Telemedicine in LAC “Telemedicine Experience in Venezuela” based on the MANIAPURE program:

1. Telemedicine in LAC“Telemedicine Experience in Venezuela”based on the MANIAPURE program: ATA/ATALACC Seattle,April 7th 2008 Eng.Morel Orta/Tomás Sanabria M.D.

2. Who are we ? • Where do we come from ? • Our experience • Our operating model • What can we offer ? • Where are we going?

3. Who are we ? Telesalud de Venezuela is a private company created by health and IT professionals whose experience originated in the Maniapure project. The company is dedicated to provide telemedicine services to rural (and more recently urban) areas of Venezuela . Our program continues to be free of charge to the Maniapure project, but for other clients, services are being financed by private and public institutions, as part of their social responsibility.

4. Who are we ? • Where do we come from ? • Our experience • Our operating model • What can we offer ? • Where are we going?

5. Where do we come from? Centro la Milagrosa Maniapure region Cedeño district Bolívar State, Venezuela

6. Where do we come from? We work in sparse and isolated communities

7. Where do we come from? Primary care at Centro La Milagrosa ADS Medicine : one MD on his Rural year & clerckships with 6th year medical students UCV Last year Dental Medicine students from UCV y USM universities and others Clinical Lab & Bioanálisis > 400 patients monthly at CLM Dental primary care since 1998 Centro La Milagrosa ADS students UCV since January 2001

8. after Our Experience before

9. Our Experience Top Specialty doctors available for the most remote regions • Rural MD makes primary evaluation • second opinion request vía Internet. • Confirmatorio sub-specialty consultation • we have been able to solve complex cardiovascular and neurosurgical cases without delays.

10. Our Experience Wonken - Municipio Gran Sabana

11. Our Experience WONKEN - Gran Sabána - WiFi

12. Our Experience Ability to solve problems fast Our team follows the community wills Multidisciplinary team Dedication and love for our work Independance in transportation

13. Our Experience Some results at La Milagrosa clinic • 12 years of telemedicine (radio, phone, fax, Internet) • 13 MDs on their rural year (one year each) • > 350 clerckship students on health related sciences • > 50 volunteer clerkships (France, Spain,USA,GB , Japan,Egipt etc) • 1.500 patients/month seen ( regional centers). • Aproximately 5% requiere teleconsultation. • Aproximately 20% of teleconsults require referal.

14. Our Experience Active centers

15. Who are we ? • Where do we come from ? • Our experience • Our operating model • What can we offer ? • Where are we going?

16. Technical Platform Digital video camera ECG PC Microscope Digital Camera Portable Lab Laptop Laptop or portable device • BroadBand Internet • ADSL • VSAT • WI-FI • BroadBand Internet • ADSL • EVDO • WI-FI Specialty MD Printer VoIP phone Firewall Scaner Rural clients Application Server Web Server Virtual Triage Center Operating Model

17. Operating Model Internal Medicine Dermatology Parasitology Cardiology E.N.T. Trauma- Orthopedics Specialty MD’s Broad Band Internet Second opinion Web based application Virtual Triage Center (VTC) Internal Medicine specialist Second opinion Web based application Broad Band Internet Rural health prof. Rural Clinic Rural Hospital Other clients Remote clients

18. Operating Model Processes Virtual Triage Center (VTC) Remote client Specialty MD’s • Generates teleconsultation and sends it to VTC. • Receives answer from VTC and makes decision by his own criteria. • Consults medical literature online. • Demands second opinion at medical sub-specialty centers. (fourth level institutions). • Physician at VTC receives second opinion request and answers general specialty questions. • Forwards sub-specialty questions to sub-specialty related health care professionals. • forwards to clients answers received from sub-specialty physicians. . • Generates service statistical data and billing information for administrative purposes. • Afiliated sub-specialty physician receives and answers requests received from VTC.

19. Operating Model Telesalud Web page

20. Who are we ? • Where do we come from ? • Our experience • Our operating model • What can we offer ? • Where are we going?

21. What can we offer ? • We can offer a wide range of services among which : • Second medical opinion services. • • Consultation and site assesment for the installation of rural telemedicine services. • • Telemedicine project management. • Telemedicine web based application design. • • Telemedicine equipment providers. • Telehealth personel education and training.

22. What can we offer? technology telesalud People with needs (patients & communities) $$ Financial resources Human resources (universities & local)

23. Who are we ? • Where do we come from ? • Our experience • Our operating model • What can we offer ? • Where are we going?

24. Where are we going ? La Esperanza -Guyana border 50 kms in 3 hours.First Internet conexion on Sat.Jan 19 2008 at 11 pm…

25. Where are we going ? January 2008 - Urimán ATALACC President , Dr J.R. Arosemena ,visits Uriman at gives advice to “microscopist”

26. Where are we going ? Assesment at Cotopaxi and Chimborazo provinces Health promotors from Fundamyf

27. Where are we going ? Telemedicine Centers / Telesalud Venezuela (TSV) I n p r o g r e s s

28. There is much to do….!! Synergy is the best way to go !!!!! thank you !! www.tele-salud.com www.maniapure.org