Helping Doctors Extend Their Reach

1. Helping Doctors Extend Their Reach Steven Normandin, President AMD Global Telemedicine, Inc.

2. My Background and Experience 1st and 2nd Generation Systems History Issues/Challenges Clinics Technical Definitions and Misconceptions New Philosophy � Telemedicine Encounter Management System The Process � Steps to a 3rd Generation Programs AMD�s Dynamic Encounter Network Questions and Answers

3. What is Telemedicine? In the past, �Telemedicine� was used to describe the delivery of healthcare remotely. Today, �Telemedicine� has been redefined and expanded to encompass the distribution of information and utilization of technology for the delivery of health care.

4. AMD Global Telemedicine Experience

8. Types of Environments Remote Hospitals/Clinics ED supportive coverage ICU connections to specialists Correctional Facilities Medical Offices-Primary Care/Surgery Follow-up Physical Rehabilitation Centers Schools Assisted Living/Long Term Care Facilities Mobile Van-Clinic Bus Mobil Health - (m-Health) Wellness Mobil Phone Applications Patient Mobility Software as a Service - (SAS) Full Features Little capital required

9. School & Mobile Van Telehealth

10. Telemedicine Extremes�.From the Sudan Desert

11. to the Arctic polar circle of Greenland

12. Why Telemedicine?How telemedicine provides solutions to medical problems Alaska Health Network Problem: How can we use otoscopy to diagnose ear infections with the goal of avoiding compromised hearing relating to repeated and undiagnosed ear infections, while at the same time reducing inappropriate antibiotic administration? Solution: Alaska used telemedicine to measure the number of images forwarded for consultation, the percentage of cases resulting in diagnosis of ear infection, the number of antibiotic prescriptions on average per year per patient, and the percentage of population presenting with compromised hearing. Most widely successful telemedicine program in the world AMD products installed in 300 sites Most widely successful telemedicine program in the world AMD products installed in 300 sites

13. Why Telemedicine? (cont.) CORRECTIONAL FACILITIES - MICHIGAN DEPARTMENT OF CORRECTIONS Problem: How can prison facilities deliver high quality care without the cost and dangers of inmate transportation? Solution: The Michigan Department of Corrections has 22 Telemedicine sites with 20 participating physicians providing care in 14 subspecialty areas. Telemedicine consults have resulted in annual savings of $125,000 in transportation costs associated with telemedicine visits.

14. Why Telemedicine? (cont.) RURAL HEALTH -GREENLAND�S NATIONAL MANGEMENT OF HEALTH Problem: How can we reduce number of patients that are medevaced while still providing timely and expert medical care to the entire population of our island? Solution: In 2008, Greenland began the process of implementing a Telemedicine Encounter Management System (TEMSTM). This system greatly reduced the number of unnecessary transports and gave the people of Greenland unprecedented access to quality healthcare.

15. Why Telemedicine? (cont.) DEVELOPING NATIONS - NIGERIA Problem : How can I provide healthcare to a developing population in developing nations like NIGERIA? Solution : In Nigeria, with the help of� the Nigerian telemedicine project team and AMD Telemedicine equipment, many people who ordinarily would not be able to receive medical care, will now be able to be seen by a specialist who can address their specific needs with the most current treatment for their conditions. Rather than build and staff large numbers of sophisticated facilities, AMD�s telemedicine solutions allowed basic clinics to share the expertise of clinicians and clinical specialist who may be located centrally or decentralized. Other Extreme Environment Deployments Military; Bosnia; Kosovo; Iraq Developing Countries; Nigeria, Sudan, Botswana Other Extreme Environment Deployments Military; Bosnia; Kosovo; Iraq Developing Countries; Nigeria, Sudan, Botswana

16. AMD Today AMD is a Telemedicine Encounter Management Systems company (TEMS): A complete end to end Clinical Telemedicine solutions provider Delivering on the five (5) elements of a complete clinical solution

17. Telemedicine Encounter Management Clinical Telemedicine 1st & 2nd Generations: - Focused on patient acceptance/experience and ease of use for healthcare providers. 3rd Generation: - Focuses on Advanced Program sustainability issues and physician/nurse practitioner utility. - Addresses shortage of primary care physicians. - Addresses the technical and implementation issues associated with 1st and 2nd Generations implementations.

20. Telemed Terms and Misconceptions

21. Telemedicine Encounter Management

24. AMD�s Dynamic Encounter Network (ADENTM) Your on-demand, ad-hoc, secure telemedicine network. FEATURES Telemedicine quality imaging and sound at bandwidths as low as 64kb No special IP lines required Lowest operation cost of any telemedicine solution Complete data capture of audio, video and data EMR data integration Ideal for soft endpoint teleconferencing applications Brokered, peer to peer sessions No remote doctor side footprint or hardware Complete physician mobility Installs without IT support / network engineering Real-time, high resolution video and audio powered by Polycom Converged Management ApplicationTM (CMATM)

25. Characteristics of successful telemedicine programs Establish a vision of your telemedicine program and future sites. Build a long term financial plan to support your project. Create a convenient and effective telehealth work environment. Appoint a full-time coordinator. Find a champion leader who will be supportive for at least the first two years. Schedule training for staff and technical support. Establish dedicated sites, policies, procedures and manuals. Provide marketing of program to medical/nursing/patients. Plan and implement into standard patient care as soon as possible. Share learned experiences with others.

26. Identify several key people for your Telemedicine team Ministry of Health Hospital Administrator Chief Information Officer Project Manager Champion Physician/Consulting Physicians Director of Nursing/ Nurse Administrator/ Chief Nurse Telehealth Coordinator (Physician, Nurse or Technician) Information Technologists/ Desk Support Biomedical Engineer/ Support Nurse