1. INSTA Intelligence Technologies (P) Ltd. AccessMyDoc A Telemedicine Solution A Telemedicine Solution

2. WHAT IS ACCESSMYDOC? A live video, audio and web based system that allows patients to receive medical care from a remotely located medical provider, i.e. “Telemedicine”.

3. General Telemedicine Process Flow

4. Features AccessMyDoc is composed of patient and doctor network: Connect to Medical provider Triage Questions for Sore Throat, Diarrhea and Nausea Patient medical history Patient adding physician to his network Patient Audit Trail (transaction log) Request for Appointment or Cancelling the appointment by patient or doctor Rx Request – Prescriptions Referral Request – Patients referring other patients

5. Features (contd..) Patient health forms Patient information and insurance details In case of emergency - contact information of patient relatives Billing questions to the staff Ask nurse a question Interfacing with Diagnostics – Lab results Provide consultation of a Super-specialty doctor from a distance through videoconferencing (3rd party tool) along with exchange of medical records online Tele-Consultation

6. Reports Number of online visits performed – by all the doctors Number of Registered Patients Number of online appointments set – by a specific doctor Number of referrals Amount of money paid to a physician or for a specific period Illness Treated for the cases of Sore Throat, Diarrhea and Nausea Demographic of registered patients

7. Development of satellite locations  Rapidly develop an outpatient program  Feed inpatient stays  Extend into competitor’s geographical areas overnight Project Power using principals of “Medical Tourism”  Establish a Center of Excellence; State-wide recognition Strengthen Relationships with Provider Community  Creating revenue source for them Hospital Benefits

8. Provide care to patients located at:  County Health Departments  Hospital outpatients (ex. ER Departments)  Physician offices  Podiatrist offices  Community Mental Health Centers Two designations: o Originating site: where the patient is located o Distant site: where the medical provider is located At the originating site a licensed healthcare professional is NOT required

9. Access to mental healthcare in rural and Inner-City communities is a challenge? The challenges faced by our pilot organizations: Availability of providers: especially for children Distance/transportation problems Abundance of cases

10. Telehealth/Telepsychiatry Solution Telepsychiatry component of telemedicine defined as delivery of psychiatric treatment remotely, using live video-teleconferencing equipment (VTC). Telepsychiatry has been approved American Psychiatric Association Psychiatric treatment via telemedicine can be as effective as when delivered during traditional outpatient appointments. The growth and success of telepsychiatry traditionally limited by the high cost of expensive VTC equipment and dedicated "point-to-point" data links – no longer exists.

11. Increase access to mental healthcare providers for your patients Cost efficient-no penalty for “no shows” Provide care to patients at:  Nursing homes  County Health Clinics  Hospitals (inpatient and outpatient)  Hospital based renal dialysis centers  Physician or other type of practitioner offices  Community Mental Health Centers Mental Health Clinic Benefits

12. Accepts case; remote visit scheduled and performed HOW IT WORKS WITH ACCESSMYDOC Request for care placed in AccessMyDoc Determination made for Mental healthcare Remote provider evaluates case and determines if remote care is appropriate.

13. HIPAA CHECKLIST USED HIPAA Citation HIPAA Security Rule Standard Implementation Specification 164.308(a)(1)(i) Security Management Process 164.308(a)(2) Assigned Security Responsibility 164.308(a)(3)(i) Workforce Security 164.308(a)(4)(i) Information Access Management 164.308(a)(5)(i) Security Awareness Training 164.308(a)(6)(i) Security Incident Procedures 164.308(a)(7)(i) Contingency Plan 164.308(a)(8) Evaluation 164.308(b)(1) Business Associate Contracts and Other Arrangements 164.310(a)(1) Facility Access Controls 164.310(a)(2)(ii) Facility Security Plan 164.310(b) Workstation Use 164.310( c ) Workstation Security 164.310(d)(1) Device and Media Controls 164.312(a)(1) Access Control 164.312(b) Audit Controls 164.312( c)(1) Integrity 164.312(d) Person or Entity Authentication 164.312(e)(1) Transmission Security Automatic logoff Admin controls access/audit trails

14. GROWTH OF TELEMEDICINE Mandated in 13 States and Counting; 35 States reimburse for telemedicine via Medicaid program (within USA) Covered by Medicare and numerous Medicaid plans (within USA) Private payors are reimbursing for it: (within USA)  Blue Cross Plans such as: Anthem (California), Hawaii, Western NY, North Carolina, WellPoint, many more  United Healthcare  Aetna  Cigna Use in Emergency Rooms, especially for mental health patients Telepsychiatric satisfaction levels measured at 80% for patients and 90% for physicians in a study funded by the National Institute of Mental Health and the Duke Endowment “Although telemedicine has been around for years, it is gaining traction as never before.” -New York Times, Business Day May 29, 2010

15. A major problem faced by hospitals are patients inappropriately going to the emergency room for illnesses that should be provided for in a primary care physician’s office AccessMyDoc’s Emergency Room Module enables hospitals to lower their cost associated with patients who use the emergency room inappropriately by utilizing remote primary care physicians and specialist to provide care, thereby freeing up valuable emergency room staff and resources for patients with life threatening illnesses. Emergency Room Module

16. ER Portal

17. Physician accepts case, remote care is rendered using AccessMyDoc Physician evaluates information collected and determines if remote care is appropriate. Information is collected about patient’s condition and sent to remote physician Patient visits ER for non-life threatening illness (i.e Acute Respiratory Infection) Benefits of Emergency Room Module: Frees up hospital emergency staff to treat patients with life threatening illnesses Links up the patient with primary care physicians in an effort to avoid future inappropriate use of the emergency room Emergency Room: How it Works

18. Outpatient Portal

19. HOW IT WORKS FOR INPATIENT CARE Physician accepts case, AccessMyDoc terminal is placed at patient’s bedside for rendering of medical care Inpatient requires specialty services not currently available at hospital; Information uploaded to AccessMyDoc Specialist evaluates information collected and determines if remote care is appropriate.

20. Patient benefits Live healthier lives because medical conditions are closely monitored Removes constraints due to geography or work conflicts Increases access to care; One Stop Shop for Services

21. A major problem faced within the population is the lack of primary care physicians and specialist within rural and underserved areas of the country AccessMyDoc’s Rural Care enables patients in areas of the country that lack adequate access to primary care physicians and specialist to receive the critical medical care needed. Rural Care

22. Patient located in rural or underserved area requires access to a primary care physician or specialist Rural Care Module - How it Works Patient with a nurse logs into AccessMyDoc and completes a medical request form AccessMyDoc notifies the remote physician of the services needed

23. Many physician offices are overwhelmed by the administrative functions required to successfully operate a medical practice. A major obstacle is the time consuming functions required of the staff to set appointments, answer general questions, fulfill prescription request, retrieve medical records and submit referrals AccessMyDoc’s patient portal module enables a patient to perform many of the time consuming yet important functions themselves. Patient Portal Module

24. Patients also save valuable time by using AccessMyDoc to interact with their personal physician’s office to: Set appointments Pay medical bills Request prescription renewals Request referrals Receive appointment reminders Patient Portal Module

26. Benefits to Public and Private Hospitals/ NGOs Presence in remote areas with less investments Creating brand value Providing the same kind of support remotely Increase in patient network and bottom-line Medical Tourism Patients from US and other countries will be using our solution, and for final treatment and surgeries will travel to the destination Country