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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: [Part 2 of thread from Mark Treat / was cut off]

    • New payment and reimbursement models which cover remote care – which is dependent upon proven financial models for remote care which justify the payment and reimbursement models. Justification is measured both in terms of health outcomes and cost savings

    Our observation is that even in the United States, where much of the health and technology infrastructure already exists, telemedicine programs often fail. The reason is that many of the pilot programs focus on one piece of the system (such as the introduction of an individual new technology or device), not the system as a whole. The changes in delivery processes and impact on other parts of the system are often ignored. Most importantly, the necessary support of the people who are stockholders in the system are also ignored. There must be a concerted effort to not only train the actors who participate in the system, but also properly communicate with them in order to overcome the natural human resistance to change.

    There is much discussion on the lack of money or reimbursement models which have certainly delayed the adoption of telemedicine. We must also recognize, however, that significant funds have been invested into pilot telemedicine programs. Unfortunately many of these programs have failed to take a holistic or systemic approach to the overall health delivery model and therefore have failed to demonstrate the promised value proposition. These failures can create reluctance to invest more heavily in rolling out telemedicine technologies. My sincere hope is that future programs will take a more holistic systemic approach to telemedicine.

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