Global learning toward local caring: Integrating medical education and practice through intelligent networks

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:

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