1. 16 February, 2003medXchange© 2003 Private & Confidential 1 INTEGRATED ELECTRONIC MEDICAL RECORD IEMR AND MEDICAL KNOWLEDGE BASE

2. 16 February, 2003medXchange© 2003 Private & Confidential 2 Continuity of healthcare Consulting Physician Dispensed Medication Laboratories Second Opinion Medical Call Center Hospital & Clinic Therapists Patient Centric Integrated Electronic Medical Record Physician

3. 16 February, 2003medXchange© 2003 Private & Confidential 3 Continuity of Healthcare The treating physician, consulting physician, hospital and clinic, dentist, optician, laboratory, therapist and pharmacist can share relevant patient information and documentation.

4. 16 February, 2003medXchange© 2003 Private & Confidential 4 Continuity of Healthcare Enabling the rationalisation of the healthcare process Reducing unnecessary medical examinations Eliminate redundancy of prescriptions Reduce risk of medication interactions and negative reactions Optimizing the hospital process and reducing hospitalization Avoiding delays in diagnosis and treatments Faster and better medical care at reduced costs Reduce risk of malpractice

5. 16 February, 2003medXchange© 2003 Private & Confidential 5 Management of "Risk Patients" Case – Disease management Using Evidence Based Medecin, EBM and good medical practice Interface or data migration out of other medical information systems Bio-sensors, laboratories, hospitals Specialised medical documentation (Orthopedic, cardiology, nephrology, radiology)

6. 16 February, 2003medXchange© 2003 Private & Confidential 6 Patient Centric Meta Database Meta Database Implant Register Physician Medical Record Health Cards Medical Information & Images Output Input Output Input I E M R Clinical Medical Records Health Profile Dispensed Medication Disease Profile Laboratory Results Medical Call Center

7. 16 February, 2003medXchange© 2003 Private & Confidential 7 Integrated Electronic Medical Record Intuitively understandable by healthcare professionals worldwide Multi Language Ergonomically structured to physicians working methods Easy to consult by patient

8. 16 February, 2003medXchange© 2003 Private & Confidential 8 Patient support applications: Examples General patient support  Optic-Card  Dental-Card  Audio-Card  Allergy-Card  Cardio-Card  Diabetes-Card  Nephro-Card  Orthopedic-Card

9. 16 February, 2003medXchange© 2003 Private & Confidential 9 Disease related & health profile Patient group profile IEMR contains patient medical & health data and documentation Patient disease related profiles are created through case – disease support applications (e.g. diabetes, nephrology, cardiology ) Patient health profiles are created through occupational health and human ability building applications Patient group profiles are created for statistical analysis of patient groups IEMR Disease related profileHealth profile

10. 16 February, 2003medXchange© 2003 Private & Confidential 10 IEMR: Ergonomic Structure Structured to follow the medical process and working methods of physicians Comprehensive and up-to-date medical data and documentation Personalised according to existing patient data

11. 16 February, 2003medXchange© 2003 Private & Confidential 11 IEMR: Disease related data Comments and notes may be entered with each value on a chart Disease related data: Example of diabetes patient Blood sugar Blood pressure Blood coagulation Medication Calorie intake Physical activity

12. 16 February, 2003medXchange© 2003 Private & Confidential 12 IEMR: Patient Documentation Patient documentation in the Integrated Electronic Medical Record, IEMR may consist of: Physician notes, letters and text documents Laboratory test and examination results X-Rays, scans, MRI, ECG, angiography, Echocardiography, Audiometrie, Visual performance, fundus of the eye, EMG, NCV, other medical imaging, etc.

13. 16 February, 2003medXchange© 2003 Private & Confidential 13 IEMR: Monitoring a diabetes patient Key diabetes indicators monitored with daily / monthly profiles Each of 5 key values entered in simple numeric format Glucose Ketone Insulin dosage Calory intake Activity level

14. 16 February, 2003medXchange© 2003 Private & Confidential 14 Case – disease support: Disease related profile A disease related profile of key medical indicators (e.g. blood sugar, blood pressure, insulin intake etc.) can be established and followed over a day, weeks, months or years.

15. 16 February, 2003medXchange© 2003 Private & Confidential 15 Knowledge Base Patient Support Applications Evaluation of patients with high health risks or chronic illnesses Occupational health risk assessment Patient rehabilitation and behavioural support Clinical studies

16. 16 February, 2003medXchange© 2003 Private & Confidential 16 Patient data creation Structured IEMR data Library of templates Yes / No question templates Evaluation templates

17. 16 February, 2003medXchange© 2003 Private & Confidential 17 Patient data creation Structured IEMR data Measurement and value templates

18. 16 February, 2003medXchange© 2003 Private & Confidential 18 Knowledge Base: Rules Defined by experts Formulas applied to patient data Library of rules and formulas

19. 16 February, 2003medXchange© 2003 Private & Confidential 19 Disease and health risk analysis Disease related and health profiles Analysis of key medical risks Supports case – disease management Analysis of overall health risks Occupational health programs Pro-active health programs Behaviour support programs

20. 16 February, 2003medXchange© 2003 Private & Confidential 20 MyHabit: Human Ability Building Evidence based guidelines for healthier lifestyle Behaviour support tailored to individual health profile Online support and feedback Monitoring and feedback of treatment adherence Human Ability Building Information Technology

21. 16 February, 2003medXchange© 2003 Private & Confidential 21 Healthcare sectors Medical Registers Integrated Electronic Medical Record Healthcare Consumer Protection Clinical Studies Personal Health Management Occupational Health Risk Patients

22. 16 February, 2003medXchange© 2003 Private & Confidential 22 Data Protection & Access Management Patient controls access to record Certain data updated by patient Medical data certified by physician All data traced to source Physician can restrict access to data Physician & Patient notified of updates EC Health Card or USB Key “access key”

23. 16 February, 2003medXchange© 2003 Private & Confidential 23 Professional Health Key Patient Health Key Internet connection Online Access Healthcare Professional Platform Windows PC & Internet Browser CD Reader “Hand Held” Computer with SmartPad

24. 16 February, 2003medXchange© 2003 Private & Confidential 24 Healthcare Rationalization Patient Greater medical security – one IEMR - Improved healthcare treatment Improved quality of healthcare Optimization of healthcare services  Early warning system in case of problems with medical implants and drugs  Supervision of compliance with medical regulations

25. 16 February, 2003medXchange© 2003 Private & Confidential 25 Healthcare Rationalization 50% efficiency of patient admission processing time 20% reduction of medical exams and tests 30% efficiency in diagnosis time for emergencies Hospital & Clinic 30% reduction of patient history research time 20% reduction in patient diagnosis time 20% reduction of medical exams and tests Physician

26. 16 February, 2003medXchange© 2003 Private & Confidential 26 40% decrease in patient audit costs 10% reduction of malpractice claims 10% reduction of medical costs Health Insurers 30% reduction of workplace health risk 20% reduction of occupational health risk Occupational Health Healthcare Rationalization

27. 16 February, 2003medXchange© 2003 Private & Confidential 27 20% shortening of time to detect problems 40% clinical study infrastructure cost reduction 30% reduction of data gathering and reporting costs Clinical & Medical Studies 20% reduction of disease emergency treatments 25% reduction of medical exams and tests 30% risk reduction of medications General Healthcare Healthcare Rationalization

28. 16 February, 2003medXchange© 2003 Private & Confidential 28 Designed by physicians for physicians Complete patient medical data and documentation Follows physician working methods Patient disease support and profile Patient pro-active health support and profile Disease and health risk analyis The IEMR & Medical Knowledge Base