Intehealth - A digital health expert

Problem: The COVID-19 pandemic has put an enormous strain on healthcare facilities and the public health infrastructure. Telemedicine has emerged as an important innovative solution for service delivery to non-critical COVID cases, which in turn support to decongest the facilities, to lower the bed occupancy rate at COVID facilities and to provide essential services to the critical patients in need.

Solution: Our aim is to create a telehealth network that connects Health and Wellness Centers or Spokes, with a nodal Medical college, or Hub, to deliver essential health services related to COVID and essential health services like ANC care, child health, first aid etc. 

How are we changing the lives? Our objective is that everyone deserves access to good quality healthcare that is ethical, evidence-based and dignified. And that is what Intelehealth is all about. We want to improve access to ethical, evidence-based, dignified, good quality healthcare for the poor.

WHO estimates that over 3.8 billion people, or half the world’s population, lack access to essential medical care. For remote and rural communities, poor geographical and financial access coupled with a lack of health education creates an accumulated disease burden. In order to receive care, rural patients turn to local “quack” doctors and faith healers, most of whom do not even have basic secondary education. Otherwise, they have to travel long distances to the nearest town or city to see a doctor, spending significant time and money doing so. Due to the delay in care seeking, conditions often go undiagnosed in the early stages and require expensive tertiary care as they progress. Approximately 100 million people in low and middle income countries are tipped into extreme poverty each year because of such health-related expenses. With the increasing availability of mobile networks and mobile internet even in remote areas we now have new opportunities to provide healthcare. Telemedicine provides an opportunity by connecting doctors in urban areas to patients in rural areas to provide healthcare.

Intelehealth is an intelligent technology platform that delivers comprehensive primary care to these underserved remote locations. The technology enables frontline health workers (FHWs) like nurses, doctors and community health workers, to provide health care services like screening, teleconsultation, and telemedicine, assist with treatment plan counseling on medication and tests, appropriate referrals to hospitals, health education & awareness and financing support. At the core of our approach is a novel digital assistant and knowledge engine (Ayu) that contains evidence-based protocols for delivering high-quality health services and improved patient outcomes. This is a history taking and baseline screening examination tool. This stretches to 79 conditions and 143 basic examinations. This reduces training and knowledge requirements of remote health workers. FHWs are well trained in basic clinical examination by their basic training. They have tools and equipment to perform basic clinical examinations and even some investigations like RBS using glucometer and Hb using hemoglobinometer. They can provide first aid care and connect patients to remote doctors for tele-consultations.

Dashboard is also available using which we can monitor functioning of each unit and data can be compiled and collected for many purposes like planning, research etc.

Our solution is benefiting the last mile population living in rural areas of the country by providing quality healthcare to marginalised & vulnerable communities.

Through a research study conducted in our model deployment in Odisha, India along with Johns Hopkins Center for Bioengineering Innovation and Design we have been able to demonstrate the following,

1. An average of 3.5km in distance saved for travel per health visit.

2. An average of 6.5 hours time saved per health visit for consultation. Doctors are not available at all CHCs and Hospitals. Even when they are available, they can be busy with surgery, procedure, deputations, VIP convoys etc. So, for getting consultation, one visit may not suffice. Again, if you have reached within reasonable time, you get consulted but the wait is long.

3. An average of INR 750 cost saved per health visit. Cost of travel, loss of wages, cost incurred for food and refreshment at the city, cost of an accompanying person etc. are also tremendous, even if consultation is free.

As Covid pandemic spreads to rural areas, India is facing a looming crisis. The rural populations have always had weak access to health services. Our application provides health services to those who are not able to receive healthcare services due to lockdown situations.

We provide free and equitable access to health services for prevention and treatment of diseases.Post-outbreak period, these communities will have to face increased malnutrition, maternal & child mortality, communicable and non communicable disease burden. We provide them with ethical evidence-based and dignified health services for their continued wellbeing during this pandemic and beyond.

Intelehealth is a free & open source digital health platform that empowers frontline health workers (FHWs) to provide a suite of essential primary health services in hard-to-reach areas. It has a chat-based digital assistant called Ayu (like Alexa for FHWs) to guide FHWs in providing basic health services autonomously. For complex cases it can connect them over low bandwidth networks with on-demand remote doctors for a teleconsultation. Ayu (previously called HxGuide) is a programmable rules-based engine with protocols developed at Johns Hopkins University.We've partnered with health organizations in tribal areas in India and conflict affected communities in Philippines & Syria to deploy our tech through their FHWs. We provide tech,training and implementation support while the partner provides staff, local expertise and community reach. This novel telemedicine platform with a digital assistant greatly augments the scope & quality of health services as compared to traditional community health programs delivering better patient outcomes.

The core technology that powers Intelehealth is OpenMRS & Android platform. OpenMRS is a Medical Record System platform and we are using it as a backend technology where we are storing data & Android is a mobile operating system we used it for our Intelehealth app. Both technologies are connected with each other.

The Intelehealth platform helps in the integration of digital assistants and telemedicine into the health delivery system in communities, hence improving the access to quality primary health care. Organisations that used Intelehealth were able to save their beneficiaries time, distance and money resulting in better health-seeking behaviour and an overall improvement in health outcomes. We’ve been able to show,

• >70% reduction in distance traveled to access primary care

• >75% reduction in time taken to access primary care

• Approximately 60% reduction in the average spend to access basic primary care

Publicly available evidence

• Efforts For Good: “This Healthcare Model From Tribal Odisha Has Been Replicated In Philippines & Syria”

• Yourstory: “Meet the 8 tech non-profits working to solve real-life problems and improve people’s lives”

• Economic Times: “N/Core tech picks up eight nonprofit startups to incubate”

• Techcircle: “N/Core incubator selects 8 tech non-profits for Cisco-backed programme”

• One of the 20 Best Startups in Baltimore right now - Technical.ly Baltimore

• Winner of the “Startup Award” - 2017 EndPoverty awards by the Social Ventures Foundation.

• CNN Tech: "Rural Indian villages are about to get lifesaving treatment through an app"

• Insight (a Johns Hopkins Newsletter): "Telemedicine Startup Connects Patients and Doctors in Rural India"

The Intelehealth app assists FHWs with an intelligent clinical guidance system. The assistant has evidence-based protocols for, (1) clinical decision support to task-shift essential health services that can be managed autonomously by the FHW & (2) guidance protocols for patient screening eliciting detailed signs & symptoms for sharing & collaborating with a remote physician to support in decision-making for diagnosis and management of cases that are beyond their level of training or support. The assistant, its protocols and telesupport are what differentiate us from other solutions such as Medic Mobile, Sana, OpenSRP and other digital health apps. Patients in hard to reach populations have diverse health needs including communicable & non-communicable diseases, maternal & child health, etc. Our platform's protocols allow a health program to train & deploy its health workers to provide many more services through deploying health-domain specific modules from the digital assistant.

This theory of change was developed over years of research, implementation and iteration. The project began as a research project at the Johns Hopkins University Center for Bioengineering Innovation and Design. Its implementation has been further refined through pilot projects in multiple geographies like India, Philippines. Haiti and Syria demonstrating the global applicability of the solution.

Current number of people served: 555,000 

No. of people served in one year: 1,695,000 

No. of people served in 5 years: 20,000,000 

With the Solver funding, we would be able to replicate our solution in low & middle income countries that has poor access to quality healthcare services. We will provide training on the use of the telemedicine app to the health personnel as well as the community health workers. We will enhance the health information system of the country and incorporate the telemedicine into the system of the Department of Health so that its operation/ implementation costs would be included in the annual budget of the department.  

If we would also be granted with more funding, then we would be able to implement the solution in more than one country, train more health personnel and increase our reach to 100,000 patients in one year. The frontline workers would be able to reach out to other members of the population, which will bring our indirect beneficiaries to an estimated 1 Million individuals. With full funding for 5 years, we could reach as much as % Million individuals. 

Since the solution will also be able to respond to the need for implementing measures to prevent the spread of COVID such as social distancing and virtual transactions, we see this model replicated in high risk areas where we operate. The solution has the potential to be the "new norm" in providing primary health care. 

The COVID pandemic might be the greatest barrier yet in achieving the kind of impact that we want as far as the solution is concerned. The effect of the pandemic is on our capacity as an organisation to cope with the sudden changes in the way things have to be done.

Another major barrier would be the poor communications infrastructure in the area of project implementation. Some of the functions on the system is dependent on internet connectivity and right now, connectivity is poor in few project sites.

At Intelehealth, we have developed a mobile app & website called as InteleSafe for frontline health workers to keep them safe while they are on the job to continue healthcare services in rural communities.It is developed to provide vetted information to help healthcare workers by providing training in proper PPE use as well as infection control practices using eLearning modules. Intelehealth has recently drafted long-term solutions in response to the need for adjusting the organisations "way of doing things" to the new normal brought about by the COVID pandemic. Along with Intelehealth's new strategic direction of generating new or added value to our patients and ensuring sustainability by prudent fiscal management, Intelehealth will implement new strategies to ensure the continued survival of the organisation. One, Intelehealth will continue and enhance access to healthcare work but develop new solution for COVID 19 recovery, redesign projects to be "COVID-proof" and strengthen community partnerships to implement projects following strict social distancing and other related measures. Intelehealth will immediately pursue organizational strengthening measures to withstand pandemics or similar events that would compromise our capacities and resources.  

To minimize the effects of changes in the leadership at the national and local level, we will ensure that policies and systems are in place in the Local Government Unit. This means advocating to the current administration to enacted policies that would ensure the continuity of the program and incorporating the strategies of the project into the plans of the health sector. 

Our team consists of 11 full time resources and 2 part time resources. This 13 member team is supported by 10 volunteers who will spend 2 hours per day on app development work.

We have experience working with Governments and NGOs for implementing successful telemedicine and digital health programs at the primary healthcare level in India, Philippines, Kyrgyzstan and Syria. Through our programs we have been able to demonstrate,

● Improvement in patient outcomes - 95% of patients reported an improvement in health status

● Patient compliance with medications - 61% of patients fully complied with treatment, 37% had

partial compliance (which is comparable to in-person care)

● Reduction in time, distance and money to access care -

○ >70% reduction in distance traveled to access primary care

○ >75% reduction in time taken to access primary care

○ Approximately 60% reduction in the average spend to access basic primary care

● Improvement in health access for vulnerable populations - 69% patients are women, 70% belong

to the scheduled tribe and scheduled castes, 99% are below the poverty line and 60% do not

have formal education.

● Patient satisfaction with care received - 4.3 out of 5

● Recognized by Niti Aayog & Invest India as a winner of the MyGov COVID-19 solutions challenge

We partner with local NGOs, hospital groups, healthcare organizations and State Governments in order to distribute the platform and reach the communities we want to serve. 

• Johns Hopkins Center for Bioengineering Innovation and Design to provide evidence-based protection advice curated by a team of experts.

• Peery Foundation, Mulago Foundation for piloting the solution and using their capital and resources to support the deployments.

• Government of Gujarat & Aaroogya Foundation (in India), Voluntary Services Overseas & Department of Health Pangantucan (in philippines) and Syrian American Medical Society (in Syria) to implement the solution in areas where the access to doctors and healthcare is difficult.

Intelehealth is a telemedicine and case management platform developed at Johns Hopkins University that connects patients and frontline health providers with remote doctors to deliver high quality health services to the last mile populations. Intelehealth has programs in India, Philippines, Haiti and Syria. We have a registered Section 8 NGO in India and a 501(c)(3) non-profit in USA.

Intelehealth is distributed free and open source – so any organization can use it and adapt it to meet their needs. We aim to be a financially self-sustaining organization. The company earns revenue through four revenue streams – software as a service (we host and manage the platform), end-user training, implementation support and licensing of the task shifting protocols. 

Intelehealth is distributed free and open source – so any organisation can use it and adapt it to meet their needs. We aim to be a financially self-sustaining organisation. We make money through 4 revenue streams – software as a service (we host and manage the platform), end-user training, implementation support and licensing of the task shifting protocols. 

• Software as a Service (SaaS): We provide Intelehealth as a cloud-based SaaS platform as a turnkey solution for telehealth programs. Implementers can choose from different subscriptions plans or pay per user.

• Ayu licenses: Enterprise licenses are available for the protocols we have built. 

• Training: We provide training to users of the software. Our user-centered training programs are designed for health workers, doctors and administrative personnel. Health worker training programs cover basic medical knowledge, training in data collection protocols for history taking and conducting physical exams, use of technology, communication skills and service attitude. 

• Implementation Bundles: A successful telehealth program hinges on a sustainable and scalable implementation model. We work with our partners to help them design unique business and operational models for service delivery to the last mile. In order to successfully build and execute a telemedicine program, we provide implementation support bundles with the software.

Intelehealth is always looking at innovative solutions to societal problems especially in the field of health. The solutions, as far as we are concerned, does not have to always come from internal sources. In fact, our main approach is collective impact - meaning, we provide a platform for stakeholders to contribute, based on their expertise and resources, to addressing problems related to poverty. In our analysis, one of the most immediate problem in the health sector is the continuing lack of access to primary health services of vulnerable populations especially those that live in Geographically Isolated and Depressed Areas (GIDA). 

Intelehealth take up partnerships with NGO's, Hospitals and Government by providing technological support to expand health intervention to more areas across the country. We envision the system to address the problem of accessibility of services. The piloting in the Odisha, India had encouraging results and we think that the more local government units that adopt this system, the better. We would especially like to focus on providing services to marginalised and vulnerable communities in low and middle-income countries.

The solution will also respond to the need for a new method of medical consultation that does not involve face-to-face transactions, given the COVID pandemic, so this is also something that would add value tothe project. 

While Intelehealth, have the expertise to set up and maintain the system during the project life, we also need monetary engagement in partnerships to sustain the solution.Our team needs more support in marketing, media and exposure, funding and revenue model and monitoring and evaluation for our solution. We are planning to expand this to multiple states and countries, so we need help in terms of looking at the operating the solution in large scale. 

1. Make a warm introduction to an implementing org in your network

2. Make a warm introduction to a funder who aligns with our stage of growth (replication)

3. Introduce us to physicians in your network (preferably from developing countries) who would be willing to volunteer time to develop protocols

4. For board members/advisors 

   1. Apply for speaking slots at key sector conferences to present our work (this has been a great way to promote our work and identify aligned partners)

   2. Represent Intelehealth at key working groups that influence health policy (eg: OpenHIE community, WHO CCG group, Global Digital Health Network)

   3. Write an article about our work, share our project case studies on your LinkedIn like this post by Shyam Kaluve or this article by Dr. Adler Archer.

   4. Conduct a workshop/lunch and learn that provides a valuable skill-set for our team. eg: design thinking, communication skills, how to pitch, etc.

   5. Become a mentor to someone in our organization’s leadership 

The COVID-19 pandemic has put an enormous strain on healthcare facilities and the public health infrastructure. Telemedicine has emerged as an important innovative solution for service delivery to non-critical COVID cases, which in turn support to decongest the facilities, to lower the bed occupancy rate at COVID facilities and to provide essential services to the critical patients in need.

This project aims to create a telehealth network that connects Health and Wellness Centers (HWCs) or Spokes, with a nodal Medical college, or Hub, to deliver essential health services related to COVID and essential health services like ANC care, child health, first aid etc. Thus patients can get appropriate advice for home-based care and appropriate referrals for management via telemedicine at the HWC level itself.