Why this solution/product proposal?
Most humans are confronted with uncertainty when they or
their loved ones develop a chronic illness and currently the traditional option
is to wait patiently in crowded doctor offices where all queries may not always
be answered to their satisfaction. The kind of questions patients and doctors
both seek are very similar for example where is the problem located in my
system (Doctor’s anatomical diagnosis)? Why is this happening (etiologic
diagnosis) and specifically why me and why are the medicines not working
(prognosis) and what are my other options? In recent years online consultations
to address these queries have become a trend both among care-givers and
care-seekers and yet the current medical education curriculum (whose primary
beneficiary is the patient) has not been able to create the kind of knowledge,
attitude and skills necessary for this evolving area. (Reference: http://www.ncbi.nlm.nih.gov/pubmed/19018905)
What is our solution/product?
Ours is a working model of a ‘Participatory learning-ecosystem’
where instead of just a single doctor, the patient gets the benefit of an
entire global (and local) network of health-professionals who optimize the
patient’s information requirements in a manner that can influence his/her
chronic disease problem in the direction of positive outcomes. This ecosystem
consists of the patient and a community health worker (local patient information-communication
manager PICM) who works closely with the patient and his local physician to
manage the patient’s information by first capturing his/her ‘illness’ related
data in the form of a detailed history as well as available investigational
reports done in the near past. The community health worker uploads the patient
data to an online health record (see our current patient records here: www.udhc.co.in and click on the ‘input’ page).
The local inputs from the patient is forwarded and moderated to a global
network of professionals who provide multidimensional inputs on the patient
along with links to current best evidence to support their inputs. Patient-Data
can be captured and shared using multiple interfaces ranging from phone to
personal computers and integrated into the patient’s online record. Our current
working model serves both urban areas as well as rural remote in two locations
in India.
How is the solution/product going to
make an impact?
Key partners and
human resources: The current product ‘Participatory learning ecosystem’
exists through a network of patients in the community visiting our tertiary
care centre in Bhopal, India where our trainees in ‘patient information
communication management’ PICM (see details of the course here: http://userdrivenhealthcare.blogspot.in/2015/04/medical-electives-in-patient.html)
interact with individual patients to create their online records (available
here www.udhc.co.in).
Key-activities: The
online patient records are created after appropriate de-identification as per
HIPAA guidelines and after obtaining signed informed consent from the patient.
The online records are further processed through an online
‘global-social-network’ of 1000+ health-professionals where the patient’s
information is carefully examined for better insights to current available
options and current best evidence toward quality improvement in the patients
subsequent care (Detailed philosophy of this model/approach here:
http://userdrivenhealthcare.blogspot.in/2015/06/dynamic-case-report-model-of-user.html).
Part of the learning ecosystem also tries to expand frontiers of current
knowledge by exploring newer options that can be tried in a scientific manner
to best benefit the patient. Engineering students work with
Medical students to understand anatomy, physiology and medicine from an
engineering perspective that often brings a fresh perspective, which helps to
infuse newer ideas that are being properly scoped and patented. The
achievements of existing PICMs and other student trainees in our learning
eco-system is evidenced in the online patient records in terms of patient and
learning outcomes available open access (although one may need training and
patience to decipher the information from its raw conversational format).
Key partners and human resources:
To scale our program/product our trained ‘patient information communication managers’ will (as appropriate to the individual patient’s choices), approach the physician practicing in the locality of the patient’s residence and brief the local-physician (who in India are generally fee for service practitioners) about his patient’s problems along with insights from the online network, thus acting as conduit to a support system for the local physician provided by our global learning network. The Indian physician workforce largely consists of fee-for-service practitioners who practice both in rural and urban India (Reference: Medical education and the physician workforce of India. J Contin Educ Health Prof (US). 2007 Spring; 27(2):103-4. http://www.ncbi.nlm.nih.gov/pubmed/17597112)
Revenue Streams:
Once such trained PICMs from every district are able to
convince local-physicians of the advantages of evidence-based support to their
practice both in terms of learning as well as patient outcomes (and their
increased ability to attract patients due to their improved information
supported functioning), PICMs can start getting 5% of the patient’s fees that
go to the local physician and 5% can go to the web-site owners. Once this is
demonstrated to be scalable, the PICMs who shall essentially be training as
entrepreneurs on a 0% interest loan (almost free training investing only their
time and efforts), shall return the training-loan-money from their 5% earnings
once their ROI breaks even.
Value Proposition:
Social Value: a) Better awareness and management of individual
health and illnesses through a networked systems approach.
b)Employment generation: A large workforce that will be
‘task-shifting’ traditional roles of ‘individual patient information
communication’ management’ that was till date a preserve of physicians but expectedly
no longer manageable by them due to the sheer volume of information growth in
Medicine.
c) Ensured ROI from the bottom of the pyramid who stand to
benefit the most from our solution.
Cost-Structure:
Investment will be necessary to advertise for PICM
Entrepreneur trainees, maintain their training with stipend after they are out
of the initial probation period (6 months) and sustain them in their own
communities through our online support systems framework that will incur costs
of maintenance. More investment engaging current MBBS graduates who are
generally unemployed or underemployed short of getting a seat in Post
graduation with a lucrative stipend can scale this model faster as now the
community PICMs (graduates other than MBBS) will not have to worry about
finding local physicians in their community as both trained MBBS PICMs and
trained other graduate PICMs will be quickly able to work as a team in the
community.
Relevant Publications around this work: (Attached).
Sample advertisement
(assuming we have enough funds to engage MBBS also as PICM entrepreneurs):
Are you wondering what to do after
graduation?
Become part of a
‘Healthcare learning ecosystem’ and grow with us as an entrepreneur. Learn
cognitive skills of clinical medicine and help to transform healthcare
globally. All graduates from any stream including MBBS are welcome.
We shall provide free training along with an attractive stipend
after completion of the probation period of 3 months. MBBS graduates will also
be provided training to develop procedural skills. All graduates have to
successfully complete the formative assessment tests that will be administered
daily online.
Eligibility:
Computer literate individual with strong language skills in English and Hindi
Methodology: Computer literate individual with strong language skills in English and Hindi
100% practical hands on learning which will be documented and stored in paper as well as archived online for formative assessment at the end of the course (also see section on 'assessment' and 'course-content' below and Telehealth center workflow plan)
Objectives of the Course:
Train course participants to effectively utilize Information and Communications Technologies ICT toward applying information driven clinical problem solving for improving patient health outcomes in the community.
Become efficient tele-health practitioners by collecting patient information through telephone and email and further processing of the data by gathering and adding evidence based solutions from medical consultants using store and forward techniques with e-mail, phone as well as face to face meetings.
Become efficient health journalists by researching and writing up case studies around interesting clinical problems as well as write health reviews to spread health awareness in local languages.
Duration: Assessment driven
Assessment of Course participants:
A system of formative Assessment will evaluate student generated data/learning points arising from their experiences during the course of their online learning interactions with virtual patients and faculty. This means there will be multiple weekly assessments and validation/corrections of the candidate's learning through a dialogue between the facilitator and the student all of which will be recorded on the web site. At the end of the course all these formative assessment data shall be qualitatively
analyzed for an overall assessment. There will be no formal exam/summative assessment at any point of the course
Course Content and learning outcomes:
At the end of the course students will be able to obtain the following learning competencies:
1. An overview of clinical problem solving
(The student will learn to prepare a patient problem list, identify an anatomical and
etiological diagnosis and as one of the stakeholders in the patient’s care facilitate a
positive relationship between the patient and his/her primary-secondary-tertiary health
professionals through efficient and optimal knowledge sharing between all these
stakeholders)
2. Master Clinical history taking and examination
(The student will learn to assist and facilitate the process of examining the patient’s
narrative and other information obtained through physical examination with and
without the help of modern technological tools such as radiological imaging and
laboratory parameters reflecting the patient’s internal chemistry)
3. Master the Essentials of anatomy, radiology, physiology and biochemistry
(This is necessary to reach an anatomical, functional and molecular diagnosis for a
given clinical problem at hand. Students will be taught to discover these essentials
while practicing online clinical problem solving beginning with the case at hand and
traveling right down to basic anatomy, physiology and biochemistry in context of case-based
information collected from clinical, radiological and laboratory data.)
Students will learn an approach to solve problems around diseases of:
Ø Cardiovascular system (Cardiology)
Ø Respiratory system (Pulmonology)
Ø Renal and genitourinary system (Nephrology, Urology)
Ø Hematological system (Hematology, Immunology)
Ø Nervous system (Neurology)
Ø Gastrointestinal system (Gastroenterolgy)
Ø Reproductive system (Men’s and Women’s health)
Ø Skin and Integumentary system
Ø Cognitive system (Psychology, Psychiatry)
Ø Musculoskeletal system (Rheumatology, Orthopedics)
4. Master Essentials of pathology and microbiology
(Necessary to reach an etiological diagnosis and students will be taught to discover these in
the context of solving their patient’s problems)
5. Master Essentials of Pharmacology, EBM and Net-searching
(Necessary to formulate a solution and treatment plan and students will be taught to discover these in the context of solving their patient’s problems)
Course Faculty: Will comprise of Medical Consultants and Professors
Onsite: 9-4 PM and virtual 24x7