The Total Telehealth Solution

The Total Telehealth Solution Overview of Telehealth Module 1

Overview of Telehealth/Telemedicine Telemedicine began over 40 years ago. Formally defined; telemedicine is the use of medical information, exchanged from one site to another via electronic communications to improve a patient s clinical health status. The word telemedicine and telehealth are mostly interchangeable - with telehealth encompassing a wider definition of remote health care. Telemedicine/Telehealth tools include: Two way video Email Smart phones Wireless tools Transmission of still images E-health including patient portals Remote monitoring of vital signs Continuing medical education Nursing call centers Telemedicine is not a separate specialty, but simply a means in which to deliver medical services

What services can be provided by telemedicine? Examples include Primary care and specialist referral services Remote patient monitoring Consumer medical and health information and finally Medical education

What are the ways in which telehealth services are delivered: Networked programs dedicated high speed lines or internet connections between hospitals/clinics and outlying clinics and health centers in rural/suburban areas. Point-to-point connections private high speed networks used by hospitals/clinics to deliver services directly or outsource specialty services to independent medical providers; examples include; stroke assessments and mental health assessments. Monitoring center links land line, wireless or internet services used to deliver patient vital readings to medical providers and finally; Web based e health patient service sites - direct consumer outreach and services over the internet.

What are the benefits of Telemedicine? Improved Access (a) it brings healthcare services to distant locations and (b) it allows the medical profession to expand their reach beyond their own offices. Cost Efficiencies (A)Through better management of chronic diseases (B)Sharing health professional staffing (C) Reduced travel times (D) Fewer and shorter hospital stays

What are benefits of Telemedicine? (continuned) Improved quality - Studies have consistently shown that the quality of healthcare services delivered via telemedicine are as good those given in traditional inperson consulations. In some specialties, particularly in mental health and ICU care, telemedicine delivers a superior product, with greater outcomes and patient satisfaction. Patient Demand - Over the past 15 years study after study has documented patient satisfaction and support for telemedical services. Such services offer patients the access to providers that might not be available otherwise, as well as medical services without the need to travel long distances.

What is the current standing of telemedicine and where is it projected to go? According to Forbes magazine, telehealth is the top health trend for 2014 with an anticipated growth rate of over 50% and with the US telehealth market projected to grow from $240 million today to $1.9 billion in 2018. The Deloitte Center for Health Solutions conducted a survey of U.S. physicians last year and found that 18% of PCPs surveyed use telemedicine for follow-up or diagnostic visits.

Current Telemedicine Physician Licensing: legal issues: When you are able to meet with a patient in cyberspace, state borders become irrelevant. Except that providers are, in most cases, limited to practicing in states where they are licensed. Each state has different licensure policies, and while some states allow interstate delivery of healthcare, others do not. Malpractice Liability: Malpractice Liability: There is little precedent on what telemedicine means for malpractice liability. As telemedicine becomes more widespread, liability issues are expected to increase.

Current Telemedicine legal issues: (continued) Online Prescribing: Online prescribing policies vary by state. Furthermore, according to the National Telehealth and Policy Resource Center concerns are emerging over quality and practices of for-profit provider entities entering the marketplace who may be treating patients and prescribing inappropriately. Credentialing and Privileging: The Centers for Medicare and Medicaid Services has issued a rule on credentialing and privileging for telehealth providers, but this rule conflicts with some state policies.

The Total Telehealth Solution E-Telmed Overview Module 2

e-telmed Overview e-telmed, Inc. supplies a single source solution that incorporates all of the necessary components to successfully implement a telehealth program. All of the software, peripheral devices and customer support are available in a seamless package for ease of use and integration with any HL7 compliant infrastructure. We are considered a level 5 telehealth solution. *Level 5 Includes a full integration of telehealth with EMR Level 4 Hybrid telehealth Level 3A Live interactive (Video based solution) 3B Store - - -and - - -Forward telehealth (recordings) Level 2 Email, fax Level 1 Snail mail, telephone *Source: CITL (Center for Information Technology Leadership

Company Background e-telmed, Inc. is a privately held U.S. corporation that was founded in 2007 by Lancelot James, CEO. e- Telmed was deployed after nearly 3 years of product development and testing. Our solution is utilized for video conferencing and video-conference based telemedicine consultations between parties in different locations. The solution includes the seamless integration of a multi user video conferencing system with white board system, CCHIT certified - web based electronic medical records, practice management solutions, Personal Health Records (PHR), e- prescriptions and e-lab tests.

Virtual Doctor s Office Our Face to Face Video Conferencing system Allows users to see up to ten other users (patients, other physicians, administrators) simultaneously without having to be physically present. The VC system helps physicians, hospitals and school districts to target a larger patient/student base by allowing them to see patients around their surrounding locations and in different cities, states or countries. Facilitates live webinars to an unlimited audience size. The VC module is provided via a secure (RC6 128 bit encryption) Cross platform connectivity (from any computer with an internet connection). Face to Face Video Conferencing is available as a cross platform mobile app and is available for Apple, Android and Kindle devices.

Patient Portal Provides access to Personal Health Records - medical history of an individual. This encrypted HIPPA compliant information is accessible from anywhere in the world Features include appointment scheduling secure and encrypted messaging prescription management patient education patient monitoring tools. Our PHR is securely tethered with the physician s EMR which ensures the accuracy of the medical information seen by the patient and other providers.

EMR (Electronic Medical Record): SSL encrypted web based EMR system which provides portability for the practicing physician. The EMR is implemented with minimal interruption to practices Includes staff training to ensure effective use of the EMR system for telehealth. The benefits of using our EMR includes: custom telehealth note templates for each speciality e-prescribing through Surescript Bi-directional lab interfaces drug interaction tables Practice Management System. Eliminates storage servers and IT Management costs. Secure data center housing of medical information.

Peripheral Devices Monitoring for up to 14 peripheral devices Bluetooth enabled devices Any brand Utilized through e-telmed Peripheral device App App available for download in Fall 2014

The Total Telehealth Solution The Patient Portal Module 3

Patient Portal Used by Patient Members to register with e- Telmed and network physicians The portal contains important HIPPA consent and insurance consent forms Patients can also update Demographic and Insurance Info from within the portal

Patient Portal Portal contains a Personal Health Record that is tethered to the doctor s EMR system The PHR contains selected clinical components Examples include; allergies, medications and complaints and also; Radiology Results, Lab Results, Procedure Results, and Provider Notes There are options from printing or downloading PHR information

Patient Portal Messaging system That allows secure communication directly to the physicians practice For items such as refill requests, treatment effects, and special appt requests. Practice Forms A practice may upload specific forms for their A practice may upload specific forms for their patients to fill out

Patient Portal Appointment Setting Key features include; Allowing members to request appointments Appointment availability is linked to the physicians calendar Accepted Appointment requests are confirmed via email and text messages These messages provide a link and access code to the Virtual Doctor s Office for telehealth consultations. Virtual Doctor s Office for telehealth consultations. All of the Patient Portal Data is secure, private and HIPPA compliant

The Total Telehealth Solution Peripheral Devices Module 4

Peripheral Devices Medical Peripheral Devices are devices that are used to transmit medical information to a computer. e-telmed s telehealth solution incorporates up to 14 medical peripheral devices that are a combination of bluetooth and video codec

Peripheral Devices These devices are: Scales Stethoscopes Pulse Oximeters Glucose meters Opthalmoscopes Spirometers EKGs Thermometers Blood Pressure Cuffs Otoscopes (Ear Scope) Speculums (Nose Scope) Laryngoscopes (Throat Scope) Dermatoscopes Opthalmoscopes Fetus Dopplers

Peripheral Devices The system works by linking any one of the noted peripheral devices either by codec or blue tooth connection to the e-telmed App on the user s Smartphone. The Smartphone stores the reading and transmits the reading through the e-telmed App to the network physician s EMR system or any other system as designated by the patient. The key differences to our solution are that (a) the information is highly encrypted and (b) users retain full control over readings which are securely stored in the Smartphone and (c) all recommended devices are FDA certified

Benefits: Our solution provides users with the flexibility to select from a large list of medical peripheral devices without being tied to any single brand or price point Allows doctors to closely monitor the condition of their patients Reduces hospital readmissions

The Total Telehealth Solution The Virtual Doctor s Office Module 5

Virtual Doctor s Office Face to Face Video Conferencing Key Features include: Provides a secure and HIPAA compliant video link to member patients It is accessible through the web site s Virtual Doctor s Office Available cross platform from a desktop or mobile device.

Virtual Doctor s Office Face to Face Video Conferencing Video Conferencing supports up to 10 simultaneous users High Definition Video quality (dependent on camera type) Multiple screen language options

Virtual Doctor s Office Face to Face Video Conferencing User features include; Whiteboard system for visual drawings/explanations Note board system for sharing conference notes with participants File sharing system for sharing specific files with participants Screen sharing system for demonstrating/sharing desktop files Video Sharing system for sharing a video during a conference E-mail system for sending invitations to other participants Multiple Video Layouts on the screen Polling and survey system

Virtual Doctor s Office Face to Face Video Conferencing The Video Conferencing system is available for any Apple, Android or Kindle Devices and is cross platform compatible. Basic Features Include Microphone and Camera settings For higher or lower resolution viewings

The Total Telehealth Solution The EMR System Module 6

EMR System Web based allows world wide access CCHIT, Klas Award on usability, ICD-10 ready, Gold Certified Surescript HIPAA compliant and Meaningful Use compliant Customizable notes for all specialties E-Prescribing, interaction tables, medication history (24 months) Electronic Labs Send and Receive results Peripheral Device Integrations

EMR System Patient Database demographics, insurance, consent forms, clinical section (complaints, allergies, medications, etc.) Scheduler Feature Create custom schedule for each physician in the practice and link the schedule to Patient Portal

EMR System E-Prescription Feature View current medications, past medications, 2 year history from Surescript and prescription writing with built in clinical summaries on each patient, drug interaction tables, dosage calculators and e- prescribe, e-fax and prescribe and print features. Other Features include; Billing modules, Claims modules, Reports modules, Library, Document Managers and Alerts and Recalls

Key telehealth EMR modifications Customizable consultation notes for ease of use when conducting telehealth consultations Customizable medication lists for ease of use when prescribing Customizable diagnosis lists We provide a recommended workflow for telehealth consultations

The Total Telehealth Solution The Total Telehealth Solution Platform and Usage Overviews Module 7

E-Telmed Platform AES Standard Encryption 128 Bit to 256 Bit Algorithm Encryption Data Compression for Added Security Firewalls at Base of System Secure Data Vaults spread across the country Servers Hosted, Owned, and Operated by e-telmed,inc Banking level security and privacy features

Telehealth by E-Telmed

Effects of Telehealth on a Physician s Practice

Standard Physician Usage Diagram

Compliance and Partnerships