Four years ago, I began developing and piloting a system based on the simple concept of using mobile smartphones to facilitate telemedicine in developing countries. What started for me as a project at the MIT Media Lab evolved into a complete system that lets a remote physician provide diagnosis and treatment advice to patients, using data that healthcare workers or the patients themselves collect about their symptoms via mobile smartphones and my software.
I designed the system to address three main issues of healthcare:
- Lack of access: Many people can’t get to doctors due to their sickness, long waiting lists to get a scheduled appointment, or transportation difficulties
- Lack of ability to pay: Many people can’t afford to see a doctor
- Lack of doctors: For many people, there are no doctors nearby
Various pilots with the system in more than ten countries in the developing world have showed promising results. In places like Botswana and Uganda, where getting a consultation from a specialist might take a person a few months wait and several days of travel, we were able to help patients obtain treatment consultations by specialists in less than 72 hours. In one pilot, we used mobile camera phones to diagnose and facilitate treatment of cervical cancer in HIV-positive women during a single outpatient visit.
Health workers who used mobile devices to enable treatment via telemedicine at their local clinics reported a sense of empowerment, as they were able to serve as the eyes and hands of remote doctors, and were able to provide effective care to patients where doctors were not physically available.
The challenges that this system addresses are not endemic to the developing world. As I began to look at US Healthcare, the same main challenges were evident, particularly for seniors.
- Lack of access: Many US seniors are immobile and require frequent visits to multiple doctors due to co-morbidity of diabetes, hypertension, and cardiovascular diseases, and other ailments such as dementia. Transporting a senior to a physician typically requires a caregiver, typically a family member or hired help, to coordinate and accompany the senior. Moreover, specialist doctor visits typically require weeks to months of wait time for schedule availability.
- Lack of ability to pay: While average income per capita in the US is higher than those in emerging markets, rising healthcare costs means Americans spend a greater and greater percentage of their earnings on healthcare, meaning healthcare is becoming less and less affordable for people. According to the US Department of Health and Human Services, health care spending in America has increased from 5 percent of GDP in 1960 to 16 percent in 2004, and is expected to increase to 18.7 percent in 2014.
- Lack of doctors: As of March 2011, there is one geriatrician for every 2,620 Americans 75 or older. Due to the estimated increase in seniors, this ratio is expected to drop to one geriatrician for every 3,798 older Americans in 2030.
So, can we apply viable health innovations from emerging markets to help US healthcare delivery?
Absolutely. However, there are numerous adaptations and considerations that must be made for these innovations to work in the US healthcare system. The technology and service processes need to be tailored to US healthcare workflows, reimbursement processes, and furthermore need to address legal regulations, such as compliance to the HIPAA regulations for privacy and security of patient data.
To meet this challenge, I started a new company, ClickMedix, taking lessons learned from my experiences with my system in developing countries, and with the goal of making a mobile telemedicine platform that works for the US healthcare system as well as emerging markets.
ClickMedix has designed, built and piloted a HIPAA-compliant, mobile telemedicine system, built from scratch to address the specific needs of the US healthcare system. It includes complete mobile telemedicine functionality and also has the ability to deliver health education to health practitioners at the point of care. I designed the system to be expanded by plugging in additional diagnostics devices, and to be customizable so that health organizations can add their own clinical protocols and build their own telehealth services using the platform. The system is also designed from the ground up to be collaborative, allowing practitioners to refer patients to specialists in their network with the click of a button and to coordinate a holistic approach to patient care.
The initial pilots of this system in the US have been successful. In one pilot, about 65% of 900 patients received diagnosis and treatment recommendations for their skin conditions, from remote dermatologists, within 72 hours. The other 35% were treated through in-person appointments with specialists. As the specialists were able to view patients’ symptoms information, they were able to determine the urgency of the patients’ conditions and accommodate earlier appointment dates. In states where asynchronous telemedicine is reimbursable, the consulting physicians were compensated for their work. Furthermore, because the patient data was already collected, packaged and organized by the system, dermatologists were able to view patient symptom information (images, questionnaire answers, text notes, videos) and provide diagnosis and treatment advice in 3-5 minutes. This vastly increases their ability to treat more patients in a given block of time.
Beneficiaries of these services include both the patients and healthcare providers. For patients, months of waiting for a physician are replaced with minutes of tele-consultation. This promotes earlier diagnosis, better treatment outcomes and easier follow-up care. For healthcare providers, the efficiency and collaboration the system brings allows them to extend their reach and effectiveness. Most importantly, the overall quality of patient care will improve and costs of healthcare provisions will significantly decrease due to early detection of diseases.
Today, the nexus of advanced mobile health (mHealth) technologies, high penetration of mobile smartphone usage, and proven innovative health services using mobile phones, coupled with urgent need for ways to lower healthcare costs, brings momentum to the adoption of proven healthcare innovations that could help save US healthcare.
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