1. W E L L M E D The Case for Urban Telehealth HII 99 Improving Health in a Digital World Washington, D.C. April 27, 1999 Moderator: Michael J. Rozen, MD

2. W E L L M E D Supposition Urban Inner City Populations are underserved and will benefit from Telehealth Many illnesses require specialist or tertiary care center support

3. W E L L M E D Inner City Underserved Access Issues Welfare Reform Aging Population Proximity Issues Hospital Consolidation Physician Location Specialty Coverage Tertiary Care Home Health Care

4. W E L L M E D Cincinnati Experience Model-Based Income/Poverty Estimates 1995 Poverty all ages100,35811.7 % Under age 18 42,76018.9 % Related children 5-17 26,45616.7 % National Average 199716.1 % Median Household Income$34,023 Source: US Census Bureau

5. W E L L M E D Cincinnati Experience Medicaid:1994 80,000 Eligible 199930,000 Eligible max20,000 Mandatory Medicaid Managed Care County 19966 HMO’s 19991 HMO Cincinnati Health Department Clinics Uninsured mix 199446 % 199870% University Hospital Uninsured Mix 199413 % 199918 % Two Urban Hospitals have closed routine services

6. W E L L M E D Helga Rippen, MD, PhD, MPH Director, Health Information Technology Institute Demographics and Policy Issues

7. W E L L M E D Johnathan D. Linkous Executive Director American Telemedicine Association The Need for Urban Telehealth

8. W E L L M E D Diane C. Lewis Executive Vice President ALTA Consulting Group Montana Terrace Smart Home Community Urban Telehealth

9. W E L L M E D Curtis T. White, Esq. President Allied Communications, Inc. The Smart Home Community

10. W E L L M E D Frank E. Ferrante Senior Manager, Network Systems Engineering Mitretek Systems Trends, Technology and Band Width

11. W E L L M E D Thank You

12. W E L L M E D Consumer Health Information: HII 99 April 27, 1999 Moderator: Michael J. Rozen, MD the Government the Private Market

13. W E L L M E D Healthcare Market US Healthcare Spending $1.1 Tril $2.1 Tril 13.4% 16.6% % of Total GNP Source: Healthcare Financing Admin.

14. W E L L M E D Internet Access 83 Million Americans over age 16 have net access (40%) 1998 - 66 Million next 12 months - 17.2m Source: Intelliquest 35 Million Households (34 %) of total 43 % increase over 98 Source: Nielsen/NetRatings 1999 Over 12.9 Million Canadian adults have net access 65 % spend at least one hour online Source: Angus Reid

15. W E L L M E D Women and the Net 71 % of women search for health content on Net compared to 56 % of men Women in US, make 80 % of health decisions and 60 % of health related purchases Source: Jupiter 1999 199743 % 199848 % 199950 % EST Source: International Data Group 199930 Million Adult Women-30% have children online Source: Cyberdialogue/findsvp

16. W E L L M E D Teens on the Net 19.3 Million US Teens 35 % wired today 44 % by end of year Source: eStats Research 1999 Home PC’s 1995 27 % 1997 43 % 1998 50 % Source: Dataquest 1999

17. W E L L M E D Consumers & Providers Which best describes pt/doc interaction? Source: Yankelovich Monitor 77% 65% 47% 43% Consumer Opinions of Doctors

18. W E L L M E D Consumers seeking Health Information on the Net 43 % of Net users go online for health information 81% Found Information useful Source: Deloitte & Touche 1999 91% Found what they wanted Source: Harris Survey Jan 8-11, 1999 6 out of 10 online seek personal health information Source: Cyber Dialogue 1998 64.4 % have searched for health-related content Source: Jupiter 1999

19. W E L L M E D Internet and Health 3 out of 10 seek information for a family member Source: Cyber Dialogue 1998 Over one half of US adults online are parents 27% of adults with children go online for children’s health content Source: Cyber Dialogue 1999

20. W E L L M E D Disease-Web Information Most helpful Reference sites Medical Societies 40% Support Groups 32% Pharmaceutical 20% Hospitals 16% Depression19% Allergy/sinus16% Cancer15% Arthritis10% Hypertension10% Migraine 9% Anxiety 9% Heart Disease 8% Source: Harris Poll Disease:

21. W E L L M E D Health ECommerce E-Commerce 1998 2002 B2B 43B 843B Consumer 8B 76B Health Spending Second Offline (120B), but only seventh (509M) online 1999 Pharmaceutical and medical EST. 44B in 2002 Source: Forrester Research 1998 Online Shoppers 49% male hh 68% over age 40 94% college 46% $50,000 + Source: Ernst & Young 1998

22. W E L L M E D Web Ad Spending 1997 $650M.34% 1998 $ 1.5B.74% 2002 $ 8.9B 3.4 % Source: eAdvertising Report 1999 Offline Ads - influence 33 % of purchases Source: BizRate.com 38 % increase in number of sites seeking online ads Source: Adknowledge.com Banner Ads 1998 - 50 % 2001 - 26% Sponsorship Model 2001 - 58% Source: eMarketer

23. W E L L M E D Health Consumers Concerns: Privacy Authentication Relevance Credibility Fraud Semantics Requirements: Immediacy Unfiltered Personalization Quality Individualized Interactive Communities Training

24. W E L L M E D The Consumer Health Record Phillip Marshal, MD, MPH Director, HealthNow Medical Record WellMed, Inc.

25. W E L L M E D Consumer Health Content/Delivery Joel Kahn, MD Chief Medical Officer Intellihealth

26. W E L L M E D Delivering Consumer Telehealth Scott M. Rifkin, MD Chief Executive Officer AmericasDoctor.Com

27. W E L L M E D The Federal Government and Consumer Health Information J. Michael Fitzmaurice, Ph.D. Senior Science Advisor for Information Technology Agency for Health Care Policy Research