1. Presentation to Minnesota Futurists “A forum for the discussion and communication of alternative futures and to assist society in understanding and creating positive futures” January 5th, 2008 “Two Shots of Espresso and a Strep Test To Go, Please” By John Fraser, CEO, MEDNET USA

2. The Problem

3. MN Futurists Question If current Healthcare system is: –Slow –Inefficient –Hard to work with –Inflexible –Expensive –Lack of lifetime care information

4. Then how do we get to: Fast health care Convenient Inexpensive Life time care recordkeeping?

5. Three Part Solution Consumer Experience Infrastructure behind the scenes New Technologies emerging

6. Healthcare Consumer Expectations Fast Convenient Secure Inexpensive I call this the “Starbucks” Model

7. Potential Solutions: Retail Clinics? What are Retail Clinics? –Clinics in Pharmacies –Clinics where you work –Examples: MinuteClinic – 400+ clinics in 25 states

8. Retail Clinic Experience? Online poll - 2,245 adults by Harris Interactive: Convenience (92 percent satisfied); Quality of care (89 percent satisfied); Staff's qualifications (88 percent satisfied); Cost (80 percent satisfied)

9. Connecting Health Care

10. Wiring Up Healthcare 1.Connecting Docs 2.Transportable Patient information 3.Security

11. Connecting Docs 1.Regional Health Information Organizations (RHIOs) 300+ in the US 2.Community and National Organizations 1.American Academy of Family Practice (AAFP) 2.AARP 3.AAA 3.Insurance and Payers 4.Hospital Groups and healthcare providers – 300,000+ 5.Public Health Organizations – 1,000 + 1.Medicare, Medicaid and public health agencies 6.First Responders 1.Police, Fire Depts., Ambulance 2.First Responder Authentication Credential (FRAC) Users 7.Employers 1.Optional HSA upgrade 8.Research Networks 1.ePCRN already collaborating

12. Transportable Patient Information VISA solved this problem for your banking information years ago! Why not adopt the same model for healthcare? Supports linking a lifetime of medical information together supporting continuity of care

13. Security Need national and International model PKI most likely technology Public Key Infrastructure (PKI) Used by all Militaries – most trusted technology Allows encrypting information that only recipient can read. (Doc A sends to Doc B) Supports digital signatures –Electronic version of handwritten signatures Why do I think this?

14. LARGEST PKI SYSTEM IN HEALTH CARE

15. What does MEDNET USA do? 1.Protects Patient Privacy 2.Provides critical patient medical and payment information ANY TIME ANY WHERE 3.Uses advanced PKI security model

16. MEDNET USA PRODUCTS Health care “Desktop” Application –Like “Cable TV” –Basic cable = low cost –Connects doctors for referrals, encounters reports, etc –$50-$100 per month in volume – low entry price Patient Health ID Card –Magstripe card ID number pulls up patient record from the participating systems, using a VISA™-like system. Healthcare Provider (Doctor) Identity –Healthcare worker (Doctor) must provide ID to access any patient records –Using HIMSS/GSA Federal Model – FRAC Compliant National Clinical Routing Service –Not a database, but a network allowing the transfer of patient records to and from authorized workers (Dr.’s) –Uses Federated Identity Management (shared) system

17. Why is this needed: It’s estimated that medical errors kill between 30,000 and 90,000 people annually in the U.S. and costs $17-$29 billion. Reduce Costs It’s estimated that $500 billion may be spent each year on duplicate or unnecessary treatments and fraudulent claims Save Lives

18. MEDNET USA User Card MEDNET Users John Q. MEDNET USA Patient Card MEDNET USA Federated Partners Identity Directory Roles Privileges Clearance Roles Privileges Clearance Internet Health Insurance Health Plans Patient’s Medical Information Hospitals Patient’s Medical Information Clinics Master Patient Indexes MEDNET USA Directory Index MEDNET SERVICES:

19. The Future Patients carry single card to allow access to important medical information Doctors are “plugged-in” to a national PKI system to share information quickly Standards allow direct computer to computer exchanges of health care information The emergence of the “Semantic Web” in healthcare.

20. Semantic Web – Next Generation Web 1998: Semantic Web technologies were outlined by Tim Berners-Lee Vision of User Agents managing everything from trip planning to your medical records 2008: 10 years later: Heavy Semantic Web research at Mayo Clinic, Cleveland Clinic, the National Institutes of Health Docs not using it yet Currently proprietary silos lock data up where it does not easily travel with a patient as they go to specialists, change providers or show up in emergency rooms

21. Conclusion Health care needs to wire up Future requires advanced security Information flow easily between docs Semantic Web make free text understandable by computers Other expert systems will support life-long continuity of care for individuals

22. Thank You! John Fraser, CEO MEDNET USA 333 Washington Ave North Suite 208 Minneapolis, MN. 55401 612-435-7602 john.fraser@mednet.org www.mednet.org