Sentient Medical Systems

1. Sentient Medical Systems Health Tech Net Meeting December 14, 2007 1

2. Sentient � A Brief History Founded in 1995 as the first national provider of Intra-operative Monitoring (IOM) services Focused on providing both technologist and remote physician reading services Since inception, have monitored over 100,000 cases 2

3. Sentient � A Brief History Neurocare business was introduced in 2004 to focus on diagnostic market Company sold to Dubin Clark, a private equity firm, in February 2007 New management team appointed after transaction � Jeff Ferguson as CEO; Andy Masetti as CFO 3

4. Sentient � By the numbers Net revenue of $19mm to $22mm, gross revenue run rate at $40mm 11k IOM procedures; 3k Neurocare procedures IOM supported by 75-80 full time technologists with 5 reading physicians plus CMO (MD, PhD) 4

5. Sentient � By the numbers Neurocare with 7 technicians plus one of �founders� of the business Perform services in 22 states Procedures performed at 200 hospitals with billings to over 500 insurance carriers (20 major ones) 5

6. Sentient � Other business points Support provided for all levels of complexity Technologists have 4 yr degrees and go through a rigorous training program Physicians all have sub-specialty training in clinical neurophysiology and monitor approx. 2000 cases annually 6

7. Sentient � Other business points Perform research and development activities partnering with medical universities and centers Relationship driven business�contract with the hospital, �sale� to the surgeon 7

8. Sentient � Why remote physician reads: Allows oversight in real time to optimize signals and to approve and select the choice of monitoring procedures Allows a consultative interaction with the surgeon, and by placing the signals in an appropriate clinical context, integrates and optimizes data relative to the clinical condition of the patient 8

9. Sentient � Why remote physician reads: Peer to peer communication and advice Superior knowledge of neuroanatomy, neurophysiology, neurology and neuropharmacology (if supervised by a neurologist) 9

10. Sentient � State of the Industry Relatively new Highly fragmented; many players Price competitive, with in-house and out sourcing options Wide variety of reimbursement procedures and policies 10

11. Sentient � State of the Industry No consensus on number of concurrent cases that can be monitored � critical industry issue Differing views on medical necessity and reimbursability of physician reads �What is telemedicine?� 11

12. Telemedicine � first issue � How do we communicate? Telephonic Real time monitoring - snapshot Streaming data 12

13. Telemedicine � Information Technology Issues Working towards using existing hospital network infrastructure � How do we address hospital firewall Shutting down OR�s to put in required lines Back at home� how do you �present� cases to physicians�transfer issues between physicians� dealing with �dropped� cases 13

14. Telemedicine � Information Technology Issues Facilitating technologist/reading physician communication Sentient solution (1) � full time contractor to work with top �40� customers to real time monitor enable the hospital network� patient outcome and reimbursement issue Sentient solution (2) � all new customers must accept real time monitoring 14

15. Telemedicine � Privacy issues Protecting confidential data while transmitting patient information �Masking� patient names during transmissions� �deidentification� Capturing �instant message� communications with proper archiving Information Life Cycle Management (ILM) critical for HIPAA compliance PWSP as Sentient HIPAA consultants 15

16. Telemedicine � Reimbursement Issues No Consistent Practices Medicaid � Some states do, some states don�t Concurrent reads � How many and how do you reimburse. Medicare guidelines recently reissued. Some carriers do not recognize or accept remote physician reads (95920) Corporate Practice of Medicine issues; differing credentialing and licensing requirements Telephonic � Some do, some don�t, some partial 16

17. Telemedicine Summary Committed to process because of improved patient care Reimbursement issues � Situation is chaotic. Industry needs to work with payors to achieve some level of standardization IT � Will evolve, but from discussion with med/mal carriers, must move to at least visual real time 17

18. Telemedicine Summary Customers � must also have a commitment to telemedicine�spotty, but moving towards embracing concept Guess � maybe 3-5 years before acceptable standardization. Key is Medicare and top 3-5 carriers. 18