IoT Telemedicine Booths

According to the World Health Organization, more than half of the world's population does not have access to quality medical care. Latin America, with its culturally and ethnically diverse populations, high levels of violence, growing political instability, and staggering levels of inequality, is quite a difficult region to tackle. Due to this, Latin American health systems are fragmented and segmented, limiting the region's ability to provide equitable access to public health services and quality medical care and guarantee the right to health of its populations. In the Latin American region alone, it is estimated that there are more than 165 million people without access to health services and  the vast majority live in rural areas with high rates of poverty

The situation in Guatemala is not dissimilar to the one across the rest of the region and many other countries around the world. Even though all working Guatemalan citizens and their families have the right to social security, the real coverage achieved by the Guatemalan Social Security Institute (IGSS) in 2011 was only 17.45%, and although the Ministry of Health (MOH) must provide free services for the rest of Guatemalans, the total effective coverage between IGSS and MOH only reached 48% of the population. Private insurance penetration is less than 5%.  As a result, PAHO estimates that more than 50% of medical care in Guatemala is financed out of pocket, suggesting that at the country level, there are approximately 8 million Guatemalans that must seek alternatives in the private sector and in many cases far away from their area of residence at an elevated cost. The situation is especially problematic for those living in the countryside, where healthcare resources are even more scarce (1.2 doctors/ 10,000) than in urban more affluent areas (4.2 doctors/ 10,000).  

Some of the consequences of this situation are reflected in the elevated rates of chronic malnutrition (49.8%), infant mortality (23.3/1000 live births), and maternal mortality (88 per 100,000 live births). In addition, Guatemala is undergoing a rapid epidemiological transition where chronic non-communicable diseases such as diabetes and hypertension are becoming more prevalent, especially among the poor. 

Considering the above, innovative solutions are needed to counter this situation and improve the well-being of the population, particularly among those historically underserved. Bitmec Health Technologies is an Guatemala-based startup that strives to improve access to healthcare services in Guatemala and abroad by developing and introducing scalable and affordable technological solutions.

Bitmec has developed an IoT telemedicine booth that facilitates access to high quality primary care in underserved areas in Guatemala and abroad. The booth’s metal structure and panels are rigid and cover a fairly small footprint (14 ft2), which enables it to be installed in almost any indoor or outdoor setting (i.e. pharmacies, plazas, community centers, etc). The booth is operated wirelessly by a POS terminal that unlocks the booth at the point of care. While seated inside, the patient interacts with a set of speakers, a high-resolution camera, a 20-inch screen, and medical-grade sensors. Among the measurements collected by the sensors are heart rate, blood oxygenation, height, weight, blood pressure, and body temperature. On the other end, remote primary care professionals (nurses and doctors) can guide the patient through the process, view these measurements in real-time, and document the encounter through a proprietary telemedicine platform that has an embedded EMR module. Once the consultation concludes, prescriptions, lab orders, and referrals can be printed out if needed through the POS terminal. Follow-up visits can also be scheduled if necessary. As for safety features, the booth has automatic disinfection and cooling systems and a security lock.  To ensure stable internet connectivity the booth has an integrated sim card, and all it needs is access to a 110v power outlet (solar power integration coming soon). Finally, a Network Operations Center at Bitmec's headquarters monitors several parameters (I.e. internet speed, level of consumables, health of the sensors) in real-time to maximize the booth's uptime. The combination of hardware and software that Bitmec's telemedicine booth offers, allows patients to conveniently and reliably receive comprehensive remote care with a close to an in-person experience that is applicable to almost any setting, particularly  for underserved populations. 

According to PAHO, 50% of the Guatemalan population does not have access to free healthcare and therefore must pay out of pocket. In many cases, basic healthcare is out of reach due to economic, cultural, and geographical barriers. Bitmec directs its solution primarily to the historically underserved and vulnerable populations, especially those living in rural and peri-urban areas in Guatemala. (>7 million). In the absence of free healthcare services, many currently address their needs by either going to the local pharmacist, seeking traditional healers to save costs or postponing treatment with private healthcare providers until symptoms worsen. The telemedicine booth proposes to be an efficient and scalable alternative to this problem by being closer to patients, of higher quality compared to other alternatives, and financially accessible. By facilitating access to primary care we believe that we can impact positively the well-being of the population we are looking to serve in Guatemala and in countries facing similar challenges.

Bitmec has assembled a multidisciplinary team that has extensive experience in engineering, public health,  economics, product design, and venture capital management. The founders of the company and the rest of the team have all been raised in Guatemala and have been exposed to the reality of the populations that Bitmec is targetting for many years.

Founders:

José Ordóñez, JD, MBA (Co-founder and CEO)

More than 20 years of experience leading impact-driven companies in Guatemala and abroad. He is a leading figure in the Guatemalan entrepreneurship ecosystem and is a co-founder or advisor to several Guatemalan startups, including Kingo Energy and HYBRICO.

David Barac, BA  (Co-Founder and President)

Serial entrepreneur with a background in international economics. Has over 5+ years of experience in the technology and impact sector in low to middle-income countries. 

 Alvaro Rivera, MD, MPH, MBA (Co-founder and Head of Innovation) 

More than 10 years of experience in community medicine, public health, and innovation in low to middle-income countries. Has been part of several healthcare initiatives in Central America, working alongside Governments, NGOs, and the private sector.

Lorena Chacón, BSc, MS (Co-founder and Director of Strategic Partnerships) 

More than 20 years of experience leading projects for international development agencies, including projects related to healthcare and human resource development in vulnerable areas.

Team:

Bitmec has recruited highly talented software and hardware engineers (10 +) from multiple backgrounds as well as product designers that have been key to the development of the company's technological solutions. The company also has personnel with several years of experience implementing high-level projects focused on community development and healthcare services in Guatemala.

Product Development:

Through design thinking, the team has been able to better understand the needs of the population that it seeks to impact and develop more appropriate solutions. We have made sure to include users (patients and providers) and key stakeholders as part of it (i.e. community leaders, government officials). After multiple prototypes and iterations, Bitmec has put together a solution that is already being implemented in rural and peri-urban areas of Guatemala with success. User feedback will remain the key to continuous improvement of the telemedicine booth.

One of the bigger challenges that Bitmec faces is navigating the regulatory landscape. In order to scale the solution to more regulated markets in the region (I.e. Mexico and Colombia) and around the world, Bitmec needs to attain international certifications. As a first step, Bitmec is preparing for the ISO13485-2016  certification (medical devices) before pursuing a CE mark and an FDA clearance. Although the latter are intended primarily for the US and the EU markets, many countries around the world require these as the minimum standard to allow new biomedical products to be imported. All of the certifications mentioned above have an elevated cost and may take a reasonable amount of time, delaying the company’s growth.  If we’re selected to participate in this program, we’d like support in this area. This includes helping us to map out the regulatory landscape around the world, connect us with experts in the field, and if possible help us secure funding (i.e. grants, loans or investment) to cover some of the expenses. Finally although not directly related to regulatory affairs, we'd like to receive advice from experts in IP to help us explore what components of our solution can be patented, the timeline, the associated costs, and identify funding sources to cover the expenses (grants or investment)

Bitmec proposes a solution to an everlasting problem in underserved areas. Through the booth, Bitmec lowers many of the barriers to access to healthcare. The booth’s design, together with all the technology that it incorporates ( I.e. IoT sensors, EMR)  and the fact that it can be installed in areas where access to healthcare is limited and still be connected to the internet, provide the underserved with an innovative and cost-effective alternative. At Bitmec, we believe that our solution is scalable to many countries around the world, especially to those that face similar geographical, cultural, and economic challenges. 

In the next 5 years, Bitmec will be focusing on growth without sacrificing quality, first in Guatemala and then expanding to other countries within the region. Bitmec will be able to accomplish this by developing world-class technology coupled with innovative business models that will facilitate access to high-quality, cost-effective, and scalable primary healthcare services in developing countries, particularly among the historically underserved. 

Our mission

To improve people’s lives by developing affordable and scalable technological solutions that facilitate access to quality healthcare.

Our vision
To become the largest technology solutions provider in the healthcare access space in developing countries.

At Bitmec, we are focused on creating impact in the areas where our solution is implemented and thus contributing to SDG indicators in the long run (i.e. SDG 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases). To accomplish this, input and output indicators have been defined to monitor our progress. As we move forward, corrective actions will be taken if our progress deviates from the planned outcomes.

Indicators that are currently measured:

Input: 

1. # booths completed per week, month, trimester
2. # of booths installed per week, month, trimester
3. % booth uptime per day, week, month, trimester

Output: 

1. % utilization per week, month, trimester
2. No. of consultations given per day, month, trimester
3. % of follow up visits completed per month, trimester
4. average customer satisfaction per month, trimester

At first, regardless of the business model, we believe that by increasing the supply of high-quality and affordable primary care services, we may influence people's health-seeking behavior. This would translate into more people demanding services in a timely manner, contributing to keeping the population healthy or preventing complications from illness. In the long run, we hypothesize that we can catalyze economic development as a healthier population may be more productive than one that is not having its healthcare needs addressed. 

IoT (sensors, NOC) and cloud computing ( EMR) are the core technologies that power our solution. However, as we collect more data we will start developing and training AI algorithms that will aid doctors in better diagnosing and treating patients remotely.  One application for AI will be for the electronic stethoscope that we have incorporated within the booth. Through AI we will be able to help doctors to distinguish normal from abnormal heart and lung sounds.  

Bitmec has promoted diversity and inclusion from day one. The company does not discriminate on the basis of race, color, religion, gender, gender expression, age, national origin, disability, marital status, or sexual orientation.  As a result, we have a multiethnic and multicultural team. At Bitmec, a special effort has been made to recruit women in STEM and as a result, highly-talented hardware engineers and several interns who are women have joined the company over the past year. To ensure that our personnel thrives within the company, monthly meetings are held with the management team in order to understand their needs regardless of the position.

Bitmec has developed 3 different business models that are being implemented in Guatemala.

1. B to C model:  Patients pay a fee per remote medical consultation.

2. B to B model: Organizations pay a monthly fee per affiliate for unlimited medical consultations.

3. Platform as a service:  Bitmec rents the technology to other healthcare providers for a monthly fee. Healthcare providers are responsible for providing the medical service and Bitmec is responsible for ensuring >90% uptime of the telemedicine booths. 

Bitmec has already started conversations with the Government for a potential B to G model, where Bitmec is paid a monthly fee per booth in a determined geographical area and is responsible for providing medical care.

Bitmec is implementing three different business models in Guatemala that are already generating revenue. However, in the long run, Bitmec intends to primarily scale around the world through a platform as a service model where the technology is rented out to healthcare providers (i.e. governments or HMOs) in exchange for a monthly fee and a pre-determined uptime. Given that the R&D, manufacturing, and scaling of our solution is capital intensive, the company will raise funds through multiple rounds and explore grant opportunities to allow growth until financial sustainability is reached.

Bitmec has been successful in raising capital from angel investors and early-stage venture capital funds (Gril Ventures). So far, Bitmec has raised 75% of its $1MM seed round. In addition, the company has received grants from USAID ($150,000), IDB ($10,000), and the Guatemalan government ($110,000) for R&D.