doctorgram - Convergence Healthcare Ecosystem

The solution that my company is working on attempts to address several inadequacies in the provision of primary care services in under-developed countries. I will use the Philippines as an example.

1. There are not enough medical staff in rural areas of the Philippines. There are, on average, 3.7 doctors and 8.2 nurses per 10,000 population in the country. Moreover, there is a great disparity across different regions in medical staffing; most doctors are located in urban areas and rural areas have few resources. This has led to many consequences on health systems including reduction in services provided, increases in errors and poorer quality of care delivered, and longer waiting times for essential services. As such, patients in rural areas with chronic conditions receive little support or management of their health issues. Between 2009 and 2019, people in the Philippines with chronic conditions (e.g. diabetes and hypertension heart disease) experienced a 50% increase in their mortality rate. 

2. People in the Philippines (an under-developed country) can ill-afford the burden of healthcare services which has been rising over time.  

3. A lack of tools to monitor the quality of primary care services at a low cost provided in rural areas.

The Convergence Healthcare Ecosystem is a telemedicine platform that facilitates the provision of accessible, affordable healthcare services in rural areas, with support on data analysis to monitor performance. It consists of two components: mobile applications (telemonitoring, vital data collection, text messaging, patient health condition management, and tele-visits) and medical toolkits. (Wireless medical devices for telemonitoring and advanced medical toolkits for tele-visit)

1. Use the "Virtual Local Clinics" (VLC) to complement existing healthcare systems in rural areas as primary healthcare centers. VLC links a local health worker to a remote nurse and/or doctor to create a virtual team. Each team member plays an important yet different role in interacting with patients at a community level. 

a. Instead of having doctors travel to rural areas, the local health worker can coordinate all medical services with patients such as scheduling tele-visits, completing documents, and collecting vital data. With doctors attending to patients via telemedicine, the resource disparity would be addressed. The waiting times for essential health services will be shortened. 

b. Patients and local health workers can communicate with remote medical staff via the platform's secured messaging system.

c. Our mobile application simulates a clinic visit workflow (human-centered design) that makes tele-visits more efficient and effective.

d. All uploaded vital data will be shared with the relevant care team. If a patient’s data is out of normal range, an alert will be sent to the care team.

e. Our mobile application automatically collects the vital data via Bluetooth that can minimize all the human input errors.

2. Use cost effective toolkits to reduce the healthcare burden and improve the quality of services. The toolkits can be shared by multiple patients within a VLC. 

a. Wireless medical devices for telemonitoring

Integrate Bluetooth medical devices (Blood Pressure Monitor, Blood Glucose Meter, Weight Scale, Thermometer, Pulse Oximeter, Electrocardiogram and Spirometer) to collect vital data. The toolkit costs less than US$400.

b. Advanced diagnosis tool kits for tele-visit. 

Integrate stethoscope, otoscope, dermatoscope, fetal doppler, and vascular doppler to improve the accuracy of remote diagnosis. The diagnosis kit costs less than US$600. In order to adapt to a rural environment, the toolkits are portable and operated with batteries without any need for an external power source.

c. Prescreening tools. 

Prescreening is one of the keys in support of early detection of diseases that helps to prevent deterioration and improve one's health status. These devices measures Fall Risk Assessment, Sleep Apnea, Ambulatory Blood Pressure Monitoring and Retina abnormality and will flag concerns associated with cardiovascular, metabolic, bone fatigue and eye diseases. 

3. Two levels of performance improvement: 1) patient-level health status improvement and, 2) system level VLC improvement  

Patient-Level health status improvement

Annual Health Risk Assessment - Summary of patient health conditions including hospitalization, mental health status, Barthel index and safety.

System level VLC improvement 

Number of active participants in each VLC. The number of patients screened and diagnosis via telemedicine will provide feedback on how engaged a local community is. The data collected will support health care providers, administrators and/or funders to plan performance improvement actions, if needed, to optimize the operations of the VLC.

Our solution's focus is on 58 million people in rural areas of the Philippines that have limited resources.

In the Philippines, mortality rates have been decreasing, with neonatal mortality rate of 12.5 per 1,000 live births, the under-five mortality rate of 28, and a maternal mortality ratio per 100,000 live births of 114 in 2020. However, there are still vulnerable subpopulations, especially in rural areas, that have not received healthcare benefits of these improvements and limited access to healthcare system still exists. 

A study in 2016 found that mortality rates among children under five years of age is 30.43% higher among those living in rural residences compared to those in urban areas.

One cause for this inequality is due to the disparity of healthcare services between rural and urban areas. Based on 2016 figures, the National Capital Region (NCR) had an allocation of 23.1 beds to 10,000 population while less than 10 beds to 10,000 population in the rest of Luzon.

Using the doctorgram - convergence healthcare ecosystem, we will be able to extend the healthcare services available to urban centers into rural areas via a VLC. With doctors attending to patients via telemedicine, the resource disparity would be addressed.

In 2018, we launched our solution in 21 rural communities serving 5000 users in the Philippines. Since then, we have worked closely with the local NGOs providing the healthcare service in order to improve our system.

Through their feedback, we have addressed several issues within our system. We made improvement to network performance which greatly reduced the time to read a large amount of user data and increased the stability of network in low bandwidth environment.

We have worked with doctors and make sure the quality of auscultation is good for remote diagnosis during tele-visits.

We have also made several improvements based on the suggestions of the NGOs. We integrated our system with their electronic medical record to help reference their patients' medical history. We implemented a QR code system, which allows the medical staff to identify patients by scanning their QR code, to streamline their workflow.

We are looking for funding to enhance our platform with new features such as machine learning, ultrasound, and fundus camera. With Solve's help, we can promote our vision to new partners to extend primary care services in under-developed countries.

In 2013, I had a conversation with my primary doctor and the idea of doctorgram was born. He had just gone on a medical mission trip to the Thailand and he shared with me the need for remote medical diagnosis tool in an orphanage there. Together, we envisioned a solution for those in the world who lack medical guidance due to cost, lack of transportation, poor medical history or unestablished habits to take care of their health. Based on the environment, our features for the platform included: portable (easy to carry and no requirement of external power), easy-to-use, cost effective, accurate diagnosis, scalable, low bandwidth and easy to deploy. To achieve these goals, we selected a mobile device as our major platform, with battery powered Bluetooth device accessories to collect vital data. We built low cost toolkits that include a stethoscope, an otoscope, dermatoscopes, a doppler, a blood pressure monitor, a blood glucose meter, a body scale, a pulse oximeter, an ECG, and a spirometer for less than $1,000. Doctors could utilize the toolkits to perform real-time assessments such as auscultation, ear examination, and skin examination remotely via a mobile application. For easy deployment, VLC is structured as a primary care system to serve local communities. In the next generation, we plan to support AI to classify, monitor, and manage the preventive care of patients which will let care team focus on the high-risk group.

NEXT YEAR

GOALS
1. Provide 100,000 people in rural areas access to telemonitoring and tele-visit services.

HOW
1. Train more local healthcare workers to manage VLCs. Based on VLC, a local trained healthcare worker will be able to coordinate all the medical services for a patient. It simply requires a local trained worker, a remote doctor, internet network, and a set of cost-effective medical toolkits for setting up a VLC.

2. Mass production of the toolkits to reduce the cost of deployment.

FIVE YEARS

GOALS
1. Extend the healthcare services to 1,000,000 users in rural areas.
2. Minimize hospitalization.

HOW
1. Work with local Non-Government Organizations (NGOs) to launch the healthcare services in the rural areas.

2. Use AI to classify each patient's health condition, allowing medical staff to focus on the high-risk group. 

3. Use AI for enhancing tele-visit experience. Based on all the tele-visit history, we may use AI for providing a recommendation to doctor for diagnosis based on the symptom, body sound and images.

4. Enhance notification system which reminds follow up and things to do. It will help on improving the workflow.

5. Integrate physical therapy to the platform.

6. Integrate with fundus camera, ultrasound, and other devices to improve the remote diagnosis during tele-visit.

Number of active patients in each VLC, the number of patients screened and diagnosis via telemedicine will provide feedback on how engaged a local community is. The data collected will support health care providers, administrators and/or funders to measure the performance improvement. If needed, the operations of the VLC can be optimized based on the outcome.

ACTIVITIES

1. Sales & Marketing to NGOs to extend healthcare services to rural areas.

2. Training of administrators for managing the organization, care teams, medical staff, and patients. 

3. Training of medical staff and local healthcare workers on how to utilize our applications to collect and monitor patients' vital data, as well as operate our medical toolkits to provide an accurate diagnosis during a tele-visit.

4. Use artificial intelligence (AI) to assist medical staff's decision.

a. classification of health risk will let care team focus on the high-risk patients

b. diagnosis recommendation based on machine learning

5. Screening - early detection of diseases

OUTPUTS

1. Provide more people access to healthcare services in rural areas.

2. Provide more accurate and effective diagnosis

3. Minimize the resource

4. Improve the workflow 

SHORT-TERM OUTCOMES

1. Extend the healthcare services to the rural area.

2. Shorten the waiting times for essential health services 

MID-TERM OUTCOMES

1.  Minimize the hospitalization

LONG-TERM OUTCOMES

1. Increase life expectancy in the rural areas.

1. Our mobile applications provide health care workers the ability to monitor patient vitals, communicate with patients securely, and perform diagnosis remotely. Our video streaming technology dynamically adjusts the compression level and video quality to match bandwidth availability, which increases the stability of network connections in rural areas.

2. We developed our own medical toolkit, which includes wireless stethoscope, dermatoscope, and otoscope. These tools, inconjunction with our mobile applications, allows real-time remote diagnosis through ear and skin exmination, and the listening of body sounds (lung sounds, heartbeat).

3. Our backend server is built to be scalable for supporting a million users and is fully HIPAA compliant.

4. We leveraged the AI technology on facial recognition and voice chatbot to enhance the usability of our system.

5. Software patent “System for locating a position of local object from remote site” (Patent Number: US 9,609,271 B2) is used to remotely position the stethoscope for auscultation.

The local healthcare workers in a VLC collect vital data by first scanning the patient's QR code to locate their record in our application. Through the use of Bluetooth devices, vital data are then collected. Using our application, the healthcare workers are also able to assist patients in submitting tele-visit and filling out health risk assessments. 

The performance of the virtual clinic can be measured by the number of active participants, the improvement of the patients' vital data, and the number of tele-visits.

GV Concepts, Inc is dedicated to enrich its company culture with diverse backgrounds. Our team comes from a variety of backgrounds, sex, races, religions, and other metrics of diversity. As of today, we have deployed our solutions to different countries and have been focusing on serving people that represent both geographical diversity as well as ethnicity, age, sex and race. 

Since the local Non-Government Organization (NGOs) have the best understanding how to implement VLCs to rural areas, we work with them and customize the features based on their needs to extend the healthcare services to these rural areas. The idea of our doctorgram telemedicine platform is based on the VLCs where the local healthcare workers coordinate, manage and collect vital data with small local communities directly. The local healthcare workers assist doctors to understand the healthcare problems of the local communities. These services do not discriminate on the basis of their education, income, age, race, or health condition of the people being served.

Depend on the target customers, we provide different schemes to accommdate their needs.

Business to Business for profit (B2B):

Our telemonitoring service will be charged based on a subscription fee. Our tele-visit service sells toolkits based on the customers' needs and a fee would be charged based on the number of encounters. We provide several tiers of plan based on the number of patients the healthcare provider manages. We also offer specialized plans for providers with special requirements.

Business to Government: 

Through a licensing contract, the government agency will have access to comprehensive telemonitoring and tele-visits services. The toolkits will be sold separately.

Business to Non-Profit Organizations: 

To NGOs, we charge our telemonitoring service based on a minimal subscription fee and offer free-of-charge to tele-visit service. The toolkits will be sold separately. We may have special contract with NGOs to sell anonymized data sets to special interest groups for research and analysis purposes+.

In order to make the project financially sustainable, the operating cost has to be low.

1.  Simple structure - primary virtual clinic with a local healthcare worker, a remote doctor and patients.

2.  Minimize the staffing resource - automation the tele-visit process, vital data collection via bluetooth devices, and using QR code to identify each patient.

3. Cost effective medical toolkit - built a basic system and worked with NGOs to deploy the solutions to under-developed countries. We are reimbursed for providing the medical toolkits and the processing of telemedicine services. We re-invested the revenue for continuous improvement and enhancements to our solution.

It will be much easier to find donors and government fund to support and sustains the project.

We market and sell the medical toolkits, telemonitoring services, and tele-visits service, analysis and training for contract partners.