1.I n T ouchHealth Extending Healthcares Reach Pioneering Technology Solutions for Healthcare Service Providers David Stuart,VP Intl Markets

2. MeduNet Collaboration Complementary Tele-Medicine Devices

Partnering with Intouch Health

(the leader in healthcare robotics)

to bring 18 years of robotic innovation

to the Saudi Arabia healthcare system.

3. InTouch Team History

2002:Founded InTouch Health

Leadership Position in Remote Presence

Control Station Remote Presence Robot 4. RP-6&RP-7 Intouch Healthfounded byYulun Wang, Ph.D. and his core development team, the world leaders in healthcare robotics 5. InTouch Team History

1989:Founded Computer Motion

Leaders in Surgical Robotics & the Intelligent OR

(Computer Motion sold to Intuitive Surgical in 2003)

Computer Motion products developed by Yulun Wang, Ph.D.

AESOP HERMES ZEUS&SOCRATES 1,400 + systems 2,000 + systems 65 + systems 6. Management Team

Yulun Wang, Ph.D. CEO

Michael Chan VP Marketing

Steve Jordan VP Engineering

David Stuart VP Intl Markets

Herb Von Winkelmann VP US Sales

7. RP-7in the Intensive Care Unit 8. RP-7 in Pediatric Medicine 9. Physician Rounding 2. Reviews patient status with nursing 3. Physician drives down hall to patient room 1. Physician logs into the robot 10. Physician ICU Rounding 4.duty nurse can accompany and update the physician on the patients condition 5. Patient visit as usual: review vital signs, concerns, and advance care 6. Physician & nurse discuss orders outside patient room 11. Hospital Applications

Remote training & clinical support

Remote resident grand rounds

Surgeon mentoring within OR

Academic Centers Partner Hospitals Education & Training

24/7 critical care consultation

Remote patient management

Leapfrog compliance

Intensivist Specialists Intensive Care Units Tertiary Hospitals Rural Hospitals Surgeons Internists Hospitalists Specialists Isolation Ward staff User/Customer

Enlarge hospital catchment area

Reduce unnecessary transfers

Speed care delivery & improve quality

Outreach

Additional patient rounds

Weekend/evening rounds

Weekend/evening on-call response

Med/SurgPatient Beds

On-call response

Referral consults

Reduce human exposure to highly infectious pathogens

Emergency Department Infectious Disease Control Customer Needs Application 12. ITH RP-7 Remote Presence Solution

Immediate access 24/7

• from home, clinic, another hospital, etc

Simultaneous access to Hospital clinical data

• PACS, labs, notes, paper charts, vital signs

Advance patient care immediately , when that patient requires fast expert attention.

13. InTouch TotalView TM 14. ControlStation Dashboard 15. Intensive Care Units Med/Surg Wards Emergency Dept Doctors Lounge Doctors Office Home Clinic Doctors Office Hospital Hospital Deployment 16. Our Aging Society 17. ITH Value Proposition

Enable physicians to

... react quickly to patients with critical needs,

more frequently consult, monitor, & round,

improve patient outcomes and quality of care,

improve hospital throughput,

...transfer knowledge more effectively,

utilize technology to gain efficiency.

18. ICU Care Problem

ICU is target of patient safety initiatives*

• High complexity & acuity

• • 16% of ICU patients experience human error in care

• • ICU mortality rate of 10-20%

• • High potential for serious LT disability

• High cost

• • ICU care represent 1/3 of hospital cost

• • 50-67% of ICU cost is concentrated in 10-15% of patients

• • Negative events = costly tests, medications, procedures, LOS

*Institute for Healthcare Improvement, JCAHO, National Quality Forum, The Leapfrog Group, Michigan Keystone Initiative 19. RP-7Robot Drivers License 20. Customer List-50+ robots

Johns Hopkins

UCLA

UC Davis

Emory, Atlanta

Mission Hospital, Los Angeles

Oakwood Hospitals, Detroit

Hackensack Medical Center

Sentara Healthcare, VA

University of Texas, Galveston, Texas

Oregon Health Science Univ.OHSU

Shawnee Mission, Kansas 5 robots

Detroit Medical Center 10 robots

Parkview (Ft Wayne, Indiana)7 robots

California Pacific Med. Center, CPMC Sutter

Imperial College, London

St. Marys Hospital, London 2 robots

San Rafaele, Milan, Italy

Acibadem Hospital Group, Istanbul, Turkey

Ethicon2 robots

Silverado Senior Living3 robots

Bitfone Corp2 robots

University of Tokyo

IRCAD/EITS of Strasbourg, France

Google

Cisco Systems 2 robots

Booze Allen Hamilton

21. Johns Hopkins Patient Satisfaction Study Telerounding is a novel use of currently available technology that significantly augments patient satisfaction with post-operative care.This may represent a window into future patient care that gives patients increased access to their physicians.Providing an acceptable and timely mechanism for inpatient/provider interaction has the potential to decrease length of stay and morbidity. LM Ellison, et al.:Telerounding and Patient Satisfaction Following Surgery 22. Remote Presence:Convergence of Communication & Transportation

Phone

Video Conference

Remote Presence

Airplane

Automobile

Communication Transportation 23. Beam Me Up!!! 24. The End

Thank you !

InTouch Health, Inc.

25.

Optional

Backup Slides

26. Sentara ROI Model 27. System Architecture Home Office Emergency Department ControlStation RP-6 Physicians Lounge ControlStation Physician Office ControlStation Broadband connections Med/Surg RP-6 Internet ICU RP-6 28. Remote Presence

ControlStation

Computer

Software

Camera

Microphone

Joy Stick

Remote Expert

RP-6

Remote piloted vehicle

Human like mobility

Two way audio-video

Pan, tilt and zoom

Virtually there interaction

Hospital Wireless Network Internet 29. Hospital IT Perspective

Leverages current or planned IT solutions

• Not a redundant system

Easy IT integration

• Leverages wireless & network infrastructure

• Seamless EMR integration

Step-wise & flexible deployment

ITH solution has broad application

(ICU, ED, Med-Surg floors)

Remote Presence can be highly effective with either EMR or paper records

Possible solution for Leapfrog

30. Physician Rounding 31. Sentara LOS Study Overview

Six surgeons

Additive afternoon and weekend rounds

19% 12 Discharge orders given via robot 29% 18 Patient discharge advanced due to robot rounds 65% 40 Patients receiving orders via robot 100% 62 Total patients visited Percent Totals 32. Market Size

Hospital Market

• 900,000 patient beds -> 30,000 RP-6s

• 90,000 ICU beds -> 9,000 RP-6s

• 5,000 EDs -> 5,000 RP-6s

• > $2 billion annualized market

• • RP-6 generates $4K/month

250,000 physicians -> 250,000 ControlStations

• $1 billion revenue opportunity ($250 mil annualized)

Billion dollar long-term care market

Significant non-healthcare markets

33. Summary

Strong Uniquely Qualified Team

Significant INITIAL market opportunity

• Strong/quantified value proposition

HUGE Total market opportunity

Solid revenue & customer ramp

Strong IP position with unique technology

34. Hospital Information Landscape ADT -Patient Search -Admitting Phy. -Patient room PACS/RIS -MR,CT,CR,PET, US -Echo Cardio LABS -Clinical labs -Range parameters -Microbiology HIS (MPI) -Demographics -Payer Bedside Monitors -Vital signes -Wave forms, tables Physician Progress Notes DICTATIONGOAL: CDR CLINICAL DATA REPOSITORY (EMR) Process specific applications CPOE Nursing Notes Pharmacy Charge capture Medication Orders -Contraindications Patient Billing & Collections Transaction Coding Physician Consult Report PhysicianProcedure Notes Vital Signs Meds (MAR) Intensive Care Parinatal/ L&D Cardio Care Med/Surg Care Respiratory Care OR & Scheduling Emergency Care 35. Hospital IS Landscape

Many IT system silos

• Evolving from paper to electronic

Department/Process specific silos

Moderate integration, especially non clinical systems HL7 Standard has significantly increased integration

Several large IT providers

• McKesson, Siemens, Cerner, Keane, IDX, Quadramed, GE Medical, Eclpsys, Epic

Most hospitals have several vendors in-house

• 55% of hospitals use best product by applications (multi-vendor)

• 36% of hospitals are 1 vendor (smaller, rural hospitals)

• 9% Home grown software

Large investment, very high switching costs

• Continued integration demands will fuel consolidation

36. Healthcare Crisis

Life expectancy increasing

Ratio of working to retired decreasing

Healthcare labor crisis is upon us

• Shortage of physicians, nurses, & caregivers

The crisis will increase

• • Age 85+ will grow 38% by 2010

• • The number of chronically ill will double

• • Availability of workers will decrease

Healthcare Workers Need to be in Two Places at Once!! 37. Leapfrog IPS Standard (ICU Physician Staffing)

Adult or pediatric ICUs are managed or co-managed by intensivists who:

Are present during daytime hours and provide clinical care exclusively in the ICU

At other times at least 95% of the time

• Return ICU pages within 5 minutes and

• Arrange for a FCCS-certified non-physician to reach ICU patients within 5 minutes

38. Leapfrog IPS and Telemedicine

Tele-intensivists can be used to meet the presence requirement when:

Ti manages and monitors care when intensivist is not on-site.

Ti workload permits assessment within 5 minutes of request.

Ti activity is proactive with patient reviews as appropriate.

Ti has immediate access tocare plan.

Ti documents activities in the patient record.

Ti has immediate access to real-time clinical data. (Bedside monitors, labs, med orders and administered, notes, images, ECGs, etc)

Ti is able to see patient clearly and talk with staff.

Data links are reliable and secure (HIPAA).

Standards for remote care exist.

Written protocol to ensure good communications.

39. Intensivists KEY to Solution

Single most important factor in improving ICU care is using intensivists to manage ICU units*

• ICUs where intensivists manage or co-manage all patients have documented a 40% reduction in ICU mortality

• Less than 15% of ICUs have dedicated intensivist

*Institute for Healthcare Improvement, The Leapfrog Group, and others 40. Benefits

Intensivist-centric ICU solution

• Deliver improved outcomes

• Reduce outliers

• Reduce ICU costs

Enables conformance to Leapfrog ICU Initiative

Technology allows inexpensive stepwise investment

• easy to initiate, expand as needed

• Leverages existing IT expenditures

Investment can be leveraged to other specialists and areas of the hospital

High physician acceptance

41. Hospital Challenges

Consistently deliver high quality care

• Provide the right medical services at the right time and at the right place

Drive efficiency gains through process improvement

• Maximize utilization of scarce resources

• Create new capacity to meet growing demand