extending us healthcare capacity with clickmedix

Ting Shih, CEO & Founder

[email protected]://clickmedix.com

Solution for Healthcare Providers: Do more, with less.

Mobile Health and Education Delivery System

Solution for Healthcare Providers: Do more, with less.

Mobile Health and Education Delivery System

Confidential | © ClickMedix, LLC 2013 http://clickmedix.com 2

• 32 Million more Americans would become insurance beneficiaries including1:

o Children with pre-existing conditionso By 2014, anyone with preexisting health problems can obtain insuranceo Medicaid expands to 133% of poverty levelo Annual out-of-pocket medical costs will be capped at $5,950 for individuals

and $11,900 for families

• Budgets for health providers2

o $10.5B cut from projected Medicare hospital payments over 10 years of inpatient or overnight care through a downward adjustment in annual base payment increases

o $4.2B cut from Medicaid disproportionate share payments to hospitals over the next decade

Challenge: Do more, with less $Challenge: Do more, with less $Challenge: Do more, with less $Challenge: Do more, with less $

Sources1 New York Times, Washington Post, CBS News, Reuters (http://awesome.good.is/transparency/web/usersubmissions/healthcare/giannini/transparency.jpg) 2 http://capsules.kaiserhealthnews.org/index.php/2013/01/doc-fix-in-senate-fiscal-cliff-plan-cuts-medicare-hospital-payments/

http://clickmedix.com/

http://awesome.good.is/transparency/web/usersubmissions/healthcare/giannini/transparency.jpg


• Budgets for health providers forming ACOs based on patient outcomeso Rewards for cost-savings achievedo Penalties for costs exceeding budget

New Healthcare Delivery Model: ACOsNew Healthcare Delivery Model: ACOsNew Healthcare Delivery Model: ACOsNew Healthcare Delivery Model: ACOs

1Source: Nyew York Times, Washington Post, CBS News, Reuters (http://awesome.good.is/transparency/web/usersubmissions/healthcare/giannini/transparency.jpg) http://www.infographicsarchive.com/health-and-safety/the-aco-prescription-cure-or-disease/#prettyPhoto/1/



• Eliminating 19-35% of operational expenses• Focusing on public-private partnerships in local communities

who can help address higher volumes and more complex case• Improving GME programs to incorporate patient-centered

quality programs to enrich experience for students and refreshing the program to reflect a 21st century health care market. This includes enhanced relationships with community partners and increased focus on outpatient care.

• Right-sizing inpatient operations and administrative functions that will help cover critical services and strengthen medical education programs

Dealing with Budget Cuts: Dealing with Budget Cuts: Louisiana State ExampleLouisiana State Example

Dealing with Budget Cuts: Dealing with Budget Cuts: Louisiana State ExampleLouisiana State Example

1Source: Nyew York Times, Washington Post, -172737281.html



Solution: Solution: Mobile Health and Education SystemMobile Health and Education System

Solution: Solution: Mobile Health and Education SystemMobile Health and Education System

As mobile technologies advances, traditional healthcare delivery models can be vastly improved through innovative mobile network powered healthcare services.

This proposal illustrates how to deliver highest quality healthcare with less resources to typically hard-to-reach and non-compliant population with chronic diseases of hypertension, diabetes, cancer, heart diseases, and dementia using mobile technologies.

The proposed mobile health solution elements have been deployed and successfully demonstrated as viable products by ClickMedix founder in more than 12 countries including the US, China, Taiwan, India, Peru, and Philippines.



Current patient health behavior exacerbates health conditionsCurrent patient health behavior exacerbates health conditionsCurrent patient health behavior exacerbates health conditionsCurrent patient health behavior exacerbates health conditions

Diseases such as heart disease, diabetes and hypertension can be prevented, reversed, and controlled with diet, exercise, early

screening and continuous monitoring.



Primary objectivesPrimary objectivesPrimary objectivesPrimary objectives

1. Serve more patients, at a fraction of the cost through mobile health (mHealth) and education services

2. Enhance medical capacity in rural areas through two-way tele-consultations and continuous training

3. Improve patient health outcomes through continuous patient management

4. Collaborate on building cost-effective health services via mobile health and education platform foro Chronic diseases (Cardiovascular, diabetes)o Maternal/child health careo Cancer screening services



• Facilitate remote medical consultation by doctors and specialists in less than 3 days for patients any where

• Increase by 4 times the number of patients a doctor can serve• Enable a single doctor to reach up to 10,000 rural patients

when combined with community health workerso Each doctor manages 10 nurseso Each nurse manages 10 health workerso Each health worker serves 100 patients through monthly home-

visit care

• Provide HIPAA-compliant communication infrastructure for improve healthcare services

• Through integration with existing EHRs, help health organizations achieve meaningful use

Our solution can:Our solution can:Our solution can:Our solution can:



Addressing healthcare challenges and aligning Addressing healthcare challenges and aligning with healthcare focus areaswith healthcare focus areas

• Telemedicine to extend reach of existing resource

• Remote training to increase workforce of skilled workers

• Public-private partnership with community-based health workers and health organizations

• Develop integrated health information system to streamline and monitor service delivery among partners

• Home care visit and follow-up care to reduce readmission rates

• Use electronic health records or integrate with existing health systems to achieve full digitization of health information

Budget Cuts:Lack of

Resources and Doctors

Increased insured patients

and senior population: More, sicker

patients

Penalties for readmission and delay to

digitization of health

information



Expected benefits from proposed mHealth Expected benefits from proposed mHealth solutionsolution

• Enable early detection of potentially dire diseases• Minimize time (< 3 days) to access medical experts for targeted

disease care• Save on consultation and transportation fees by minimizing clinic

visits (up to 25% savings for seniors3)

Benefits

• Increased revenue from patient retention and telemedicine consultations

• Attract more patients by offering specialty care• Reduced paper work and administrative costs (up to 25% reduction3)

• Increased revenue from patient retention and telemedicine consultations

• Attract more patients by offering specialty care• Reduced paper work and administrative costs (up to 25% reduction3)

• Increased medical capacity to treat patients and capture revenue previously on backlog

• Improved collaboration among medical experts and referring primary physicians and rural nurses

• Real-time data for expedited healthcare interventions• Enhanced health education materials from global base of health

demographics• Reduced costs from data collection and analysis

• Real-time data for expedited healthcare interventions• Enhanced health education materials from global base of health

demographics• Reduced costs from data collection and analysis

3Source: http://www.alliedhealthworld.com/visuals/smartphone-healthcare.html



Patient sees local health

provider with health issue

Health provider (health workers, nurses,

primary doctors)

uses ClickMedix to capture

appropriate patient info

Treatment Plan

Treatment and

follow-up care

Treatment Advice

Patient case

Doctors review and collaborate on case

From:Hospital Referral Centers

$

1.Links appropriate doctors and specialists2.Package data securely with time series, multi-media analysis

How It Works: mHealth telemedicineHow It Works: mHealth telemedicineconnect patients to doctors anywhereconnect patients to doctors anywhereHow It Works: mHealth telemedicineHow It Works: mHealth telemedicineconnect patients to doctors anywhereconnect patients to doctors anywhere



How to serve 10,000 more patients at lower costs?How to serve 10,000 more patients at lower costs?

Community Partners/Satellite Clinics

Hospitals

Telemedicine and remote training

Mobile phone reach to patients

Urban hospitals and medical universities

By extending the reach of scarce medical experts to provide remote diagnosis/treatment and education to community partners, who become increasingly skilled at caring and engaging end-patients.



Do more with lower-cost health workers equipped Do more with lower-cost health workers equipped with smartphones and diagnostics deviceswith smartphones and diagnostics devices

Do more with lower-cost health workers equipped Do more with lower-cost health workers equipped with smartphones and diagnostics deviceswith smartphones and diagnostics devices

Digital stethoscope: records audio sounds and send to remote doctor for diagnosis

Note: can integrate with other diagnostics devices as identified (blood pressure cuff, blood glucose meter, etc.)

Otoscope for tele-ENT

Fundus scope for tele-diabetes retinopathy screening

Dermatoscope for tele-skin cancer screening

Tele-radiology application enabling multiple doctors to review images



Home or on-the-go mHealthcare KitHome or on-the-go mHealthcare KitHome or on-the-go mHealthcare KitHome or on-the-go mHealthcare Kit

14



Health workers or nurses can use smartphones with ClickMedix to capture Health workers or nurses can use smartphones with ClickMedix to capture diagnostics and symptoms information to expedite treatmentdiagnostics and symptoms information to expedite treatment

Health workers or nurses can use smartphones with ClickMedix to capture Health workers or nurses can use smartphones with ClickMedix to capture diagnostics and symptoms information to expedite treatmentdiagnostics and symptoms information to expedite treatment

1) Measurable improvement in health outcomes

2) Reduction in time to delivery effective treatment

3) Reduction of workforce operational costs



ClickMedix system connects every step and ClickMedix system connects every step and maximizes benefits for patients and providersmaximizes benefits for patients and providers

ClickMedix system connects every step and ClickMedix system connects every step and maximizes benefits for patients and providersmaximizes benefits for patients and providers

Assess / Triage

Patient record generation via SMS and call-centers

Auto-assessment to generate leads

Diagnose / Treat

Point-of-care diagnostics

Remote diagnosis via telehealth

Treatment administered through home-visit nurses or doctors

Follow-Up / Prevent

Auto-reminders

Home-visits

Shared record with family members and doctors

Improve/Train

Aggregated data to expedite funding for intervention development

Continuous training to build medical capacity

Infectious Diseases

Mothers &

Children

Chronic Diseases



Products

Click-Education

Description

• Medical schools• Training institutions

Customers

Click-Research

•Tele-Geriatrics Certification•Tele-Home Care Certification•Mobile Telehealth Certification

Click-Health

• Primary care clinics, rural clinics• Secondary and tertiary hospitals• Telehealth centers• Home-visit health workers• Nursing homes• Patients

•Tele-Primary Care•Tele-Geriatric Care•Tele-Maternal & Pediatric Care•Home-Visit Care•Electronic health record (EHR) and device integration

•Epidemiology research•Clinical trial research

• Research organizations• Pharmaceutical companies

ClickMedix can be configured for select ClickMedix can be configured for select healthcare services or packaged solutionshealthcare services or packaged solutions

Click-Specialist

• Primary care clinics, rural clinics• Secondary and tertiary hospitals• Telehealth centers• Patients

•Tele-Dermatology•Tele-Wound Care•Tele-Radiology



• Featured Programso Harvard Massachusetts General Hospital Department of Dermatology:

Hansen’s Disease Teledermatology Screening, Trinidad & Tobagoo Grameen Health Innovations, NYC: Primary care for low-income women and

children, USAo Albert Einstein College of Medicine: Rural Health Teledermatology, Uganda

and Guatemalao Global Development Collaborative: Tele-primary care, Peruo University of Illinois at Chicago Medical Center: Teledermatology and Tele-

Wound Care, USAo China Hospital: Home-visit maternal care and geriatric care, China

ClickMedix ProgramsClickMedix ProgramsClickMedix ProgramsClickMedix Programs



• Contact:Ting Shih, CEO & Founder of ClickMedix

Email: [email protected]

Website: http://clickmedix.com

Joins in to create the future of healthcare!Joins in to create the future of healthcare!Joins in to create the future of healthcare!Joins in to create the future of healthcare!


mailto:[email protected]


http://clickmedix.com

Company Overview


• Founded and developed by MIT / Harvard / Carnegie Mellon University graduates and faculty in 2011 after 3 years of pilots in more than 10 countries

• Our Mission is to bring faster, lower-cost, and higher-quality health services to all patients regardless of income-level and household environment by connecting patients and frontline health providers to medical experts using mobile technologies.

• We are world-class technologists, public health practitioners, development activists, entrepreneurs, and business strategists to bring new sustainable and cost-effective telehealth solutions powered by mobile phones.

• Our innovative connected mobile health (mHealth) and education platform connects health service providers, reduces cost of service delivery, and optimally utilizes tiers of existing health system for patient care. A community health-worker or a clinic nurse with a Click-enabled mobile phone is able to act as the primary agent for quality healthcare delivery.

ClickMedixClickMedixClickMedixClickMedix


International DeploymentsInternational DeploymentsInternational DeploymentsInternational Deployments

Geriatric and

Chronic Diseases

Maternal and Child

Health

Infectious Diseases


Clients/Partners

Services PopulationReach

Click-Health: geriatric care, maternal/pediatric care

Click-Specialist: dermatology

420,000

Click-Specialist: dermatology, pre/post surgery, cervical cancer Screening

100,000

Click-Health: diabetes/nutrition study, TB surveillance, HIV+ staging

Click-Education: maternal and pediatric care, tele-geriatrics certification

90,000

Clinics / hospitals

Governments

Research Institutions and medical schools

43

3

3

Our Customers (International)Our Customers (International)Our Customers (International)Our Customers (International)


Outcomes of using ClickMedix Outcomes of using ClickMedix implementationsimplementations

Outcomes of using ClickMedix Outcomes of using ClickMedix implementationsimplementations

• Government health departments- Government of Botswana saves 500K USD annually on transportation alone- Less crowding in hospitals and increased capacity to see more patients through remote

consulting doctors• Non-government health organizations

- Saves 2-5 personnel resources from digitizing paper-forms while getting real-time data and auto-generated reports

• Health providers- Additional revenue by enabling tele-consultation with remote specialists while providing

better treatment to patients• Community health workers

- Increased efficiency (e.g. more patients visited) due to time-savings from filing paper reports

• Patients- Faster treatment (days instead of months)- Eliminated unnecessary travels (saved on transportation and loss of wage)

• Medical schools & research institutions- Enhanced education through access to real-patient cases and consult responses- Enhanced international reach of patients and network of other medical experts- Real-time research data collection and analysis


• Witnessed rapid improvements in patient health when a remote expert/specialist is involved to provide diagnosis and treatment advice for symptoms unfamiliar to local health practitioners

• Medical Expert = health practitioner who specializes in treatment of particular diseases and can quickly recognize associated symptoms

• Some patients who otherwise would need to wait for months or even years to see an expert/specialist received effective treatment within 72 hours via remote consultation

• 100% patients accepted mobile-phone usage of capturing symptoms information including images when used by health practitioners

• Training health practitioners to use mobile phones took an hour or less• In-country health practitioners including health workers liked the “novelty” of

using mobile phones for data collection• In-country health practitioners felt empowered to treat their own patients

through advice of remote experts/specialists • Cost savings realized through reduction of transportation costs and increased

ability to serve more patients without increasing staff

Lessons LearnedLessons LearnedLessons LearnedLessons Learned


Deployments: USDeployments: USDeployments: USDeployments: US

Client/ Partner Problem Statement Reach (2011) Improvements

American Academy of DermatologyTele-dermatology for university-affiliated and federally-fundedClinics (2010)

• Lack of dermatologists (3:100,000 patients)

• On average, county clinic shave 600-1,000 backlog of patients needing dermatology diagnosis

• Cost of care is prohibitive for patients to seek dermatological care

• Cost of hiring dermatologist for government clinics/hospitals are prohibitive to having enough dermatologists for the patient population

Current:• 162K population coverage• 140 clinic GPs (general

physicians) and nurses trained

• 30dermatologists trained• 27 clinics• 10 cities in the USScale up plan: Increase # of clinics using

service by at least 100%

• Reduced triage and treatment time from months to <72 hrs

• Reduced referral scheduling time from average 6 months to < 3 weeks

• Reduced time for medical resident to seek attending approval from days to < 24 hrs

California state medical centerTele-dermatology for US city medical hospitals and 7 clinics (2010)

Current:• 22K population coverage• 120 clinic GPs (general

physicians) and nurses trained

• 3dermatologists trained• 1 hospital, 7 clinics

• Reduced backlog from 500 to almost 0 in 3 months



University of Illinois Telehealth Center for 5000+ state clinics teledermatology Consultation (2011)

Current:• 5M population coverage• 5,000 clinic GPs (general

physicians) and nurses being trained

• Deployment in progress

United StatesUnited StatesUnited StatesUnited States


Deployments: Africa and CaribbeanDeployments: Africa and CaribbeanDeployments: Africa and CaribbeanDeployments: Africa and Caribbean

Client/ Partner Problem Statement KPIs: Reach (2011)

Improvements

Botswana Ministry of Health

•Mobile tele-dermatology•Mobile tele-pre/post oral surgery•Mobile tele-radiology•Mobile cervical cancer screening(2009-11)

• Lack of medical doctors (1 surgeon, 1 dermatologist, 5-10 radiologists for the country’s public health system)

• High costs of travel and logistics to treat patients and manage health staff

• Inefficient reporting and monitoring mechanism

• 120K population by 20 rural GPs

• 6 current GP

• Reduced triage time from months to < 72 hrs• Reduced treatment time from months to days• Reduced transportation cost to ~500K/year (USD)• Reduced time to seek foreign second opinion from 6-12

months to < 24 hrs• Reduced data reporting time from months to minutes• Reduced personnel hours spent on reporting and

analysis

Uganda Kisoro Hospital

Mobile tele-dermatology(2011-12)

• Lack of medical doctors (1 primary physician)

• No Internet availability• No electronic record

system

• 10K population • Reduced triage time from months to < 72 hrs• Reduced treatment time from months to days• Eliminated transportation costs

Egypt Ministry of Health


• Inconvenient travel by patients to seek specialist care

• Long wait time to see specialist

• Lack of specialists in remote areas

• 10K population by 20 rural clinicians (GPs, nurses)

• 5 current GPs

• Demonstrated in-person and remote diagnosis concordance of > 70%

• Reduced triage time from months to < 72 hrs• Reduced treatment time from months to days• Reduced time to seek foreign second opinion from 6-12

months to < 24 hrs• Reduced data reporting time from months to minutes• Reduced personnel hours spent on reporting

AfricaAfricaAfricaAfrica


Deployments: Africa and CaribbeanDeployments: Africa and CaribbeanDeployments: Africa and CaribbeanDeployments: Africa and Caribbean

Client/ Partner Problem Statement KPIs: Reach (2011)

Improvements

Guatemala District

Hospital


• Lack of medical specialists

• High costs of travel and logistics to treat patients and manage health staff

• 50K population by 5 rural clinicians (GPs, nurses)

• 1 current GP

• Reduced treatment time from months to < 72 hrs

• Reduced time to seek foreign second opinion from 6-12 months to < 24 hrs

• Reduced data reporting time from months to minutes

Guatemala Mayan Medical Aid Clinic


• No trained dermatologist

• 20K population by general physicians and nurses

• Reduced treatment time from months to < 72 hrs

• Reduced time to seek foreign second opinion from 6-12 months to < 24 hrs

Trinidad DistrictHospital


• No trained dermatologists to assist in early screening of highly prevalent Hansen’s Disease

• 10K population by general physicians and nurses

• Increased detection of Hansen’s Disease• Enabled early treatment of identified patients

CaribbeanCaribbeanCaribbeanCaribbean


Client/ Partner Problem Statement KPIs: Reach (2011) Improvements

St. Luke’s Medical Center


• Lack of dermatologists• Rural clinics have significant

backlog of patients needing dermatology diagnosis

• Travel logistics often prevents patients from seeking dermatological care

• Costs of hiring dermatologist are prohibitive to having enough dermatologists for the patient population

• 125K population coverage

• 2 dermatologists trained



Caloocan City

Mobile tele-maternal health(2011-12)

• Low utilization rates of pre-natal services in urban poor communities

• 1,000 pregnant women by 200 CHWs

• 5 current CHWs

• Improved mothers’ knowledge in maternal care

• Improved utilization of pre-natal services in urban-poor communities

• Improved maternal and child outcomes among pregnant women

Society for Nutrition, Education & Health Action (SNEHA)

Mobile tele-maternal and child health (2012)

• Lack of general population knowledge about maternal and child care

• 200 population coverage

• Real-time population data collection for mothers and newborns

• Early detection of treatment needs for mothers and newborns

AsiaAsiaAsiaAsia

extending us healthcare capacity with clickmedix

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