A Dutch Forum, including all relevant parties, has been founded to design and coordinate a process of development from current routines of care with ICD's (implanted cardiac devices) towards telecardiology. Rationale of the construction of the Forum, incl. the description of a frame of references is elaborated.

1. Onward with Telemonitoring – The Dutch Forum on Telecardiology. Rob Halkes Van Spaendonck Management Consultants Peter Boogaard - Cygnea Astrid van den Hoek – Van Spaendonck Ref.: RHA/21January, 2010 Presentation to Eucomed, CRM TELEMONITORING GROUP meeting on January 21 st , 2010 in Brussel

6. Telecardiology shows 2 mutual dependent areas of development 5 Technological Developments Developments in medical care 1 2 3 4 6 Development cubes of telecardiology

7. Specifically: Technological developments and Medical care Three technological dimensions: 1) Communication – data exchange From external and periodic control To continuous and one-way feed to distant inspections To interactive, two way and real time management; 2) Parameters en detection, From simple and predominantly technical To complex and broad spectrum, and other physiological vital signs; 3) Therapeutic action From simple and in reactive stimuli To personal and adaptive To pattern recognition and preventive. Three dimensions of medical care: 1) Medical conduct From therapeutic and responsive To adaptation to personal profiles To interactive prevention; 2) Organisation and management of medical treatment From cardio clinic, specialist centred to multidisciplinary and third-party support To pluralistic and including patient self management; 3) Patient values From passive, informed and non integrated To empowered, differentiated and integrated.

9. Is one specific party capable to initiate such a process on its own and to realise what needs to be done to get telemonitoring of CRM devices accepted, implemented and reimbursed?

10. How to bring about a collective cooperation with all parties involved and stimulate course of further development?

13. “ Frame of References” A frame of Reference is a set of recommendations , conditions and criteria that parties concerned agree upon to take as their starting point when embarking on their design, conduct and research of telecardiology.

23. Invitation to actively monitor and support Register at www.NHRA-NFT.nl

24. Join us in Autumn at the EU Conference How to forward the development of telecardiology

26. Rob Halkes BU Van Spaendonck – Value innovation in Medical and Life Sciences T +31 418 578000 F +31 418 578010 M+31 653 420722 G.E.H . Tutein Noltheniuslaan 7 E r.halkes@VanSpaendonck.nl 4181 AS Waardenburg W www.medicalandpharmamarketing.com; the Netherlands Van Spaendonck’s BU “Value Innovation in Medical and life Sciences” is a focused consultancy firm. Van Spaendonck management consultancy supports and directs parties and professionals involved to their choices and processes to create and develop their USP , a better market position and performance. In the dynamics of health care systems, pharmaceutical and the medical devices industry, health care insurers, social parties, and health care professionals will be challenged more and more to their added value. The business unit “Value innovation for Medical and Life Sciences,” has the needed expertise and experience to initiate and develop processes and clinics for health care, marketing, sales and management systems, professional development, and strategic organisational change. 20 years of consultancy expertise to pharmaceutical and medical industry, life sciences and health care. Actual research and publications in health care and marketing developments.