The document describes TeleMaster, a telemedicine platform that provides remote diagnostic services. It can be used to create centralized medical call centers or allow physicians to provide remote diagnostic services from their clinics. TeleMaster securely transfers medical data, manages diagnostic workflows and queues, and allows remote diagnosis using various medical devices. Case studies demonstrate how it has been used in Israel to reduce costs and improve efficiency at a cardiology call center processing over 18,000 Holter readings per year and to remotely monitor over 2,000 congestive heart failure patients through home monitoring devices. It has also been used in India on a project with over 51,000 medical kiosks enabling virtual patient-physician encounters.

1. TeleMaster
Telemedicine Platform
Jan 2010
Talor Sax talor@ewavemd.com
VP Business Development +972-54-222-3575 (Israel)
www.ewavemd.com +1(419) 825-6771 (USA)

2. Agenda
• Profile
• TeleMaster Product Description
• Case Studies
– Remote Diagnostics
• Procardia Call Centre
• Disease Management – CHF patients
– Orissa Project
• 51000 Medical Kiosks with Patient/Physician Virtual Encounter

3. EWAVE MD PROFILE

4. eWave MD – Profile
• International software company
• Healthcare oriented since 2000
• Secure Web-based solutions and products specialists
• ISO 9001:2000 compliant
• Over 250 professionals
• Active in US, Europe, Brazil, India
• ~ 10, 000 physicians worldwide
• ~ 3,000,000 patients
• Outpatient EMR – National HMO
• Patient Portal and PHR

5. eWave MD – Profile
• This video was produced by Maccabi Health Services
• The clip shows the reality of a Maccabi patient
• Most of the applications were developed by eWave MD
* To view this video online please visit:
http://www.youtube.com/watch?v=tbOlQ7e7LX8

6. Partners
Technology
Devices •
Applications
Certifying
Entities
Member
Organizations

7. Products
“TeleMaster”
Turn Key Telemedicine Solution Platform

8. TeleMaster
• TeleMaster is a proven, robust and flexible telemedicine turn-
key solution, designed to respond to the broadest range of
needs within the scope of modern eHealth.
• TeleMaster is a secure medical tele-diagnostic platform
providing physicians with diagnostics and treatment for
patients who are physically remote.
• Provides both immediate real-time (Emergency/Urgency) and
queued diagnostics.
• Supports both centralized diagnostic centers for on-site
physicians, as well as virtual distributed diagnostics in which
physicians provide diagnostic services remotely from their
clinics.
• A Centralized Medical Call Centre

9. TeleMaster - Turn Key Telemedicine Solution Platform
• Enables a wide range of Telemedicine
implementations such as (or combination of):
• Remote Diagnostic Services
• Home Care Monitoring
• Virtual Encounters
• Telemedicine Kiosks

10. From anywhere by any one to anywhere and anyone
Remote Hospital
Diagnostic
physician
Remote
Diagnostic
physician
VPN Clinic
VPN
Remote
Diagnostic
physician
On-premise
diagnostic physicians
Remote
Diagnostic
physician Diagnostic Center
Patient home

11. Telemedicine Process
• Collect Data from • Transfer files to
Medical devices diagnostic call
• Open API – center (virtual or
connect any physical)
device
Collect Transfer
Publish Diagnose
• Store and publish • Diagnosis
result Workflow
• initiate medical • Physical or Virtual
interference Diagnosis Center

12. TeleMaster: a triple win situation
• Increase
Care efficiency
Giver
Payer
• Reduce
Costs
Patients
• Improve Life
Quality
• Awareness

13. Use ANY medical device (Public use or Home use)

14. Benefits
• Increases efficiency
• Complete Workflow Management
• 100% Secured & Reliable
• Queue Management
• Expendable

15. Benefits – Increase Efficiency
• TeleMaster Management application has Proven
increase in diagnosis capacity -
E.g. Procardia ECG call centre is manned only with Cardiologists due to the workflow designed
by eWave MD making it unnecessary to use nurses or technicians;
HR available: During morning hours: 3 to 4 doctors
Lunch time closed and doctors work on received holter readings from technicians;
Afternoon1 to 2 cardiologists
Overall working hours: 0800-1900
Actual Average time required for each diagnosis: 1 minute 39 seconds

16. Benefits – Complete
• Complete Process
– TeleMaster automatically manages the entire process -
Collect, transfer, diagnose, publish;
– no need for the referring provider to contact the
diagnostic center directly

17. Benefits – Reliable and Secured
• Secured Reliable Complete and 100% monitored file
transfer
– TeleMaster is a critical application influencing life and
death
– TeleMaster secures the file transfer on any type of
communication infrastructure ensuring 100% that any
sample take will be delivered to the expert in complete
– TeleMaster will alert on any loss of data or delay in
providing answers

18. Benefits - Queue Management
• On large scale telemedicine operations, queue
management and process management are critical
to ensure the required SLA to any patient and
referring physician
• TeleMaster manage queues, will route any incoming
exam to the right expert based on availability and
other business rules

19. Benefits - Expendable
• TeleMaster is an open system, enabling expanding it
to cover additional needs such as local regulations,
local billing, local workflow etc.
• TeleMaster can work with any medical device

20. Supporting Services
• Based on our Flexible Software Platform and unique
Suite Of Services we offer:
– Rapid deployment of clinical information systems
– Secured, Standard based, interoperability and highly
Customizable clinical solutions
– Taking complete responsibility on all of the operational
aspects; Servers, Maintenance, Support, Training etc.

21. call centre workflow
• An important factor for the success of the TeleMaster is
based on the “call centre workflow”
• Designed to reduce costs in Human Resources, as well as
increase in efficiency.
– Huge costs lay in the Human resources required to answer in a speedy way
“peeks” of calls when most of the day these same Human Resources are idle.
• Automated Queue Management System,
– Enabling the prioritization of incoming readings via several parameters like:
– Emergency/Urgency;
– Time of arrival for evaluation;
– Type of commercial agreement;
– Etc.

22. TeleMaster Compatibility with
• 12 lead ECG
• Single Lead ECG
• Holter
• Blood Pressure
• Precision weight scale
• Glucometry
• Spirometry
• Height
• Spo2
• Temperature
• Etc.

23. Implementations
• Health Insurance
– Improvement of service
– Reduction of costs, efficiency etc
– Retention of users
• Oil Companies;
– Remote locations of difficult access
• Private and public hospitals
– Hospitalization home
– "High Early“
– Senior Citizens
• National Organizations to provide healthcare;
– Release of the emergency units of "false cases”
– Dramatic reduction in costs (release of beds, fewer people in the emergency room etc.).
– Retention of citizens in remote areas

24. CASE STUDIES

25. Case Studies
“TeleMaster” - Remote Diagnostics
National Level Center
Procardia (Israel); Raytel (USA)

26. Procardia Cardiology remote diagnostic center
• 18,000 Holter readings performed during 2009.
• 1,200 Holter readings during December 2009;
•
• Medical Device used: Dell Mar Reynolds – Life Card CF (USA);
• Compact Flash card reader : SanDisk or any one available
• Software required: Local Dell Mar Reynolds software installed in local PC
to enable downloading of the Holter reading locally, and
transmitting it to the diagnostic center (TeleMaster).
• Human resources required (2009):
» 5 technicians per day;
» 5 days a week
» 22 days a month
» 12 months/year.
• These technicians are trained in the initial evaluation of the Holter, “arranging” all the
required information after first analysis for the Cardiologist approval.
• Total Technician time paid per year: 7,920 hours
• 2 cardiologists performing evaluations and referrals during idle time in the ECG call centre.
• Average time per technician/per Holter reading (including idle time): 26.4 minutes
•

27. Procardia Cardiology remote diagnostic center (cont)
• 140,000, 12 Lead ECG readings during 2009.
• 11,775, 12 Lead ECG readings during December 2009;
•
• Medical Device used: Norav Medical (Israel);
• Human resources required (2009):
• Procardia ECG call centre is manned only with Cardiologists due to the
workflow designed by eWave MD making it unnecessary to use nurses or
technicians;
• During morning hours: 3 to 4 doctors
• Lunch time closed and doctors work on received holter readings from
technicians;
• Afternoon1 to 2 cardiologists
• Overall working hours: 0800-1900
• Actual Average time required for each diagnosis: 1 minute 39 seconds
•
• Software required: Local Norav Medical software installed in local PC to enable
downloading of the ECG, and transmitting it to the diagnostic center (TeleMaster).
• (as per clients request)

28. Case Study – Remote Healthcare
• Tele-diagnostic service for cardiac exams
• Used by Leumit & Maccabi (Israel) & Philips
Healthcare (USA)
• Cost reduction – profitable for both provider and
patient
• Improves waiting period for tests and results
• Supports a virtual and physical interpretation center

29. Solutions and Products – Telemedicine Applications
Tele EKG
Tele Holter

30. Holter Diagnosis Technician

31. Case Studies
Disease Management
National Level HMO
Maccabi HMO

32. Congestive Heart Failure (CHF)
Home Care Chronic Disease
Management Model

33. Maccabi Health care – CHF patients monitoring
• Home Care
• 2,000 patients – largest CHF study in the World
• Monitored 24 hours from home by medical call
centre
• With and without Video
• Blood Pressure and Precision Weight scale

34. Solutions and Products – Disease Management
• Improve the quality of health care services provided
• Improve and maintain quality of life
• Reduce unnecessary hospital admissions (e.g. due
to patient anxiety)
• Reduce administrative Primary Care Physician (PCP)
visits
• Decrease mortality
• Reduce costs
• Establish central database for patients as a
supporting tool for DM (Disease Management)

35. Solutions and Products – Disease Management
Tele-monitoring
Regional
center HUB
PCP
RF
Information Systems
Call
center Devices:
•BP
• pulse
•Weight
Maccabi Patient house

36. Background
• There are ~ 6000 CHF patients, 0.3% of total
Maccabi members
• Half of them are hospitalized once a year v.s. the
other half that are hospitalized more than once a
year
• Mortality within six months after hospitalization
is 18%
• On average, each patient has 22 family doctor
visits a year

37. Program Objectives
• Improve the quality of health care services provided
• Improve and maintain quality of life
• Reduce unnecessary hospital admissions (e.g. due to patient
anxiety
• Reduce administrative Primary Care Physician (PCP) visits
• Decrease mortality
• Reduce costs
• Establish central database for CHF patients as a supporting tool
for DM (Disease Management)

38. Major Benefits
For the patient:
•Expands access to professionals outside the immediate geographical area of residence.
•Patients receive results immediately, regardless of their location.
For the health system, diagnostic center and physician:
•Expands clinical service delivery to broader geographical audiences.
•Supports billing, management, workflow, and storage.
•Improves efficiency by focusing on medical services rather than administrative tasks.
•Supports centers of excellence and enhances reputation.
•Increased efficiency, thus reducing costs with increase quality of service.
Product Features
•Flexible, customizable process definition and workflow management.
•Supports integration and interoperability with PACS, billing, electronic medical record solutions and other information
systems
•HIPAA-compliant
•Exam priority management according to: type, source and other relevant characteristics
•Event-driven expert system with decision support capabilities
•Entry of exam results in pre-defined and customized forms
•Comprehensive reporting
•Main storage of all medical data and diagnostics
•Strong archiving, search and retrieval capabilities
•Administrative tracking including billing and process reporting
Centralized and Distributed Diagnostic Center
• The flexible workflow of the TeleMaster enables the use of;
Local call centers, located in One or various physical location;
Virtual call centers
Remote users, interconnected via the Net.
• All data is stored and secure in one database, regardless of where the information is viewed.

39. Orissa Telemedicine Project - Solution Overview

41. Virtual Encounter Workflow

42. Thanks
Talor Sax talor@ewavemd.com
VP Business Development +972-54-222-3575 (Israel)
www.ewavemd.com +1(419) 825-6771 (USA)