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Satelite Medical Clinic with Cost-Effectiveness

By WooYoung Lee | 16 Apr, 2015

Shortages of physicians have appeared in a number of developing countries. It seems likely that these shortages could worsen in some countries over the next two decades, as a result of rising demand for, and falling supply of, physicians, unless countermeasures are taken quickly.
My project is to establish sustainable primary care clinics at the underdeveloped countries ( Physician Density per 1000 population < 0.9 ) and connect them with the hospital through mHealth.
The savings from the underdeveloped country reorganization may not be substantial enough in the developed country’s currency unless it is at a very large scale.
But I think we can make sustainable and cost-effective medical clinic through wireless technology, standardized patient categorization, triage according to acuity of symptom and task shifting from physician to nurses.
And I study reimbursement model for this clinic sharing in savings over anticipated cost like Accountable Care Organization.
This would be the sustainable role model run by its own profit to help the underdeveloped country.
I hope to have the privilege to ask for your wisdom as a innovator.

Best regards
WooYoung Lee,MD



A/Prof. Terry HANNAN Moderator Replied at 11:15 PM, 16 Apr 2015

Woo, your posting raises in my mind ideas on how we 'focus' health care. There is no doubt the presence of "physicians" in health care delivery is critical but not always essential. Access to them or other knowledge resources is important however technologies now and in the future will allow those on the ground, nurses, nurses aides, other health care workers and PATIENTS to manage health care "without the doctor".
Focussing on the "reimbursement" model for service delivery in health care in my mind perpetuates many of the existing problems with health care delivery in ALL nations.
As Warner Slack of Harvard Centre for Clinical Computing stated, "medicine is not a business, out business is clinical care".
I am aware that I have posted this short story before, told to me by one of the fathers of health informatics Prof L Weed however it can never be read too many times.
Also worthwhile reading in addition to the postings below is Erik Topol's "The Patient Will See You Now"
In the latter regard, I remember the day in a medical centre on a ward with a modern information system when they wanted to present a patient to me on rounds.
I said “ Do not present a new patient: tell me who is going home today”.
The nurse volunteered the name of a middle-aged woman who had Lupus for 10 years. I suggested that they give me 15 minutes with the patient and then they could return for discussion.
I asked the patient to tell me all about each of her problems. She knew very little about the medical problems.
“ Do you have a copy of your own medical record?”
“ Are all your medications in your bedside stand, and does the nurse come around at regular intervals to see if you are taking the right ones at the right time?”
“No. The nurse just comes with little paper cups with pills in them, and I swallow whatever is there.”
“ Do you know what a flow sheet is – what parameters we are trying to follow – what end points we are trying to reach?”
At this point I called the staff back together and told them what I had found. Their reactions were:
“ We never give patients their records.”
“ We do not have time to give the medicines that way.”
“ It would not be safe to leave them her with them unattended- she is on many powerful drugs.”
“ The patient is not very well educated and I do not think she could do all the things your questions imply.”
I then said:
“ But you said she is going home this afternoon. She lives alone. At 2 PM you will put her in a wheelchair, give her a paper bag full of drugs, and send her out the door. Are you going home with her?”
“ No. Is her management at home our problem?”
“ You just said she could not handle it – who will do it?”
“ The patient may not seem well educated or very bright to you, but what could be more unintelligent than what we are doing?”
We must think of the whole information system, and not just infinitely elaborate on the parts that interests us or fit into a given specialty. Patients do not specialize, and they or their families are in charge of all the relevant variables 24 hours a day, every day. They must be given the right tools to work with. They are the most neglected source of better quality and savings in the whole health care system. After all:
1. They are highly motivated, and if they are not, nothing works in the long run anyway.
2. They do not charge. They even pay to help.
3. There is one for every member of the population.”

Attached resources:

Paul Gonza Replied at 12:40 AM, 17 Apr 2015

Hello Prof. Terry,

Thank you for invaluable inputs into this discussion. Your observations are factual almost everywhere. Most of us healthcare workers are closed to the subject of "Quality and Safety in Healthcare." It is not uncommon to hear healthcare workers blame patients failing on anti-retroviral (ARV) drugs on the basis of their educational background. We tend to imply that those with less education are more likely not to pay attention to their health problems and are highly unlikely to follow instructions especially in treatment of diseases using the chronic care model. My observation has been to the contrary, highly educated patients are more problematic as far as adherence to HIV/AIDS medicines is concerned compared to less educated patients. The so called "patients with low education level" once given information about their condition and reasons why they need to adhere often times follow the physicians advise.

Hilde Eugelink Replied at 3:20 AM, 17 Apr 2015

Dear WooYoung Lee,

We have experience in Mali strengthening radiology capacity in rural
hospitals by introducing a telemedicine platform allowing consultation of
peers (radiologists in university hospitals) and professional learning.
Though the technology in itself was relatively simple, the way it was
developed and its impact is encouraging to further invest in telemedicine.

An article on the impact our our telemedicine model was recently published
in the Journal for Telemedicine and eHealth


With better infrastructure, new diagnistic software coming up on the market
and availability of clinic decision making applications, I would see it is
certainly feasible and also possible to develop a good business model for
this concept.

best regards,

Hilde Eugelink

with kind regards / met vriendelijke groet, Hilde Eugelink Sector
Developer Health / Community Relations International Institute for
Communication and Development (IICD) P.O. Box 11586, 2502 AN The Hague, The
Netherlands Visitors: Raamweg 5, 2596 HL, The Hague, The Netherlands Phone:
+31 (0)70 311 7311 Fax: +31 (0)70 311 7322 Skype: Heugelink Follow us:

A/Prof. Terry HANNAN Moderator Replied at 4:37 AM, 17 Apr 2015

Hilde, is this project part of Antoine Geissbuhler's work in Mali? Terry

Hilde Eugelink Replied at 4:49 AM, 17 Apr 2015

No, but we have worked with him on another RAFT project in Mali. We know
him quite well!

with kind regards / met vriendelijke groet, Hilde Eugelink Sector
Developer Health / Community Relations International Institute for
Communication and Development (IICD) P.O. Box 11586, 2502 AN The Hague, The
Netherlands Visitors: Raamweg 5, 2596 HL, The Hague, The Netherlands Phone:
+31 (0)70 311 7311 Fax: +31 (0)70 311 7322 Skype: Heugelink Follow us:
www.iicd.org - facebook.com/iicd.org - twitter.com/iicd

*People - ICT - Development*

Working on Mo, Tue, Thu, Fri

Jossy Onwude, MD Replied at 8:17 AM, 17 Apr 2015

I certainly agree with you about the shortage of doctors across the globe.
There are many proposals on ways to solve this problem and yours is one of
them.I love it and feel it would work. I went another way towards solving
this problem by identifying med school dropout due to finance or lack of
interest in med school due to finance as a major contributor towards this
doctors shortage problem. Two years ago, I built a crowdfunding
platform that helps fund medical students in need to finance but it didn't
work out well because no one wants to just give away money to this students
and would rather loan them. So am currently working on a lending/loaning
platform for medical students with plans to include other health profession
students with the aim of solving the global health workers shortage
problem. If you find this project interesting and would like to talk more
about it or know how you can help, please reach out to me. By the way, this
is totally non profit.

Jossy Onwude
Medical Intern

Joaquin Blaya, PhD Moderator Replied at 11:13 AM, 17 Apr 2015

Both of these sound like great ideas and perhaps we could think about
setting up an expert panel to address how to help in implementing them.

As far as the telemedicine, my limited experience in that area is that it's
usually the funding model that makes or breaks a project. If for example
the national health insurance covers a telemedicine visit then projects
flourish much quicker. If on the other hand there is little insurance
coverage or financial sustainability from other sources then these projects
tend to end after the pilot phase.

For the loan project, I think this is a great idea, here in Chile we have a
crowd loan program called cumplo.cl which had an online platform for people
to loan money to others. They built their platform from scratch but being a
social business they might be able to share their experiences or even their
platform. I can ask them if you think it might be worthwhile.


chris macrae Replied at 1:09 PM, 17 Apr 2015

My neighbour in washington DC owns the learning satellite www.yazmi.com -it has common frequency across nations represnting 5 billion people in asia and africa We would really like to brainstorm this can help in the sorts goals ghd stands for

Ironically the problem is finding what content would be most used in context of preferential option poor health service -in other words cost pf developing satellite elearning content (and its interface wit real trainingmodes) for prjoect wiht small audience and big training base across africa and asia is almost the same

Elizabeth Glaser Replied at 3:57 PM, 18 Apr 2015

Chris , I had never heard of Yazmi until now. It is very interesting idea. Do you know of anyone governments or NGO actively using this systems for remote learning?

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