Precision Population Health Platform for the Post-Pandemic World

PreMedicus® is a physician led digital medicine startup with a novel real-time precision population health platform that enriches virtual or in-person patient-provider encounters by using clinical and AI algorithms to pre-diagnose, triage, document, inform and predict risk. 

CEO: Anthony P. Kimani, MD, FCCP, MBA

COVID-19 disrupted the global health landscape forever, exposing gross deficiencies in even the most advanced healthcare systems, with pandemonium reigning as emergency departments and intensive care units were overrun. The result has been a remarkably rapid digital transformation made possible by congruence in positive patient and provider sentiment regarding digital health and telemedicine.  The paradigm is quickly shifting to favor digitally-enabled, patient-centered, inter-connected health systems that consistently deliver personalized, high quality, cost-effective and efficient population based care.  This is beyond the reach of most of the world’s population if we depend on current health information technology.

PreMedicus® develops mobile device software designed to democratize specialized medical knowledge and overcome the deficiencies of legacy electronic health record systems currently in use.  We liberate the patient-provider interaction by unobtrusively embedding technology that provides value to all the stakeholders.  We have been in R&D since 2015, steadily building an integrated suite of mobile applications (apps) that work together to digitally streamline critically important medical and business functions in a highly secure cloud environment. These digital tools engage patients, expedite virtual or in-person evaluation, increase workplace safety, optimize staff workflow, provide clinical decision support, and provide strategic data insights to population managers.  

We are a B2B company serving health and life insurers, large employers, hospitals, retail pharmacies, pharmaceutical companies and national health systems by improving the quality and reducing the costs of acute illnesses like COVID-19, and preventable non-infectious diseases like diabetes and coronary heart disease. 

We have prioritized customer discovery and market validation with key high level opinion leaders in target markets, understanding their digital health transformation needs over the last 5 years. While in Merck KgaA’s 2016 Digital Health Accelerator cohort we spent 3 months in Kenya evaluating the ecosystem, testing our mobile app and holding focus groups with patients, physicians, pharmacists and telecom leaders.  In 2017 we traveled to England to attend an NHS Digital conference on their urgent and emergency care initiatives. We receive regular information as registered software vendors with NHS Wales, NHS Scotland and Crown Commercial Service. We have received feedback from top 10 U.S. health insurers in 2018 and 2019, interviewed global health leaders in Miami at the 2019 international IFC Global Private Healthcare Conference, and met with life insurance, private equity and venture capital firms since 2019.  All these interactions have deeply influenced our software development strategy, value propositions and business model.

There is a wide gap between the quality of Medicine practiced in developed and resource constrained nations. Millions of patients die every year around the world without the benefit of life-saving medical management strategies widely available to those in wealthy countries. Even if it was possible, it would take decades to train enough Emergency Medicine, Hospital Medicine and Critical Care physicians to meet global needs when these physicians are in short supply in developed countries. 

With the worldwide diffusion of smart mobile devices and the rapid advances in computer  technology, we now have a tremendous humanitarian opportunity to introduce carefully designed evidence-based digital health tools augmented by AI to assist healthcare providers in caring for their patients, and to bolster their knowledge and skills wherever they are located. Our precision population health platform has the built-in knowledge base and electronic documentation infrastructure to support delivery of individualized, low cost, high quality medical care to millions of people around the world. We will subsidize the costs of making our platform available free to any low income nation with grants and revenue from deployment in medium and high income countries.

Our solution will create value for commercial enterprises, faith-based organizations, charities, non-profits and government entities whose mission is population wellness and the mitigation of disease burden in the people they serve. These population managers will see improved care rendered at lower cost by an unfettered and better informed work force. The people using our virtual assistant apps will become so engaged in their own care and empowered with information that they will take a seat at the head of the table of their health management.

Underserved and vulnerable individuals will receive special focus. These people will have the full power of computer technology working on their behalf to identify them, enhance their well-being, forewarn of predictable diseases, and pre-diagnose illness early allowing for timely intervention.

This confidence stems from our successful integration of powerful synergistic existing computer technologies to create exponential value. Our pilot study may be the first to document parity of machines and humans in the complex medical task of real world diagnosis and triage decision making. We combined these proprietary algorithms with the power of natural language processing, AI/ML, world-class medical knowledge databases & global GPS to create a unique platform that delivers on these promises.

Several factors are key to scaling our impact:

• highly engaging user interfaces that welcome rather than intimidate.
• assurance of user privacy and data security.
• low data entry burden.
• personalized, easily understood and readily accessible health information.
• stable IT infrastructure.
• automated data analysis that is available on demand, and highly relevant to population managers.

We have considered all these elements in the design of our solution from the outset.

We will scale our impact in the first year by initially starting small; collaborating with only one or two large population health systems in the USA and UK carefully chosen for philosophical, regulatory and technological compatibility. Once we demonstrate that our platform is well integrated with their databases, we will evaluate functionality rigorously using limited data sets to reduce complexity.

When we have achieved robust results and fine-tuned our AI/ML models, we will carefully enroll several more partners in the second year, and again test our system’s response and output. After reaching a six sigma level of confidence in our processes and infrastructure, we will translate our digital assistants into multiple languages and rapidly roll out to a representative group of high, medium and low income nations in Year 3.

The key success indicators that we monitor against our impact goals are:

1. Achieving high user engagement.

• Metrics: Number of downloads, new users, active users, retention, digital surveys.
• Pilot results: Digital surveys showed an average 4/5 user satisfaction rating.

2. Matching expert physician diagnostic acumen with our digital pre-diagnosis algorithms.

• Metrics: Correlation with top 3 expert physician diagnostic considerations.
• Pilot results: Cardiac (100%), urinary tract (100%), gastro-intestinal (88%), musculoskeletal (87%), neurological (80%), respiratory (75%).

3. Matching expert physician triage accuracy with our digital triage algorithms.

• Metrics: Sensitivity, specificity, positive and negative predictive values.
• Pilot results: 86%, 88%, 93%, 76% respectively.

4. Maintaining >99% system availability.

• Metrics: AWS cloud service up time reports.
• Pilot results: 100% system availability.

5. Quantifying value delivered to population managers.

• Metrics: Population manager supplied cost and quality indices.
• Pilot results: Not applicable to pilot study.

Our plan is to monitor and report these metrics quarterly.

There are many barriers to successfully launching and scaling our precision population health platform globally. Our main challenges are:

Value Proposition Validation:

While the pandemic has dramatically accelerated digital health innovation and opened new doors for us, the all-consuming task of Covid-19 patient care has delayed our clinical trial. Without objective evidence of our platform’s value creation in a large sample size published in a reputable peer-reviewed scientific journal, it is difficult to acquire customers and grow rapidly. We are aggressively seeking partnerships to accomplish this task.

Business Model and Price Optimization:

Most digital health companies have found it challenging to find a profitable business model with reluctance of consumers, health enterprises and governments to pay for software tools. We will have to develop discrete business models and pricing structures for different markets and economies.

Sustainable Partnerships:

Few digital startups partnering with established companies do so as peers. We will screen potential partners very carefully to ensure both parties benefit, and we avoid the pitfall of “beta purgatory”.

Regulatory Barriers:

Compliance with widely diverse international digital health requirements may pose significant barriers to entry as we scale. We will factor the ease of doing business into our global expansion planning.

Partners:

• Cloud services/Machine learning/AI (Amazon Web Services);
• Cloud management services (Cloudnexa);
• Natural language processing and speech to text translation (Google Cloud);
• Medical education (Centers for Disease Control & Prevention, National Library of Medicine, Merck Manuals);
• Medication documentation (National Library of Medicine);
• Secure text communication (Twilio);
• Technical support software (Zendesk).

We are applying to The Trinity Challenge because it dovetails extremely well with our mission, vision and strategic goals, and is a catalyst to the work we have been doing for the last six years. There is no pivoting involved in carrying out the mandates of the Challenge.

Winning the Challenge would be game-changing by providing remarkable opportunities and helping us overcome multiple high barriers. First and foremost, it would authenticate our vision of a world where any person on the planet with access to a smart mobile device receives world-class personalized health advice and owns their digital health records. We would have access to the world’s most admired technology companies and health organizations, making it much easier to complete our value proposition validating clinical trial, recruit highly talented staff, and attract high quality capital partners. This synergy would help us solve our business model and price optimization dilemma and open doors to where and when we grow to achieve global reach.

Many entrepreneurs especially those from emerging nations would be inspired and invigorated by our success. It would be an honor for our team to mentor some of them.

We would be delighted to partner with large healthcare and IT partners that have mentoring and innovation integrated into their very DNA. We will benefit immensely from their experience in developing and globally scaling services and products, their business relationships and their guidance in solving the inevitable problems that will arise.

 Our wish list for population health managers is NHS Digital in the UK, and Cleveland Clinic Foundation, Providence St. Joseph Health, University of Pittsburgh Medical Center and Kaiser Permanente in the USA.

Amazing IT partnerships would be with Amazon (Sagemaker AI/ML, health data lakes), Google (NLP and GPS analytics) and Apple (health data integration).