The Total Telehealth Solution

Overview of TelehealthModule 1

Overview of Telehealth/Telemedicine

• Telemedicine began over 40 years ago. Formally defined; telemedicine is the use ofmedical information, exchanged from one site to another via electroniccommunications to improve a patient’s clinical health status. The word telemedicineand telehealth are mostly interchangeable - with telehealth encompassing a widerand telehealth are mostly interchangeable - with telehealth encompassing a widerdefinition of remote health care.

• Telemedicine/Telehealth tools include:– Two way video– Email– Smart phones– Wireless tools– Transmission of still images– E-health including patient portalsE-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 bytelemedicine? Examples include

– Primary care and specialist referral services– 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 servicesare delivered:

• Networked programs – dedicated high speed lines orinternet connections between hospitals/clinics and outlyingclinics and health centers in rural/suburban areas.clinics and health centers in rural/suburban areas.

• Point-to-point connections – private high speed networksused by hospitals/clinics to deliver services directly oroutsource specialty services to independent medicalproviders; examples include; stroke assessments andmental health assessments.

• Monitoring center links – land line, wireless or internetservices used to deliver patient vital readings to medicalservices used to deliver patient vital readings to medicalproviders and finally;

• Web based e health patient service sites - direct consumeroutreach and services over the internet.

What are the benefits of Telemedicine?

• Improved Access(a) it brings healthcare services to distant locations(a) it brings healthcare services to distant locationsand

(b) it allows the medical profession to expand theirreach 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 shownthat the quality of healthcare services delivered viatelemedicine are as good those given in traditional in-that the quality of healthcare services delivered viatelemedicine are as good those given in traditional in-person consulations. In some specialties, particularly inmental health and ICU care, telemedicine delivers asuperior product, with greater outcomes and patientsatisfaction.

• Patient Demand - Over the past 15 years study afterstudy has documented patient satisfaction and supportstudy has documented patient satisfaction and supportfor telemedical services. Such services offer patientsthe access to providers that might not be availableotherwise, as well as medical services without theneed to travel long distances.

What is the current standing of telemedicineand where is it projected to go?

• According to Forbes magazine, telehealth is the tophealth trend for 2014 with an anticipated growthhealth trend for 2014 with an anticipated growthrate of over 50% and with the US telehealth marketprojected to grow from $240 million today to $1.9billion in 2018.

• The Deloitte Center for Health Solutions conducted asurvey of U.S. physicians last year and found thatsurvey of U.S. physicians last year and found that18% of PCPs surveyed use telemedicine for follow-upor diagnostic visits.

Current Telemedicinelegal issues:

• Physician Licensing:When you are able to meet with a patient in cyberspace,When you are able to meet with a patient in cyberspace,state borders become irrelevant. Except that providersare, in most cases, limited to practicing in states wherethey are licensed. Each state has different licensurepolicies, and while some states allow interstate deliveryof healthcare, others do not.

• Malpractice Liability:• Malpractice Liability:There is little precedent on what telemedicine means formalpractice liability. As telemedicine becomes morewidespread, liability issues are expected to increase.

Current Telemedicinelegal issues: (continued)

• Online Prescribing:Online prescribing policies vary by state. Furthermore,according to the National Telehealth and PolicyOnline prescribing policies vary by state. Furthermore,according to the National Telehealth and PolicyResource Center “concerns are emerging over qualityand practices of for-profit provider entities enteringthe marketplace who may be treating patients andprescribing inappropriately.”

• Credentialing and Privileging:The Centers for Medicare and Medicaid Services hasThe Centers for Medicare and Medicaid Services hasissued a rule on credentialing and privileging fortelehealth providers, but this rule conflicts with somestate policies.

The Total Telehealth Solution

E-Telmed OverviewE-Telmed OverviewModule 2

e-Telmed Overview

e-Telmed, Inc. supplies a single source solution that incorporates all of thenecessary components to successfully implement a telehealth program.All of the software, peripheral devices and customer support are availableAll of the software, peripheral devices and customer support are availablein a seamless package for ease of use and integration with any HL7compliant 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 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 thatwas founded in 2007 by Lancelot James, CEO. e-Telmed was deployed after nearly 3 years of productwas founded in 2007 by Lancelot James, CEO. e-Telmed was deployed after nearly 3 years of productdevelopment and testing. Our solution is utilized forvideo conferencing and video-conference basedtelemedicine consultations between parties in differentlocations. The solution includes the seamlessintegration of a multi user video conferencing systemwith white board system, CCHIT certified - web basedelectronic medical records, practice managementwith white board system, CCHIT certified - web basedelectronic medical records, practice managementsolutions, 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 bephysicians, administrators) simultaneously without having to bephysically present.

• The VC system helps physicians, hospitals and school districts totarget a larger patient/student base by allowing them to seepatients 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)• 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 - medicalhistory of an individual.history of an individual.

• This encrypted HIPPA compliant information isaccessible from anywhere in the world

• Features include appointment scheduling– secure and encrypted messaging– prescription management– patient education

patient monitoring tools.– patient monitoring tools.

• Our PHR is securely tethered with the physician’s EMRwhich ensures the accuracy of the medical informationseen by the patient and other providers.

EMR (Electronic Medical Record):

• SSL encrypted web based EMR system which provides portability for the practicingphysician.

• The EMR is implemented with minimal interruption to practices• 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– 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• 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 PortalThe Patient PortalModule 3

Patient Portal

• Used by Patient Members to register with e-Telmed and network physiciansTelmed and network physicians

• The portal contains important HIPPA consentand insurance consent forms

– Patients can also update Demographic andInsurance Info from within the portalInsurance Info from within the portal

Patient Portal

• Portal contains a Personal Health Record thatis tethered to the doctor’s EMR systemis tethered to the doctor’s EMR system

– The PHR contains selected clinical components

• Examples include; allergies, medications andcomplaints and also;

• Radiology Results, Lab Results, Procedure Results, andProvider NotesProvider Notes

– There are options from printing or downloadingPHR information

Patient Portal

• Messaging system

– That allows secure communication directly to the– That allows secure communication directly to thephysicians practice

• For items such as refill requests, treatment effects, andspecial appt requests.

• Practice Forms

– A practice may upload specific forms for their– A practice may upload specific forms for theirpatients to fill out

Patient Portal

• Appointment Setting Key features include;– Allowing members to request appointments– Allowing members to request appointments

– Appointment availability is linked to the physicianscalendar

– Accepted Appointment requests are confirmed viaemail and text messages

– These messages provide a link and access code to theVirtual Doctor’s Office for telehealth consultations.Virtual Doctor’s Office for telehealth consultations.

• All of the Patient Portal Data is secure, privateand HIPPA compliant

The Total Telehealth Solution

Peripheral DevicesPeripheral DevicesModule 4

Peripheral Devices

• Medical Peripheral Devices – are devices thatare used to transmit medical information to aare used to transmit medical information to acomputer.

• e-Telmed’s telehealth solution incorporates upto 14 medical peripheral devices that are acombination of bluetooth and video codeccombination of bluetooth and video codec

Peripheral Devices

• These devices are:– Scales– Stethoscopes– Stethoscopes– Pulse Oximeters– Glucose meters– Opthalmoscopes– Spirometers– EKGs– Thermometers– Blood Pressure Cuffs– Otoscopes (Ear Scope)– 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 peripheraldevices either by codec or blue tooth connection to the e-TelmedApp on the user’s Smartphone.App on the user’s Smartphone.

• The Smartphone stores the reading and transmits the readingthrough the e-Telmed App to the network physician’s EMR systemor any other system as designated by the patient.

• The key differences to our solution are that (a) the information ishighly encrypted and (b) users retain full control over readingswhich are securely stored in the Smartphone and (c) allhighly encrypted and (b) users retain full control over readingswhich are securely stored in the Smartphone and (c) allrecommended devices are FDA certified

Benefits:

• Our solution provides users with the flexibilityto select from a large list of medical peripheralto select from a large list of medical peripheraldevices without being tied to any single brandor price point

• Allows doctors to closely monitor thecondition of their patientscondition of their patients

• Reduces hospital readmissions

The Total Telehealth Solution

The Virtual Doctor’s OfficeThe Virtual Doctor’s OfficeModule 5

Virtual Doctor’s Office“Face to Face” Video Conferencing

• Key Features include:

– Provides a secure and HIPAA compliant video link– Provides a secure and HIPAA compliant video linkto member patients

– It is accessible through the web site’s “VirtualDoctor’s Office”

– Available cross platform from a desktop or mobiledevice.device.

Virtual Doctor’s Office“Face to Face” Video Conferencing

– Video Conferencing supports up to 10simultaneous userssimultaneous users

– High Definition Video quality (dependent oncamera type)

– Multiple screen language options

Virtual Doctor’s Office“Face to Face” Video Conferencing

• User features include;– Whiteboard system for visual drawings/explanations– 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– 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 anyApple, Android or Kindle Devices and is crossApple, Android or Kindle Devices and is crossplatform compatible.

• Basic Features Include

– Microphone and Camera settings

• For higher or lower resolution viewings

The Total Telehealth Solution

The EMR SystemThe EMR SystemModule 6

EMR System

• Web based – allows world wide access

• CCHIT, Klas Award on usability, ICD-10 ready, Gold• CCHIT, Klas Award on usability, ICD-10 ready, GoldCertified Surescript

• HIPAA compliant and Meaningful Use compliant

• Customizable notes for all specialties

• E-Prescribing, interaction tables, medicationhistory (24 months)history (24 months)

• Electronic Labs – Send and Receive results

• Peripheral Device Integrations

EMR System

• Patient Database – demographics,insurance, consent forms, clinical sectioninsurance, consent forms, clinical section(complaints, allergies, medications, etc.)

• Scheduler Feature – Create customschedule for each physician in the practiceand link the schedule to Patient Portaland link the schedule to Patient Portal

EMR System

• E-Prescription Feature – View currentmedications, past medications, 2 year historymedications, past medications, 2 year historyfrom Surescript and prescription writing withbuilt in clinical summaries on each patient, druginteraction tables, dosage calculators and e-prescribe, e-fax and prescribe and printfeatures.– Other Features include;– Other Features include;– Billing modules, Claims modules, Reports

modules, Library, Document Managers andAlerts and Recalls

Key telehealth EMR modifications

• Customizable consultation notes for ease ofuse when conducting telehealth consultationsuse when conducting telehealth consultations

• Customizable medication lists for ease of usewhen prescribing

• Customizable diagnosis lists

• We provide a recommended workflow for• We provide a recommended workflow fortelehealth consultations

The Total Telehealth SolutionThe Total Telehealth SolutionPlatform 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 aPhysician’s Practice

Standard Physician Usage Diagram

Compliance and Partnerships