Presentation given in Med-eTel 2011 - Presenting a case study for remote virtual consultation in rural india

1. eWAVEMD VIRTUAL CONSULTATION PLATFORM Med@Tel April 2011 Roberto Schliesser VP Telemedicine Solutions eWave MD schliesser@ewavemd.com

2. AGENDA About eWaveMD eWave MD eHealth platform Market overview Remote Virtual Consultation Workflow example Business model

3. ABOUTeWAVEMD An international company developing web-based medical applications since 1999. Part of the eWave Group, an integrator and provider of software solutions, employing400 software professionals. Our solution serves more than 1K physicians and 3M patients.

4. ACCUMULATIVE EXPERIENCE 2001 - 2,000,000 patients PHR 2003 – Large Scale Healthcare SOA implementation (IHE) 2003 – Patient Information Kiosk 2004 – Centralized Web-Based EHR (1,500 physicians) 2005 – Remote Cardiac Diagnostics 2006 – eWave MD spinoff 2006 – PQRI & EHR for the USA Market (eHealth Made Easy) 2007 – Home Based CHF Disease Management 2009 – Remote Consultation (India) 2010 – Full ONC Certification (Meaningful Use)

5. Home Care Remote Diagnostics Disease Management eWaveMD Unified e-Health Platform Remote Virtual Consultation eSched PHR ARTEC (Advanced Rural Telemedicine Clinic) EMR ONE PLATFORM, MULTIPLE SOLUTIONS

6. THEeHEALTHPLATFORM – PRODUCT LINE

7. OUR PLATFORM’S ADVANTAGES Fully browser-based platform to enable accelerated implementation of electronic medical record solutions Off-the-shelf software modules and accelerators Rule-Based Engine at the user level for maximum customization Multiple segment solutions

8. ONE PLATFORM: FROM DEVELOPING TO DEVELOPED WORLD SOLUTIONS The platform supports a wide range of solutions, from basic needs in India to more complex demands in the US. eHealth platform “Progress Note” - US vs. INDIA US - eHealthMadeEasy India - OTTET virtual consultation

9. 3.4 billion people live in rural environments with minimal or no Healthcare infrastructure WORLD STATUS Source: Un World urbanization prospects 2009.

10. Public health systems fail to deliver basic health services Lack of infrastructures Shortage of qualified medical personnel Wide target area with limited accessibility Uneducated manpower RURALHEALTH STATUS

11. RURAL HEALTH STATUS - UN MDG The Target MDG’s and general goals: Child health Reduce by two thirds – between 1990 and 2015 – the under-five mortality rate Maternal Health Reduce by three quarters the maternal mortality rate Achieve universal access to reproductive health Achieve – by 2010 – universal access to treatment for HIV/AIDS HIV Infectious diseases Reduce to half by 2015 and begin to reverse the incidence of malaria and other major diseases Reduce to half by 2015 and begin to reverse the spread of HIV/AIDS

12. OURGOALS Provide a new “Health Delivery Channel” for rural populations by enabling virtual medical services Improve availability and quality of medical care for rural populations Establish an environment for virtual medical services, which is easy and simple to implement and maintain Provide an IT infrastructure for additional medical services Create the infrastructure for a National Centralized EHR “The Goal of the Mission (NRHM) is to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women and children.”

13. India, National Rural Health Mission (NRHM) “In India in 2009-10 the Federal government has increased the support for NRHM, which aims to improve the availability and access to quality healthcare for people living in remote areas from Budget estimate of Rs.12,070 crore (US $2.7B) by Rs.2,057 crore (US $462M)” China, New Rural Cooperative Medical Scheme (NRCMS)“Funding for NRCMS is provided by central and local governments on a per capita basis (CNY20 in 2003, CNY80 in 2009) and rural residents contribute a fixed amount on a voluntary basis (CNY10 in 2003, CNY20 in 2009).” UN Millennium Development Goals The UN and WHO are implementing variety of projects for strengthening rural healthcare project around the globe in order to mean the UN MDG. THEMARKETS

14. Provide primary health care based on eWaveMD Electronic Health Record (EHR) and Medical Video Conferencing at the village level Communications (Cellular, VSAT) Urban healthcare Medical clinic in the rural village THESOLUTION

15. THEMEANS Provide primary care services in rural areas using eWaveMD eHealth platform Centralized control Comprehensive Electronic Health Record (EHR) Single data source ARTEC – Advance Remote Telemedicine Clinic (at the point of care) Medical Video Consultations Integrated Medical devices Consultation & Treatment workflows e-Learning

16. THE VIRTUALCONSULTATION SOLUTION

18. VideoConferencing

19. Integrated Medical Devices

20. Integrates Communications

21. Simpleto maintain

23. THEVALUEPROPOSITION “In 2009, the Indian government spent more money on transportation of rural population to the hospitals than on the medical treatment itself” – Telemedicon, 2010

24. THE VIRTUALCONSULTATION SOLUTION National level Centralized EHR Province District level Rural level

25. THE VIRTUALCONSULTATION SOLUTION

26. WORKFLOWS& SCREENS

27. LOGIN PAGE

28. AGENT > HOMEPAGE

29. AGENT > PATIENTDEMOGRAPHIC

30. AGENT > INITIAL CONSULTATION

31. PROVIDER > HOMEPAGE

32. PROVIDER > INITIAL CONSULTATION

33. AGENT > INITIALCONSULTATIONCONT’

34. MEASUREMENTS WIZARD

35. PROVIDER > SECONDARYCONSULTATION

36. PROVIDER > SECONDARYCONSULTATION CONT’

37. AGENT > SECONDARY CONSULTATION

38. SUMMARY & PAYMENT

39. VIRTUALENCOUNTERWORKFLOW

40. eWaveMDRemote Virtual Consultation Business Models The NHR Mission is an articulation of the commitment of the Government to raise public spending on Health from 0.9% of GDP to 2-3% of GDP.

41. Service model Technology Operator Service provider Responsible for the solution implementation and ongoing operations Setup and installation, training, maintenance and support Customization and feature upgrades for both the platform and ARTEC Not responsible for the health services Based on down payment plus monthly fee per ARTEC station, regardless of the number of tests performed Sales model Standard B2B sale model Responsible for system setup Installations, knowledge transfer (train-the-trainer), maintenance and support Based on perpetual license, plus yearly maintenance BUSINESSMODEL

42. Choosing the best suited model depends on the following key aspects: Credit rating Deal size Local infrastructure and manpower BUSINESSMODEL (CONT’D)

43. SERVICE APPROACH – RESPONSIBILITIES Customer responsibilities: Infrastructure (Primary Care Center) Communication Healthcare Operations (provider, nurses, technicians, etc.) eWaveMD responsibilities: Technology and know-how Implementation services Training Quality of services rendered Day-to-day support and maintenance Financing – secure revenue stream

44. Thank you!

45. THE ARTECREQUIREMENTS - I General The ARTEC is designed to serve as a kiosk station in remote rural areas which lack modern infrastructure. The design of the ARTEC must enable the user to "carry" the device for long distances without additional human assistance or accessoriestools . While working, the ARTEC shall provide a "comfortable " work environment, similar to working with a PC workstation or dedicated kiosk, but at the same time, it should be easy to carry (in a suitcase or similar). The ARTEC should be able to absorb small shocks (such as when carried on the back of a motorcycle). The ARTEC Station should be modular to enable customized orders Weight & Size Should be up to 6 Kg Countertop design Should be portable (reasonable size) CPU Low power for use with backup battery for 6-8 hours The ARTEC computing power shall be defined by video conference requirements. (enable to run a full CIF HD video conference over a protocol such as H264 SVC). Power 6-8 hours operation on battery Connect external standard battery (12V) Battery Charge Electricity Solar panel

46. THE ARTECREQUIREMENTS - II Medical devices Integrated medical devices with optional assembly (the medical devices integration to the system shall be in a similar concept to a hospital bed monitor). The following medical devices shall be Integrated in the Kiosk hardware. Stethoscope Blood pressure Temperature SPO2 ECG 1 lead ECG 12 lead Peak flow meter spirometer Supported for medical devices shall be configurable according to the customer's requirements (the medical devices shall be assembly dependent). Screen Touch screen (optional) 12”or higher with minimum resolution 1024 – 768 | changed to 10" for Kontron Memory support video conference min requirements (SVC). Storage Low power robust hard drive (SSD)

47. THE ARTECREQUIREMENTS - III Communications Integrated communication with optional assembly for: LAN (Ethernet 10/100) GPRS 3G HSPDA modem WLAN WiMax Parts and connectors USB 2 - Support integration with existing medical devices such as glucose meters, Portable x rays, etc. Serial Adapter Medical connectors for the integrated medical devices: BP connector, SPO2, ECG … Operation System support Linux Win 7 Printer (optional) Thermal Printer - internal Multimedia

48. THE ARTECREQUIREMENTS - IV Build in speakers (standard) Earphone and Mic plugs Build in Webcam – HD resolution Security identifications (optional): Card reader Fingerprint reader Monitoring and support Remote diagnostics for the ARTEC hardware (including peripheral) Remote monitor for the ARTEC software Remote monitor medical devices Remote assistance Environment conditions Should suit external rural conditions High environmental temperatures Humidity Dust