Praanno by Praava Health

COVID-19 patients with mild and moderate symptoms are recommended home care, but currently receive limited guidance on how to manage their health. Without proper management, their illness could escalate and further spread to their families or healthcare workers and put stress on an overburdened health system. Praava Health’s Praanno software tool will facilitate symptom management for COVID-19 patients not requiring hospitalization. Through biometric reporting, push notifications and evidence-based guidelines, Praanno will provide ongoing remote medical advice to quarantined patients and family members, including clear directions as symptoms evolve over time. Praanno has the capacity to support health providers by promoting clear standards of care for their patients, via the provider-facing interface. Praanno also has potential applications beyond COVID-19 in managing chronic illness. This could alleviate the growing burden on a saturated national health system and offering a scalable solution for symptom screening and management to respond to emerging health threats. 

An unchecked COVID-19 pandemic in Bangladesh could lead to extreme mortality and contagion due to high rates of poverty and insufficient supply of quality healthcare. A leaked UN memo projects the COVID-19 pandemic could result in up to 2 million deaths in Bangladesh, and that patients will be left untreated because of “a complete saturation of the health system early in the epidemic.” 

Therefore, for a healthcare system that is already stretched, and has only 500 ventilators for a population of 170 million, there is an urgent need to prevent such saturation by managing patients with mild-to-moderate COVID symptoms at home and preventing cross-infections at hospitals. 

To ensure proper home management for the projected 70M Bangladeshis with mild/moderate COVID symptoms, patients need ongoing guidance on how to manage their health. Without such management, their illness could escalate further, potentially resulting in higher rates of transmission and mortality, especially among health workers, who already make up 12-15% of reported COVID-19 cases in Bangladesh. 

Praanno is an AI machine-learning tool that will facilitate symptom management for COVID+ or suspected COVID+ patients not requiring hospitalization. The tool includes both patient-facing and provider-facing interfaces. Patients can use the tool to screen, track and manage their symptoms over time at home, and receive personalized guidance to prevent escalation of mild/moderate illness. Praanno’s provider-facing interface will allow doctors to manage their patients remotely at scale, using clear international standards of care. 

Praanno includes the following features: 

1. Dynamic tool for reporting biometrics. 

   1. Frequency and nature of biometrics reporting is based on risk assessment for each patient, based upon the latest clinical recommendations. Praava has identified and developed pathways for 5 risk categories. 

   2. Based on risk group, patient and family member will:

      1. Report biometrics/other necessary information over time.

      2. Receive push notifications on self-management tips.

      3. Receive recurring follow-up calls and recommendations from Praava doctors.

      4. Be advised on if and when they should seek hospital care.

   3. Praanno will push data back to the care team to follow up as required. 

2. Educational content, including awareness videos and other tools. 

3. Provider-facing: latest evidence-based guidelines, pathways, and algorithms for COVID-19 to guide consistent decision-making, especially critical when knowledge on the virus evolves quickly.

Praanno will primarily benefit COVID-19 patients who do not require hospitalization (~80% of all COVID+ patients, projected 70M in Bangladesh). Praanno will also benefit their families, by helping them care for their loved ones and preventing household transmission. Praanno will especially help high-risk populations (those with chronic illness or the elderly) that may need help managing their symptoms and are at higher risk for severe infection. Lastly, the tool will benefit healthcare professionals: by providing real-time guidance for COVID-19 patient management and by preventing further spread of the disease among healthcare workers.

In the long-term, Praanno will have application for managing diseases other than COVID-19, which is important in a country like Bangladesh, where chronic illness is one of the top causes of mortality and the hospital-centric health system addresses people’s conditions too late. Praanno’s symptom management interface will help these individuals access high quality care more easily and build trust between patients and providers. Since Praanno is a scalable, automated, personalized tool, this solution is not limited to Bangladesh. Praanno will be able to reach anyone with access to the internet or a cell phone - giving it applicability to other markets as well. 

Praanno addresses the immediate COVID-19 response while also promoting preventative and mitigation measures for the future. Praanno will limit COVID-19 transmission by allowing people to access health services at home, and reducing the burden on the hospital system so it can remain focused on treating severe COVID-19 patients. Additionally, the tech solutions we are building will have an impact beyond COVID-19, by strengthening access to affordable primary care through virtual channels. This would alleviate the growing burden on a saturated health system and improve its resilience in the face of current and future health threats, like chronic disease. 

Currently, no one else in Bangladesh is building digital tools that can help manage COVID-19 from home. Praava is pioneering digital health care delivery models in Bangladesh by connecting the millions of Bangladeshis who use smartphones to the quality healthcare resources they need. Praanno uses ML/AI algorithms to assess users’ risk and make personalized care recommendations based on international-standard clinical expertise. Praanno is an automated, scalable tool that can be accessed anywhere, any time of day, using a mobile device. 

Additionally, Praava’s Praanno tool is innovative in how it is integrated with Praava Health’s brick-and-click service delivery model, which combines high-quality onsite health services with cutting-edge technology to improve health. Praava’s model has established a brand grounded in quality at every level, firmly positioning them to effectively build out and scale the technology that increases access to these services. 

It is our belief that apps that build networks of poorly trained medical professionals and underregulated processes will not meaningfully improve health in countries like Bangladesh, where more people are dying due to lack of quality healthcare than access to care alone. There is an urgent need to address access and quality together. 

Strong primary care systems are the backbone of any pandemic response, and will strengthen our ability to respond to the current pandemic and build a stronger system for the future. 

Praanno’s technology allows clinical pathways and interventions to be delivered to patients through existing chat-based tools. It is built on top of a core Machine Learning & AI framework allowing patient’s individual behaviours and engagement with the technology to deliver personalized experiences, thereby maximizing the chances of delivering a successful clinical outcome. 

The architecture is comprised of 3 core layers: 

1. Presentation Layer: This is the customer-facing component of the technology integrating the chatbot with existing messenger platforms (E.g., Facebook messenger, Viber and Imo). This allows Praanno to reach its patients over tools that are already in use and have high engagement among the population in Bangladesh.

2. Core Layer: This is the ML/AI backbone of the technology holding business logic around patient care plans, content plans and doctor administration. 

3. Internal Layer: This supports internal-facing tools including integration with the Praava’s Hospital InformationSystem, business intelligence and holds all patient reports. 

The technology stack is anchored around a PHP Laravel backend, POSTGRES Data layer, Dialogue Flow for ML/AI & interoperable FHIR standards delivered over the Google Health Cloud. There are two service gateways wrapping both internal and external services allowing easy integration and authentication with third parties.   

We are currently piloting the Praanno tool internally at Praava and through a partnership with a2i, a program within the Bangladeshi Government’s Information and Communication Technology Division. The pilots will allow us to assess usability and user interface, as well as track outcomes of patients over time. You can see screenshots of the product interface here: https://drive.google.com/drive/u/1/folders/1qjJU598MCSdxV7Vgcik56O6hTD5kSxWy

We are currently piloting the Praanno tool internally at Praava and through a partnership with a2i, a program within the Bangladeshi Government’s Information and Communication Technology Division. The internal pilot has enrolled 30 patients and the a2i pilot will include an additional 40 patients. Praava doctors will support these patients and their families with symptom management. After the pilots, we will roll out the technology to the broader population. 

In the first year, we expect to serve about 1 million people, which is 1.5% of the total projected COVID-19 infections in Bangladesh. Within 5 years, we expect to serve about 10 million people, assuming use beyond COVID-19.

The current market size for the Praanno Symptom Management Tool is more than 70 million infected cases not requiring hospitalization/acute care in Bangladesh. BRAC data projects that there will be approximately 133 million total COVID-19 cases in Bangladesh, of which 89 million will be symptomatic. The CDC estimates that about 80% of symptomatic COVID-19 patients have mild-to-moderate symptoms, which translates to about 70 million people in Bangladesh. The audience for the Praanno tool also includes family members of COVID-19 patients, high-risk individuals, and medical professionals, so the total addressable market is likely larger than 70 million. 

In the next five years, we will rapidly scale Praava’s presence physically and digitally, which will enhance the use-case for Praanno and increase the number of people we can enroll. With rapid clinic expansion, our goal is to become the go-to clinic to all outpatient services across Bangladesh’s urban communities. In one year, we will expand to 2 additional clinics to complement our flagship hub in Dhaka, and will expand to 38 clinics (35 spokes and 3 hubs) by 2027 in Dhaka and Chittagong.

We will also amplify our technology by mobilizing an online to offline channel with an enhanced patient app and virtual primary care platform, and serve patients with data-driven care. COVID-19 has accelerated Praava’s focus on technology, with the rollout of the Praanno tool. 

In addition to the Praanno tool, Praava is building a suite of technological solutions to increase access to quality primary care services:

1. Fully integrated HIS system, where data is collected and analyzed to track patient outcomes and build a system of value-based care. 

2. Virtual Primary Care where patients can access quality clinical consultations & referral network via telemedicine.

3. Patient Facing Mobile App already allows patients to book appointments, review test results, request prescriptions or message their doctor. It will be enhanced with online health mart, videoconsults and health tracker integrations.

4. Online Symptom Checker, the first in Bangladesh with Bangla localisation. 

5. Praava “On-Demand”: Patients can request prescriptions online for home-delivery and request other Praava home services. 

Praava Health currently employs more than 200 employees, including medical professionals and patient caregivers, a team of experts in operations, business innovations, marketing, IT, and others in the corporate office. 

The core team for Praanno specifically includes six people with representation from the CEO, medical services, IT, and strategy. However, as the Praanno tool evolves and grows, we will likely engage additional team members from medical services, marketing, IT and others in the corporate office. 

Sylvana Sinha (Founder, Chairman, & CEO; JD; MPA/ID) is an entrepreneur with more than a decade of experience leading diverse, interdisciplinary teams in international law, business, development, and government relations.

Dr. Paramita Karim (Consultant, Family Medicine) has more than 11 years of experience working as a clinician. She has worked with NHS Tayside, ICDDRB & Apollo Hospitals Dhaka. Before joining Praava Health, Dr Paramita was serving as the Chief Medical Officer at Maya Clinic.

Ponchanon Datta Rone (IT & Application Lead Engineer) is an IT Specialist with expertise in core network planning and software development. He previously work as a programmer analyst at a Canadian software company and a planning specialist engineer at Banglalink. Mr. Rone earned several international engineering certifications from global giants such as Huawei, Oracle, and Red Hat. 

Md. Abdullah Al Saleh Anand (System Analyst) is a computer engineer highly proficient in software architectural design and IT idea development. He has worked as a software developer and post-product support assistant for the software firm IamDigital, and served as an idea developer for Yellowray, a linux-based calling system in SIP protocol. 

Summer Hu is a fellow in the CEO's office at Praava Health. Prior to joining Praava Health, Summer was a management consultant at Oliver Wyman with experience advising leading healthcare organizations.

Anushi Shah (Strategy Intern, MPH) is an MBA candidate at the Yale School of Management. Prior to Yale, Anushi was an Analyst at RTI International, supporting clients in designing, implementing, and evaluating multi-million-dollar national healthcare programs. 

Telemedicine Providers: Praava is partnering with a number of national telemedicine providers and seeks partnerships to enroll them onto the Praanno platform so they can 1) access latest clinical guidance and 2) enroll their patients. 

Government: Praava is currently partnering with a2i, a program within the Bangladeshi Government’s Information and Communication Technology Division, to pilot Praanno. The pilot will include 40 COVID+ patients from both urban and rural settings in Bangladesh. 

Hospitals: Praava seeks partnerships with authorized government hospitals treating COVID-19+ patients to pilot Praanno. COVID-19+ patients not requiring hospitalization or COVID+ patients being discharged will be enrolled into Praanno for symptom and recovery management.

Diagnostic centers: Praava seeks partnerships with public diagnostic centers with testing permission for COVID-19 testing to pilot Praanno for patients who test positive for COVID-19. Upon testing positive for COVID-19, the patient will be enrolled into Praanno. From there, their symptoms and recovery will be monitored through Praanno.

Praava’s international partnerships include the Joslin Diabetes Center at Harvard Medical School; Lifetrack Medical Systems for input on radiology scans; and Narayana Health to offer patients video consultations with over 30 specialists at Narayana.

See Praava Health Series B deck: https://drive.google.com/drive/u/1/folders/1qjJU598MCSdxV7Vgcik56O6hTD5kSxWy

To date, Praanno’s development has been completely self-funded through Praava resources. Once Praanno has launched in the Bangladesh market, we intend to raise funds to broaden Praanno’s reach and build additional product features. We see tremendous potential in the near- and long-term to monetize the Praanno’s data assets: biometric data collected from millions of users. Regionally, governments and private organizations would benefit from this data source, because it provides insights into the health and clinical outcomes of high-risk patients. Globally, there is an appetite from technology companies who seek to use Praanno data to build scalable, automated technologies to improve healthcare equity worldwide. 

We would like to deepen our partnerships with top medical and engineering schools in the US, including MIT, Harvard and Columbia, and work with students who are innovating in health  delivery systems and technology and who can help to expand distribution channels for our solution.

Praava seeks to fundamentally shift the way people get care in Bangladesh. In a country where healthcare is highly transactional and hospital-centric, we’re flipping healthcare delivery on its head, building a value-based system driven by outcomes, not volume. 

We’re rethinking how technology can transform a doctor visit, with Bangladesh's first fully-integrated HIS, patient portal app, and new technology like Praanno. 

After the founder's mother almost died from basic surgery in Bangladesh, Sylvana embarked on a global listening tour to learn more about the health system that failed her family. She heard personal stories, one in particular that stuck: A maid making $3 a day borrowed money when her daughter got sick. Not to pay for the best doctors in Bangladesh -- but to travel to India where she thought she’d get better care. 

She began to understand that the problems went deeper than high costs or poor quality. People do not trust their doctors and feel demeaned at each visit. 

So she built a company from the ground up that would restore trust and dignity to the patient experience. Her hope was for Praava to be a voice for change, challenging other providers improve quality -- eventually shifting the entire system to one that treats patients with dignity. Praava is the combination of “praan” (life) and “aava” (beam)  -- together, meaning“beam of life” -- a symbolic reflection of what we’re building.

Praanno’s technology allows clinical pathways and interventions to be delivered to patients through existing chat-based tools. It is built on top of a core Machine Learning & AI framework allowing patient’s individual behaviors and engagement with the technology to deliver personalized experiences, thereby maximizing the chances of delivering a successful clinical outcome.

At Praava, we do not believe that technology will ever replace doctors - but we do believe that technology like AI can help improve clinical outcomes and save more lives, and also enable doctors to do what they do best: treat patients.