending (weakening of diseases)  Personal Goals      Medical Condition Management:  Diabetes Management  Hypertension Management  Medication Management  Plastic Surgery Consult  Vitamin / Supplement Management     Achieve & Maintain Goal Weight Build Muscle Tissue Increase Strength & Endurance Increased Metabolism Addiction Control Smoking Cessation Mobility Improvement & Measurement Skin Elasticity Diet / Nutrition Planning  Calcium & Iron Supplement Support  Joint & Arthritis Management After Surgery Scheduling / Appointment Management:  Laboratory Test Schedule  Chiropractor Scheduling All Rights Reserved ©2010 Artisan HealthCare, Inc.
    48. 48. All Rights Reserved ©2010 Artisan HealthCare, Inc.
    49. 49. Crafting a better way to practice Medicine Personal Health & Wellness Record All Rights Reserved ©2010 Artisan HealthCare, Inc.

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