Pro-Patient Tech

Lifestyle Medicine (LM) is a newer, evidence-based field of medicine that prioritizes healthy, personalized lifestyle modifications to prevent, treat, and even reverse chronic diseases. LM focuses its recommendations and therapies in six pillars: diet/nutrition, physical activity, sleep, emotional well-being, avoiding toxic substances and environments, and social connectedness. The field has seen an explosion of interest in recent years from both patients and physicians. Not only is LM relevant, but it is also powerful. Many of the interventions are actually more potent than existing standard of care allopathic remedies. For instance, the Center for Medicare Services (CMS) funded Diabetes Prevention Program uses LM principles to prevent the progression of metabolic disease in pre-diabetics and is more powerful than metformin. LM changes were shown to be better than surgery alone in preventing prostate cancer recurrence. There is a special LM board-certification, which is amazing if physicians have the time and money to pursue that. However, we believe that if they don't, the knowledge and resources within LM should still be accessible to them. 

Even if someone is LM trained, they will find enormous benefit in using PPT. Incorporating LM into our traditional patient visits is extremely challenging for many reasons, including limited resources (time, money, energy), the existing momentum of traditional visit focuses, and the existing EHR ecosystem and its limitations. One of the major pain-points of LM physicians include inability to incorporate the numerous screening tools that the LM handbook advocates for in order to thoroughly screen for at-risk lifestyle behaviors that can be changed to prevent chronic conditions. Numerous physicians have posted to inquire if anyone has been able to accomplish this successfully, and no one has. Currently, these screening tools have to be given to the patient usually on paper, then scored manually, and then interpreted with a different rubric for each one. The LM handbook states that physicians should hire help to complete this important aspect of providing preventive care. Unfortunately, most physicians and healthcare systems are not in a position to financially handle that burden.  

Another practice burden for LM practicing physicians is trending vital signs and lab values. EHRs are only set up to flag abnormal values, whereas prevention is based on detection of trends in the wrong direction. Physicians have to manually look for prior results and/or click to trend the data instead of it being displayed easily. 

One more burden is that most practices don’t have the bandwidth to send out reminders to patients for their screening tests, including mammography or colonoscopy, and yet typically, the physicians do keep track of when they are due. Patients do want these reminders, too, which can greatly enhance compliance and therefore increase early disease detection. 

Lastly, keeping track of the action plan that is co-created with the patient is virtually impossible with current EHRs. We interviewed dozens of physicians and none of them were doing this. If they wanted to do this with existing tools, it would add significant amounts of redundancy in efforts. 

Pro-Patient Tech (PPT) brings Lifestyle Medicine (LM) principles to physicians in a user-friendly and integrated manner, broadening the access to LM resources to all communities. This platform augments any existing EHR to allow physicians to synchronously and asynchronously engage their patients with improving their lifestyle and prevent chronic disease in a successful and sustained manner. In doing so, PPT's ultimate goal is to improve outcomes for as many people in the world as possible. 

PPT solves the following pain points of practicing LM effectively: 

- collecting screening tool information to identify risky lifestyle behaviors

- trending vital signs and lab values to detect and intervene on preventable chronic diseases

- reminding patients about preventive screening tests, like colonoscopies and mammograms

- maintaining an up-to-date, co-created, and shared action plan per patient

- decreasing the charting burden

- keeping a searchable multi-media repository of up-to-date lifestyle medicine educational resources

PPT is an EHR augmentation platform. Physicians can use any EHR of their choice and still engage with PPT in a non-redundant manner. It integrates with various sources of health data, and it automatically generates a physician note that can be copied and pasted back into the EHR of choice. 

In designing PPT, on the physician end, we prioritized simplicity, customizability, and integration. Also, everything that technology can do automatically (e.g. scoring and interpreting the screening tools, sending reminders) is done automatically; however, it does not replace the physicians' role in the patient-doctor relationship in any way. PPT does not automatically assign recommendations to the patients' action plans based on their scores. Rather, a list of suggested recommendations will appear to the physician, and the physician will still have to choose them to add to the patient's action plans. 

On the patient end, we prioritized the user-experience and providing ample resources. Each action plan item automatically comes with resources that will aide the patient in accomplishing their goals. Also, patients can take multi-media notes, peruse their own results, and track symptoms, medications, action plan items, or whatever they like. Aside from the action plan, the other main engagement between physician and patient is the reminders. One set is for the screening tools. Patients will receive reminders automatically until they get those done. The other set is for the screening tests, like colonoscopies and mammograms. Patients can mark off when they have completed a certain test to stop getting reminders. 

This is the first and only LM-focused digital health solution, but this solution does more than just assist with LM practice pain points. It broadens access to LM principles to every practicing physician, since we are all familiar with how screening tools work, how trends in our health data should be interpreted, and how screening tests should get done. This access is important for people working in resource-limited environments where time and money is limited. Everyone deserves to hear LM-based options from their physicians to both prevent and treat chronic illnesses, and with Pro-Patient Tech, everyone now can.

The target population for this solution includes patients whose health outcomes can improve through lifestyle changes, which is almost everyone. To access them, we are going through their physicians. Physicians will be mostly primary care physicians and medical sub-specialties. There will also be content targeting surgery patients and ancillary care clients, like physical therapy patients. 

Just like any medication that we take, there is evidence behind the effectiveness of the lifestyle modifications recommended through this platform that guarantee a change in the disease state. Just like we wouldn't withhold evidence-based pharmaceuticals just because we don't think a patient will comply with it, It is morally unethical for physicians to withhold lifestyle advice to patients. In fact, some patients are actually more willing to change their lifestyles than take medications for their chronic conditions. These are our primary target market. Unfortunately there is a gap in knowledge about the evidence-based lifestyle modifications that can be done to advance one's health. Furthermore, there are not enough Lifestyle Medicine trained physicians to reach every one of these patients. It is important to give all physicians a solution that can give patients access to these important lifestyle modifications that could greatly improve their health outcomes. 

Equity in healthcare is created by the existing healthcare system. Grant-funded and government-funded care programs cannot provide the highest level of care that everyone deserves. LM is a promising field to not only bridge but completely close the gap in healthcare inequity. One of the main reasons we are pursuing this project is to further this potential. There are several communities that may never have access to an LM trained physician because they live in underserved areas where physicians don't have as much time or money to pursue LM certifications. This platform, at just $10/month, will be accessible to almost any practice. Even at this low price, some practices may find it unaffordable. Our underlying philosophy is to never let finances be the reason that someone would not use this platform. We will find a way to support every practice that is interested in this platform, even allowing free use if we have to. 

Our concern for equity in healthcare is also evident in our pre-existing content. Many handouts are already translated into Spanish. There are several culture specific recommendations and educational resources that we have added as well.   We also want to be able to translate this app into multiple languages. 

Through our purpose-driven approach to create more avenues through which LM content can be disseminated widely, we hope to make significant progress in affecting the health outcomes of our target population. 

Dr. Nupur Garg is an MIT and Yale Medical School graduate who is double board-certified in Emergency Medicine and Lifestyle Medicine. She has published the only board review book for Lifestyle Medicine and it was received very well among physicians. She also has her own Lifestyle Medicine Clinic and is always looking for ways to use technology to add efficiency in her practice. She has been a social entrepreneur for decades, winning the MIT Ideas competition as a student and also winning the Grand Prize at the MIT Grand Hack in 2014. She has had an interest in patient engagement before she became interested in lifestyle medicine and this startup is a great blend of both of these interests. 

Misha Manulis is an experienced engineer and technical leader with a background in autonomous systems, space-based solutions, e-commerce, fintech, consumer electronics, and mobile applications. He has started several technology companies and led teams across multiple engineering disciplines at startups and enterprises.

We have many connections through different agencies, companies, and individuals who can assist us furthering our ultimate goals. 

For example, Dr. Sarah Schuetz is a Lifestyle Medicine physician who has a decade of experience in education that's both accessible to patients and physicians. She is partnering through her educational company to provide multi-media lifestyle medicine educational content in all fields. 

We also have relationships with value-based care organizations, like Wellvana, who have similar mission based initiatives to improve health outcomes without providing care directly. They are enthusiastic about supporting our initiative and potentially integrating it into their own offerings to their network of physicians. 

Finally, we are excited to be connected to large health systems like Yale and Mount Sinai who can access millions of patients through their network. Dr. Garg was previously the head of the Lifestyle Medicine working group at Yale and still maintains contacts there. 

As can be seen in the demo video, the physician facing side of our platform is near complete. We are near completion of finalizing the pre-populated data that will be added. We meet with physicians 1-2 times per week to get their input on the interface and are coming to a point of information saturation. We have  begun meeting with patients about the patient-facing side. We launched our landing page after testing different pricing models, and we are posting it in various Lifestyle Medicine physician groups to get sign-ups. We have a list of ten physician practices willing to launch PPT at the pilot stage. Most of the other physicians want to launch PPT ASAP but after the pilot stage. 

PPT currently is in prototype mode. Once the prototype is finalized, the CEO, Nupur Garg, will begin using it in her LM practice first and very shortly after that, two other physicians will begin using it in their LM clinics.

Dr. Garg has participated in social entrepreneurship projects and won since she was an MIT student, including the MIT Ideas competition, the MIT Hacking Medicine Hackathon, and she was also a finalist for the World Bank Development Marketplace with a telemedicine solution. While she is still in contact with some of the people she met while participating in those competitions, MIT Solve sticks out the most because of the network of people that being a part of a Solver team will give us. This includes access to leaders, experts, advisors, coaches, and even people with close ties to our solutions' industry. Furthermore, while she has close ties to healthcare organizations in India, Brazil, Argentina, New Zealand, England,  Germany, and Portugal, that network may be helpful for us to launch globally in other places. 

MIT Solve will be useful in other ways as well: 

- funding. Currently we are self-funded. While our team is well-positioned to accomplish our goals through the use of our own talents and professional skills, extra funding can allow us to take more risks that may help accelerate our timeline. Having a booth at physician conferences is also extremely costly, and the funding will assist with those expenses as well. Upon de-risking our solution, potential access to in-kind licensing and legal services and VC funding is also extremely attractive. One specific area of funding we would like to apply for is the development of the tech needed to facilitate shared medical appointments and health-based communities within PPT. 

- media exposure. Our go-to-market requires strong marketing. While Dr. Garg is well-ingrained in certain social media groups for physicians, there are plenty of physicians who don't use social media. Also, people can use the patient-facing app to learn about general LM principles, even if their physician isn't a user. Media exposure will help enormously in these areas. 

- vetting of trusted brand. We believe that people may be jaded from haring of yet another digital health solution. For many years, many large and small companies alike have tried to uncover the elusive holy grail of digital patient health engagement. The vetting of being one of the Solver teams will help convince certain skeptics. 

- peer group support and education. We find it immensely joyful to be out and about among start-up founders. Especially in a group of people trying to make the world better through their solutions, we would love to participate in such a group. 

Patient engagement is a challenge for primary care because resources are already limited and patient engagement is a nice-to-have, but not part of standard of care yet. Existing solutions are focused on making sure patients don’t miss appointments and providing a more efficient marketing platform. Other solutions are cost-prohibitive or affordable and failed to capture the market. The innovation in our solution to this problem is not just in the technology but also in the go-to-market. Pro-Patient Tech (PPT) is the first digital health solution designed for Lifestyle Medicine clinicians, which is widely regarded as the future of medical care. In terms of go-to-market, by addressing a pain-point of physicians rather than adding more work for physicians, we can finally align incentives with the patient and physician through technology. The physician is incentivized to use PPT because it makes their lives easier: they get billable screening questionnaires completed; it saves them time with note-writing; it keeps track of action plans; it trends labs and vital signs better than any existing EHR; and it integrates with just a click of the button. PPT actually is designed to help them with their job, and the more patients they have signed up further eases their daily workload. On the patient side, they want to be healthy, and increased patient engagement will also improve their health outcomes. 

The patient-facing side of the platform is a product called Caspia. Caspia displays the same information the physician sees but in a patient-centric manner. It also includes resources for the patient to assist with meeting their lifestyle goals, multimedia note-taking, important reminders, and symptom/medication tracking. Information in Caspia can be shared with extremely precise sharing controls, allowing maximum patient privacy while facilitating community support. There are so many benefits to the patient owning their health information, but products to date tried to mirror the physician-facing side too much. Our innovation actually was born from the patient-facing side, making it unique in that it primarily tries to address barriers to patients that leave them disengaged from their health. 

To date, there has never been an independent platform that is widely used that allows patients to manage their own health information. Physicians can use PPT to keep patients engaged and informed about their health in a way that has never been achieved before. After unlocking the potential of patient engagement to improve health outcomes, the sky is the limit to how much we an expand on optimizing that. There are so many ideas we have to facilitate community, access to affordable health services, and accessible health information. Furthermore, PPT is truly an answer to equity in healthcare for so many reasons. It facilitates a path away from the paternalistic culture of physician-patient relationship and towards better transparency. 

There are three impact goals or axes that Pro-Patient Tech (PPT) is aiming to achieve: 

1. Facilitate dissemination of Lifestyle Medicine medical education through physicians to patients. 

2. Increase patient engagement in their health. 

3. Improve overall patient health outcomes at all socioeconomic levels. 

These three impact goals are in somewhat of a chronological order. For the next year, we aim to focus on being the best digital health tech for primary care physicians to facilitate LM principles in their patient visits. Achieving product-market fit for physicians is essential for the initial success of PPT. Without this step, we will not be successful in reaching patients or growth. Physicians must be bought into the potential for LM to positively impact their patients. Then, focusing on a way to integrate that into their own practice would be a natural next step. Our product fits right into to any physician practice. For this first impact goal, after five years, we aim to have reached product-market fit among physicians across the world. 

The second impact goal is to increase patient engagement in their health. This particular goal will start to materialize more successfully in year two and grow substantially by year five. We are starting by having different designs in the recommendations between positive prescriptions and negative prescriptions. Positive prescriptions are ones that we are asking the patient to begin or add to their lifestyle. One example is to eat a cup of steamed vegetables with your dinner every night. This will be displayed like a meter that fills with each success, and resets periodically, like daily, weekly, or monthly, depending on the recommendations. Negative prescriptions are ones that we are asking the patient to limit or stop from doing anymore. One example is to limit smoking. This will be displayed like an ongoing stopwatch for each negative prescription displaying how long it's been since their last behavior of that negative prescription. 

Finally, the last impact goal for PPT is to improve patient health outcomes through patient engagement in their health, especially as they begin to successfully adhere to lifestyle medicine principles. This particular goal is the most exciting impact goal for PPT. We hope our technology will not only improve physician and patient satisfaction, but it will also be a digital health tech tool that can actually be used to successfully improve people’s health. 

Throughout each step, we will be measuring our the usage and impact of our platform among various socioeconomic statuses to ensure that we are furthering our mission in equity. 

From the beginning, we have thought carefully about metrics to have in place to track our progress on our ultimate goals. There are numerous parameters to track, including regarding several ways to measure health outcomes. Some of them include DALYs, number of prescriptions, number of comorbidities, lab values, vital signs, and of course, screening tool scores. As we begin, our metrics don't necessarily reflect the ultimate goals that well. To get to the point of affecting patient outcomes, we must achieve product-market fit. Those metrics are centered around traction and usage. 

We are also highly concerned with metrics surrounding equity. Evaluation of outcomes based on demographics and zip codes will help with tracking this priority. 

Of course, all of the data surrounding health outcomes comes from people's health information, which we will not have access to. We have predetermined that anyone who wants to contribute to our understanding of how this platform is affecting their health outcomes must opt IN to share their data, and they must opt in with each data type they wish to share. There will not be any automatic sharing upon creating a profile. Eventually, we wish to partner with academic institutions and other clinical research entities to enlist people in clinical studies to measure the improvements in their health and even more detailed biomarkers before and after using the platform. 

Our theory of change is that technology can and should be used to improve patient engagement, which would also improve patient outcomes. To date, competing incentive have burdened products with features and user flows that don't make the most sense for the target goals. There is a great opportunity for the right person, right tech, right data, right motives, right time synergy to create a new and successful paradigm of healthcare. 

There are significant opportunities for improvement on the current healthcare system. Many avenues have already been explored. The newest area of evidence-based medicine is quickly gaining traction as both rejuvenating to physicians who were otherwise feeling burnt out in their professions under the current healthcare system dynamics AND patients who are growing increasingly wary of being told to take pharmaceutical therapies with no alternatives. Patient engagement remains the holy grail of healthtech entrepreneurship, and almost everything has been tried except making Lifestyle Medicine content accessible to both physicians and patients in a manner that adds value to both groups.  In doing so, we are locking in our go-to-market success while still ultimately achieving our ultimate goals of patient health improvement. 

This go-to-market plan is the real innovation in our platform. Without it, we are just increasing extra work for already burnt out physicians to do just out of the goodness of their heart. Also, without that plan, we are relying on people to suddenly trust that our platform will deliver them to their ultimate health goals without anyone to vouch for it. In combining solving a key pain point for physicians in a way that disseminates powerful, evidence-based lifestyle medicine recommendations, we are carrying out a recipe for widespread improvement of health outcomes. 

The first line of the description of this question - that technology is the application of science and evidence-based knowledge to the practical aims of human life - describes our technology precisely. The computer software engineering part of our technology is the relatively "easy" part. The evidence-based science of Lifestyle Medicine needs to be adapted to actionable and engaging recommendations that actually inspire change. Lifestyle Medicine does rely on oftentimes centuries-old practices that have been proven through modern scientific methods to be beneficial to one's health. This field is rapidly developing with ongoing research in almost every area of medical science. Behavioral change does not come from explaining evidence to people. Behavioral change between physician and patient comes from patient engagement. 

There are many potential barriers to patient engagement, including lack of time, which technology can assist with. Imagine walking around with your own personal physician all day, every day. One would guaranteed to be relatively healthier than without that. Using technology, we can magnify the reach of a physician to their patients through our platform. The real technology is about the manner in which that magnification is done. It must be done in a way that is both useful for the physician and potentially saving time and also effective for the patient. This delicate balance has led to us creating two completely different designs for the physician side of this platform versus the patient facing side. On the patient facing side, we are employing numerous behavior change designs that are well vetted, including stopwatches for behaviors that people are trying to limit and a progress bar for behaviors that people are trying to increase (e.g. number of vegetable servings in a day). Employing these ideas will help enormously in reaching our ultimate goals. 

Dr. Garg began her Lifestyle Medicine practice believing that everyone, no matter what their income level is, should have access to excellent healthcare. She has two separate models that allows people who are uninsured and underinsured to also seek treatment under her care. She also is leading a Community Health Needs Assessment in her town through her work as a member of the Commission on Aging. Lastly, she presents to underserved communities regularly through different organizations that she actively seeks out and offers her services to for free. She is committed to making sure that Lifestyle Medicine care is not just something that wealthier communities have access to. She is determined to ensure that equity is present in her platform as well. 

In physician and patient interviews when demo'ing mockups of the app, she often seeks a diverse array of people to get ideas from. Translating the app to different languages is an important milestone after product-market fit. Also, she has made sure to include a variety of recommendations that are culture specific, including regarding the specific foods that are recommended. With food recommendations more closely aligned with their native foods, people are more likely to make the recommended changes rather than if they don't recognize the recommended foods. 

One important area of equity is also with LGBTQ communities. From the pilot version of this platform, there is inclusive language in every aspect, including the patient demographics, screening tool questions, recommendations, and resources. 

Being inclusive is not just the ethically correct choice, but it is also a great way to gain traction among various communities. These communities often feel unseen with technology because they are not often the target market. These are often sometimes the communities that can benefit the most from increased engagement with their health. By ensuring that people do feel seen through our platform, we will set ourselves up for success in those communities. 

Our business model is B2B to physicians, starting with solo practitioner practices (Direct Primary Care) and then spreading from there. There would be a subscription that increases with more users and perhaps as we add more features. We would start at $10/month. 

From there, we will gain patient users. Once we achieve product-market fit with patient users, then we have a number of verticals to explore to increase our revenues. One potential idea is a service marketplace. Another idea is a telemedicine service portal. Lastly, we may also get paid partnerships with research organizations about Lifestyle Medicine. We are in discussion with our national physician group - American College of Lifestyle Medicine, to potentially offer a discount to their members if any of their members want to use this platform. 

We are refraining from ads and selling data in any shape or form. Depending on usage patterns, we may also add on a freemium model on the patient side. 

We plan to stay as close to bootstrapped as possible with only seeking outside funding to potentially accelerate our timeline, but not to be the only manner in which we would be able to achieve our timeline. Therefore, we will be charging from Day 1 and working to achieve traction and financial sustainability from the beginning. 

Once the patient engagement is in place, there are countless ways to monetize, and through enacting those, we will be financially stable. 

We have not received any sources of funding for this project. We have spent $11K of personal funds on this project's pre-cursor and $1K on this specific project to date. We have a prototype and at least a dozen beta clinics signed up to start paying $10/month for the initial product.