EFA TECHNOLOGY MEDICAL AGING

1. EFA TECHNOLOGYMEDICAL AGING Dr. MaryRose Reaston Insight Diagnostics, Inc. April 21, 2010

2. Diagnostic Medical Device and Service Company Founded by Dr. MaryRose Reaston and Phil Reaston Headquartered in Las Vegas, Nevada Offer EFA testing services nationwide Who Is iDi? �Before we get into it a few words of introduction about Insight Diagnostics, the company���Before we get into it a few words of introduction about Insight Diagnostics, the company��

3. The Electrodiagnostic Functional Assessment (EFA) is the best tool to diagnose soft tissue injuries. The EFA can help physicians offer better patient care and employers to manage injury claims efficiently. Why the EFA? The two major things I would like you to walk away with at the end of this presentation��The two major things I would like you to walk away with at the end of this presentation��

6. Combines all five AMA accepted diagnostic tests into one comprehensive, objective and re-producible test: Range of Motion FCE Pinch Strength Grip Strength Electromyography (EMG) Range of motion Old goniometer New 6 Degrees of Freedom Old Tests Made Better

7. $200 billion annually in lost man hours and medical costs Workers� Compensation costs exceed $60 billion per year Soft tissue injuries are 80% of all Workers� Comp claims Soft tissue injuries are often non-specific, difficult to diagnose and treat or �box in� Soft tissue injuries are the leading cause of lost work time and productivity Challenges in the Workers� Comp Landscape �Currently we are primarily focusing on the Workers� Compensation field where there are some surprising facts to consider���Currently we are primarily focusing on the Workers� Compensation field where there are some surprising facts to consider��

8. Current diagnostic tools are subjective - �process of elimination� Diagnostics are dependent upon �subjective� complaints Current tools not designed to look at soft tissue injuries NCV and iEMG are designed to evaluate nerve and muscle status X-rays, MRIs and CT scans are not designed to be dynamic or to assess muscle functioning Challenges for the Current Tools �The other problem that you run into that the current arsenal of tools available to the medical community have some significant limitations.��The other problem that you run into that the current arsenal of tools available to the medical community have some significant limitations.�

9. Diagnosis With the Current Tools �Apart from being subjective, currently nothing really focuses on soft tissue injury� The MRI, X-ray and CT are good for evaluating structure, but they are static and give no information about functional ability. A traditional FCE is time consuming and often produces invalid results because it depends upon the patient�s effort (which cannot be controlled)�Apart from being subjective, currently nothing really focuses on soft tissue injury� The MRI, X-ray and CT are good for evaluating structure, but they are static and give no information about functional ability. A traditional FCE is time consuming and often produces invalid results because it depends upon the patient�s effort (which cannot be controlled)

10. �MRI�s produce a 64% false positive; Myelograms 24%; Computed Tomographic scans 36%; Discograms 37%... �contributing to increasing rates of low back surgery� Jensen, Brant & Ross, et. al. University of Pittsburgh NEJM Vol . 331, 1997 Short Comings of the Current Tools �On top of that���On top of that��

11. Diagnosis With the EFA �The real innovation in the EFA is that it is designed exclusively to objectively diagnose soft tissue injuries��The real innovation in the EFA is that it is designed exclusively to objectively diagnose soft tissue injuries�

12. EFA Advantage � through the concurrent mapping of many co-active muscles and muscle group activity, sEMG as a measure of back function can distinguish individuals with and without LBP with an accuracy of 90% � Roy, DeLuca & Emley, et. al. Rogers Memorial Hospital Bedford MA JRRD Vol. 34 No. 4, 1997

13. �A disruptive technology or disruptive innovation is a term describing a technological innovation, product or service that uses a "disruptive" strategy, rather than an "evolutionary" or "sustaining" strategy, to overturn the existing dominant technologies or status quo products in a market.� www.wikipedia.org The EFA Is a True �Disruptive Innovation� �From a business point of view���From a business point of view��

14. The EFA is a medical/legal evaluation using our proprietary equipment and service protocol for diagnosing and assessing soft tissue injuries. Can complement or replace other diagnostic tests such as the MRI or iEMG Combines all five AMA accepted diagnostic tests into one comprehensive, objective and re-producible test: Range of Motion FCE Pinch Strength Grip Strength Electromyography (EMG) FDA Registration � Class II Diagnostic Medical Device with strong intended use section Conforms with AMA Guidelines Complies with ACOEM What Is the EFA? �So what exactly is the EFA, and what does it do?��So what exactly is the EFA, and what does it do?�

15. Tests muscle tone, spasms, usage, fatigue and ischemic changes Bilateral test performed for comparison Broad-band frequency range and refined electronics 6 channels of range of motion while measuring EMG: Flexion Extension Rotation Lateral movements of patient Lead Fail detection EFA Testing �When we run the test, here is what we actually do��When we run the test, here is what we actually do�

16. Defines precise injury site Accurately diagnoses and determines the approximate age of an injury, and determines the significance of disc pathology Determines if patient is compliant, malingering or in pain Is non-invasive and non-loading Results provided in a Comprehensive Medical Report by Board Certified Physicians Can provide site-specific treatment recommendations to assist the physician EFA Testing �continue��continue�

17. EFA Referral Triggers �How do we define if a patient can benefit from an EFA?� These are the referral guidelines in the nurse case managers for Travelers. For RSD onset of claim�.a much more objective IME evaluation.�How do we define if a patient can benefit from an EFA?� These are the referral guidelines in the nurse case managers for Travelers. For RSD onset of claim�.a much more objective IME evaluation.

19. By integrating range of motion and functional capabilities while simultaneously assessing muscle activity, the EFA can objectively ascertain a patient�s effort. Objective Medical Evidence �We can tell if the patient is actually compliant or not�� �We can tell if the patient is actually compliant or not��

20. Readout shows difference between Proper (top) and Improper (bottom) recruitment of type II motor units. Objective Medical Evidence �The output looks like this�� Southwest University school of medicine dept of physical medicine and rehab.�The output looks like this�� Southwest University school of medicine dept of physical medicine and rehab.

21. �How can we tell the differences based on the output���How can we tell the differences based on the output��

22. Bilateral changes Muscle compensation Muscle spasms Fatigue Usage Absence of the flexion-relaxation response Distinguishing Between Acute vs. Chronic Injuries �We can date the injury because�� You can apportion an injury your only responsible for an aggravation of a pre existing injury and this is how we can tell what degree of the injury is yours, if any. Since you only have to return the person to pre injury status. We take the date of injury and take the mechanism of injury and if consistent with the date and the mechanics of the injury we can tell you if its yours or not. Every muscle in the body has an assigned function so if there are injured muscle groups not related to the mechanics of the injury then it�s not related to the incident.�We can date the injury because�� You can apportion an injury your only responsible for an aggravation of a pre existing injury and this is how we can tell what degree of the injury is yours, if any. Since you only have to return the person to pre injury status. We take the date of injury and take the mechanism of injury and if consistent with the date and the mechanics of the injury we can tell you if its yours or not. Every muscle in the body has an assigned function so if there are injured muscle groups not related to the mechanics of the injury then it�s not related to the incident.

23. Correlates subjective complaints of patient with objective findings of the test Correlates to validate mechanics of injury Confirms current injury diagnosis or suggests a more appropriate diagnosis Reviews medical records Offers findings and recommendations including FCE Has held up in court in various states The EFA Report �When you get the report back, here is what it contains���When you get the report back, here is what it contains��

24. EFA POPPNot Able to Perform Essential Tasks Range of Motion Test shows compliance and normal range of motion. Evidence of older pathology is only seen in the EMG readings. This is on a young female wanting this particular job. This also applies to a post loss. If you doing a range of motion fce this person can bend there head all the way backwords 6 degrees of freedom for range of motions. She looks great!!!!!This is on a young female wanting this particular job. This also applies to a post loss. If you doing a range of motion fce this person can bend there head all the way backwords 6 degrees of freedom for range of motions. She looks great!!!!!

25. EFA Post-Offer Pre-Placement (POPP)Not Able to Perform Essential Tasks EMG data collected during Range of Motion Test provides objective evidence that pre-existing pathology exists and the job duties put the employee at risk for injury. This individual would have passed a standard POPP test, been approved for hire and resulted not only in an injury claim, but possibly ADA issues These results show what is actually third graph bending head forward and backward and it is not working and in the fourth graph down there are a lot of spasms compensating for the other muscle that is not working. This shows a chronic injury with older pathology so you can apportion it out. Older pathology so you can apportion it out. We completed 100 claims how many do you think went to court 0 to court all returned to work. Pre date the date of loss in some cases and in other we could outline site specific treatement and get them back to work faster. That third graph down went to physical therapist and gave exercise it would cause more problems not the fault of the PT that PT just didn�t have the proper diagnosis. These results show what is actually third graph bending head forward and backward and it is not working and in the fourth graph down there are a lot of spasms compensating for the other muscle that is not working. This shows a chronic injury with older pathology so you can apportion it out. Older pathology so you can apportion it out. We completed 100 claims how many do you think went to court 0 to court all returned to work. Pre date the date of loss in some cases and in other we could outline site specific treatement and get them back to work faster. That third graph down went to physical therapist and gave exercise it would cause more problems not the fault of the PT that PT just didn�t have the proper diagnosis.

26. EFA POPPPass: Able to Perform Essential Tasks Normal at Rest readings show age related changes that do not affect the essential job functions and could prevent ADA and MSA issues

27. EFA POPPPass: Able to Perform Essential Tasks Normal Range of Motion EMG recordings

28. Travelers Study Methodology: EFA claim numbers were tracked as consults were performed. A control group was obtained by matching claims from the Managed Care Database using ICD-9 code (3 digit), SIC (2 digit), Attorney Involvement, Age (+/- 2 years) and Gender. Control EFA Return to Work days 275 213 Paid Claims $16,437 $12,598 Paid Med $17,524 $13,265 Paid Expense $5,481 $4,047 Total Incurred $39,442 $29,910 Conclusion: While the EFA group was comprised of older individuals and proportionally more males, the totals paid on the EFA claims were nearly $10,000 less on these claims. Average RTW was 62 days sooner. This took into consideration this was all in California and Nevada which many of you may know is a no fun state for workers comp.This took into consideration this was all in California and Nevada which many of you may know is a no fun state for workers comp.

29. Lankford Construction Company Case Challenge: LCCO has enormous exposure to real and alleged soft tissue injury claims because LCCO works in all 50 states. Cost on workers� comp claims per year were $1.6 Million in 2006. Solutions: Changed insurance companies. Introduced EFA as a diagnostic tool for all soft tissue injury claims. Applications: On a back injury claim in a monopolistic state, immediately had the employee undergo this non-invasive test and presented the results from the EFA to the medical provider and therapist.� They were able to utilize the results and prescribe the correct therapy returning the employee to full duty - no restrictions in a matter of weeks instead of months or even years. Results: Cost on workers� comp claims reduced from $1.6M to $3,200 in 2008. The EFA was incorporated in LCCO�s new hire application process and into LCCO�s insurance company�s special account instructions. Injured Workers are returned to work faster. Prior to employment to work at Lankford construction and since it�s non invasive and non loading as a condition of employment you must sign a statement that you agree to take the EFA when injured and if you refuse you will be fired. Prior to employment to work at Lankford construction and since it�s non invasive and non loading as a condition of employment you must sign a statement that you agree to take the EFA when injured and if you refuse you will be fired.

30. Meets Daubert requirements Because EFA is non-loading and non-invasive, Orders to Compel can be secured for it iDi�s expert witnesses have been proven in court where EFA was major or sole evidence in multi-million dollar claims from the Federal level down: U.S. District Court, Civil: Motion to Compel as part of sanctions. Evaluation proved patient had use of injured side. Defense zero dollar verdict. Texas Worker�s Comp Commission, case 14xxxx: EFA aged injury to predate employment. The EFA Holds Up in Court Daugert �There are two requirements to meet Daubert meet That the testing is scientifically valid and the expert witnesses have to be experts in that fieldDaugert �There are two requirements to meet Daubert meet That the testing is scientifically valid and the expert witnesses have to be experts in that field

31. Federal Court Case Federal Register EFA Findings Testimony: [Ms. Geressy's] . . . carpal tunnel like symptoms are related to hypertonicity in the cervical region . . . causal relationship to the symptoms . . . are non-work related in nature . . . from the cervical region and . . . non-industrial in nature. U.S. District Court. 980 F. Supp, 640, 64-48 (E.D.N.Y., 1997): Geressy v. Digital Equipment Corporation This is an unprecedented case�.The largest product liability settlement everThis is an unprecedented case�.The largest product liability settlement ever

32. Federal Court Case Federal Register EFA Findings Testimony: We saw no evidence of any cumulative trauma disorder or any injury due to repetitive motion. We concluded that she did not have carpal [**15] tunnel syndrome but that her complaints were caused by pathology in her cervical musculature. Based on our examination we concluded that her health complaints were not caused by her work.

33. Substantial Probability of a Change in the Outcome at Trial: This newly discovered evidence is unique and directly relevant to the critical issue of causation. It is substantially probable that this medical report, created almost a year before the litigation was filed would have caused the jury to evaluate all of the evidence at trial differently. The outcome at trial could well have been different if this evidence had been available. Jack B. Weinstein, Senior United States District Judge. Federal Court Case

34. Indergard vs. Georgia Pacific Sears 6.2M Changes in the Legal Climate and EFA With the advent of the American with Disabilities act which was in 1109 employers have to be very much aware of a work comp claim turning into an ADA claim and there is no insurance for that. And these are two prime examples. Indergard � The essence in all of this and the benefit of the EFA is that both of these claims that turned into ADA claims That an FCE is now considered a medical evaluation and must comply with the EEOC Grab the jmar grip��.In English for an FCE is valid they would take the grip and squeeze it for the validity scale but the EEOC says you can only test for the job description and for the body part that was injured that is what the EFA does and it is eeoc compliant and it can tell you objectively only tool that complies with adaa changes and eeoc. Sears can give you 6.2 million reason why this is important. A woman worked for Sears, she had a workers comp claim they required her to take an fce and she failed the fce and the doctor said she couldn�t go back to work because she failed the FCE. However, she wanted to go back to work and under a collective bargaining agreement and Sears the doctor didn�t know what to do went on fmla and exhausted it and sears fired her and she sued them under ada and it was a class action suit and they had a 6.2 million dollar settlement agreement and the efa would have bypassed that. It is the only objective tool out there that could have prevented this.With the advent of the American with Disabilities act which was in 1109 employers have to be very much aware of a work comp claim turning into an ADA claim and there is no insurance for that. And these are two prime examples. Indergard � The essence in all of this and the benefit of the EFA is that both of these claims that turned into ADA claims That an FCE is now considered a medical evaluation and must comply with the EEOC Grab the jmar grip��.In English for an FCE is valid they would take the grip and squeeze it for the validity scale but the EEOC says you can only test for the job description and for the body part that was injured that is what the EFA does and it is eeoc compliant and it can tell you objectively only tool that complies with adaa changes and eeoc. Sears can give you 6.2 million reason why this is important. A woman worked for Sears, she had a workers comp claim they required her to take an fce and she failed the fce and the doctor said she couldn�t go back to work because she failed the FCE. However, she wanted to go back to work and under a collective bargaining agreement and Sears the doctor didn�t know what to do went on fmla and exhausted it and sears fired her and she sued them under ada and it was a class action suit and they had a 6.2 million dollar settlement agreement and the efa would have bypassed that. It is the only objective tool out there that could have prevented this.

35. POPP Testing Fitness-for-Duty of current work force Fitness-for-Duty on a claims basis Post-Injury evaluation Medical Set-Aside evaluation ADA evaluation/compliance More objective IME EFA Applications

36. The Electrodiagnostic Functional Assessment (EFA) is the enhancement and combination of five accepted medical tests, and it is a valuable tool to assist in the diagnosis and treatment of soft tissue injuries. The EFA can help employers and their insurance companies to lower their expenses, ensure better care for their employees and increase overall productivity by getting them back to work sooner and closing the claims faster. Conclusion

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