IoT Telemedicine Booth

According to the World Health Organization, more than half of the world's population does not have access to quality medical care. One clear example is Latin America, with its culturally and ethnically diverse populations, high levels of violence, growing political instability, and staggering levels of inequality. As a result, 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 proper access to health services, and the vast majority of those affected live in rural areas with high rates of poverty and violence. 

The situation in countries like Guatemala is not dissimilar to the one across the rest of the region and many other developing countries around the world. For instance, 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. However, the rate of coverage in certain areas with high levels of poverty and violence is estimated to be much lower. The penetration of affordable private insurance is quite low, as it is estimated that the uptake of these plans is of 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. 

These statistics are quite alarming and can have a huge negative impact on the economic growth of a country.  Similarly to Guatemala, the statistics described above are comparable to the ones of many countries around the region, particularly neighboring countries like Honduras, El Salvador, and Belize. 

Considering the above, innovative solutions are needed to counter the inequities in access to healthcare in these countries that can help to improve the well-being of the population, particularly among those who live in fragile contexts. Bitmec Health Technologies is a Guatemala-based startup that strives to improve access to primary healthcare services by developing and introducing scalable and affordable technological solutions.

Bitmec has developed a plug-and-play IoT telemedicine booth that enables healthcare providers (i.e. insurance companies, and governments) to facilitate access to high-quality primary care regardless of the context. The booth is rigid and covers a fairly small footprint (14 ft2), which enables it to be installed in almost any indoor or outdoor setting (i.e. pharmacies, plazas, fields, community centers, companies, etc).

To initiate a consultation, the booth can be activated through different methods at the point of care, including a self-service kiosk embedded on the outside panel of the booth. 

After being granted access and while seated inside, the patient interacts with a set of speakers, high-resolution cameras, a flat-screen, and several 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 can guide the patient through the data uptake process, view these measurements in real-time, and document the medical 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 or sent electronically. Follow-up visits can also be scheduled if necessary. Our telemedicine booth can also be paired with vending machines that dispense medications, improving its value proposition at the point of care and closing the cycle in hard-to-reach areas in one stop. 

As for safety and security features, the booth has automatic disinfection and cooling systems and a security lock. To ensure stable internet connectivity, the booth may use different methods such as fiber optic, mobile, or alternatively, depending on the context, satellite connectivity is also possible. The booth only requires access to a 110v power outlet. In addition, the booth has an integrated battery bank that allows it to operate in bad-grid areas. In case of no electrical grid at the point of care, solar power integration is also possible.

Finally, to ensure maximum uptime or availability of its solution, Bitmec has set up a Network Operations Center at its headquarters, that monitors several parameters (I.e. internet speed, power, level of consumables, health of the sensors) in real-time. If maintenance is needed, there are protocols in place that allow remote or in-person actions depending on the situation.

The combination of hardware and software that Bitmec's plug-and-play IoT telemedicine booth offers, allows patients to conveniently and reliably receive comprehensive remote care from healthcare providers with a close to in-person experience that is scalable to almost any context.

According to PAHO, in the region, around 40% of the population does not have access to free healthcare and therefore must pay out of pocket. Basic healthcare is often out of reach due to economic, political, cultural, and geographical barriers. Bitmec has built a solution that enables healthcare providers either private or public to expand their coverage to reach those who have been historically underserved and/or vulnerable populations, especially those living in rural and peri-urban in developing countries. In the absence of accessible 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 at an elevated price. The telemedicine booth proposes to be an efficient and scalable alternative to this problem by being closer to patients, and of higher quality compared to other available alternatives. By improving access to primary care we believe that we can impact positively the well-being of the populations, as healthier populations are more productive and therefore contribute to their economic development.

Bitmec has put together a multidisciplinary team that has academic background and extensive experience in engineering, public health,  economics, product design, and venture capital management. The founders and its valuable team members have all been raised in Latam and have worked closely with the target population that the company is looking to impact. 

Founders:

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

More than 20 years of experience leading impact-driven companies in LATAM. 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 Product) 

More than 10 years of experience in community medicine, public health, and innovation in LATAM and the Middle East. Has been part of several healthcare initiatives in Central America, working alongside Governments, NGOs, and the private sector.

Pablo Mazariegos, BE, MBA ( Head of Engineering)

More than 10 years of experience developing and implementing complex hardware solutions in Central America.

Product & Operations 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.

As part of product development, we have made sure to include users (patients, payors, and providers) and key stakeholders (i.e. community leaders, and government officials) in the process. This interaction has been key to allowing Bitmec to develop a better product that responds to their needs.  

Currently, there are > 2500 active users that have received remote primary care through the telemedicine booths in Guatemala and Honduras. To date, there are > 30 booths deployed on the field and many of these are located in communities with an average size of 5000 inhabitants. 

Being selected would greatly support the different needs that Bitmec currently has. The first challenge is purely financial. We are headquartered in Guatemala, which is a country that is not really part of the Latam Venture Capital market. Therefore it is more challenging when it comes to fundraising and we believe that through your network we would be in a better position to secure additional funding. Second, being part of such a valuable peer network could expose us to people with the technical skills that can help us to speed up technology developments. Third, as we look to enter new markets with our product, regulation is always a key aspect that slows down growth. Therefore, obtaining help from professionals from different backgrounds on this matter would help us to scale our solution as soon as possible and continue generating a positive impact around the world.  

In developing countries,  primary care options in many contexts are limited and are for the most part pharmacies, neighborhood stores, and traditional healers. For instance in Guatemala in 2012, it was estimated that there were more than 6,500 pharmacies throughout the country, which are regularly attended by pharmacy assistants who dispense medications, and unfortunately, many of them with limited clinical knowledge. In addition, according to 2011 estimates, more than 1/3 of the country's population consults a traditional healer to solve their health problems. Additionally, in the country, it is estimated that there are more than 110,000 neighborhood stores that thousands of people attend daily where they can buy basic medicines and even those that are sold under medical prescription illegally. Although these options can partly alleviate the access problem, the diagnostic capacity, and chosen therapeutics by these actors might cause greater damage in many cases in the long run.

Unlike traditional telemedicine  (video call or video chat), our solution is far more comprehensive, as it is supported by several technologies that allow providers to perform a more thorough evaluation remotely at the point of care and thus offer a higher quality service. Our plug-and-play solution enables healthcare providers to expand their coverage in hard-to-reach areas with high uptime and zero initial investment. This technology can be scaled around the world, especially to those areas that face geographical, political, cultural, and economic challenges. 

Our solution has strong potential to break the "status quo" wherever is implemented, meaning that it would reshape the way primary care is given in many contexts. This applies to both public and private healthcare delivery options. We strongly believe that Bitmec's solution would one way or the other push incumbents to either step up the quality of their service, partner with others, or disappear. For example, in community settings, a partnership between a healthcare provider using our technology and a local pharmacy would create synergies. In general, with the availability of better primary care options, those who benefit the most are the patients. In the long run, a healthier population thanks to better access to primary care has more potential to prosper.

• 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.

Within the next year, the focus is on perfecting our value proposition. To accomplish this we are investing a good amount of the company's resources into R&D and regulatory matters. In addition, we are learning on the ground how to be more efficient. Our milestone for the next year is to be able to introduce several AI-based diagnostic tools, improve the accuracy of the sensors, reduce inefficiencies, and in parallel obtain regulatory clearance from regulatory bodies such as ISO. Once we achieve these milestones, we would be in a better position to scale to many countries in the region and therefore generate a more positive impact. 

Impact measurement in healthcare is a complex process. However, as a company, we are currently focusing on input and output indicators that in the long run, if we are successful, the impact will eventually be noticeable. For instance, we are measuring how many booths are installed or how many consultations have been given by healthcare providers using our booths, which might not reflect impact immediately but eventually, we would be able to observe a decrease in certain indicators that can be attributable to better access to quality healthcare through our technological solution, particularly in underserved areas.   

Five years from today and aligned with our vision, Bitmec´s solution will be deployed in several countries in LATAM and also in other continents such as Africa and Asia. This will happen by sticking to basic principles and continue measuring the indicators that have been set over time and implementing the corrective measures that are necessary to keep improving our technology and growing our footprint. 

Bitmec is focused on generating a positive impact wherever our solution is implemented.

Although this solution is geared towards supporting good health and well-being (SDG 3), indirectly also impacts other SDG goals such as poverty alleviation (SDG 1) and reduced inequalities (SDG 9).

To accomplish this, input and output indicators have been defined and are measured to monitor our progress. As we move forward, corrective actions will be taken if our progress deviates from the planned outcomes.

Some of the Indicators that are being measured:

Input: 

• # booths built per month, trimester, year
• # of booths installed per month, trimester, and year. 
• % booth uptime per day, week, month, trimester, year 

Output: 

• % utilization per week, month, trimester
• # of new users per week 
• No. of consultations given per day, month, trimester
• % of follow-up visits completed per month, trimester

In addition to these indicators, to keep track of the effectiveness of our solution, our partners (healthcare providers) grant us access to aggregated data that they collect through our platforms, which allows us to measure several outcome indicators. These include treatment adherence, complications, child malnutrition, etc.  

Theory of Change 

Goal: To improve access to primary care services for underserved populations in developing countries.

Key Assumptions:

• There is a lack of primary care services in many developing countries
• Telemedicine can be an effective way of providing primary care services regardless of the context. 
• Despite the lack of access to healthcare, most underserved areas have the basic infrastructure that is needed to offer consultations through Bitmec's Telemedicine booth. 
• Providing primary care services through Bitmec´s telemedicine booth will lead to improved health outcomes for residents in underserved areas.

Key Activities:

• Identify and recruit partners (i.e. governments, insurance companies, and private practitioners) who are willing to offer telemedicine services through Bitmec's telemedicine booth.
• Establish a telemedicine solution that is user-friendly and accessible to those living in underserved areas.
• Advertise the service through several channels at the community and regional level
• Provide training to primary care providers on how to use the telemedicine platform and deliver care remotely through the booth.
• Monitor and evaluate indicators that will help to establish if the solution is achieving its desired impact. 

Outcomes:

• Increased access to primary care services for residents in the underserved areas.
• Improved health outcomes for residents who receive care through Bitmec's telemedicine booth. 
• Greater satisfaction with healthcare services at the local and regional level
• Increased utilization of preventive healthcare services, leads to a reduction in healthcare costs over time.

This model assumes that our solution will increase access to primary care services, and individuals in underserved areas will have improved health outcomes and greater satisfaction. This model is in great part supported by academic research that has been conducted in different settings that suggest that leveraging the type of technology we are implementing to increase access to healthcare and impact well-being is acceptable and cost-effective. 

A key aspect of the model is that by monitoring and evaluating the availability and effectiveness of our solution over time, adjustments can be made as needed to improve and achieve the desired long-term goals in any context.

Our IoT Telemedicine Booth incorporates several technologies that have been adapted to meet our users' needs. For instance, IoT (i.e. sensors) and cloud computing (i.e. mobile and desktop applications) are some of the core technologies that power the solution. These technologies allow patients and providers to interact with each other seamlessly and also allow Bitmec to monitor the operation of the booth remotely. 

In addition to the technologies described above,  AI/ML tools are being developed. These tools will aid doctors to improve their diagnostic capacity and thus improve the quality of care they provide remotely. For instance, one of the applications of AI is a diagnostic tool for the electronic stethoscope we have developed. Through this AI tool, healthcare providers can distinguish normal from abnormal heart and lung sounds.  

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 assembled a diverse 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. 

At Bitmec, there is an open-door policy, which takes care of establishing an environment of trust and mutual respect between management and all of the team members. In fact, at Bitmec's headquarters, there are no walls.  To ensure that our personnel thrives within the company, monthly meetings are held in order to get their input regardless of their role. 

In addition, there are protocols in place that allow team members to report any job-related situations that may arise with HR.

Bitmec offers the only platform-as-a-service (PAAS) solution for decentralized IoT-driven primary care.  Through our leading-edge telemedicine infrastructure and remote monitoring and control software, we help healthcare providers, insurance companies and public health systems expand their reach with high uptime and zero initial investment. 

Bitmec will scale around the world through a platform-as-a-service (PAAS) model where the technology is licensed to healthcare providers (i.e. governments, insurance companies, or HMOs) in exchange for a monthly fee and a pre-determined uptime (i.e. >95% availability). Given that the R&D, manufacturing, and scaling of our solution is capital intensive, the company will continue to raise funds through multiple rounds and explore grant opportunities to allow growth until financial sustainability is reached through the PAAS model.

Although challenging, Bitmec has been successful in raising capital from angel investors and some venture capital funds (Magma Partners). So far, Bitmec has raised around 75% of its $1.5 MM seed round. In addition, the company has received grants from USAID ($150,000), IDB ($10,000), the Guatemalan government ($110,000), and others for R&D and CAPEX.

In addition, Bitmec is already generating revenue from the booths that are  being implemented by healthcare providers in Guatemala and Honduras.