Extending e-health to rural areas Tuxtla, May, 2006 Alcatel Alenia Space broadband telemedicine solutions

Broadband satellite telemedicine - 2 All rights reserved © 2006, Alcatel Alenia Space Extending e-health to rural areas : geographical context French initiative in South East of France, Department of les Alpes Maritimes 4 valleys whose access is very difficult Landslides, snow in winter are blocking roads Aging population Local medical staff isolation

Broadband satellite telemedicine - 3 All rights reserved © 2006, Alcatel Alenia Space Extending e-health to rural areas : objectives Professionals Maintain general practitioners in mountainous/isolated areas Maintain qualified staffs in local hospitals Provide remote assistance / expertise to local staff to treat patients Patients Accelerate recovery at home or in usual environment Provide locally new services avoiding travelling to urban hospitals Reduce hospitalization frequency, transfer and cost Increase populations confidence into local teams Deal with medical but also social aspects Maintain quality of life

Broadband satellite telemedicine - 4 All rights reserved © 2006, Alcatel Alenia Space Extending e-health to rural areas : set up of a specific program To achieve the objectives, setting up of a specific program including medical training, teleconsultation & tele-expertise with relevant partners Strong partnership : General Council Alpes Maritimes telemedicine local development, contractual matters and funding, planning, communication Nice Faculty of Medicine provides medical expertise, specialists coordination, referents in local hospitals, training program Alcatel Alenia Space leader for satellite technology, telemedicine Workstation and e-health applications, network installation / configuration / optimisation, end-users support, technical training supervision, maintenance

Broadband satellite telemedicine - 5 All rights reserved © 2006, Alcatel Alenia Space Extending e-health to rural areas : Satellite network architecture A9780 DVB-RCS based satellite network Hub and applications platform hosted at Alcatel Alenia Space France premises and managed by AASF technical team 12 sites : 8 local hospitals (isolated area) and 4 Hospitals in Nice (urban area)

Broadband satellite telemedicine - 6 All rights reserved © 2006, Alcatel Alenia Space Extending e-health to rural areas : DVB-RCS technology Two ways satellite broadband technology. Ground network independency (2W architecture) of the DVB-RCS satellite solution enables customers currently suffering of the lack of terrestrial broadband networks, to access value added services DVB-RCS standard compliant : mature and fully operational technology implementing DVB-S norm (DVS-S2 ready) on the forward link & offering powerful capabilities (up to 2 Mbps return) on the return link to access and transmit over satellite from anywhere. DVB-RCS system ensures interoperability with heterogeneous network like terrestrial, mobile, wireless and secures customer investments in infrastructure It supports current and upcoming IP services, providing network functionality to support new generation of interactive and multimedia applications (high quality video based applications)

Broadband satellite telemedicine - 7 All rights reserved © 2006, Alcatel Alenia Space Extending e-health to rural areas : SIT installation Ease of installation of the DVB-RCS satellite terminal allows fast installation of a new site and its integration into the overall network. Ground, wall, roof Vehicle Container

Broadband satellite telemedicine - 8 All rights reserved © 2006, Alcatel Alenia Space Extending e-health to rural areas : DVB-RCS technology & telemedicine requirements 2W design & High Rate on return link (medical training, teleconsultation, tele-expertise/telediagnosis) High quality video transmission from teacher/specialist side (H264) Asymmetric/Symmetric traffic Applications interactivity (videoconference, questions/answers) Very high image quality transmission QoS mechanisms (medical training, teleconsultation, tele-expertise /telediagnosis) Robust audio communication Guaranteed BW Multicast (medical training) Satellite is the best solution (coverage, terrestrial multicast nodes) Point to multipoint architecture Videostreaming Push of contents

Broadband satellite telemedicine - 9 All rights reserved © 2006, Alcatel Alenia Space Extending e-health to rural areas : Medical training Doctors, nurses, auxiliary nurses, pharmacists 3 hours sessions (1-2 per months) Management of end-of-life care : physical, psychological, social, spiritual, and practical needs of patients and caregivers Emergency : introduction to the use of a Semi-automatic defibrillator Geriatrics : disorders of sphincter / swallowing risks and elimination Gastroenterology : repercussion of non-steroidian anti-inflammatory (NSAI) drugs usage Proctology : acute pain identification and treatment Psychiatry, Gynaecology, Endocrinology, Dermatology

Broadband satellite telemedicine - 10 All rights reserved © 2006, Alcatel Alenia Space DVB-RCS HUB Management tools Security Applications & services DVB-RCS Remote SIT End user WS Extending e-health to rural areas : Medical training Each participant connects to the Alcatel Alenia Space broadband medical training application Contents Presentation Return : 256kbps remote participants/512kbps teacher

Broadband satellite telemedicine - 11 All rights reserved © 2006, Alcatel Alenia Space Extending e-health to rural areas : examples Unlimited number of participants Meeting room with several participants and video-projector and wall screen Remote pointer session recording for further use

Broadband satellite telemedicine - 12 All rights reserved © 2006, Alcatel Alenia Space Extending e-health to rural areas : teleconsultation Nurses, doctors, specialists Regular ½ hour point to point sessions Psychiatry : patient with personality or mental disorders, mortality / morbidity related disorders (suicide, injuries from accidents, substance abuse) Elderly Nutritional disorders Kinesytherapy: evaluation, diagnosis, rehabilitation in locomotion Cognitive disturbances Orthoepy: speech and swallowing troubles Dermatological or rheumatologic disorders Gerontology : Care of scabs, podology and chiropody

Broadband satellite telemedicine - 13 All rights reserved © 2006, Alcatel Alenia Space Extending e-health to rural areas : teleconsultation Telemedicine WS Each participant connects to the same core application DVB-RCS HUB Management tools Security Applications & services Patient transfer, local hospital recovery ? Return : kbps

Broadband satellite telemedicine - 14 All rights reserved © 2006, Alcatel Alenia Space Extending e-health to rural areas : tele-expertise / telediagnosis Specialists ½ hour point to point sessions Specific tele-expertise application with advanced image processing capabilities Interconnecting with DICOM compliant modality Radiology (fractures, angiogram, mammography,..) Dermatology (melanoma or dermatitis or pictures/MRI examination, tissue microscopic examination) Cardiology (prevention, investigation and treatment of diseases involving the cardiovascular system) Anatomo-pathology

Broadband satellite telemedicine - 15 All rights reserved © 2006, Alcatel Alenia Space Extending e-health to rural areas : tele-expertise / telediagnosis DVB-RCS HUB Management tools Security Applications & services SIP

Broadband satellite telemedicine - 16 All rights reserved © 2006, Alcatel Alenia Space Extending e-health to rural areas : tele-expertise / telediagnosis DICOM compliant Acquisition from DICOM modalities Image manipulation (any manipulation is remotely reproduced) zoom contrast, brightness black & white magnifying glass measurements, annotation window levelling scrolling Tele-cursor Return : 1024 kbps Echography Return : 512 kbps Diabetic eye disease examination

Broadband satellite telemedicine - 17 All rights reserved © 2006, Alcatel Alenia Space Conclusion Leading position in telemedicine using satcoms System and solutions integrator, not only a supplier Take advantage of Alcatel Group competencies for network architecture definition (terrestrial, mobile, satellite, wireless) and integration of end users applications for medical uses Build robust partnerships for industrial solutions (cost sharing, roadmap) and commercial deployments success (user acceptance) Design and provide end-to-end solutions for e-Health vertical market (unique interlocutor) Have got a unique experience in Europe of deploying and exploiting an operational medical training and teleconsultation network Is the coordinator of the Healthware European project (Aeronautics & Space program – European Commission ), which is the reference in Europe regarding telemedicine by satellite and the driver for the development and the deployment of DVB-RCS based telemedicine applications :

Broadband satellite telemedicine - 18 All rights reserved © 2006, Alcatel Alenia Space Contacts Pascal LOCHELONGUE (technical manager) Olivier AUTRAN (marketing manager) Pierre LEON (local marketing manager)