EvEMR Company Overview by Ian Bakar

Product & Company Insight

Welcome to EvEMR The transformation of medical documentation from paper to electronic formats is inevitable. Technological advances, government incentives and the potential to deliver effective, cost-efficient care are all aligning to facilitate this revolution. Presently, the market for Electronic Medical Records (EMRs) is fragmented, chaotic and disorganized and there is no single solution that provides for the needs of the behavioral health community. When consolidation begins in the EMR market, behavioral health clinicians are at risk of being left on the fringe of EMR services due to their small overall percentage of the EMR market. Fortuitously, this chaotic market and the launch of the DSM-V, the latest edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders, present an opportunity.

We’ve designed a product that is not only evidence based, but built around clinical workflows and integrated with evidence-based medicine.

EvEMR is developing three products that will meet the needs of behavioral health providers: EvPsych, EvPsychLite and EvCoder. These products will deliver a simplified way to incorporate evidenced based measures, DSM-V criteria, practice guideline-based clinical decision support and patient education material at the point of care. With this robust feature set and with providing EvEMR’s products free of charge to clinicians, we believe that EvEMR will become the dominant EMR service provider for behavioral health. This, in turn, will produce a massive database of deidentified patient data. This data will come from a large patient population from real-world clinical scenarios on a scale that has heretofore been impossible to accomplish. The knowledge from this database has the potential to greatly enhance the psychiatric field’s ability to care for patients.

EvPsych The EvEMR flagship offering is a modular product built around a clinical notewriter application: EvPsych. This notewriter functions as the tool that will deliver the diagnostic criteria for the DSM-V in a checkbox menu at the point of care. These structured elements emit in the note and feed the registry. Since the majority of a behavioral health note is narrative, there is a main free text area for this content supplemented with a pallet of structured text that can be easily chosen and subsequently incorporated into the narrative. Fields containing the patients past medical and psychiatric history are included in the notewriter so that the users do not have to go outside of the note to get this data. These historical elements are structured text as much as possible to help strengthen the registry for research. The mental status and physical exams lend themselves to structured text while allowing for accompanying free text options. Assessment and plan (A/P) items are integrated in the database along with the lab/rad/medication ordering modules to create a coherent clinical note. Clinical decision support is integrated within the graphical user interface (GUI) of the clinical note section in a non-intrusive way. Current EMRs typically have a very basic note-writer that allows the use of free text. Presently, psychiatric EMRs that do incorporate structured text do not do so in a way that is advantageous for a diagnostic criteria frame of reference. Most EMR companies focus their efforts on other portions of the application; yet writing clinical notes will be the majority of what a provider does with a behavioral health EMR. We believe that EvPsych’s focus on a high quality clinical note-writer with an intelligent blend of free and structured text will deliver critical research elements and provide valuable point of care guidance. In addition to the clinical note, EvPsych includes a comprehensive patient summary. Elements of the patient summary that are required to complete a clinical note are included in the encounter note. For example, past psychiatric history, family psychiatric history, active medication list, social history and substance use history, will be prepopulated into the clinical note. This will allow a quick overview of pertinent patient data. The reports section allows providers to quickly view practice level data. The reports section can also be used to feed information from the database back to the providers to help them improve their clinical care. The clinical library is integrated into the clinical decision support at the point of care, and includes patient handouts, clinical practice guidelines and CME activities. EvPsych integrates a patient portal to gather key clinical information. Questionnaires such as side effects, and evidence based screening and outcome measures were developed as 4

a self-administered module and subsequently incorporated into the clinical note. The intelligent database has recommended time frames when these measures should be administered. These tools can be automatically administered to patients with access to a kiosk or tablet at the time of check-in, or from the patient portal at home. Although providers will have full override capability to adjust the time frames or turn these features off, we feel that most providers will want to follow recommendations from the professional literature. These questionnaires and clinical reminders based on the clinical practice guidelines are another unique feature of EvPsych. From a technical standpoint,

EvPsych is a web-based application hosted on a HIPAA-compliant server. The importance of being web-based cannot be overemphasized, as this allows the flexibility to run EvPsych on multiple operating systems (Windows, Mac, and Android) and on multiple hardware platforms (PC, Mac, iPod, iPad, iPhone, Droid, Nexus, etc.) Additionally, this greatly reduces the complexity, cost and maintenance requirements as compared with locally installed server based systems. This also provides a “built-in” remote capability, as EvPsych will be accessible wherever Internet access is available. In addition to the software,

EvEMR offers a full suite of additional products and implementation services to enhance the clinical utility of our service. Many behavioral health providers are small practices and do not have a technical support infrastructure. EvEMR can provide onsite technical assistance to select and install hardware, map printers and scanners, set up wireless networks, scan previous notes and other IT tasks. EvEMR’s staff is experienced at deploying IT systems and can make the transition from paper to an EMR seamless. Additionally, EvEMR staff can provide on-site training for clinical personnel and clinical workflow analysis. With the combination of training, workflow and IT solutions, EvEMR offers service that makes it a market leader. EvPsych will offer a robust set of clinical analytics. With the growing trend of pay-for-performance and an increased focus on quality and evidenced based care, clinicians need analytics tools that enable them to measure their practice’s performance. In a group practice, EvPsych will allow leadership to monitor the patient outcomes for their staff. Practitioners will be given

clinical decision support tools that will help them adhere to clinical practice guidelines. EvPsych was built with the goal of enabling clinicians to comply with maintenance of certification requirements as a by-product of their daily practice. EvPsych will change the face of behavioral health care and generate valuable research. This is accomplished by linking the integration of patient entered outcome measures, structured historical text, and structured mental status exam findings to treatments. EvPsych brings these features to the point of care in an easy to use, standardized way that is based on the best clinical practice guidelines available. Research will no longer have to be done on small sample sizes, but instead on massive numbers of patients in real world settings. Dashboards will be built that can match patients to treatments that are most likely to be effective based on their patient entered questionnaires, the history of present illness, past medical history and their mental status exam findings. We will be able to identify patterns of symptoms within disorders that tend to be more responsive to certain interventions, which can help lead to studies of the etiology of these disease subsets. No other program in behavioral health does this today. This information can then be used to develop better interventions and medications for patients. Monitoring of medication compliance and side effects can allow us to identify potential adverse reactions to medications much earlier than has heretofore been possible, allowing interventions to be applied before more patients are injured.

EvPsych Highlights » FREE » Complete EMR » Full DSM-V with templates » Integrated E&M coding » Clinical decision support » E-Prescriber » Web-based » Hosted on a secure, reliable, HIPAA compliant server

While it might be easy to see the value in the data generated by psychiatrists using the program, there is also a much larger user population that will also generate valuable data. EvPsych is available to social workers and psychologists as well as primary care physicians. While social workers and most psychologists do not prescribe medications, it is standard practice for them to keep a list of medications that their patients are taking. Clinical notes from these providers will enable us to link outcome measures with medication interventions. In actuality, social workers and psychologists might provide the largest amount of data on medications and outcomes. Primary care providers, social workers and psychologists, treat the majority of behavioral health problems. Making EvPsych available to these groups allows us to capture a data set that would otherwise be lost. Practicing medicine is difficult and costly enough. EvPsych is easy to learn, easy to use, simple and intuitive.

» Unlimited support » Clinical practice guidelines » Notewriter » Patient portal » Group therapy » Medical legal support

EvPsychLite EvPsychLite, our on-the-go DSM-V reference tool, is a smartphone app derived from basic portions of EvPsych. It contains four functionalities: a static DSM-V reference tool, an interactive DSM-V checklist, a simple clinical decision support guide and an e-prescriber. Users are able to look up diagnoses and review the diagnostic criteria that make up the categorical diagnoses. The second portion consists of the HPI checklist function in which a user selects the criteria and the business rules provide diagnoses based on the criteria selected. The third portion is the clinical decision support that describes how to treat patients who have a given disorder. The last portion of the app is the e-prescriber. The e-prescriber is easy to use yet robust in features, including drug-drug interaction checks, electronic refills and memorizing the prescriber’s common practices to facilitate rapid script entry, to name just a few. Users can use EvPsychLite to determine a diagnosis and then easily prescribe a medication for the disorder. Even though EvPsychLite is not a full EMR, it serves as a valuable reference tool for all health care professionals. The E&M coding feature is a native application, and the other features are web-enabled. This allows data mining of information from EvPsychLite. EvPsychLite will generate a robust data set of its own, the e-prescriber will generate a powerful database on prescribing patterns of all kinds of medications, and the interactive DSM-V will capture what symptoms and diagnoses are selected.

EvPsychLite Highlights » DSM-V reference tool » Interactive DSM-V checklist » Clinical decision support guide » E-prescriber

EvCoder Prescribing mental health providers have recently been mandated to convert from the traditional CPT coding to E&M coding. This has been a difficult transition as the rules for coding are complex. EvCoder, has a simplified way of guiding the user to the appropriate E&M level code, and also provides a reference tool for new 2013 CPT codes. This is an indispensable tool for clinicians working to adjust to the new coding rules. We’ve taken the most common outpatient E&M coding scenarios seen in clinical practice and simplified them into an easy to use series of checklists. It takes just a few taps to determine the correct E&M code for any clinical encounter, and is perfect for use in both primary care and psychiatric practices. EvCoder also provides the most common CPT codes used in primary care and behavioral health in an easy to use reference. Whether you are a primary care or behavioral health provider EvCoder will be your go-to outpatient E&M coding app. EvCoder is an application that can be used on any smartphone. It allows providers to easily generate an E&M code, and more importantly, ensure they get credit for the work they have done.

EvCoder Highlights » Integrated E&M coding » Useful for psychiatry and primary care » Available in the Apple App Store and Google Marketplace

EvRx EvRx is an easy to use electronic prescriber that can be accessed from a smartphone, tablet, laptop or workstation. Not only can clinicians complete a prescription in a matter of seconds with EvRx, but it also offers a host of other functions as well. EvRx comes with free tech support, a medical advisor with drug-to-drug interactions, a quick renewal feature and product monographs. Providers have access to patients complete medication profile along with a comprehensive medication database. EvRx enables communication with pharmacists and patients. Additionally, clinicians can access medical news along with other pertinent medical information.

EvRx Features 3 Quick & Easy Steps 1. Pick a patient 2. Pick a drug

Refill Advisor Fast and easy way to refilling patient’s prescriptions

3. Send to nearest pharmacy

Favorite Drug Search by: » Drug name » Chemical name

Patient File Search by: » File number » Last name, first name » Date of birth » Health insurance number

Exception Drugs Fast and easy way of filing the request form or adding payment codes next to the prescription

Therapeutic Advisor » Drug-to-drug interactions » Therapeutic duplication » Therapeutic replication

Pharmacological Profile » Active drugs » Prescribed drug history » Drugs to be renewed » Demographic

Benefits of EvRx For Providers » Write prescriptions and renewals in seconds » Automatically detect harmful drug-to-drug interactions » Facilitate decision-making with the integrated therapeutic advisor » Optimize treatment options by consulting the patient’s pharmacological profile » Send stop messages and change of treatment notices directly to pharmacies » Improve communication between physicians and pharmacists » Fewer phone calls from pharmacists to clarify content of prescriptions

For Patients » Lower risks of errors while processing prescriptions » Lower complications caused by drug-to-drug interactions » Improve quality of the treatments received » Faster prescription delivery in pharmacies

For Pharmacists » Reduces the risk of dispensing errors related to illegible prescriptions » Faster prescription processing » Far fewer clarification phone calls to physicians » Creates customer loyalty » Reduces client waiting time due to illegible or missing information » Script can be filled before the client arrives at the pharmacy

Did You Know? » 31% of paper prescriptions never even make it to the pharmacy » E-prescriptions have an 11.21% increase in patient pick-up » Using an e-prescriber reduces clarifying phone calls by 53%. » On average, $1 is saved per new prescription due to increases in technician productivity

EvPharmacy EvPharmacy helps pharmacies improve efficiency and provide better care to patients through its intuitive, highly visual and secure interface. Designed to put every pharmacy at the forefront of technology, our cloud-based interface allows for maintenance free use, with real time data-entry and reporting functions, ideal for multi-site pharmacies.

Advanced Management:

» Price simulator with quick response to patient questions about pricing. Ideal for new patients joining the pharmacy via incoming transfers. » Scans documents such as prescriptions and consents. » Thermal and laser printing of labels, receipts, pill dispensing, and reports.

Ideal for multi-site operations, provides unparalleled and accurate management reports which generate added value to data, centralize patient information, prevent fraud and improve operational control.

» Capacity to create patient groups.

Increased Profitability:

» Product management including prices, creation of new products, substitution preferences, and identification of all patients having a prescription on file for a specific drug/product.

Easy to install, simple to use and significantly reduces acquisition and maintenance costs. Minimal infrastructure required. Accessible Everywhere: Easy to use, intuitive and secure; it requires minimal training.

Cutting Edge Technology:

» Multiple surfing abilities via keyboard shortcuts, mouse and touch screen.

» Communication with robots, scales and packagers. » Multiple interactive reports with drilldown integration. » Integration with EvRx via the EvScriptWay communication network.

Eliminates the need for complicated updates and backup management EvPharmacy has: Integration with modules for drug interaction alerts, dosage interactions, allergies, product monographs and patient files. » Individual pharmacy configuration and customization. » Patient records management includes: health insurance information, clinical information, allergies, intolerances, diagnoses, family history notes, patient preferences, prescriptions and documents. » Prescriptions management includes: add, change, renew, regenerate, discontinue/hold, resume, claims, incoming and outgoing transfers. » Postdated prescriptions management capability. » Provides various tools that enhance productivity such as generating prescriptions for emergency contraception and pharmacist interventions. » Templates with replaceable fields for patient printouts

» Seamless data conversion from pharmacy’s current software.

EvPharmacy Highlights Processing » User-friendly and secure » Processing system features complete transaction history

Intuitive Design » Standardized architecture allows fast development and effective integration » Real-time dashboard for prescriptions, pharmacy group/banner, etc. » Instant keyword search

Functionality » Digital counter calculates a rannge of numbers for a selected prescriptions » Manage reports, requests and user data » Attach files to a pharmacy, home, professional, patient or prescription » Real-time decision-making module with warnings, reminders and substitutions » Share data between pharmacies » Easy to read, modify and retrieve data via web services

EvScriptWay The EvScriptWay network offers a direct and effective way to communicate with the patient’s physician. This network greatly improves the process of filling prescriptions by:

1. Promoting the pharmacy in the provider’s EvRx prescriber The pharmacy will be accessible in the provider’s EvRx prescriber after each prescription is written. After choosing your pharmacy, providers can send the prescription information facilitating the communication process.

2. Fast script input via barcode reader » All information related to the barcode is automatically transferred to the pharmacy management system. » Process a new prescription as quickly as a renewal. » Pharmacy’s are registered in the patient’s profile as a favorite.

3. Receiving script information in advance In the pharmacy management system, a blinking indicator will glow when a new prescription is received.

4. Electronic prescription renewals Eliminates the need for faxes to physicians for refills. EvScriptWay allows the system to send prescription refill reminders directly into the provider’s EvRx prescriber.

EvScriptWay Highlights » Direct and effective communication with clinicians » Faster script input via barcode reader » Electronic prescription renewals » Receive the script information in advance

In addition to all the benefits provided by the EvScriptWay network, only one prescription per week is needed to make your investment profitable.