Team Telemedicine

Health workers in the developing world need access to digital health tools, telemedicine physician support, and timely, relevant continuing medical education delivered electronically and tracked through their accrediting body. The Addis Clinic provides all of these resources for free in order to strengthen health systems, deliver healthcare innovations equitably, and to communicate important public health updates in real time. We provide all of these things directly to health workers and help them to navigate the fragmented and often expensive mHealth field.

We believe that Team Telemedicine alleviates three crucial problems facing the world today.

1. The World Health Organization estimates a shortage of seven million health workers globally. The lack of trained medical personnel contributes to prolonged illness, missed work, and early death around the world, especially in rural parts of Africa. Volunteer physicians have been active in rural African communities for decades; however, our telemedicine model provides convenient physician access to communities with less than one doctor per 10,000 people. In Kenya, where we are piloting our program, the Cabinet Secretary for Health estimated a shortage of 42,800 health workers in 2018. 

2. Wrongly diagnosed illness, improper treatments, and lack of access to care are among the leading causes of death in Kenya. Team Telemedicine educates lower-skilled clinical officers by connecting them with more experienced senior volunteer physicians who can provide a second opinion and correct critical mistakes. More than 98 percent of our volunteer frontline health workers reported learning a new clinical skill as a result of their collaboration with a volunteer physician. 

3. Finally, our program model reduces the spread of disease, thereby eliminating one fear that prevents people from seeking medical care.

We hire Kenyan clinical officers and nurses who are Healthcare Recruiters. Their primary goal is to recruit other clinical officers and nurses to participate in our 12-month program using telemedicine to care for their poorest and most vulnerable patients. Healthcare Recruiters help their peers download our asynchronous telemedicine technology tool, currently Collegium Telemedicus, from the Android app store. They provide a half day digital learning experience about how and when to use telemedicine technology and afterwards, they provide ongoing technical assistance and troubleshooting.

Our US staff curates and disseminates existing clinical materials, including free COVID-19 screening and treatment tools and resources. US staff also recruit volunteer physicians who are board certified and trained to provide expert opinions on case referrals sent by clinical officers and nurses in Kenya.

A Patient Triage Specialist located in Kenya reviews case referrals and assigns them to a physician within our volunteer network. Cases are screened for quality and completion prior to being assigned to a physician in order to maximize volunteer efficiency.

Lower-skilled health workers thus have 24 hour telemedicine support from a physician and access to contextually appropriate clinical education materials in one place.

We are delivering physician-level expertise to people who cannot afford to travel to see a physician and who live in underserved communities. We are currently piloting our program in western Kenya in communities with less than one physician for 10,000 people. 

Our program model focuses on patients who visit private clinics that employ only nurses and/or clinical officers to provide care. They are people whose illnesses such as HIV/AIDS, tuberculosis, asthma, chronic pain, and diabetes prevent them from work.

We are informed by data collected from our telemedicine technology as well as by firsthand accounts from both patients and providers. Their data indicates disease prevalence among populations within a community; however, patients often report how their poor health affects their livelihood and well-being. In many instances, they are stigmatized within their communities and left in dreary and unhealthy quarantine conditions. 

Our providers, including our Healthcare Recruiters, play an active role in curating our clinical education library. Healthcare Recruiters and volunteer referrers in Kenya provide additional input about the expertise they need in order to treat patients and the user experience and design of the telemedicine technology.

Specifically, we are providing "tools that support and protect health workers" as stated in this Grand Challenge. A telemedicine tool in the hands of clinicians with few other available resources can also inform decision-making at the local level and report disease outbreaks in areas without consistent reporting. 

Our telemedicine approach is unique in three ways: 

1. We are one of the few organizations operating a global humanitarian telemedicine program with a focus on physician-health worker partnerships rather than technology alone. This strategic decision was based on prior failures of other global telemedicine organizations where technology was prioritized over local partnerships. Not only have we amassed an international force of volunteer physicians who support Kenyan frontline health workers with more than 1,000 medical consultations per year, we also have invested in direct partnerships with local organizations in Kenya to ensure rigorous and comprehensive execution of medical recommendations. 

2. To strengthen the investment in our partners, we provide a unique and free telemedicine technology training and certification to frontline health workers. Our team of educator consultants, physicians, and staff at The Addis Clinic developed our International Telemedicine Technician Training Program (IT3P), a customized full-day program for use throughout Kenya. 

3. We are an implementing partner that relies on existing health infrastructure in order to distribute essential skills and tools which can strengthen health systems. We increase the earning power of health workers with cash payments, hiring them as part-time contractors, and then we provide free telemedicine subscriptions, free trainings and support to use telemedicine, and 24-hour clinical support during patient interactions. In Kenya, organizations such as Medic Mobile and Living Goods work with Community Health Workers. In contrast, Team Telemedicine relies on Clinical Officers and Nurses who can provide immediate care under the supervision of a remote physician using telemedicine.

Our existing technology is an asynchronous telemedicine app that can be dowloaded to an Android smartphone. Health workers can input patient data, attach lab results, photos, and videos and the store-and-forward technology operates with as little as 2G cell network service. The health data is delivered to a Patient Triage Specialist who then assigns the case to a physician accessing the data from a mobile phone, laptop, or desktop computer.

We plan to create a technology tool with an integrated digital storage library so that health workers can heave the option to read more about the clinical cases they find most perplexing within their communities.

We have used Collegium Telemedicus since 2018 and have consulted more than 2,000 patients. Telemedicine has a long history of being deployed in development contexts. In 2018, Doctors Without Borders was the largest user of Collegium Telemedicus. In 2016, the authors Borja Martínez-Pérez, Isabel de la Torres-Díez, and Miguel López-Coronado wrote about the sheer volume of Mobile Health Applications such as telemedicine in use by the World Health Organization (Martínez-Pérez B, de la Torre-Díez I, López-Coronado M. Mobile health applications for the most prevalent conditions by the World Health Organization: review and analysis. Journal of Medical Internet Research. 2013 Jun;15(6):e120. DOI: 10.2196/jmir.2600.)

As such, it is nearly commonplace for telemedicine technology to be used  for disease management. We are, however, providing evidence that it can be used as a principal method for strengthening health systems and managing diseases.

Activity 1 - Health workers receive free access to telemedicine subscription and follow-on training and technical assistance 

Output 1 - Health workers learn how to optimize use of telemedicine during patient interactions

Short Term Outcome 1 - Health workers use telemedicine to treat patients with greater frequency and competency, resulting in better patient care

Long Term Outcome 1 - Health workers use telemedicine regularly in their facilities, encouraging and teaching their peers in the regular use of telemedicine

Activity 2 - Health workers gain 24 hour access to a global network of volunteer physicians

Output 2 - Health workers receive clinical guidance about disease diagnosis and disease management

Short Term Outcome 2 - Health workers become more familiar with advanced clinical skills and methods in the delivery of healthcare

Long Term Outcome 2 - Health workers become highly-skilled practitioners with advanced diagnostic skills and the ability to treat a variety of illnesses

Activity 3 - Health workers have free access to continuing education materials and a digital storage library of clinical guidance

Output 3 - Health workers obtain CPD (Kenyan equivalent of continuing medical education) by attending digital courses using their smartphone or computer

Short Term Outcome 3 - Health workers learn how to incorporate continuous learning into their daily practice

Long Term Outcome 3 - Health workers become more knowledgeable in science and the medical professions

81 health workers today

360 health workers in one year

10,000 health workers in five years

Within the next year, we will have 360 health workers using our solution. Based on evaluation of our current user data, this will benefit approximately 6,500 (2%) of their patients who have complex illnesses. As we have already described, Healthcare Recruiters are an essential component in order to equip and train 360 of their peers. We have already received funding for this stage of our program and have hired five Healthcare Recruiters.

Within the next five years, we will reach 10,000 users and 180,000 patients by collaborating with the Kenya Red Cross or directly through the Ministry of Health in order to equip a majority of Kenya's Clinical Officers and Nurses to use our solution. 

The total number of people impacted in five years will be more than 600,000 health workers, patients, and families.

We are seeking NGO registration in Kenya 

Buy in from the Kenya Ministry of Health

Funding for Healthcare Recruiters

The process for NGO registration will take six months, and we are beginning that process. Once achieved, we will hold more meaningful conversations with the Kenya Ministry of Health about incorporating our program model into their requirements for Clinical Officers and Nurses in the country.

We have relationships with USAID and a letter of support from the Kenyan Red Cross that will help us to obtain buy-in from the Ministry of Health.

It will cost 667,200 USD to hire 139 Healthcare Recruiters for one year in the effort to reach 10,000 health workers. However, this can be funding shared by private partners, Republic of Kenya, World Health Organization and others.

Full-time staff: 3 (2 US, 1 Kenya)

Contractors: 9 (2 US, 7 Kenya)

Volunteers: 159

Dr. Stephen Chan is Associate Professor of Medicine at the University of Pittsburgh School of Medicine and serves as the Director for the Vascular Medicine Institute at the University of Pittsburgh Medical Center. He is a standing member of the NIH/NHLBI RIBT study section, holds multiple grants from the NIH, is an elected member of the American Society for Clinical Investigation, and holds an Established Investigator Award from the American Heart Association.

Wade Munday holds a graduate degree from Vanderbilt University and has worked in nonprofit management for over ten years, with several years of professional experience at Boston Children’s Hospital and the National Health Care for the Homeless Council. Meghan Moretti holds a Bachelor of Science in Operations Research from the United States Military Academy, a Bachelor of Science in Nursing from Columbia University, and a Master of Science in Nursing as a Family Nurse Practitioner from Pace University. 

Our Kenya team consists of Director of Patient Care Antony Mugambi, Patient Triage Specialist Phelix Wambogo, and Healthcare Recruiters Edwin Otieno Wara, Austine Ouma, Dennish Onyango Otieno, and Benjamin Odoyo. They are all clinical officers and registered community health nurses.

Erin Kim brings 10 years of experience working as a Technical Advisor at the U.S. Agency for International Development and a Master of Public Health in Health Policy and Management from Boston University School of Public Health.

Our current partners for software development are:

• Collegium Telemedicus
• IntelliSOFT Consulting

Our partnership goals for software development include:

• Creating a Kenyan software product that incorporates a digital storage library and access to Ministry of Health CPD online units

Our partnerships for organizational growth include:

• Kenya Red Cross
• Local healthcare facilities

Our goals include:

• Share best practices with The Addis Clinic in the use of telemedicine in a local facility context
• Share data for a research evaluation of telemedicine-enable care vis-a-vis standard care for patients
• Leverage narratives and other evidence for marketing and communications

We seek partners who can:

• Facilitate conversations with other NGOs and Ministries of Health to obtain buy in
• Evaluate disease-specific outcomes within our current set of data
• Provide introductions and establish relations ships with investors and grantors

Our Software as a Service Model (Saas) includes leasing access to our newly-developed telemedicine technology to the Ministry of Health to better equip health workers throughout the country. 

We are looking to develop a commercial model in which our provider-to-provider model of training and telemedicine-based assistance will help fill the critical gap in health worker shortages throughout the country. 

Other forms of commercial telemedicine models have achieved success in Kenya. A direct-to-consumer model was piloted in Kenya and acquired by Merck for an undisclosed sum before ceasing operations in the country. Our revenue model will be based upon owners of private clinics purchasing access to The Addis Clinic telemedicine and then paying for specialty services. Before acquisition by Merck, ConnectMed charged consumers $12 per visit to a telemedicine kiosk designed to provide treatment for common illnesses. Our break-even goal is to serve 2,100 patients per month at an average cost of $12 per patient, generating $300,000 per year in revenue. We currently serve 60-80 patients at no cost.

We will continue to provide free medical care for people at the base of the financial pyramid, people who earn less than 400 ksh per year. Our business plan relies on generating revenue for Kenyan physicians to treat middle and high income patients for basic illnesses and some specialty care. 

Through cost sharing, a patient pays 1,200ksh for access to a telemedicine consultation for ailments when a GP would otherwise refer them to another facility. The Addis Clinic retains a portion and the telemedicine consultant receives the remaining fee. The Addis Clinic profits coupled with in-kind physician services will sustain the operations that we will provide for low income patients.

We want to connect with a community that can help us refine and develop our software tool, evaluate our data, and lead us to investor and grantor relationships. We also desire to highlight the benefits of telemedicine use in the age of COVID-19, especially in parts of the world that have not yet experienced the worst of the disease. 

We seek software engineers who can help to create a telemedicine tool that incorporate a digital storage library in the most cost effective way.

We also seek board members and advisors who can help us to refine our business model by identifying a broader payor model for telemedicine service in Kenya.

Sloan School of Management