1. Privileged & Confidential - Property of WorldCare Health (Malaysia) Sdn Bhd 1 Asia Pacific Development Information Programme Telemedicine - Creating an Effective Teleconsultation Network

2. Privileged & Confidential - Property of WorldCare Health (Malaysia) Sdn Bhd 2 Telemedicine - An Overview Telemedicine is defined as the provision of “any type of medical service from a distance” The major types of telemedicine applications are: –Electronic Medical Records –Continuing Medical Education –Personalized Health Information –Teleconsultation All telemedicine applications require the use of multimedia equipment and telecommunication systems

3. Privileged & Confidential - Property of WorldCare Health (Malaysia) Sdn Bhd 3 Types of Telemedicine Activities - Electronic Medical Records Electronic Medical Records (EMR) store all healthcare information of a person to create an independent set of medical records Healthcare providers can access the EMR from any location in order to provide diagnosis based on the most complete level of information The EMR should result in the creation of a Personalized Lifetime Health Plans The EMR of all the individuals should provide data and services to enhance health planning and policy making at the national level (Source: Malaysian Telemedicine Flagship Application)

4. Privileged & Confidential - Property of WorldCare Health (Malaysia) Sdn Bhd 4 Types of Telemedicine Activities - Continuing Medical Education Continuing Medical Education (CME) application results in healthcare professionals, regardless of their physical location, being provided with medical educational materials through a multimedia environment Through telemedicine CME courses healthcare providers are constantly made aware of the latest medical innovations Through this ongoing interaction with other medical professionals, healthcare providers in remote locations feel less isolated and more willing to work in such locations

5. Privileged & Confidential - Property of WorldCare Health (Malaysia) Sdn Bhd 5 Types of Telemedicine Activities - Personalized Health Information Personalized Health Information (PHI) delivers high quality health information to any multimedia user A PHI system should provide affordable and reliable health information in a user-friendly manner to individuals This system should empower individuals to take responsibility for their state of health It should assist the individuals in maintaining a healthy lifestyle (Source: Malaysian Telemedicine Flagship Application)

6. Privileged & Confidential - Property of WorldCare Health (Malaysia) Sdn Bhd 6 Types of Telemedicine Activities - Teleconsultation Teleconsultation is the provision of medical opinions through the use of a telecommunication medium Teleconsultation is dynamic i.e. it requires interaction from both the referring medical practitioner and the consulting physician whether simultaneously (through video-conferencing) or at different times (through store & forward systems) An effective teleconsultation system incorporates features of the other three telemedicine applications, in other words it should: –Provide electronic medical records of individuals who have used the teleconsultation system –Provide practice linked continuing medical education –Provide access to relevant information to both healthcare providers and users

7. Privileged & Confidential - Property of WorldCare Health (Malaysia) Sdn Bhd 7 Teleconsultation - An Overview Teleconsultation is the provision of medical opinions through the use of a telecommunication medium An effective teleconsultation system should be capable of transmitting: – medical images - x-rays, CT, MRI, etc. – medical data and –voice To be effective, teleconsultation systems have to be: –Extremely Reliable –Efficient and Fast –Cost Effective

8. Privileged & Confidential - Property of WorldCare Health (Malaysia) Sdn Bhd 8 An Effective Teleconsultation System Reliable –A reliable and useful system will require a “Paradigm Shift” whereby patients, medical officers at the rural sites, specialists at the centers of medical excellence and all other healthcare professionals buy into this new form of healthcare delivery. The Paradigm Shift can occur through: Comprehensive “Change Management” procedures which would carefully and thoroughly explain this new healthcare delivery system A pilot project conducted over a few years involving sites that may be considered to be the most receptive to new ideas –Medical validation of system is necessary –The system would need to be tested on the prevailing national telecommunication infrastructure –Security features such as firewalls, passwords and digital signatures should be incorporated to deter misuse.

9. Privileged & Confidential - Property of WorldCare Health (Malaysia) Sdn Bhd 9 An Effective Teleconsultation System Efficient and Fast –Teleconsultation acquisition spokes need to be near potential customers and be able to transmit cases quickly through existing telecommunications infrastructure –Standard Operating Procedures (created through experience and with the active input of healthcare professionals) and checklist to ensure efficiency and reliability Cost Effective –Utilize a system which strives to make both the general and specialist medical practitioner more efficient in utilizing their time –Store & Forward technology utilizing normal phone lines –Use of an effective compression technology (such as wavelet compression) which has been medically validated –Minimal use of Video Conferencing Systems

10. Privileged & Confidential - Property of WorldCare Health (Malaysia) Sdn Bhd 10 An Example of a Teleconsultation Network Hub 1 (Mirror to Hub 3) Acquisition Spoke Acquisition Spoke Hub 4 (Mirror to Hub 2) Acquisition Spoke Acquisition Spoke Hub 3 (Mirror to Hub 1) Acquisition Spoke Acquisition Spoke Hub 2 (Mirror to Hub 4) Acquisition Spoke Acquisition Spoke Virtual Private Network Notes: 1) Each Hub is normally situated at a Center of Medical Excellence 2) Acquisition Spokes could be connected through normal telephone lines while Hubs would be connected with higher bandwidth phone lines (such as ISDN) Acquisition Spoke Acquisition Spoke

11. Privileged & Confidential - Property of WorldCare Health (Malaysia) Sdn Bhd 11 An Example of the Teleconsultation Process Patient Local Physician Sub/Specialist Clinician Specialist Radiologist/Pathologist International Centers of Excellence Malaysian Centers of Excellence Pantai Hospital (Hub 1) National Heart Institute (Hub 3) Hospital National University Malaysia (Hub 2) Harvard University Cleveland Clinic Duke University Johns Hopkins London Clinic University Hospital (Hub 4) Other Hospitals (Hub 5..etc.) Malaysian Hub US Central Hub Acquisition Spoke

12. Privileged & Confidential - Property of WorldCare Health (Malaysia) Sdn Bhd 12 TeleMedicine Information System Acquisition Spoke Fax Documents Video / Audio X-Rays, CT, MRI Pathology Slide Any other form of Medical Information ANY Vendor: GE, Siemens, AGFA, Kodak, Fuji, etc. …. Centers of Excellence Hub Hospital 1 ANY Vendor: GE, Siemens, AGFA, Kodak, Fuji, etc. …. Hub Hospital 3..etc ANY means of Telecommunication Plug and Play Gateway Flow of Medical Data Intelligent Tracking, Routing and Storing of Medical Information; Internet Compatible A Teleconsultation Information System Hub Hospital 2

13. Privileged & Confidential - Property of WorldCare Health (Malaysia) Sdn Bhd 13 Benefits of Teleconsultation Extends the reach of specialist healthcare from centers of medical excellence to rural or underserved areas Through the teleconsultation system, the general practitioners at the acquisition spokes have immediate access to a wide range of medical specialties Patients eventually have one “Super Family Doctor” monitoring their wellness Provides immediate benefits in the form of improved diagnostic and treatment recommendations to rural areas The system retains the patient medical information which can be viewed by the attending medical practitioner even if the patient has moved to a different location The cases available on the network can eventually act as a medical education tool

14. Privileged & Confidential - Property of WorldCare Health (Malaysia) Sdn Bhd 14 Practical Suggestions Study teleconsultation projects being undertaken by other countries (such as Malaysia) and private teleconsultation companies Ensure initial acceptance from senior healthcare and information technology professionals Evaluate and document the country’s existing telecommunications and healthcare infrastructure Initiate a pilot project on a Build Operate and Own (BOO) or Build Operate and Transfer (BOT) basis Ensure the pilot project takes into account the limitations of the above infrastructure Clearly outline the goals and objectives of the pilot project and provide the necessary support