1. The Use on New Technologies to Improve Patient Experience ACHPE June 2015 Larry Friedman, M.D. Associate Dean for Clinical Affairs Professor of Medicine and Pediatrics University of San Diego, San Diego

2. Defining A Great Patient Experience Patients Assume Doctors Make the Right Decisions Access Right Time and Right Place Information Involvement in Care By Providers Internet Learning Convenience “One-Stop” Shopping Choice Offered Options and Participation in Care Slide 2 of 15

3. Home Telemedicine: Convergence with EHR and Mobile Monitoring Slide 3 of 15

4. Once logged in, patients can: View test results Read messages from physician & clinic View upcoming appointment details & cancel appointments View past appointments & After Visit Summaries Send non-urgent messages to physician & clinic View preventive health reminders View current and historical information in the health record Slide 4 of 15

5. Practical Telemedicine Understand the Evolving Technology Integrated Into Electronic Records within Two Years Understand Why You Are Doing It Distant Site Perspective Expert Site Perspective Understand Your Business Model (if any) How Will You Get Paid and By Whom Understand the Alternatives Are There Better Ways to Provide the Care Understand the Legal Implications American Doctors Are Very Sensitive About This Meyer and Friedman, Closing the Distance in Medicine, San Diego Physician, July 2010, 36-39. Meyer, Clarke, Troke and Friedman, Essentials of Telemedicine for Connecting the Academic Health Center and Remote Providers to Enhance Patient Care, Academic Medicine 87(8), 2012. Slide 5 of 15

6. Decision-Making Metrics How Will it Integrate With Your Practice How Does it Affect Work Flow How Will you Assess Satisfaction How Will You Decide and Negotiate Contracts Is It Value-Added Will Your Patients Use It How Does it Compare to the Alternatives Who Will Do the Work Telemedicine Work Flow E-Health Work Flow Home Monitoring Work Flow What Are the Potential Revenues What Are the Potential Expenses Slide 6 of 15

7. Key Success Factors Physician and Administrative Leader They Need to “own” the program IT Capability and IT Leader Fiber Optics—Preferred More Stable Satellite Understanding all Billing and Legal Issues Doctor to Doctor Less Complicated Slide 7 of 15

8. Satellite Satellite Slide 8 of 15

9. Satellite Success Satellite Success Slide 9 of 15

10. Practical Applications Synchronous: Real Time Doctor to Doctor Acute and Chronic Care Acute Strokes Post-Operative Care Specialty Consultations Asynchronous: Time Delayed Imaging Pathology Dermatology Slide 10 of 15

11. BLOOD PRESSURE CONTINUOUS GLUCOSE MONITORING WEIGHT & BODY COMPOSITION SLEEP OPTIMIZATION ACTIVITY EXERCISE AND HEART RATE Slide 11 of 15

12. Smart Band-Aids 4G Wireless Data Network Body Area Network Peripheral Sensors Gateway Mobile Health Technology Slide 12 of 15

13. Practical Mobile Health Monitoring Advantages Patients Participate in their Own HealthCare Can Interface With Electronic Health Records Adds to Clinical Information for Decision-Making Challenges Potential Flood of Clinical Data: Who Will Monitor Not Clear Who Will Pay If Doctors Monitor Quickly Evolving Technology Rapidly evolving interface needs Slide 13 of 15

14. UCSD Jacobs Medical Center (2016) 245 New Inpatient Beds and Outpatient Pavilion Hospital for Advanced Surgery The Pauline and Stanley Foster Hospital for Cancer Care Hospital for Women and Infants Thornton Hospital (existing) Sulpizio Cardiovascular Center (existing) Outpatient Pavilion (planning phase) Slide 14 of 15

15. Questions Slide 15 of 15