1 © 2011 Cybernet Medical

The MedStar Remote Patient Monitoring System

Cybernet Medical Contact Information:

Dr. Charles Jacobus

Phone: 734-668-2567

Mail: 3885 Research Park Drive

Ann Arbor, MI 48108

Web: www.cybernet.com

www.cybernetmedical.com

E-Mail: support@cybernetmedical.com

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Cybernet Overview and Background

Expertise in Medical Device Development, Man-Machine Interfaces and Robotics.

Network Computer Applications: Entertainment, Virtual Reality, Medical.

Primarily R&D for DoD, NASA, NIH.

Over 30 U.S. Patents awarded.

In medical areas, Cybernet’s patents cover methods for transmitting physiological signs/vital signs over the Internet, cellular networks, and SATCOM to multi-user browser-based database systems - and specifically, phone hub vital signs collection systems.

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Cybernet Medical History

1989 Cybernet Systems founded, in Ann Arbor, MI, to develop human-computer technology; R&D for DoD, NASA, NIH.

1994 First Internet connected wireless, programmable, portable vital signs measurement devices invented.

1994 Complete Internet based Scientific Analysis Software. 1996 First Internet telemedicine patents awarded. 1999 First outside investors. 2000 Cybernet Medical founded. 2001 First MedStar Patient Monitoring System introduced:

Cardiac. Chronic Illness Management. Home Care.

2004 added Personal Activity Log structured question set capability, IVR, video call, and wound care picture taking.

2007 added Kiosks and cellular. 2010 added MedStar Care Terminal hub that combines all of the above.

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MedStar Awards

2003 – Frost and Sullivan’s Emerging Medical Technology Award.

2004 – Inducted into NASA’s Space Technology Hall of Fame.

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MedStar Data Hub Overview

MedStar enables real time clinical decision support and real-time clinical alerts.

Allows compliant patients to self-manage and medical staff to deliver care to the most needy.

HIPAA Compliant.

FDA Approved.

MedStar Care Terminal The Next Generation of Care

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Supports any combination of devices. Available as stand-alone PC software. Combines web view, Personal Activity

Log Structured Dialogs and personal monitoring.

Attractive picture frame look – Even shows your digital photography!

USB, Serial, Bluetooth device connections.

Ethernet, Phone, Cellular, SATCOM data links.

Large easy-to-read fonts. Easy-to-use patient interface. Multi-touch screen – no keyboards.

MedStar CT - App The Next Generation of Portable Care

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Support for any combination of devices.

Combines web view, Personal Activity Log Structured Dialogs and personal monitoring.

Bluetooth device connections. Cellular or Wireless data links. Portable, full-featured client. Easy-to-use patient interface. Multi-touch screen.

MedStar Kiosks

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Multiple Patient Authentication.

Dialogs, Measurement, and EMR Accessibility.

Portable or Fixed Base Versions.

Customized measurements and symptom-eliciting dialogs.

MedStar Interactive Voice Response

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Scheduled Reminders. Interactive Dialogs. Input of hand-taken

measurement data. Clinical alerts.

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Web EMR Overview / How It Works

Collect Data in the patient home or from a Kiosk.

Uplink through Phone, Cellular, Broadband, SATCOM.

Secure Access through authenticated Web.

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Data Collected and Presented

MedStar Unit: Glucose Weight Temperature Blood Pressure Pulse Oximetry (Pulse Rate, SPO2) Spirometry (Peak Flow, Total Flow Volume) Coagulation (PT/INR)

Personal Activity Log two-way patient structured dialogs for symptom reporting

Interactive Voice Response (IVR) Medication reminders

EKG/ECG/EEG

Videophone Capable

Wound Camera

Web Site Electronic Medical Record

Lab Records

Images

Electronic Stethoscope

Doctor & Patient Communication Multiple Patient ,Kiosks Web or Care Terminal Interfaces Care Terminal Function available as

stand-alone PC Software

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Data Types & Disease Protocols

Disease Protocols Available: Diabetes. Congestive Heart Failure (CHF). Hypertension. Asthmatics. Congestive Obstructive Pulmonary Disease

(COPD). Obesity. Depression & Medication Compliance. Infection & Wound Care. Wellness

Medical Compliance

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Medical compliance is incorporated as a feature in the EMR.

The compliance device shown has been developed for NIH and is cost effectively producible in consumer quantities (1000 units+).

Cues pill dispensing by prescription.

Measures each dispensure, reports wirelessly to a MedStar data hub.

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Example PALStar Screens:

Personal Activity Log (PALStar) Structured Question Sets

Web-Based Question Programming and Review Screens:

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Interactive Voice Response

Use the same PALStar subjective question and response web interface to create dialogs – Automatic text-to-speech.

Call patients to remind them to test or take medicines.

Call patients or caregivers on alerts.

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PC / Broadband Option

Collect Patient Data into broadband connected PC.

Full Web, PALStar, and MedStar functionality.

Patient access to

their own web portal.

Software can be

downloaded.

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Wound Care

Import images from any digital camera.

Annotate images using standard conventions.

View images as a slideshow to highlight recovery or regression.

Complete reports available (linked to vital signs if desired).

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Two-way Video Calls

Alerts clinician that

call is waiting. No extra call

charges. Open Skype based. Optional Digital

Stethoscope audio.

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HIPAA Compliance

The MedStar System is HIPAA Compliant:

No Patient Identifier stored on the individual MedStar Unit.

Data is transmitted encrypted.

De-encryption only at secure sites.

Data available only via secure, 128-bit encrypted and password protected web sites.

Patients can feel safe that their personal information cannot be read by anyone except those who are supposed to.

Physicians / Healthcare Organizations have a traceable ‘forensic’ record of exactly who has ever seen, modified, downloaded, or transmitted data – which provides peace of mind protection.

Caregiver Benefits – access from anywhere, and with no additional hardware technology: just a normal web browser, which can be accessed from home, office, mobile phone, or wireless PDA.

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Security Management

Personnel / Procedures: All persons working in, near, or potentially with MedStar servers sign HIPAA

confidentiality agreements, NDAs, and have work history background checks. Emergency Recovery Procedures exist and are implemented.

Physical: All servers are in a locked rooms with limited and controlled access. Server room is environmentally controlled. Fire Extinguishers are located throughout the server room. Building is single-tenant, and all doors are secured via alarms. UPS and generator power backup is present.

Disaster Recovery: Disaster Recovery procedures defined and all employees are trained. Recovery tests performed annually. Offsite hot-sites and geographically distributed hosts supported to mitigate disasters. Back-up schedule is followed and tapes are stored in a secure offsite location.

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Internet Database Overview

Physician, Patient, and Manager Interfaces.

Automatic Alerts, Alarms and Notifications.

Customizable and Printable Reports.

Full Search Features. Complete Inventory

Management Software. HIPAA Secure.

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The Three Different User Types

Patients – Patients can only view their own information. They have no edit or print capabilities.

Healthcare Professionals – Physicians can view their own personal information, and have the ability to view and edit their patients’ information, as well as to prescribe monitoring procedures for patients, and manage their own home medical device inventory.

System Managers – Managers have read, write, and view abilities over all parts of the service and database. They can also add new devices into inventory, and add manual readings into a patient’s electronic medical record.

Each user has a unique login ID and password, and is identified within the database with a unique ‘User ID’.

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Login

128 bit encryption technology.

Physicians.

Patients.

Nurses / Medical Technicians.

System Managers.

Administrative / Financial.

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Health Provider’s Home Page

Health Provider has access to: Patient Info.

Device Info.

Personal Profile.

Help.

Immediate indications of critical needs patients: Values out of limits.

Non-compliant.

Completed monitoring procedures which now need review.

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Online and Printable Reports.

Data reports. In-, Out of-

Compliance Reports. Procedure

Summaries. Patient History. Inventory

Management.

Reporting Features

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What Makes MedStar Ideal

‘A la carte’ approach – the system is designed to be modular and on

the fly customizable to suit any situation without any hassle.

This also keeps costs down by allowing you to only buy the components a particular patient needs. You can always add other components as the need arises, or swap out older components for newer ones with zero upgrade charges.

Designed to the lowest common denominator – simple for any patient of any age or physical state.

Inexpensive – medical devices sent to the home often don’t come back or come back broken. A broken/lost MedStar is only a $250 loss, not multiple thousands of lost dollars.

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MedStar Value Proposition

Web-based data delivery system – health care providers can access data from anywhere via secure access.

Continuous Improvement to the entire MedStar System – patient units and software are always being improved based on customer feedback.

We are a research and development company – we can solve any and all problems immediately, without the need for expensive outsourcing. If you desire a feature in the system – software or hardware, we are happy, willing and capable of making changes to suit your needs on a very rapid turn-around time.

The ability for you to customize the site yourself – add your own educational materials, customize the site, service, and system as your own programs change.

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MedStar Reduces Risk Reduced Risk In:

Regulatory: HIPAA – totally compliant, FDA – totally compliant. Very quick initial up time is possible.

Low Financial Expenditure: MedStar is a low cost solution, and can be leased for less than $1 per patient, per day.

Cybernet is a financially stable company, and is dedicated to the MedStar product line. Cybernet’s MedStar can weather any delays in reimbursement through ventures in other areas.

Cybernet is an R&D house, and can control the development of the MedStar to best suit your needs.

We have worked in teams for over 20 years.

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MedStar Overcomes Top Three Healthcare Challenges

Biggest Challenge is how to provide preventative medicine versus reactive medicine, in order to improve patient outcomes. We’re all already convinced that telemedicine is the way to do that.

So what are we left with? Patient Acceptance – the MedStar is unobtrusive and easy

to use. Healthcare Provider Acceptance – the MedStar system

allows providers to manage more patients, more easily, using their home computer.

Cost of service – the MedStar is very low cost.

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Patient Compliance – 95% Patients felt empowered by taking an active role in their

own treatments.

Patient Acceptance – 91% Patients found the MedStar System easy to use, and

wanted to continue using the system when the study duration ended.

14% Fewer Errors in reported data When MedStar collected data was compared to patient

reported data, the MedStar data contained fewer erroneous results.

Proven MedStar Results

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92% report an increased knowledge about their disease and increased discipline in areas such as diet, exercise and activity level.

100% of patients report an increased awareness of things they do in everyday life that can or does affect their disease.

100% of patients report increased willingness to follow physician advice regarding their disease, and increased comfort knowing their data is being monitored and reported to the physician.

83% report a decrease in the number of visits to the doctor, ER or hospital admissions.

Outcome Results

Information Analytics

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Medstar EMR and databases are extensible and flexible.

Web & phone interfaces are built on re-tailorable report writing technology so pages, reports, and presentations are extensible.

We have use-case tailor codes for diabetes, COPD, CHF, wound care, etc., but the core of the system is not highly specialized for specific disease states.

Our goal has been to build the system to be as measurement, dialog, and device-agnostic as possible.

The system as built is indefinitely scalable, and can be hosted practically anywhere.

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Health Provider Patient List

Patient List: Includes only this

physician’s patients.

Displays patient ‘status’ – active, archived, needs review, etc…

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Patient Profile

Profile includes: Patient contact

information.

Medical history.

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Patient Procedure

Procedure settings: Data Limits.

Compliance.

Subjective Questions (See IVR and PALSTar).

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Patient Data Display

‘From’ and ‘To’ date selection.

Text or Graphical.

Printable.

Comment fields.

Data Tagging.

Color indications of out-of-limit values.

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Patient Data Display

Long-term data available for trending and analysis.

Trending available across entire patient population.

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Device Management

Displays all the devices used by a patient or in the physician’s inventory.

Includes: Device history. Current location. Date due back. Device ID.

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Physician Profile

Personal and Business contact information: Personal info not

available to patients.

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Search Page

Search for: Patients.

Devices.

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Manager’s Home Page

Displays ‘Pending Tasks’ which require immediate attention.

Can view and edit all Patient and Physician information.

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Patient’s Home Page

View all their medical data.

View Physician instructions.

Acts as an electronic, objective patient data diary.

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Training

“Train the Trainer”: Cybernet trains our customers’ staff. Knowledgeable staff then go and train their patients and peers.

Training Options are for Healthcare Staff (including non-patient care staff such as managers and supply clerks) and Patients.

Typically a 1 day training seminar:

Onsite or video-conference.

Printed materials supplied.

‘Hands on’ training provided for management staff, health care providers, teaching staff, and students.

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Typical Training

Training Covers: MedStar Web System. Managers:

How to manage inventory. How to enroll/manage health care professional access. How to input billing related issues.

Healthcare Providers: How to enroll patients. How to view/print data, using graphs or text. How to set warning limits, and out of compliance bounds.

Patients: How to view their data online. How to self manage using the online MedStar System.

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Customer Service Standards

Caregiver Education: maintaining the ability for caregivers to remain current in their knowledge of the MedStar System (from upgrade to upgrade, or when new products are introduced).

Notification: users are notified when updates are made, either to software or hardware.

Standard Training Options available for new features.

Partnership with ForaCare provides Help Desk that is always available: Phone and Virtual Help Desk – online help is available for every

aspect of the System, 24x7.

Tier II Service Technicians are available 8am – 6pm EST, Monday – Friday. 24 hour maximum response time.

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Customer Service Standards

Patient Education: Technical/System Use Education:

Online help is available. Manuals are written to a 7th grade reading level, including

descriptive color pictures. All manuals can be modified to include any information (such as

contact, or health-education related). Options exist for patients to call Cybernet directly with technical

questions. Cybernet will not answer health related questions.

Health Condition Education – Caregivers can send customized information to patients through

the MedStar Web System, or through the PALStar Question and Answer Unit.

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Customer Service Standards

Product Delivery: Available on GSA Schedule.

Shipped to Care Provider (or designated single location).

As ‘plug-n-play’ in the MedStar Kit – comes pre-configured, just plug

into a phone or broadband jack.

As component parts – can be installed by anyone following simple instructions.

Can be returned by pre-paid shipping labels.

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Customer Service Standards

Repair Maintenance: MedStar Patient Data Only Hubs:

Only need to have batteries changed every 6 months.

MedStar Patient Data Only Hubs and Care Terminal units: Can be cleaned using a damp towel. Designed to be rugged, waterproof, and can operate in arctic and

tropical conditions. Average equipment life is 5 years. Designed to be serviced by Cybernet Technicians only. All MedStar devices have a 1-year warranty.

MedStar Servers:

Zero maintenance if managed by Cybernet. Standard IT maintenance otherwise. Cybernet provides free software upgrades.

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Customer Service Standards

Repair Procedures: Only to be repaired by Cybernet certified technicians. If a unit breaks, recover the unit and call Cybernet. Most problems can be fixed over the phone, through the

programming interface. Units that can’t be fixed, are returned to Cybernet for repair or

replacement. Cybernet can issue a temporary or replacement unit by overnight

delivery. All hardware has been designed to military requirements for stress,

shock, and environment.

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Customer Service Standards

Calibration Needs: ZERO It is impractical for patients to be expected to calibrate their

devices, and expensive and inefficient for devices to need to be shipped back and forth between caregiver and patient for calibration. This completely negates the reasons for remote monitoring.

The MedStar was designed to need no calibration, and the OTS components that operate with the MedStar System were chosen for their ease of use – including needing no calibration.

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Customer Service Standards

Referral Source Education:

Cybernet provides complete product and marketing literature on all

MedStar Products – digital and hard copy.

All research, studies, regulatory paperwork and press clippings can be provided as needed.

We are willing to act as advisors if you need us to answer any questions of your current or potential clients – we keep client information confidential.

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Reporting and Tracking Capabilities

Compliance checking

Out of Limits

Trending Abilities, Graphs or Text

Customizable Reports

Standard Reports Include:

Data report

Compliance Reports

Critical need patient reports (based on out of limit values)

End of Procedure Reports

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Online and Printable Reports

Data reports In-, Out of-

Compliance Reports Procedure

Summaries Patient History Inventory

Management

Reporting Features

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Typical Roll Out and Implementation

1. Cybernet sets up servers – this is ‘behind the scenes’, no patients or providers involved. Servers are located at Cybernet, in our secure data center, or at your secure data center.

2. You decide the scope of the project (numbers of MedStars, numbers of sites, numbers of patients and staff needed).

3. Cybernet trains your staff, patients, management on the use of the MedStar Patient Units and MedStar Data System.

4. Cybernet ships products.

5. Your staff (health care professionals) begin using the system, delivering MedStars to patients, and training patients.

6. Your health care professionals monitor patients using the MedStar Web System – through daily log in, and automatic email/pager/other notifications of critical events.

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What Makes MedStar Ideal

‘A la carte’ approach – the system is designed to be modular and on

the fly customizable to suit any situation without any hassle.

This also keeps costs down by allowing you to only buy the components a particular patient needs. You can always add other components as the need arises, or swap out older components for newer ones with zero upgrade charges.

Designed to the lowest common denominator – simple for any patient of any age or physical state.

Inexpensive – medical devices sent to the home often don’t come back or come back broken. A broken/lost MedStar is only a $250 loss, not multiple thousands of lost dollars.