1. Establishing a Canada-Brazil Telehealth Partnership Establishing Canadian expertise and products and helping Brazil to establish, expand and manage their own telehealth and telemedicine networks

2. Infotelmed and LCE This presentation has been prepared by: LCE LCE Communications Montreal. Canada Infotelmed Communications Inc www.infotelmed.cawww.infotelmed.ca LCE Communications reg www.LCE.cawww.LCE.ca with the collaboration of the www.edumed.netwww.edumed.net Edumed Institute, Sao Paulo, Brazil

3. Infotelmed and LCE Brazil: a snapshot 182 million inhabitants 50% of Latin America’s output 8th world economy US$ 15 B Foreign Direct Investment New socialist government prioritized health and education as main goals 7th largest world software market, US$ 10 B among world’s 10 largest health sectors

4. Infotelmed and LCE Brazil’s ICT sector US$ 35 billion revenue, growth @ 10% annual investment expected @ US$ 12 billion 6 fixed telephony providers 40 million telephony users, growth @ < 2% 18 cellular providers 40 million cellular subscribers, growth @ > 20% 20 million Internet users, 30 million by 2005

5. Infotelmed and LCE Brazil’s health care sector 1 Overall Statistics US$ 50 B industry yearly turnover (public+ private) every citizen entitled to Unified Health System 7 K hospitals, up to 3.33 beds/1,000 inhab. 15 K clinics & labs, 54 K pharmacies, 145 health coops 40% yearly growth (private) Main trends for sector home care, telemedicine improved quality

6. Infotelmed and LCE Brazil’s health care sector 2 Three largely separate systems free public Unified Health System (SUS) covers 75% of population, paid by Brasilia’s budget private health plan system covers 23% of population (40 million souls), includes medical insurance, medical cooperatives, self- management health plans, community health plans private medical care, covers 2% of the population, self-paid

7. Infotelmed and LCE Brazil’s health care sector 3 Status of Health Care System private medicine and university-based public medicine very advanced: AIDS/HIV & infectious diseases, cardiology & cardiac surgery, oncology, plastic surgery, reconstructive surgery, immunology public health mostly in sorry state, low level of wages and per capita investment improving in efficiency and coverage due to IT investments, education and training, managerial reform

8. Infotelmed and LCE But Brazil, like Canada, has health care challenges: 1 Demographics, Brazil 2002 vast territory, 8 M sq.km (Canada at 9 M) 182 million inhabitants, median age 27 yrs 17 births/1,000 pop., annual growth 1.15% 86% literacy, 30% < 8 years of studies Population Distribution north / west vast expanses (like Canada), densities < 1 per sq.km high concentration coastline capitals (Rio at 291/sq.km) average 17 inhabitants per sq.km 76% urban, 24% rural, 89% < 50,000 inhabitants, 65% < 20,000

9. Infotelmed and LCE But Brazil, like Canada, has health care challenges: 2 Distribution of Wealth min. wage for 15% in richest southern states, up to 59% northeast minimum wage at US$ 80 / month for 40% of working force income 20% richest = 27 times 20% poorest 29% below poverty level Health Status life expectancy at birth: male: 67 years, female: 75 years infant mortality < 1 yr old: 10/1,000 born alive, northeast 18, south 6 chronic and degenerative diseases account for 57% to 65% deaths

10. Infotelmed and LCE But Brazil, like Canada, has health care challenges: 3 Aboriginal Health National Indian Health Service public health service under construction, family health concepts barefoot community health agents (natives) disease profile still related to poverty, low immune defenses Aboriginal Population large Indian reserves among poorest of poor 8 million inhabitants (1500’s) today < 600,000

11. Infotelmed and LCE But Brazil, like Canada, has health care challenges: 4 Health Care Professionals, 2002 360K physicians (208/100,000), 170K dentists (96/100,000) 90K registered nurses (52/100,000), 500K nurse assistants (289/100,000), 170K other allied health total at about 1.3 million professionals Large Regional Disparities 65 to 554 physicians per 100,000; São Paulo state alone accounts for 95,000 physicians (26,5%) 160 counties with 93% of physicians, 3,400 remaining with 7% 43% counties < 10 resident physicians, 38% have none

12. Infotelmed and LCE Opportunities for Canadian telehealth (TH) expertise and products Telehealth Status just starting: pioneers are large and rich private hospitals, excellence centres in public universities telehealth yet to be adopted by public health sector few succesful experiments underway, growing fast potential is enormous: size of country, very large distances highly unequal resource distribution and service provision absolute lack of services in so many areas attention to Canadian leadership, achievements

13. Infotelmed and LCE Infotelmed: who we are Federally incorporated research and consulting company established since 1998, www.infotelmed.cawww.infotelmed.ca Focus: telehealth, health care telematics, telemedicine, e-health Under contract, federal & provincial governments, diverse organizations: Evaluation of telehealth networks and projects, more than 50 urban, rural and isolated communities for Health Canada, resulting in substantial reports Reports: telehealth industry competitiveness, profile and capability in Canada (Industry Canada) - final reports available online Needs assessments and analyses Development, Strategic & Operational plans - implementation of telehealth Member, The Keston Group, www.keston.comwww.keston.com international group of consultants & researchers medical imaging, medical physics and telehealth

14. Infotelmed and LCE Who is involved at Infotelmed Jocelyne Picot, BA, MA, PhD, President of Infotelmed Author of several reports and articles and frequent speaker on the subject of telehealth Adjunct Professor at McGill University Experienced consultant and researcher in the field of telehealth and telemedicine: developed and implemented unique tools and mixed qualitative- quantitative approach to needs assessments and evaluation of telehealth Consultant to the largest French-speaking hospital in Canada - recognized as a Canadian expert in the field of telehealth Founding member of the Canadian Society of Telehealth (CST)

15. Infotelmed and LCE LCE Communications: who we are LCE carries mandates with Brazilian institutions technical & scientific partnerships, technology transfer & distribution Edumed Institute mandate: to mediate and negotiate projects with governmental entities & private institutions - aim: financing, grants, donations to establish technical and scientific partnerships: health care, telemedicine, telehealth, computer-mediated education LCE LCE Communications Montreal. Canada Consulting & engineering office, since 1990 services in telecom and telehealth systems worldwide contracts, Brazil as niche market mandates cover: telemedicine applications, telehealth programs, telecom technologies

16. Infotelmed and LCE Who is involved at LCE Luiz C. Esteves, P.Eng., M.Sc. principal consultant and director of LCE Communications consultant to TIW, Telus, SRT, medium / large corporations consultant to Brazilian companies manager at space programs, telecom projects, R&D assistant professor at Catholic University, Rio Author, McGraw-Hill book company, 1981 in the works - telehealth

17. Infotelmed and LCE The Edumed Institute – the Brazilian partner not-for-profit NGO organization (2000) 21 staff members and associates develops and partner with telehealth and educational projects headquartered in Campinas, Brazil’s foremost technological area with representations countrywide coordinates consortium of 25 public/private institutions work relies on partnerships with: universities, hospitals, government, private sectors R&D in IT and digital communications applications development of distance health education and training

18. Infotelmed and LCE Who is involved at Edumed Dr. Renato E.M. Sabbatini, Ph.D. Post-doctoral fellow, Max Planck Institute, Neurobiology, Germany Ph.D. (Physiology), School of Medicine, Sao Paulo University Founder, director of The EduMed Institute President, Latin American and Caribean Federation, International Medical Informatics Association (IMIA – LAC) Member, Internet Commission of the American Medical Informatics Association (AMIA) Dr. Sabbatini is a visionary and enthusiastic adopter and promoter of telehealth and CME programs in Brazil

19. Infotelmed and LCE Edumed : projects which need Canadian expertise * * products & content Amazon Telehealth Project telemedicine services, indigenous people Pediatric Oncology Network Project videoconferencing and Internet network of specialized hospitals for cancer treatment Brazilian Telecardiology Network videoconference and telemedicine initiative via hi-speed network, protocols and clinical directives for cardiovascular health services Telemedicine for Family Health wireless IP distance education network for municipal health secretariats UNIMED health cooperative telemedicine / distance education project, neuroradiology subproject

20. Infotelmed and LCE Project One – first steps which have already been taken Initial efforts have been: Health Canada - Amazon Telehealth Project highlights CIDA - submission of Amazon Telehealth Project highlights Industry Canada –preliminary discussions and meetings Already happening with Edumed: case conferences set up with CHUM in Montreal supply, satellite-based, home care, portable wireless VC products translation & certification proposal, cardiac triage software participation of Dr. Picot, International Telehealth Seminar, May, Brazil participation of Dr. Sabbatini, CST Quebec conference, October

21. Infotelmed and LCE Next steps: bilateral visits and feasibility study Feasibility study aimed at information and intelligence gathering visits to Edumed Institute by the Canadian consultants interviews and information gathering in the region served by Edumed in-depth study of relevant documentation from: CIDA, Health Canada, WHO, the IADB and International Trade complete needs assessment report, obstacles, recommendations target: selection / definition of appropriate Canada-Brazil joint project Bilateral visits Field visit by LCE and ICI to undertake study Dr Sabattini’s visit to various telehealth sites in Canada, attendance at CST conference in Quebec city, October 2004

22. Infotelmed and LCE Involvement of other partners AudiSoft portable wireless narrowband videoconference & telemedicine unit Colabnet user-controlled satellite bandwidth allocation software & home care wireless support solutions (Smart Labrador partner) March Networks home care wideband support solutions Smart Labrador, MUN Faculty of Medicine telemedicine and CME/CHE content support ( IC ’s Smart Communities )

23. Infotelmed and LCE Thank you! We appreciate you giving us your time to participate in this presentation And now we need to know: what further steps do you propose we take? what can Industry Canada do to help move this joint project forward? contact information: esteves@lce.ca jpicot@infotelmed.caesteves@lce.cajpicot@infotelmed.ca company information: www.LCE.ca www.infotelmed.cawww.LCE.cawww.infotelmed.ca

24. Infotelmed and LCE Edumed: stepping stone to other projects in Brazil Santa Casa (philantropic hospital) teledermatology project, additional prospect to AudiSoft and Colabnet technology solutions, content providers’ support FioCruz (federal research institute) telemedicine, CME, CHE partnership: content, technology providers COPPE / SECTI (federal university / Science & Technology Secretariat) technology partnership, hospital hi-speed network expansion and support to State government telehealth initiatives satellite providers (early adopters of new technology solutions) network performance optimization