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Steve Garguilo

Emerging Markets, Johnson & Johnson

TEDCRED 500+

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What can a sustainable telemedicine business model look like, and how do we get buy-in from those with the resources to make it happen?

In developing regions such as sub-Saharan Africa, the ratio of people-to-doctors is as high as 50,000:1. In the US, this ratio is 390:1. This means patients have to travel long distances at a considerable expense just to reach a doctor.

I worked with a team from Penn State University (http://www.mashavu.com/) on a unique, sustainable telemedicine solution comprised of highly low-cost, ruggedized biomedical devices designed specifically for the developing world. Devices will collect medical information including weight, body temperature, lung capacity, pulse rate, blood pressure, stethoscope rhythms, photographs and basic hygiene and nutrition information. These readings would be paired with a healthcare questionnaire, medical history, and pictures which describe their symptoms, and then sent to a doctor for remote triage. The doctor then provides feedback through the same device. The solution would enable doing the initial triage and would provide the patient with remote health advice.

Though there have been MANY telemedicine projects in the past, most of them were experiments - they were VERY expensive and lacked an entrepreneurial outlook to ensure economic sustainability. A major constraint is that 95% of the biomedical diagnostic equipment used in Africa is imported, extremely expensive, not ruggedized and not repairable when it fails. This will be a low-cost, ruggedized option for decentralized diagnosis and triage of patients.

Three years of work in Kenya and Tanzania shows that people are willing to pay for a service like this because it cuts down on travel time/costs, and a pay-per-use business model will make this a sustainable venture rather than philanthropic. What should the model look like to really make it work? What are the flaws with this concept? How can we manage/mitigate/be willing to embrace the complexity? I want to influence decision makers at J&J, but don't have all the answers. I look forward to responses from the TED community!

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    Feb 20 2011: There is no doubt that remote technologies which can measure patients biometrics and move the point of care from a physician to the patient have matured to the point where they are reliable, safe and secure. There is no greater opportunity to improve the healthcare system.

    Our company [www.nalarihealth.com] is focused on solving this exact question: how to create a sustainable telemedicine program in order to improve patient’s health, quality of life, access to care – and save money. Our focus is in the United States, which is challenging enough, however when you expand that to third world countries which lack much of the basic infrastructure (such as reliable connectivity) the challenge is even greater. The largest challenge however is not in overcoming the technology barriers (even the connectivity issues can be resolved with new secure wireless technologies) but rather in modifying the healthcare system as a whole such that the new business processes which are enabled by technology take hold.

    My belief is that a systemic approach must be taken in order to create sustainable improvements in any healthcare system. There are a number of critical success factors, which include:

    •Facilitating a process for individuals to find a physician and have a meaningful encounter with the physician, even if the physician is remote
    • Doctors adopting new ways to practice medicine and manage their patient relationships
    • Support for patient self-monitoring and management of their own health
    • Sophisticated remote patient monitoring, with analytics which trigger alerts and interventions targeted to specific needs of individual patients – before the patient requires hospitalization
    • Remote, low cost, care coordination by skilled professionals in both health and information technology to facilitate new remote care delivery models. Technology alone will not do it, people will be required.

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