Bruce A. Kehr, M.D.Bruce A. Kehr, M.D.Founder and CEO, InforMedix, Inc.Founder and CEO, InforMedix, Inc.

Mary Gardner, RN, MA, CCM, CDE Program Manager, High Risk Diabetes and COPD

XLHealth

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• Too many medications at home• Old medications not destroyed• New prescriptions received: new dose, different

medication, generic vs brand labeling• Inconsistent communication between multiple

providers: pharmacies, PCP, Hospitalist, Specialist

• Which pill is which?

?

??InforMedix, Inc. - Confidential and Proprietary

“What medication do I take?” “What did the doctor say?” “What is the correct dose?” “What is the correct time?” “What do each of these medications do?” “Why are they important?” “Why do I need them, I feel better”?”

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Source: Manhattan Research 2004 data

Dis

ease

Pre

vale

nce

Reported rate of non-complianceInforMedix, Inc. - Confidential and

Proprietary

Failure to take medication as prescribed: Causes 10% - 28% of total hospital admissions Causes 33% of CHF hospital admissions Causes 75% of Schizophrenia admissions Causes 68% of NNRTI resistant/mutated HIV

virus Results in $100 billion/year in unnecessary

hospital costs Causes 40% of nursing home admissions Costs the U.S. economy $300 billion/year

(N Engl. J Med 8/4/05, National Pharmaceutical Council, Archives of Internal Medicine, NCPIE, American Public Health Association, AIDS 2006 20:223-232)

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Senior Citizens with Diabetes and Co-MorbiditiesSenior Citizens with Diabetes and Co-Morbidities

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Disease State Est. U.S. Prevalence

Annual Total Health Care Costs @ $16,500 Per Patient (1),(2)

Est. Annual Cost with 25% Improved Adherence (1),(2)

Annual Net Savings

Diabetics over age 65

10,000,000 $165 Billion total

$16,500 per patient

$87 Billion total

$8,700 per patient

$78 Billion

$7,800 per patient

(2)American Association of Clinical Endocrinologists (AACE)

(1) Predictors of medication adherence and associated health care costs in an older population with type 2 diabetes mellitus; a longitudinal cohort study; Balkrishnan R, et. al. Department of Public Health and Sciences, Wake Forest University School of Medicine, Winstons Salem North Carolina, USA

Congestive Heart Failure – The #1 Cost to Medicare

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Disease State Est. U.S. Prevalence

Number of Non-Adherent Heart Failure Patients = 50%

Annual Hospital Costs of Non-Adherent Patients (1),(2)

Annual Hospital Costs of Adherent Patients (1),(2)

Annual Savings

Congestive Heart Failure

7,500,000 3,750,000 $46 Billion total

$12,270 per patient

$11.5 Billion total

$3,068 per patient

$34.5 Billion total

$9,202 per patient

(1)Outpatient Management program of patients with chronic heart failure; Cacciatare, G. et. al; Servizio Centrale di Cardiolgia

(2) Cost of hospitalizations for heart failure: sodium retention versus other decompensating factors; Bennett SJ, et. al.; Indiana University, Indianapolis, USA; PubMed index for MEDLINE 10076109

InforMedix is a source and repository of critical intelligence around how individuals are InforMedix is a source and repository of critical intelligence around how individuals are adhering to their prescribed medication and care plansadhering to their prescribed medication and care plans

Our patented Our patented Med-eXpert™Med-eXpert™ information system provides information system provides real-time, customizable , and real-time, customizable , and actionable information on the medication adherence and health status actionable information on the medication adherence and health status of chronically ill of chronically ill outpatients .outpatients .

Two portable appliances Two portable appliances used by patients to follow their medication and care plans, and to used by patients to follow their medication and care plans, and to record and transmit medication adherence and health status information to the Med-eXpert record and transmit medication adherence and health status information to the Med-eXpert System System over telephone lines:over telephone lines:

The The Med-eMonitor™Med-eMonitor™, a robust, portable, interactive, “smart pillbox,” which stores , a robust, portable, interactive, “smart pillbox,” which stores and/or manages up to 25 medications, while tracking patients’ adherence to their and/or manages up to 25 medications, while tracking patients’ adherence to their medications and care plans.medications and care plans.

The The Med-ePhone™Med-ePhone™, which prompts, monitors and records medication adherence and , which prompts, monitors and records medication adherence and health status assessment delivered to patients over mobile phones and landlines using health status assessment delivered to patients over mobile phones and landlines using Interactive Voice Response Systems (IVRS).Interactive Voice Response Systems (IVRS).

Mission-critical information can be uniquely customized for each customer’s and patient’s Mission-critical information can be uniquely customized for each customer’s and patient’s needs needs at both individual and population levels to more effectively and efficiently reduce at both individual and population levels to more effectively and efficiently reduce healthcare costs, improve health outcomes and increase patient satisfaction.healthcare costs, improve health outcomes and increase patient satisfaction.

InforMedix, Inc. - Confidential and Proprietary

InforMedix, Inc. - Confidential and Proprietary

Care GiversCare Givers

Monitoring Center(s)Monitoring Center(s)

PatientsPatients

Medical ProfessionalMedical Professional

PharmacistPharmacist

Family MemberFamily Member

Med-eXpert™ Information Med-eXpert™ Information RepositoryRepository

Patient Interface DevicesPatient Interface DevicesMed-eMonitor™Med-eMonitor™Med-ePhone™ Med-ePhone™ Third Party Third Party

Confidential and Proprietary

♦Med-eMonitor reminds the patient to take their medications from the exact bin or bottle as required (e.g. “Sunday PM,” “Bin 17,” “Specific number code or color of blister card,” “Specific Prescription Vial”)

♦Med-ePhone prompts medication use at specific times, assesses reasons for non-adherence, asks simple health status questions

♦The patient will confirm that they have taken these medications so that adherence can be monitored and reported

♦Important notifications sent out to Care Givers and/or the health care team

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Population LevelPopulation Level Participant LevelParticipant Level

Export Datasets to XML, Word, Excel, RTF, PDF, CSVExport Datasets to XML, Word, Excel, RTF, PDF, CSV

InforMedix, Inc. - Confidential and Proprietary

InforMedix, Inc. - Confidential and Proprietary

Designed for Easy Interface with Legacy SystemsDesigned for Easy Interface with Legacy Systems

InforMedix

Repository

Patient/ Appliance Interaction

Data

Urgent Alerts

Monthly Reports by Individual, Population

Population Data

Confidential and Proprietary

Urgent alerts provided if medications missed or health declines, to enable rapid, targeted interventions by care managers, pharmacists, or family members

Monthly trend analysis reports available on the Web, using graphics to present medication adherence and other health information; to be used by physicians, and incorporated into online patient-accessible personal health record

Managed outcomes information to evaluate program effectiveness; used by health insurers, disease management companies, Medicare, Medicaid, and pharmaceutical manufacturerscrolevel health

Patient interacts with appliance of choice to receive and record medication and care plan adherence information

Additional Repositories Storing: Disease-Specific Information; Health Claims/Cost, Physician Encounter, Hospital/ER, Laboratory, Radiographic Data

1

2

3

4

Med-eXpert™

InforMedix, Inc. - Confidential and Proprietary

Confidential and Proprietary

Government Funded Research Programs Using Med-eXpertGovernment Funded Research Programs Using Med-eXpertDisease State Academic

CenterFunding Source

Number of Programs

Number of Patients

Duration of Research Program

Medication Adherence Results

Care Plan Adherence Results

Presentations and Publications

HIV+ with drug abuse and severe mental illness

University of California, San Francisco

SBIR/STTR 1 76 Six months 89.5% N/A 2008 International Association of Physicians in AIDS Care (IAPAC) , and submitted for publication

Stroke prevention using Coumadin (Warfarin) and automated lottery system

University of Pennsylvania

PA Tobacco Settlement, Aetna FoundationNHLBI

Phase 1

Phase 2

Phase 3

20 patients

100 patients

268 patients

Six months In first 20 patients, adherence increased from 78% to 97.7%

Out of range INRs decreased from 35% to 12%

Multiple lay publications and insurance company publications

Schizophrenia in “Wounded Warriors”

Baltimore Veterans Hospital

SBIR/STTR 1 22 Three months The Med-eMonitor System provided for compliance enhancement with medications and protocols.

Ease of central evaluation by treating professionals, additional education, and reduced on-site evaluation

Feasibility of Using the Med-eMonitor System in Monitoring and Enhancing Research Protocol Compliance and Health Status in Schizophrenia,” Drug Information Journal, 37 (281-289), 2003

Confidential and Proprietary

Government Funded Research Programs Using Med-eXpertGovernment Funded Research Programs Using Med-eXpert

Disease State Academic Center

Funding Source

Number of Programs

Number of Patients

Duration of Research Program

Medication Adherence Percentage

Care Plan Adherence Percentage

Presentations and Publications

Schizophrenia

University of Texas Health Science Center San Antonio

NIMH Phase 1Phase 2

20100 of 230 enrolled

One Year 94% in Phase 1

N/A “The Med-eMonitor™ for improving adherence to oral medication in schizophrenia”, Bendle S, Velligan DI, et.al:

Schizophrenia Bulletin, 31(2): 519, 2005;

International Congress of Schizophrenia Research 2005; “Intervention to Improve Adherence to Anti-psychotic Medication”, Velligan, DI, Weiden, PJ:

Psychiatric Times, August 2006, Vol XXIII, No. 9 ;

The Clinical Handbook of Schizophrenia

Confidential and Proprietary

Government Funded Research Programs Using Med-eXpertGovernment Funded Research Programs Using Med-eXpertDisease State Academic

CenterFunding Source

Number of Programs

Number of Patients

Duration of Research Program

Medication Adherence Percentage

Care Plan Adherence Percentage

Presentations and Publications

Congestive Heart Failure in a Veterans Population

Wayne State University, Detroit Veterans Hospital

NIH 1 18 Three Months

94% 96%, improved physical quality of life

“Pilot Study of a Web-Based Compliance Monitoring Device For Patients with Congestive Heart Failure,” Artinian,N, Harden,J,et.al., Heart & Lung, 2003: 32, 226-233;

“Telehealth as a Tool for Enhancing Care for Patients with Cardiovascular Disease” Artinian, N, Journal of Cardiovascular Nursing, Vol. 22, No.1, pp 25-31, 2007

Confidential and Proprietary

Government Funded Research Programs Using Med-eXpertGovernment Funded Research Programs Using Med-eXpert

Disease State Academic Center

Funding Source

Number of Programs

Number of Patients

Duration of Research Program

Medication Adherence Percentage

Care Plan Adherence Percentage

Presentations and Publications

Diabetes St.Vincent/ University of Pennsylvania

Center for Healthy Aging/Federal

1 20 Three Months

92% HbA1c dropped 18.7% (p<.002)

Remote Monitoring and Management of Rural Diabetic Patients Using a Web-based Medication Adherence/ePRO Monitoring Device” Farberow, B, Disease Management Congress, 2005

InforMedix, Inc. - Confidential and Proprietary

Tennessee Medicare Program – Real-Time CommunicationsTennessee Medicare Program – Real-Time Communications

InforMedixInforMedix teamed with teamed with XLHealthXLHealth and and ADTADT to to deliver a real-time medication and care plan deliver a real-time medication and care plan communications program to participants with diabetes and heart failure communications program to participants with diabetes and heart failure in a Medicare program in in a Medicare program in Tennessee. Tennessee.

InforMedix/XLHealth/ADT ParadigmInforMedix/XLHealth/ADT Paradigm

InforMedix, Inc. - Confidential and Proprietary

Tennessee Medicare Program Tennessee Medicare Program (continued)(continued)

Communicating the Medication and Care Plan for Diabetics with CHFCommunicating the Medication and Care Plan for Diabetics with CHF

♦ Prompt and record adherence to medications using Seniors’ Prompt and record adherence to medications using Seniors’ existing medication storage containers (e.g. plastic pillboxes, existing medication storage containers (e.g. plastic pillboxes, blister cards, standard prescription vials)blister cards, standard prescription vials)

♦ Prompt and record glucose levelsPrompt and record glucose levels

♦ Prompt and record systolic, diastolic BP, daily weightsPrompt and record systolic, diastolic BP, daily weights

♦ Reminders about proper care per ADA guidelinesReminders about proper care per ADA guidelines

♦ Meal planMeal plan

♦ Schedule annual eye examSchedule annual eye exam

♦ Check feet for cracks or sores and use temperature probeCheck feet for cracks or sores and use temperature probe

♦ Check Lipid levelsCheck Lipid levels

♦ Schedule quarterly doctor visit for HbA1C blood testSchedule quarterly doctor visit for HbA1C blood test

InforMedix, Inc. - Confidential and Proprietary

Reminder to wear protective shoes.Reminder to wear protective shoes.

Questionnaires:Questionnaires:

Prodromal signs of strokeProdromal signs of stroke

Change in medicationsChange in medications

HospitalizationsHospitalizations

ER VisitsER Visits

Depression inventoryDepression inventory

Patient Satisfaction SurveyPatient Satisfaction Survey

Tennessee Medicare Program Tennessee Medicare Program (continued)(continued)

Care Plan for Diabetics with CHFCare Plan for Diabetics with CHF

InforMedix, Inc. - Confidential and Proprietary

Tennessee Medicare Program Tennessee Medicare Program (continued)(continued)

Medication Adherence Rates and Health Status Monitoring Results Medication Adherence Rates and Health Status Monitoring Results Using Med-eXpert Information System:Using Med-eXpert Information System:

♦ 153 seniors 153 seniors with heart failure and diabetes were enrolled into the twelve month with heart failure and diabetes were enrolled into the twelve month program, program, many with fifth and sixth grade education levelsmany with fifth and sixth grade education levels

♦ 97%97% retention rate once participant began using the Med-eMonitorretention rate once participant began using the Med-eMonitor

♦ 90%90% rate of medication adherencerate of medication adherence

♦ 93% 93% response rate to answering health status questionnairesresponse rate to answering health status questionnaires

♦ 90%90% response rate to reminders about self-care checks and healthy behaviorsresponse rate to reminders about self-care checks and healthy behaviors

♦ Program terminated after 12 months on 7/31/08 due to end of MHS ProgramProgram terminated after 12 months on 7/31/08 due to end of MHS Program

InforMedix, Inc. - Confidential and Proprietary

Tennessee Medicare Program Tennessee Medicare Program (continued)(continued)

1480 Real-time, actionable alerts provided the opportunity for rapid, 1480 Real-time, actionable alerts provided the opportunity for rapid, targeted interventions by ADT and XLHealth staff:targeted interventions by ADT and XLHealth staff:

Description of Alerts to XLHealth Number of AlertsHospitalized this month 52ER this month 48

Blisters, redness, cracks or cuts on feet new this week 63New, severe pain in your legs that is so bad you can't bear it, even when resting? 2Lack of Device Acceptance 7Blood sugar > 299 37

PHQ#1: During the past month, have you often been bothered by feeling down, depressed or hopeless? 41

PHQ#2: During the past month, have you experienced a loss of interest or pleasure in daily activities? 39

Not using temperature probe (for feet) provided 14

Overall Medication Compliance Low (<85%) 223Single Medication Compliance Low (<85%) 90

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Tennessee Medicare Program Tennessee Medicare Program (continued)(continued)

1480 Real-time, actionable alerts provided the opportunity for rapid, 1480 Real-time, actionable alerts provided the opportunity for rapid, targeted interventions by ADT and XLHealth staff:targeted interventions by ADT and XLHealth staff:

Alerts to ADT and XLHealth

MS1: Missed Medication due to Side Effects 308

MS2:Glucose too high (> 299) 36

MS3: Blood pressure too high (Sys> 130, Dias>80) 44

MS4: Warning Symptoms 43Sudden numbness, or w eakness of the face, arms or legs, especially on one side of the body? 23

Sudden confusion, trouble speaking or understanding? 6Sudden trouble w alking, dizziness, loss of balance or coordination? 14

Chest Pain 1

MS5: Foot Changes 20

MS6: Medication Change 109

Nonactivity 42

Noncommunication 262

Total 1,480

INFORMEDIX, INC.INFORMEDIX, INC.

Georgetowne ParkGeorgetowne Park5880 Hubbard Drive5880 Hubbard DriveRockville, MD 20852Rockville, MD 20852

Telephone: Telephone: 301-984-1566301-984-1566Website: Website: www.informedix.comwww.informedix.com

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Med-eXpert™ SystemMed-ePhone™

Med-eMonitor™