Extending US Healthcare Capacity with ClickMedix

Solution for Healthcare Providers: Do more, with less.

Mobile Health and Education Delivery System

Ting Shih, CEO & Founder
ting@clickmedix.com
http://clickmedix.com

Challenge: Do more, with less $
• 32 Million more Americans would become insurance beneficiaries
including1:
o Children with pre-existing conditions
o By 2014, anyone with preexisting health problems can obtain insurance
o Medicaid expands to 133% of poverty level
o 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

Sources
1 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/

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

New Healthcare Delivery Model: ACOs
• Budgets for health providers forming ACOs based on patient outcomes
o Rewards for cost-savings achieved
o Penalties for costs exceeding budget

1
Source: 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/


Dealing with Budget Cuts:
Louisiana State Example
• 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

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


Solution:
Mobile 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 conditions

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


Primary 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 for
o Chronic diseases (Cardiovascular, diabetes)
o Maternal/child health care
o Cancer screening services


Our solution can:

• 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 workers
o Each doctor manages 10 nurses
o Each nurse manages 10 health workers
o 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

Addressing healthcare challenges and aligning
with healthcare focus areas

Increased Penalties for
Budget Cuts: insured patients readmission
Lack of and senior and delay to
Resources and population: digitization of
Doctors More, sicker health
patients information

• Public-private
partnership with • Home care visit and
• Telemedicine to community-based follow-up care to
health workers and reduce readmission
extend reach of
health organizations rates
existing resource
• Develop integrated • Use electronic health
• Remote training to
health information records or integrate
increase workforce
system to streamline with existing health
of skilled workers systems to achieve
and monitor service
delivery among full digitization of
partners health information


Expected benefits from proposed mHealth
solution
Benefits
• 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)

•• Increased revenue from patient retention and telemedicine
Increased revenue from patient retention and telemedicine
consultations
consultations
•• Attract more patients by offering specialty care
Attract more patients by offering specialty care
•• Reduced paper work and administrative costs (up to 25% reduction3))
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
Real-time data for expedited healthcare interventions
•• Enhanced health education materials from global base of health
Enhanced health education materials from global base of health
demographics
demographics
•• Reduced costs from data collection and analysis
Reduced costs from data collection and analysis
3
Source: http://www.alliedhealthworld.com/visuals/smartphone-healthcare.html

How It Works: mHealth telemedicine
connect patients to doctors anywhere

$

Patient Doctors review and
case
collaborate on case

Patient sees Health provider 1.Links appropriate
local health (health workers, nurses,
doctors and specialists From:
primary doctors)
provider with 2.Package data securely
uses ClickMedix to Hospital Referral
health issue with time series, multi- Centers
capture
appropriate media analysis
patient info
Treatment Treatment
Treatment
and
Plan Advice
follow-up
care


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

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

Community Partners/
Satellite Clinics
Hospitals

Telemedicine and
remote training

Mobile phone
reach to patients

Do more with lower-cost health workers equipped
with smartphones and diagnostics devices
Note: can integrate with other diagnostics devices as identified (blood
pressure cuff, blood glucose meter, etc.)

Digital stethoscope: records audio sounds and
Otoscope for tele-ENT
send to remote doctor for diagnosis

Fundus scope for tele-diabetes retinopathy
screening
Tele-radiology application enabling multiple
doctors to review images

Dermatoscope for tele-skin cancer
screening


Home 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 treatment
diagnostics 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
maximizes benefits for patients and providers

Assess /
Triage
Mothers
& Patient
Children record
generation Diagnose /
via SMS and Treat Follow-
call-centers Up /
Point-of-care Prevent
Infectious Auto- diagnostics Improve/Train
Diseases assessment Auto-
to generate Remote reminders Aggregated data to
leads diagnosis via expedite funding for
telehealth Home-visits intervention
development
Treatment Shared
Chronic
administered record with Continuous training
Diseases
through home- family to build medical
visit nurses or members capacity
doctors and doctors


ClickMedix can be configured for select
healthcare services or packaged solutions
Products Description Customers

•Tele-Primary Care • Primary care clinics, rural clinics
•Tele-Geriatric Care • Secondary and tertiary hospitals
Click- •Tele-Maternal & Pediatric Care • Telehealth centers
Health •Home-Visit Care • Home-visit health workers
•Electronic health record (EHR) • Nursing homes
and device integration • Patients
• Primary care clinics, rural clinics
•Tele-Dermatology
Click- • Secondary and tertiary hospitals
•Tele-Wound Care
Specialist • Telehealth centers
•Tele-Radiology
• Patients
•Tele-Geriatrics Certification
Click- • Medical schools
•Tele-Home Care Certification
Education • Training institutions
•Mobile Telehealth Certification

Click- •Epidemiology research • Research organizations
Research •Clinical trial research • Pharmaceutical companies

ClickMedix Programs

• Featured Programs
o Harvard Massachusetts General Hospital Department of Dermatology:
Hansen’s Disease Teledermatology Screening, Trinidad & Tobago
o Grameen Health Innovations, NYC: Primary care for low-income women and
children, USA
o Albert Einstein College of Medicine: Rural Health Teledermatology, Uganda
and Guatemala
o Global Development Collaborative: Tele-primary care, Peru
o University of Illinois at Chicago Medical Center: Teledermatology and Tele-
Wound Care, USA
o China Hospital: Home-visit maternal care and geriatric care, China


Joins in to create the future of healthcare!

• Contact:
Ting Shih, CEO & Founder of ClickMedix
Email: ting@clickmedix.com
Website: http://clickmedix.com


Company Overview

http://clickmedix.com

ClickMedix
• 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.


International Deployments

Geriatric
Maternal and
Infectious
and Child Chronic
Diseases
Health Diseases


Our Customers (International)

Clients/ Services Population
Partners Reach
Clinics / hospitals Click-Health: geriatric care, 420,000
maternal/pediatric care
43 Click-Specialist: dermatology

Governments Click-Specialist: dermatology, 100,000
pre/post surgery, cervical cancer
3 Screening

Research Institutions Click-Health: 90,000
and medical schools diabetes/nutrition study, TB
3 surveillance, HIV+ staging
Click-Education:
maternal and pediatric care, tele-
geriatrics certification

Outcomes of using ClickMedix
implementations
• 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


Lessons Learned
• 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


United States
United States
Client/ Partner Problem Statement Reach (2011) Improvements

American Academy • Lack of dermatologists Current: • Reduced triage and treatment time
of Dermatology (3:100,000 patients) • 162K population coverage from months to <72 hrs
Tele-dermatology for • On average, county clinic • 140 clinic GPs (general • Reduced referral scheduling time from
university-affiliated and
federally-funded
Deployments: US
shave 600-1,000 backlog of
patients needing
physicians) and nurses
trained
average 6 months to < 3 weeks
• Reduced time for medical resident to
Clinics (2010) dermatology diagnosis • 30dermatologists trained seek attending approval from days to
• Cost of care is prohibitive • 27 clinics < 24 hrs
for patients to seek • 10 cities in the US
dermatological care Scale up plan:
• Cost of hiring dermatologist Increase # of clinics using
for government service by at least 100%
California state clinics/hospitals are Current: • Reduced backlog from 500 to almost 0
medical center prohibitive to having • 22K population coverage in 3 months
Tele-dermatology for US enough dermatologists for • 120 clinic GPs (general • Reduced triage and treatment time
city medical hospitals the patient population physicians) and nurses from months to <72 hrs
and 7 clinics (2010) trained • Reduced referral scheduling time from
• 3dermatologists trained average 6 months to < 3 weeks
• 1 hospital, 7 clinics
University of Illinois Current: • Deployment in progress
Telehealth Center for • 5M population coverage
5000+ state clinics • 5,000 clinic GPs (general
teledermatology physicians) and nurses being
Consultation (2011) trained


Africa
Africa
Client/ Partner Problem Statement KPIs: Reach Improvements
(2011)
Botswana • Lack of medical doctors • 120K
(1 surgeon, 1 population by
•
•
Reduced triage time from months to < 72 hrs
Reduced treatment time from months to days
Ministry of dermatologist, 5-10 20 rural GPs • Reduced transportation cost to ~500K/year (USD)
Health radiologists for the • 6 current GP • Reduced time to seek foreign second opinion from 6-12

•Mobile tele-
Deployments: Africa and Caribbean
country’s public health
system)
months to < 24 hrs
• Reduced data reporting time from months to minutes
• High costs of travel and • Reduced personnel hours spent on reporting and
dermatology
logistics to treat analysis
•Mobile tele-pre/post
patients and manage
oral surgery
health staff
•Mobile tele-radiology
• Inefficient reporting
•Mobile cervical cancer
and monitoring
screening
mechanism
(2009-11)

Uganda Kisoro • Lack of medical doctors • 10K population
(1 primary physician)
• Reduced triage time from months to < 72 hrs
• Reduced treatment time from months to days
Hospital • No Internet availability • Eliminated transportation costs
• No electronic record
Mobile tele-dermatology system
(2011-12)
Egypt Ministry • Inconvenient travel by • 10K population • Demonstrated in-person and remote diagnosis
patients to seek by 20 rural concordance of > 70%
of Health specialist care clinicians (GPs, • Reduced triage time from months to < 72 hrs
• Long wait time to see nurses) • Reduced treatment time from months to days
Mobile tele-dermatology specialist • 5 current GPs • Reduced time to seek foreign second opinion from 6-12
(2008-2011) • Lack of specialists in months to < 24 hrs
remote areas • Reduced data reporting time from months to minutes

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

Guatemala • Lack of medical • 50K • Reduced treatment time from months to < 72
specialists population by hrs
District • High costs of travel 5 rural • Reduced time to seek foreign second opinion
Hospital
Mobile tele-dermatology
Deployments: Africa and Caribbean
and logistics to
treat patients and
clinicians from 6-12 months to < 24 hrs
(GPs, nurses) • Reduced data reporting time from months to
manage health staff • 1 current GP minutes
(2010-11)

Guatemala • No trained • 20K • Reduced treatment time from months to < 72
dermatologist population by hrs
Mayan Medical general • Reduced time to seek foreign second opinion
Aid Clinic physicians from 6-12 months to < 24 hrs
and nurses
Mobile tele-dermatology
(2011-12)

Trinidad District • No trained • 10K • Increased detection of Hansen’s Disease
dermatologists to population by • Enabled early treatment of identified patients
Hospital assist in early general
Mobile tele-dermatology screening of highly physicians
(2011-12) prevalent Hansen’s and nurses
Disease


Asia

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

St. Luke’s • Lack of dermatologists
Rural clinics have significant
• 125K population
coverage
• Reduced triage and treatment time
from months to <72 hrs
•
Medical Center backlog of patients needing • 2 dermatologists • Reduced referral scheduling time from
dermatology diagnosis trained average 6 months to < 3 weeks
Mobile tele-dermatology • Travel logistics often prevents
(2011-12) patients from seeking
dermatological care
• Costs of hiring dermatologist are
prohibitive to having enough
dermatologists for the patient
population
Caloocan City • Low utilization rates of pre-natal
services in urban poor
• 1,000 pregnant women
by 200 CHWs
• Improved mothers’ knowledge in
maternal care
communities • 5 current CHWs • Improved utilization of pre-natal
Mobile tele-maternal
services in urban-poor communities
health
• Improved maternal and child
(2011-12)
outcomes among pregnant women

Society for Nutrition, • Lack of general population • 200 population • Real-time population data collection
Education & Health knowledge about maternal and coverage for mothers and newborns
child care • Early detection of treatment needs for
Action (SNEHA)
mothers and newborns

Mobile tele-maternal
and child health (2012)


Extending US Healthcare Capacity with ClickMedix

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