Experience 5: Deliver digital MAS (Medicine as a Service) to anyone

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By 2025 Digital Medical Centers (DMC’s) could provide services without medical facilities. A re-conceptualized Digital Medical Infrastructure (DMI) that serves the poor could capitalize on the fact that over 60% of slum dwellers already have mobile phones.

Services include medical tests by dispersed Medicine-As-a-Service (MAS) Devices. These are inexpensive over-the-counter products with sensors to run dozens of medical tests when connected to a tablet or phone. In minutes test results are uploaded to a medical profile. Standardized diagnoses and treatment will be by AI Doc’s structured medical interviews. Treatments will include automated patient monitoring and delivery of generic medicines by drones. Outcomes tracking with network-wide learning will produce continuous improvements in diagnosis, treatments and cure rates.

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A shortcut was built into in Expandiverse Technology. Its new Digital Earth didn’t need an expensive and advanced new generation of devices to run it. Even though every device could benefit from waiting until it had enough processing power and new software before it could enter this digital future, it didn’t need to wait. There was a workaround.

The cheap and fast way was to add Virtual Teleportals to all kinds of existing devices. Virtual Teleportals let everyone access an Expandiverse Digital Earth from the devices they already owned and used, without needing to wait or spend the money to replace them.

Virtual Teleportals recognize that there is plenty of processing power available, but it is unequally distributed. As long as the heavy lifting could be done anywhere, such as by backend servers in data centers, less powerful devices could access a Digital Earth without needing to be upgraded or replaced.

Since over 60% of slum residents have mobile phones, Virtual Teleportals let new Digital Medical Centers (DMC’s) deliver a Digital Medical Services everywhere they were needed.

By using existing devices to access a Digital Earth’s medical systems, it wasn’t necessary to build a first world medical system. The poor could receive digital medical care everywhere.

Virtual Teleportals let everyone access an Expandiverse Digital Earth from the devices they already owned and used, without needing to wait or spend the money to replace them.

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Digital Medical Centers (DMC’s) used Virtual Teleportals to deliver a Digital Earth’s medical care everywhere it was needed.

Incorporation:  DMC’s were incorporated and run from countries that permitted global medical services. Their medical staffs came from any country that let medical professionals work online around the world. Their patients came from everywhere medical services were allowed to be accessed from outside their country, but mostly their patients were the poor who had little choice.

Management:  Each global network of Digital Medical Centers was run as if there was a giant control center on one floor of a skyscraper. In the control center multiple teams and screens each ran one country’s chain of DMC’s. Dashboards tracked the medical operations and patient data on a minute-by-minute basis. Artificial Intelligence (AI) and “big data” analysis kept watch over facilities, staffs, patients, treatments and results. The current levels of positive and negative outcomes were watched carefully. Any deviation produced alerts like the check engine light on a car’s dashboard. Negative gaps were identified, analyzed and fixed. Positive gaps were identified, analyzed and replicated if possible as opportunities for system improvements.

What made this remarkable was there wasn’t a control center. A set of medical management Shared Spaces ran the global network of DMC’s. The medical managers were in many places worldwide so they could operate continuously 24X7. As daytime circled the planet these medical management Shared Spaces circled the Earth with it to ensure the smooth delivery of medical care everywhere DMC’s were allowed to operate.

Patient “visits” and medical tests:  The DMC’s serve large numbers of patients through their smart phones or tablets, because diagnosis and treatment are by interactive communications. Each patient is “seen” online, in a personal and private medical Shared Space, without an in-person visit. If it’s a new patient a DMC profile is created immediately from the person’s online directory profile.

The patient’s medical tests are done at any location where there is a tablet or phone with appropriate external medical testing sensors. (224) MAS (Medicine As a Service) Devices have become widely available because the sensors to run over 50 medical tests have become available as an off-the-shelf product that costs less than $150, and these can be interfaced to many inexpensive tablets and phones. Test results are uploaded in minutes, for immediate availability in the patient’s private Shared Space “visit.”

A MAS Device starts by connecting to the patient’s online profile and using the profile’s biometric data to confirm patient identity. It then has clear picture menus of groups of tests. Example groups are a baseline medical profile for a new patient; tests for pregnant women; tests for children under five years old; and groups of tests for people with specific symptoms or conditions like the flu, a locally endemic disease, or a chronic condition like high blood pressure. For each test the MAS Device illustrated how to set it up, then used the device’s camera and image recognition to confirm it was set up properly, then ran the test automatically. After a patient’s tests were finished it reported the data automatically within minutes by updating the patient’s medical profile with all the test data, eliminating the administrative steps.

(Already today a pre-cursor MAS Device runs 33 medical tests, is expected to cost $150 in production volume, and has been field tested at more than 80 medical facilities in India.) (224)

Diagnosis:  Using the medical test results and a structured patient interview, symptoms are evaluated by an AI Doc (an Artificial Intelligence system; 243). The AI Doc’s diagnosis provides a standard treatment plan, which is personalized to each patient’s condition and severity.

By tracking each patient’s outcomes against the initial diagnosis, a back-end Active Knowledge system used self-optimizations to make continuous improvements. After doing large numbers of treatment plans and continuously improving them, many patterns of symptoms and test results produced reliable diagnoses with high “Diagnosis Certainty Scores.” Most proved reliable enough to not need to be checked manually.

In about 20% of the cases, however, the Diagnosis Certainty Score was low enough that an appropriately specialized nurse or doctor was alerted. The nurse or doctor performed a live online examination in the patient’s medical Shared Space, then finalized the diagnosis and treatment plan.

Treatment plan:   Each treatment plan is provided to the patient as a series of short videos in the patient’s native language. These are often re-recorded by other patients of the local DMC using free tools in their medical Shared Spaces. The re-recordings are automatically tested with other patients by Active Knowledge optimization and the best of them kept. This produced multiple versions of each video to select from — if one isn’t clear enough, others are available.

The patient watches their treatment videos online in their private medical Shared Space. Each video is followed by a list of likely questions based on questions asked by previous patients. Each question is answered in another short video. The treatment plan and videos remain in the patient’s private Shared Space with the DMC so the patient can check them any time.

Because home care is usually needed, some of the videos include ways to prepare a patient’s bedroom and bathroom so they are sanitary and safe given each kind of economic circumstance, including for those who live in slums.

The patient can add one or more caregivers to their private DMC Shared Space, because home care is usually provided by relatives and close friends. This provides caregivers with access to the patient’s treatment plan so they can see what to do and how to prepare the home healthcare spaces. There are also other DMC resources and videos for caregivers, to answer their questions on how to be helpful.

Medicines and supplies:  If medications or medical supplies are prescribed they are delivered by drone, either to the DMC or a secure location for pickup by the patient, or directly to the patient by a drone that homes in on their smart phone’s location. For example, if a patient is sick at home, the medications can be delivered there.

Patient monitoring:  If a patient has a short-term disease, during each of the following treatment days the patient’s medical Shared Space is used for AI Doc Monitoring of the patient. Depending on the treatment plan, this can include live, two-way minute-by-minute monitoring throughout the day. Each patient’s medical Shared Space stays Focused (open) during treatment to monitor the patient’s condition through reminders, interactions and virtual medical tests.

If needed, wearable medical sensors had become inexpensive enough that many patients either bought or borrowed a set, then reused them for DMC healthcare monitoring when a family member was sick in the future.

Daily treatment plan and To Do List:  To start each treatment day the AI Doc provides a new “Day Plan” for the patient to follow. This includes that day’s expected medical milestones and a “To Do List” to meet the clinical milestones.

If a patient has an infectious disease like the flu, each day their Day Plan tells them if they contagious and should stay at home, or if they are well enough to go out and be with healthy people.

To Do List examples include medication reminders, temperature checks, suggested amounts of bed rest, fluid (water, tea, soup, etc.) reminders, and procedures that fit each patient’s needs such as gargling, walking or specific exercises or stretches such as for knees or backs. Interactions include fluid, diet and bowel questions, with suggestions if wanted or needed. The clinical milestones and To Do List items have short videos available to explain them, but these are optional and seldom used more than once.

When a patient does each item it can be recorded in simple ways such as by saying “I did that.” To respond to a request a patient could say “My temperature is 101.3.”

The results from each day’s Day Plan are what the patient does or does not do. These are used by the AI Doc to prepare the next day’s “Day Plan” and its “To Do List.” If the expected clinical milestones are met, the next Day Plan reflects that. Conversely, if clinical progress is not made treatment is adjusted accordingly. For patients who miss one or more responses, default Day Plans are pre-set based upon previous outcomes from similar non-responsive patients.

Chronic disease care / Tiers of service:  If the diagnosis is a long-term or chronic disease, the patient can decide on one of three levels of care. These are often economic decisions because of cost — with all automated tiers more affordable than in-person medicine.

The lowest level of chronic care is a generic Day Plan and with a daily To Do List that the patient repeats independently with no monitoring and only periodic follow-up. (This parallels the same level of patient responsibility as in many first world medical treatment plans — a quick occasional doctor’s visit with a short list of instructions and no daily personal follow up.)

The middle level is an open Shared Space for daily monitoring, including a personalized Day Plan with a daily To Do List that is monitored at the level of whether or not each day’s activities are done or not. (This exceeds what most first world patients receive on a daily basis.)

The highest level of chronic care includes minute-by-minute monitoring of patient vital signs using inexpensive wireless/wearable monitors and sensors. The patient’s medical Shared Space includes continuous AI Doc monitoring of the patient’s vital signs and healthcare activities. If any vital signs or activity levels warrant it, automatic reminders or alerts are triggered to (depending on pre-set non-compliance and severity thresholds) first to the patient, second to the patient’s caregiver(s), and third to the DMC’s medical staff for live Shared Space contact and intervention. (Even though a patient may be poor and at home, this exceeds what first world patients receive unless they are in a hospital with connected medical monitors and an attentive medical staff.)

Continuous improvement:  Since DMC’s deliver online they take advantage of every kind of exponential growth in technology. They use Active Knowledge that tracks every patient interaction on every day during diagnosis and treatment. Each patient has a personal dashboard that is constantly available in their private medical Shared Space so the patient can compare their personal medical progress to larger numbers of patients who face a similar illness or condition, at every moment.

At the end of every patient’s treatment, the DMC does an automated outcome assessment that includes both objective and subjective metrics. This includes the patient and any caregivers included in the recovery process. Both the medical results and each participant’s subjective judgment of the result are assessed, in case the patient’s vital signs demonstrate health but the patient or caregiver isn’t satisfied in some way.

Active Knowledge treats every interaction as a learning experience and an improvement opportunity because cultures, customs, preferences and patients are different all over the world. The DMC’s constantly use the the best medical outcomes and patient satisfaction to pick the most effective and affordable affordable devices and procedures to fit every type of medical need and patient that they serve. Active Knowledge constantly uses these data to pick the best kinds of interactions, balancing both the medical results that can be achieved and the patients’ preferences for how to reach that.

Visible results:  On a global level, the DMC management Shared Space includes many kinds of dashboards. Some differentiate by geography such as countries, cities, or individual neighborhoods. Some track each disease or condition at that moment in time, or over a period of time such as one city’s treatment of the flu as longitudinal graphs that evolve from the beginning through the end of that year’s flu season. Some are demographic such as all pregnant patients or all children under the age of five. Some are income or postal code based, which reveals differences in health and disease patterns between different income groups.

The data sets are constantly analyzed to produce the best standardized treatment results, to customize each treatment protocol to fit different cultures and types of people served.

For example, to DMC’s it is clear which medicines work and when they should or should not be used; which medical tests make a difference and which are a waste; which daily treatment goals produce patient progress and which don’t work; when overnight patient care is actually needed and when homecare works better; and when a live doctor is best and when an AI Doc is enough.

DMC’s have the unique ability to base their decisions on data and evidence rather than expert opinions, vendor marketing or local routine medical practices. They use evidence to provide systematic services at price points that fit different abilities to pay at the various income levels of each country in which DMC’s provide services.

Public health services during infectious disease outbreaks:  On a global scale infectious disease outbreaks had to be contained constantly. When an infectious disease outbreak was discovered, the DMC’s maintained alert systems to notify government and world public health organizations. They then worked closely with them to deliver large volumes of automated medical services rapidly to the affected communities and those groups of patients. In each of these cases, the outside governing body decided whether the DMC services would be provided at full or reduced price, or for free — subsidizing the automated identification, mass contact and treatment at volume prices.

DMC’s welcomed these campaigns because that subsidized them in rapidly adding huge numbers of new potential patients to their patient populations. Each potential patient received a private medical Shared Space , a set of baseline medical tests using locally distributed MAS (Medicine as a Service) Devices, and a Shared Space on the potential patient’s device they could use instantly the next time they became ill. Large numbers of potential patients were added to the DMC’s, and governments rapidly built public health services that were ready to handle disease outbreaks at low cost.

Structured services and prices:  Some of the DMC’s structured services included tiered pricing, first world specialists, medical research and special services for the poor.

For a tiered pricing example, live consultations with remote doctors or nurses were always immediately available for a fee. Their live image always appeared in a medical office that fit the patient’s country’s expectations for a quality doctor’s or nurse’s office. Each doctor’s or nurse’s medical credentials were a link from the person’s image to their schools and professional licenses. For appearance, their credentials were framed and hung images on their office wall, but these were links that could be examined by patients at any time. If the doctor was from a different country and the credentials were in a different language, translation was automatic.

DMC’s welcomed and paid doctors and nurses from first world countries who wanted to provide medical services either full time or part time. They also worked with first world medical schools to provide rotations and residencies in online global telemedicine, as well as part-time jobs for medical and nursing students who needed to earn extra money.

The DMC’s had special services for research projects run by doctors, medical schools, pharmaceutical companies, medical device companies and others. They used each study’s criteria to create research panels of patients who wanted to receive medical services for free in return for participating in these medical studies. Harvard’s Dr. Richard Chester did this to gain rapid access to the specific types of infectious disease patients he needed for each of his research studies and papers. He saw some of his panels’ patients repeatedly, and others just once, depending on each of his studies’ data needs.

Highly automated and inexpensive online Shared Space medical services were always available to the poor who own little more than a smart phone. This willingness to assist the large numbers of poor people that governments would rather ignore is often what makes it possible for DMC’s to be allowed to do business in some countries. The fact that DMC’s provide the poor with quality medical care at extremely low or no cost to the government made DMC’s a win-win for everyone.

DMC facilities:  For patients who needed to visit a DMC facility, and for seriously ill patients who needed overnight care, local facilities were built quickly and inexpensively. These were usually in lower class or poor neighborhoods — including in slums around the world. They were often financed by local home health care workers who wanted to open and run a local medical facility.

In Airbnb style, the front rooms of existing homes were turned into small DMC outpatient clinics. Available bedrooms were turned into overnight patient rooms. Connected kitchens and bathrooms were upgraded if needed. A lot of cheap tablets were mounted throughout the DMC rooms so online visibility of everything that happens in all of the healthcare rooms was continuous in private Shared Spaces.

To track the health of overnight patients every minute, these patients wore wireless health monitors and sensors. Their thresholds were pre-set in each overnight patient’s treatment plan so high or low readings automatically fired alerts to both the local DMC’s staff caring for the patient and remote DMC medical and administrative staff in Shared Spaces around the world.

DMC facility staff:  Most DMC neighborhoods were too poor to have many independent local doctors and nurses. The local staff of a DMC were like home healthcare workers with little specialized education or training. They were called LCW’s or Local Care Workers. Family members of the House’s owners or their neighbors were often recruited as the first LCW’s, then guided and mentored digitally in the local DMC’s Shared Space while they worked. The guides were RHW’s (Remote Healthcare Workers), who were professionals or experienced semi-professionals that helped manage and run local DMC facilities — each with its own Shared Space so the RHW’s could keep multiple DMC Shared Spaces open on multiple screens, and turn to each as needed.

If a new patient needed to be registered an LCW simply gave them a pre-configured tablet that did the registration automatically and quickly.

If an existing patient had a medical or a business question an LCW gave them a tablet with their personal, private medical Shared Space so the patient could talk directly to the medical or business people who could help them.

At the facility, the LCW’s main outpatient job was to run MAS Devices medical tests, which were designed to be so simple almost anyone could run them.

The main in-patient job was to provide food and personal assistance to the patients that were staying overnight. LCW’s were guided in doing this by each patient’s Day Plan and personal To Do List. They were mentored by RHW’s (Remote Healthcare Workers) in Shared Spaces from the many two-way tablets mounted on the DMC’s walls, tables and counters.

While LCW’s provided services the RHW’s gave LCW’s two-way on-the-job guidance until the LCW was experienced. Working together remotely was constantly improved until remotely administered DMC setups, patient sign ups, in-person medical tests, treatments and overnight care were sufficient.

Around the world, Remote Healthcare Workers from all time zones provided digital guidance to LCW’s. The RHW had multiple large screens, each screen with one DMC’s Shared Space. A single Shared Space was typically subdivided into multiple live views throughout the DMC. The LCW’s were tracked individually by the tablets and smart phones mounted throughout each local DMC facility. On the RHW’s screen the active LCW views were auto-highlighted, with special colors for new LCW’s, so the RHW could check large numbers of LCW activities quickly — and pay special attention to new LCW’s.

RHW guidance could be as simple as how to clean and prepare an empty patient room, to how to care for a patient who is having a difficult time during the middle of the night.

Again, this relieved financially strapped governments from needing to build and run expensive first-world style hospitals for the poor, for which many countries had little interest or money.

DMC remote medical and administrative staff:  The first world’s medical system had hired away nearly all of the doctors, nurses and medical administrators available from poor communities worldwide, so the DMC’s neighborhoods and groups were dramatically underserved.

The DMC’s remote staff used Shared Spaces to provide medical assistance to the AI Docs and local LCW’s — these RHW’s (Remote Healthcare Workers) were their doctors, nurses and medical administrators. By using Shared Spaces across large numbers of DMC’s, the RHW’s substituted for the shortage of doctors, nurses and other healthcare specialists and services across the large, poorer parts of the less developed world.

At the same time, the DMC’s provided worldwide employment for healthcare professionals who wanted to see large numbers of poor people receive the health care they needed. This attracted many well educated and talented professionals from medical nonprofit organizations who wanted to make a direct personal contribution to solving the world’s needs for healthcare. They worked full time or part time with the DMC’s, providing a new automated medical infrastructure that could grow to serve the billions of poor people left out of the first world’s medical systems.

The DMC’s had an open opportunity to develop automated medical systems that could deliver the world’s most personalized medical services with high quality and high levels of patient satisfaction. As these developed medical outcomes that equaled first world medical systems, across a growing range of medical services with volume capacities at low cost, the first world could start turning to DMC’s to help solve its medical cost problems.

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