Individual Executive Summary

Red Group Memorial Hospital aims to adopt EMR as the primary method of collecting and storing patient data rather than the traditional model of documenting the information in sheets of paper. EMR alludes to the use of an electronic platform to document information about patients, such as the outwards manifestations that they present with, the initial examinations and diagnostic tests that are undertaken, and the treatment plan adopted. The information is significant because it aids in evaluating and following up on the progress of the ailing individuals over time. This business plan articulates the Red Group Memorial Hospital objective of incorporating electronic medical records into its operations, the processes that will be involved in achieving the goal and the duration used to accomplish them.

Business Description

Red Group Memorial Hospital intends to incorporate a new system of operations where medical providers, including nurses, physicians, laboratory technologists, and pharmacists, will receive and document patient content electronically. Some of the content that will be included in the EMR is the patients' contact information, their vital signs, tests and procedures that they have undergone and the medications that they have received (Bardach et al., 2017). The strategy for documenting and storing patient content is significant because it can be accessed and used by all interdisciplinary team members that are in charge of patient care; therefore, it ensures effective continuity of care. Subsequently, the information can be accessed scrutinized in future visits to the healthcare organization, enabling healthcare providers to use appropriate, patient-centred treatment plans. Figure 1 provides a detailed description of the role that EMR will play in the healthcare organization.

Figure 1: Summary of the roles that EMR will play

Retrieved from https://doi.org/10.1197/jamia.M1097

Mission Statement

The incorporation of EMR into the healthcare organisation's operations will enhance the quality of care that ailing individuals who visit it receive. The strategy will improve patient care by making critical content about the invalid individuals to be accessible to all members of the interdisciplinary teams involved in the treatment process. Subsequently, the premise will also make the organization highly competitive because it will provide effective, timely care devoid of the hurdles inherent in the old system, such as perusing large volumes of data while searching for patient information.

Business Environment Analysis

Implementation Plan

The initial step in implementing the plan to initiate the use of EMR in the healthcare organization will be identifying the various resources that are essential to the process. The resources required during the process include human resources in the workforce who will play multiple tasks needed during the process and the vendors who will supply the necessary inputs (Abdekhoda et al., 2019). Another significant resource is financial resources. The organization will need monetary resources to fund different elements, including purchasing the required software and hardware and recruiting staff members who have the necessary expertise to carry out the various processes needed for the plan to be successful (Lambooij et al., 2017). Subsequently, another vital resource required is time. The healthcare organization will set aside a specific duration for implementing the plan and setting it into motion.

The second step in the operations planning is selecting the vendor who will be responsible for providing the essential software in the installation of EMR. It is necessary to find a suitable vendor who can offer the appropriate software for the EMR project. Subsequently, while implementing the plan, it is also essential to instigate adequate measures that enhance the effectiveness of the EMR project (Wu et al., 2017). For example, each physician should have sufficient working space to ascertain that patients' data privacy is maintained. Co-working healthcare professionals such as nurses, pharmacists and laboratory technologists should have a minimum space of 1.5m between them to ensure that patients' content is not compromised. Subsequently, the designers should acquire adequate training and support that equips them with the skills they need to use appropriate strategies while implementing the EMR project for it to be effective.

Another critical process that is an essential part of the action plan geared towards installing EMR is training the personnel on the effective use of EMR. The medical facility staff members, including the medical personnel and supportive staff, should enroll for lessons that will equip them with the skills they need to document and use EMR effectively (Abedkhoda et al., 2017). Subsequently, they need to learn the regulatory stipulations that should be adhered to while EMR. Similarly, physicians also require training that will enable them to use EMR effectively to enhance the standards of care that patients receive. During the implementation of EMR, it is necessary to integrate the process that occurs in different departments such as the pharmacy, the nursing station, billing area and laboratory to ensure that disseminated content reaches the appropriate destination (Lambooij et al., 2017). Therefore, the selected EMR software should have all the necessary features to integrate the processes that occur in different departments effectively.

The selected vendor should also install the software that can aid in providing culturally competent care. It should offer features that allow the translation of documented content from one language to another depending on the needs of patients. Subsequently, it should provide elements such as visual aids that help those with low literacy levels to comprehend the disseminated content (Wu et al., 2017). On the other hand, the selected vendor should also have the capacity to provide the required content effectively within the identified timelines. They should deliver the software and hardware promptly to ensure continuity of care.

Financial Plan

The accrued funds required in implementing the EMR project will be distributed between the various needed elements, as shown in the table below.

Figure 2: Table demonstrating a breakdown of Expenses incurred while installing EMR

Figure 3: Table demonstrating a breakdown of equipment Expenses incurred for the EMR

Achievements and Milestones

The senior personalities in the organization will be tasked with the role of scrutinizing the processes encompassed while implementing the EMR project to determine their suitability to the organizational operations. The strategies used to gauge the achievements and milestones during the projects are shown in the table below.

Figure 3: The funds used in EMR

Conclusion

The business plan provides the protocols that can be used to identify targets that should be met. It includes identifying the areas that need transformation to enable the organization to use the EMR effectively. EMR is a strategy through which healthcare provides document and store patient information safely using electronic methods. The implementation process is elaborate, including identifying and acquiring the required medications. It also includes determining the resources needs in the field. For example, the resources needed to undertake significant operations in the clinical systems ensure that every element needed to make the project effective is available for use in the program. The process also requires constant evaluation to ensure that every activity is completed on schedule. Implementation of the project will ensure that the organization achieves its objective: providing quality care to the patient population. It will be a significant step towards the organization's success and effective progression of the healthcare operations.

Business and Industry Profile

Shreveport, Louisiana, is in Caddo Parish is one of the largest cities in the state, with a population "182,616”(census.gov, n.d.). Verses Bossier which is the sister city, has a population of "68,159” (census.gov, n.d.). There are five major hospitals with multiple clinics that provide medical care to both city's inner and rural communities. Ochsner/Louisiana State University (trauma), Willis Knighton, Overton Brook Veterans Administration hospital, and Christus Shumpert. Red Group Memorial Hospital provides medical care to residents of Desoto, Lincoln, and other Parishes, including Caddo and Bossier Parish, with a combined population of 324,888. All these medical facilities and clinics are located within a 20-mile radius of each other, making it convenient for residents to get high-quality medical care. This is the very reason why Red Group Memorial Hospital wants to purchase the electronic medical records system so that we can streamline the flow when it comes to treating patients and go paperless. The system will result in the hospitals and clinics saving much money yearly on fewer mishaps, wrong diagnosis, and storage for paper records, and It will also “eliminate duplicative or otherwise needless lab tests, imaging scans or other services”( Bill Barrow, 2011). The Facilities will be able to service and treat more patients because of add-on services like telemedicine and being able to send referrals to other facilities via the new electronic platform.

Customer and Patient Profile

The population that is served here consists of “6.8% under the age of 5, 24.4% under the age of 18, 15.5% age 65/over, and 53% of the residents are female” (census.gov, n.d.) This is shown below in the chart, and as you can see, females are the largest population that we serve due to a high rate of high blood pressure, infant mortality, low birth weight babies, breast and gynecological issues, and the increased need for preventive care in the community. 30% of the residents that Red Group Memorial hospital and clinics serve have incomes that are over $35,000, and they have medical insurance; as a part of reaching the community, the Red Group Memorial Hospital has an outreach program within the primary care clinics. They serve the residents that are low income, homeless, disabled, and elderly by going out to where they are to do an assessment and administer care. This group of citizens is mainly on state/federal assistance, fixed incomes that fall below $27,000, and most minorities who live in rural areas with no transportation.

Industry Trends and Forecast

Industry Size and Competition

Red Group Memorial Hospital is the smallest and newest of the hospitals in Caddo parish, with 4 Family Medicine clinics located in 4 parishes in the northwest part of Louisiana. The hospital, which is in the heart of Shreveport, has a surgical suite for day surgeries and is not a trauma center, but we are equipped to handle emergencies and transfer patients when they are stable. RGM offers a variety of Family Medicine inpatient and outpatient services to the community who range in age from neonates, newborns, and the elderly. Our physicians provide the best in preventive care like diabetes, heart disease, high blood pressure, cholesterol, nutrition, obesity, and cancer screening to teach patients how to manage their medical conditions and heal the community. Our clinics provide the following additional services well-child, acute/chronic care for children & families, Immunizations, audiology screening, vision screening, developmental screening, etc.

Red Group Memorial hospital holds the staff to the highest standards for giving the best and top-quality care to our patients, which is why this facility has not failed any inspections by the state or federal government during inspections. Has had a high rating and no demerits with Joint Commission during yearly audits. Implementing the Electronic Medical Record system will only increase the quality of care because of quicker response which will lead to a high rate of healing. That alone will make the hospital and clinics more competitive and lead to more patient referrals and incoming revenue for the hospital. Red Group Memorial hospital is already holding its own when it comes to competing with the four other hospitals in the area, but the electronic medical records system, once it is implemented, will take the facility to higher-level competition.

Marketing Analysis and Plan Review

Market Needs

Red Group Memorial Hospital plan to implement electronic medical record (EMR) in all its facilities. The electronic medical record (EMR) is a digital version of a patient's records/paper chart. It Contain a patient's medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results (Health IT.gov, 2019). Most Medical Centers are currently unable to admit more patents or provide outpatient medical services due to lack of the required necessary technological tools such as the EMR. One of the core advantages of an EMR is that health information can now be created, shared, and managed by authorized providers in a digital format. Most of the EMR technology systems operate on a smaller scale and can be installed without the requirement of in-house servers and can also offer extensive customizations & improvements whenever needed (Research and Markets, 2021). The ability to build and share information with other health care providers and organizations like laboratory, offices, specialists, imaging facilities, pharmacies, and emergency facilities, will streamline the treatment process allowing both the patients and hospital to save on time and money.

Market Trends

EMR technology add considerable value to the US Economy. It had total nationwide economic impact of $90B in 2009 including more than $5.8b in tax payments. The global electronic medical records market size in 2020 was valued at $27B. It is expected to witness a compound annual growth rate (CAGR) of 5.9% over the analysis period 2020-2027or US$38.8B. The Electronic Medical Record Systems market in the U.S. is currently estimated at $7B. Key factors responsible for the EMR market growth is attributable to increasing demand for streamlining electronic healthcare systems along with technological advancements in the field of healthcare information technology (IT). Also, government’s initiatives and incentivization is promoting EMR and it is anticipated to continue to drive market growth. Patients and their families as well as caregivers continue to demand a higher quality of care and to be treated by skilled healthcare professionals. EMR technology rises to the play to ensure these demands are met by the hospital and its workers. EMR also gives patients access to the portal so that they can view their medical documentation.

Market Growth

The EMR market continues to advance in the global healthcare market. In the 2020, EMR segment accounted for more than 54% or $28B share of the global revenue. The U.S witnessed EMR market share of 45.0% in 2020. This growth could be linked to favorable Acts or healthcare reform and policies that mandate the use of electronic health records by healthcare providers as well as the availability of well-established infrastructure with high digital literacy. The EMR technology is becoming popular in hospitals and its being adopted in small-scale facilities. Due to its high success and demand, the acute type of segment in 2020, held a market growth share of about 47%. This large market share could be because of EMR popularity among the physicians and healthcare providers. In 2017, use of EMR in outpatient surgeries grew exponentially and claimed a revenue share of $18B and is projected to increase to $40B by end of 2022 (Research and Markets, 2021). These records of growth can be attributed to the large amount of medical data generated in hospitals and healthcare facilities.

Marketing Research and Analysis

The Healthcare industry and their market leaders are fully represented and actively participates in the development of the new EMR technology system. They are also actively involved in its launching, collaborations, expansions, and acquisitions to keep up with the competition. Most tenured organizations, small players, and start-ups are investing aggressively in mergers & acquisitions to gain a competitive advantage. Example is the recent acquisition of Kantar Health by Cerner Corporation for roughly $375 million (Globenewswire, 2021). With this acquisition, a combination of Kantar’s life sciences expertise and Cerner’s collection of real-world data & technology would work well to improve patients’ outcomes. Health technologies connect people and information systems. EMR is designed to create smarter and better care for individuals and communities. This digital technology assists clinicians in making care decisions and assists organizations in managing the health of their populations. With the help of EMR system, many healthcare organizations also offer an integrated clinical and financial system to help manage day-to-day revenue functions, as well as other relevant services to support clinical, financial, and operational needs that are client focused.

Competitive rivalry/ Threat of new entrants

Competitive rivalry or threat of new or more hospitals implementing the EMR facilities is significantly low. Some popular EMR systems used by competitors include Praxis, Cerner, and GE Healthcare (Research and Markets, 2021). Periodically, upgrades and enhancement in the EMR technology is released. Hospitals and healthcare organizations who live up to the expectations will continue to flourish and gain momentum in their practice. Hospitals that continue to use outdated technology and fail to meet patients quest for quality care will fail and possibly retire their businesses.

Competitive advantage

Ample number of suppliers for the EMR product are available for the Hospital and great professional relationship has been established with them. As volume increases from the implementation of this new technology system, there’s clear expectation of improvement in both margin and overall profitability level. The Hospital currently has a relatively large number of inpatient and outpatient who will benefit immensely from this implementation of EMR system and are simply patiently waiting for its implementation. It will save them tons of time and money as they can simply authorize the sharing of their health information between one healthcare office to another and their affiliates. Accessing their health records and updating their appointment is just a click away.

Key Customers

The key customers for EMR are patients of all ages who has need for Hospital visit, Ambulatory Care, Physician’s Clinic, Laboratories, Pharmacies, Acute, Ambulatory and Post-acute care.

Also, health care Professionals, health Services and other businesses may also obtain the EMR product through Licensing, Technology Resale and Subscriptions.

Marketing and Sales - Overview

The proposed business plan can tackle sizeable volumes of both inpatient and outpatient due to the EMR technology enhancement. Though the cost of implementation is large, the Hospital will position a fair price and comparable to nearby competitors.

Marketing and Promotion Channels

Internet Marketing – The aim of utilizing this channel is to spread the word to certain healthcare professionals and patients who could benefit from the convenient of utilizing their digital devices to access or share healthcare information and records. They can also use this safe system to interact with their physician, scheduled procedure on a specific day, view their Lab results or refill a prescription.

Traditional media

The Hospital will use the traditional media such as Television ads, Local Radio stations, newspapers, and magazines, and billboards to launch marketing campaigns. Which will help draw customers in by spreading the word to patients and the public about the availability and usefulness of the EMR system.

Other Social Media Outlets

networks including Facebook, Instagram, Twitter, WhatsApp, etc. The Overall purpose of utilizing these channels is to properly educate the customer base on the EMR and its usefulness to in improving health care. The hospital also will advertise the EMR usefulness and availability in various social media.

Digital Billboards $1500 quarterly (.30 shared rotating spot for $50 per day)

Television: With a contract for a minimum of 10 spots per bulk purchase.

(non-primetime - Cable channels .30 spot with a price range of $40 to 57 per).

(Primetime spots .30 spots - $62 to 115 per spot)

Selected: (20 non-prime time spots and 10 primetime spots) =$1420.00 and an additional (PT) spot for $80 which bring this investment to $1500 bi-monthly.

Radio With a contract for a minimum of 5 spots per bulk purchase.

(non-primetime - stations .30 spot with a price range of $20 to 30 per).

(. 30 sec Primetime - $45 to 100 per spot)

Selected: (8 non-prime time spots and 30 primetime spots) =$1500.00 bi-monthly

Magazine: $1000 Ad with semi-annually for a ½ page advertisement

Newspaper: $500 Ad with semi-annually for a ½ page advertisement

Internet: $250 every Annually

Total of $27,250

Financial Information

As seen in the above balance sheet snapshot, our organization has maintained its current assets as well as liabilities and shows a healthy equity based upon traditional financial metrics. This financial statement shows that the organization has the capability of keeping our liabilities and debts low on a consistent basis while maintaining our assets through sustainable revenue practices. According to Moseley “The financial achievements of the strategy determine the firm’s ability to continue to obtain the capital necessary to support both future strategies and current operations” (2018, P.280). As it is reflected in the balance sheet, the organization has the financial stability to support this strategic while also showing that there are liabilities which can benefit from cost savings in other areas such as reduction in costs of medical records management.

Income Statement & Operating Budget

Next, we will review the organizations income statement or operating budget to review the revenue versus expense outline of the company. Analysis of an organization’s profits, and potential losses is necessary when weighing the resources needed to commit to a strategic plan while determining the impact the implementation can have on the financial viability of the business (Kennedy, 2020). This will help to give a perception of the costs related to our current operations in preparation for implementation of the strategic plan.

“The underlying logic behind a business plan is to try to predict the future of a company by using specific marketing, strategy, financial research and planning tools” (Daxhelet & Witmeur, 2011, Pa.5). The impact of the strategic plan on the organizations financial future can be better predicted by review of the operating budget. The below operating budget shows the income from revenues received in relation to outgoing cash flow for expenses related to operational function.

Projected Start Up Costs

The costs associated to the strategic business plan are based upon the vendors proposed implementation costs and include the following:

1. Initial EMR Licensing:

The proposed costs of the of the selected EMR system will consist of $2000.00 per full-time provider which includes full revenue cycle management for submission of medical claims. In addition, an initial fee of $400.00 per full-time provider will be required for electronic prescribing of controlled substances and $1200.00 per site implementation.

$2000 x 23 full-time providers = $46,000 + $400 narcotic licenses x 23 full-time providers = $9200 + $1200 x 7 sites (1 hospital + 6 clinics) = $8400 for a total initial cost of $63,600.

2. Monthly Fees:

Following implementation of the system, there are monthly usage fees related to the maintenance of the system and billing functions. Those costs consist of $1200.00 per full-time provider along with $800.00 per location. In addition, if automated patient communications are utilized, there are additional expenses for these services based upon volume which have been predicted to be 4000 automated messages/reminders for the entire organization at $1200 at $0.30/each.

$1200 x 23 full-time providers = $27,600 + $800 x 7 sites (1 hospital + 6 clinics) = $5600 + $1200 (4000 patient communications) = Total cost of $34,400/monthly.

3. Annual Costs:

Annually, the organization will need to pay service fees for renewal of each provider license which consist of $500 per full time provider as well as renewal of controlled substance tokens at $400 per full time provider. $500 x 23 full-time providers = $11,500 + $400 x 23 full time providers = $9,200 for a total annual cost of $20,700.

4. See below exhibit for breakdown of projected costs.

Break Even Analysis

“The underlying logic behind a business plan is to try to predict the future of a company by using specific marketing, strategy, financial research and planning tools” (Daxhelet & Witmeur, 2011, Pa.5). The impact of the strategic plan on the organizations financial future can be better predicted by review of the year-to-year analysis to determine if there is a financial benefit for the organization if the strategic plan is to be fulfilled. The below breakdown shows the costs of the organization from year to year in addition to the costs of the new EMR system in comparison to our current/previous expenses and is broken down by fiscal year with the intention of showing historical expenses versus future projections.

The primary objective of the proposed strategic plan is to give Red Group Memorial Hospital optimal operational efficiencies with the implementation of a more cost effective and clinically beneficial EMR system. As outlined in this financial information section, the organization would benefit from this transition and our goal in providing the discussed financial data is to identify how this change can bring about better financial health for the organization in years to come with increased profitability due to overall cost reduction.

Operational plan

“The best strategic planning involves as many employees as possible, particularly those in the positions that will be responsible for implementing the plan that results” (Moseley, 2018, P.384). Production and distribution are both key elements in the operational functions of the organization. The objective in implementation of a new Electronic Medical Records system is to increase employee production by providing an efficient and comprehensive system which gives personnel the ability to spend less time on administrative tasks. By augmenting the production rate of personnel, we are able to positively impact the distribution of quality care to patients as clinicians are able to devote more time and attention to patient treatment. As we alter the way in which patient care is provided, the organization should also see a positive change in patient outcomes and satisfaction.

An organization may experience various obstacles such as business, industry, and environmental uncertainties that may arise during operations, some of which are controllable by the organization while others are not. However, these should be identified in advance to create a contingency plan to prevent any interruptions to supply and labor. Scenario planning is a great way to create a contingency against operational uncertainties as it allows stakeholders to play out potential scenarios which could impact the efficacy of the strategic plan. Utilization of the Six Sigma methodology as well as the SWOT analysis tool are also effective preventative measures that can be used to establish contingency plans against interruptions to supply and labor. These tools help to identify areas of strengths, weaknesses, opportunities, threats as well as distinguishing defects in a process to prevent errors and improve outcomes (Harrison, 2010).

Source: Org Charting.com

As seen from the organization chart above, the Hospital runs Hierarchical organizational structure. The chain of command goes from the top – the board of director down to entry-level and low-level employees with each employee having a supervisor. These group of top executives form the central core management of the hospital.

Key personnel, roles, and responsibilities. 

Board of Director – As a corporation, the hospital’s activities are overseen by boards of directors including the formulation of policy and procedures that govern the hospital, its employees, customers, contractors, and vendors. Board’s members consist of influential members of the health care and local communities.

Chief Executive Officer (CEO) – The hospital’s CEO is the top boss responsible for everything that goes on in the hospital. The CEO have Chief Administrative Officer (CAO),

Chief HR Officer, Chief financial officer (CFO), Service Support Director amongst others who report directly to him.

Reference

Abdekhoda, M., Dehnad, A., & Zarei, J. (2019). Determinant factors in applying electronic medical records in healthcare. East Mediterranean Health Journal, 25(1), 24-33.

Bardach, S. H., Real, K., & Bardach, D. R. (2017). Perspectives of healthcare practitioners: An exploration of interprofessional communication using electronic medical records. Journal of interprofessional care, 31(3), 300-306.

Barrow, B., & The Times-Picayune. (2011, November 11). LSU health system begins switch to online patient records statewide. NOLA.com. https://www.nola.com/news/education/article_bdb5c069-64d4-57a7-aad2-4ca26f2b6a24.html

Bojkovska, K., Grozdanovska, V., & Jankulovski, N. (2017). Financial management and financial planning in the organizations. European Journal of Business and Management, 9(02).

Daxhelet, O., & Witmeur, O. (2011). What financial backers expect from business plans: Effectual versus causal logic. Working Paper CEB 11–029

GlobeNewswire, (2021). Cerner Finalizes Acquisition of Kantar Health. https://www.globenewswire.com/en/news-release/2021/04/01/2203475/10862/en/Cerner-Finalizes-Acquisition-of-Kantar-Health.html

Grand View Research, (2021). Electronic Health Records Market Size, Share & Trends Analysis Report by Type (Post-acute, Acute), By End-use (Ambulatory Care, Hospitals), By Product (Web-, Client-server-based), By Business Models, And Segment Forecasts, 2021 – 2028. https://www.grandviewresearch.com/industry-analysis/electronic-health-records-ehr-market

Harrison JS. Strategic Planning and SWOT Analysis. Chapter 5, Essentials of Strategic Planning in Healthcare. Chicago, IL: Health Administration Press; 2010.

Health It.gov, (2019). What is an electronic health record (EHR)? https://www.healthit.gov/faq/what-electronic-health-record-ehr

Lambooij, M. S., Drewes, H. W., & Koster, F. (2017). Use of electronic medical records and quality of patient data: different reaction patterns of doctors and nurses to the hospital organization. BMC medical informatics and decision making, 17(1), 1-11.

Kennedy, R. Y. (2020). Analysing the Financial Resources of the Business. In Handbook of Financial Planning and Control (pp. 13-25). Routledge.

Moseley III, George B., (2018) Managing Health Care Business Strategy, Jones & Bartlett Learning LLC. as retrieved from https://www.gcumedia.com/digital-resources/jones-and-bartlett/2017/managing-health-care-business-strategy_2e.php

Orgcharting.com, (n.d). Hospital Org Chart Examples. https://www.orgcharting.com/hospital-org-chart-examples/

Research and Markets, (2021). Electronic Medical Record Systems - Global Market Trajectory & Analytics. https://www.researchandmarkets.com/reports/1206719/electronic_medical_record_systems_global_market#cat-pos-9

U.S. Census Bureau QuickFacts: Shreveport city, Louisiana. (n.d.). Census Bureau QuickFacts. https://www.census.gov/quickfacts/shreveportcitylouisiana

Wilson, B. (2019). Hospital Executive Positions Explained: Understanding Healthcare Leadership. https://www.carevoyance.com/blog/hospital-executive

Wu, C. H., Chiu, R. K., & Yeh, H. M. (2017). Implementation of a cloud-based electronic medical record exchange system in compliance with the integrating healthcare enterprise's cross-enterprise document sharing integration profile. International Journal of Medical Informatics, 107, 30-39.

Retrieved from https://doi.org/10.1197/jamia.M1097

Year to Year Analysis

Year 2020 Cash Investments Inventories Accounts receivable Pre-paid expenses EMR Expenses Property and equipment Leasehold improvements Equity and other investments Less accumulated depreciation Goodwill 894147 364236 189642.33 4368489 3894661.1 223423.56 1236542 26149.65 122698.61 16423 150 Year 2021 Cash Investments Inventories Accounts receivable Pre-paid expenses EMR Expenses Property and equipment Leasehold improvements Equity and other investments Less accumulated depreciation Goodwill 1407249 490971 264896 5231566 2672918 118700 1353766 33562 150896 32874 190