Mikaela - Pregnancy telemonitoring

A quarter of the 2.5 million Venezuelan migrants in Colombia are women of fertile age, this is more than 700,000 people. This has been evidenced by the increasing number of births reported in the country's public institutions. Of the pregnant women, about 40% did not receive prenatal check-ups, and 45% stated that their perception of health is between fair and poor.

The migration of pregnant women is not a local problem. Around 281 million people in the world are migrants due to different situations (economic, political, and social, among others). About half are women and a quarter of them are women of fertile age. Usually, the birth rate in the migrant population is higher than that of the natives, so it is estimated a large number of women are in this situation. 

In pregnancy, maternal morbidity is largely preventable. The main thing is access to health services and continuity of care. Prenatal care consultations are the moment where possible risks are detected and technology such as monitoring physiological variables like blood pressure and weight can contribute to the timely detection of problems. As this population usually has poor access to health services due to their displacement situation, this population has high rates of diseases, and even maternal mortality due to lack of follow-up. 

Taking into account variables such as the continuous displacement of pregnant migrants and that health services are not interoperable and are not connected, telehealth interventions could allow continuity of health care and coordinate actions in the territory where patients are.

In Netux we have three solutions that could contribute to the solution of this problem: 1. Mi Historia Clínica: It is a software solution that allows care in the telemedicine modality and that contains electronic medical records (EHR). 2. Mi Paciente Telemonitoreo, is a solution that allows you to connect with home biomedical devices such as scales, blood pressure monitors, and pulse-oximeters, among others, and 3. Mi Paciente Mikaela is a software for capturing physiological variables such as heart rate, oxygen saturation, and blood pressure through the cell phone camera using artificial intelligence and computer vision.

Due to, it is not practical to assign medical devices to each of the migrants for telemonitoring, our solution proposes a combination of the Mi Historia Clínica solution with data captured by cell phone camera through Mi Paciente Mikaela. Our solution allows flexibility so that through a cell phone telehealth care can be carried out such as orientation consultations, education, and follow-ups; but also consultations through telemedicine. Our solution would allow us to be more effective through the capture of physiological data, such as heart rate, blood pressure, oxygen saturation, and preliminary estimation of initial risks as a pre-screening and subsequent follow-up of pregnancy. 

In case of finding elements of risk, through the solution, we can inform and notify the institutions responsible for the assurance of the population as well as governments to establish preventive interventions. In case of need, our solution would allow the population to have reports to present and share with hospitals in case of an emergency with the registration of all care in the telemedicine modality and the capture of vital signs.

Our solution would be aimed at the migrant population in a state of pregnancy, regardless of their reasons. Their lives will be impacted by having constant accompaniment through a digital solution to which they can go whenever they need it and require guidance on the status of their pregnancy, and thus be able to serve as a link with the health services of the region. This can be done with hospitals and partner organizations that can guide women.

Usually, this population does not have access to basic services and must be begging to have a daily income that allows them to solve basic needs. Access to health services is limited and with a series of legal and organizational requirements. Our solution will have no restrictions for follow-up and care and will allow coordination of the efforts of governments and NGOs to ensure the required access and treatment. 

Our solution will aim to reduce the problems of access to quality health services. And it will allow timely action in events such as emergency care when an unexpected event happens. 

Our company develops technology products for the monitoring of equipment, processes, and people. 

We have different products that support the capture of patient data through telehealth (Mi Historia Clínica), with synchronous and asynchronous communications by video, voice, or text (Mi Paciente Telemedicina). And Remote monitoring of the patient through clinical-grade devices (Biomedical devices) or wearables (Mi Paciente Telemonitoreo) or by computer vision (Mi Paciente Mikaela). In addition, we have the capability of capture of data through surveys (digital forms) through omnichannel communication with the patient or user.

For the development of these solutions, one of the capabilities of the institution is its human talent. In which there is specialized technical staff, systems engineers, software developers, and scientific staff with master's and doctoral degrees. This is the reflex of the DNA of the organization which focuses on developing knowledge-based solutions that add value to our clients. 

In addition to this, we have had experience in implementing solutions with sponsors such as USAID aimed at vulnerable populations, departments, and regions with limited access to health services in conjunction with local government entities. 

Particularly, in this type of project we have worked with the migrant and pregnant population, which has allowed us to know their needs and how we can contribute to them.

Our solutions aimed at remote diagnosis and treatment have been created as alternative care for people who have limited access to the system.

Through the product Mi Historia Clinica, more than 150 thousand consultations have been made in different specialties. With the product Mi Paciente Telemonitoreo more than 300 patients have been treated and we currently have a project to monitor respiratory and chronic diseases with more than 480 patients in real-time. With the product Mi Paciente Mikaela, we have developed proofs of concept but it has not been tested in the market yet. 

Netux is a technology development company for the health sector, focused mainly on institutions, monitoring equipment, and processes. 

By being in close contact with health sector actors, we have realized that we can have a greater impact on communities. We have an interest in becoming a health, wellness, and/or life care service provider. 

With the knowledge we have of digital technologies in health, we focus on new paradigms such as:

• The empowerment of people to care for their own health.
• Digital therapies as a tool for continuous care.
• Obtaining large volumes of data from the day-to-day of the person to use them in health care.
• Individualized health allows individualized actions to be taken from the person's information that is given in multiple layers.
• 4P health as Preventive, Participatory, Predictive, and Personalized health.

Thus, we have developed recent products such as Mi Paciente telemonitoreo, Mi Historia Clínica, among others. We are committed to growing in new products and services that allow us to scale our solutions worldwide. We have moved forward little by little with consistency. All the products have served the population of all social levels and all territories in our country. 

However, if we want to have the impact we dream of, we must have the accompaniment and vision of organizations with global impact such as SOLVE. We are sure that belonging to this community will allow our solutions to have an exponential impact and consequently contribute to the health care of people and communities not only in Colombia but in Latin America and the world. 

Digital interventions in Colombia have been poorly implemented. Colombia has used telemedicine as a replacement for face-to-face care and usually the traditional method is videoconferencing. This vision means that there is low satisfaction on the part of health personnel and the population. 

Our solution is close to solving the problem, by carrying out mainly telehealth actions and not health services. The focus is on advice, guidance, mentoring, and risk detection, in that sense the doctor is not the main actor but the paramedical personnel such as nurses, community workers, and the community itself have an active role in health care through self-monitoring of variables and daily answers about their health status.

To change the paradigm we have state-of-the-art technology, such as the detection of vital signs through computer vision and software developments in the cloud that take data from different sources to build risk models and prioritize care. 

Our solution focuses not on the provision of health services to cure the disease but on prevention with the paradigm of efficiency and cost reduction caused by diseases that can be preventable such as those associated with maternal morbidity (Preeclampsia, Gestational Diabetes, Preterm Labor Syndrome, among others)

Our global impacts seek to preserve the health status of mothers and newborns, regardless of their particular situation. We seek to demonstrate the responsibility that governments have to the attention of the population that transits their territories.

We will help migrants reach their final destination healthily and safely, avoiding changes in plans due to health problems. Through our channel, we will guide all possible help.

In the short term, we seek to broaden the patient base that uses our solution and feed it with data that will allow us to refine the solution. In the long term, we are oriented and wish to contribute to the reduction of maternal mortality in the world, through the reduction of extreme maternal morbidity due to preventable causes.

We plan to measure the progress of our solution from three levels. Operational, health, and diseases

At the operational level, the indicators will allow us to evaluate that our solution is also working through: 

• Number of women active in the solution: Women who log in at least once a month.
• The proportion of teleorientations: We will measure how many orientations we give to the users
• Follow-up time: We will measure how long during the pregnancy we follow each of the users.

At the health level, we will evaluate how we improve health conditions and the perception they have about the intervention. We will use indicators defined by the government of Colombia such as: 

• The average time between the first prenatal check-up and the date of breastfeeding counseling.
• Antenatal care coverage: percentage of live births with four or more antenatal care visits.
• Percentage of pregnant women who undergo first trimester ultrasounds.
• Percentage of pregnant women with second-trimester detailed ultrasounds.
• Percentage of pregnant women screened for diagnosis of gestational diabetes
• The proportion of births attended by qualified health personnel.
• Quality of life survey
• Overall satisfaction with the program. 

Finally, we will evaluate the impacts on the disease, according to the information system of epidemiological surveillance in Colombia. SIVIGILA

• Extreme Maternal Morbidity per 1,000 Live Births
• Maternal mortality per 100,000 live births.

In this way, we can improve our solution, depending on the benefits to pregnant women. 

Activities

1. To Promote the use of the telehealth model with vital signs capture
2. Training in the use of the telehealth solution
3. Provide teleorientation and training through the solution
4. Provide telemedicine care
5. Capture Vital Signs through the camera and self-managed forms

Short-term results

1. Increasing awareness of telehealth as a follow-up modality
2. Increased adoption of our solution
3. Identification of signs and symptoms of interest
4. Obtaining data at the clinical level to individualize care
5. Increase the database for analysis

Medium-term results

1. Increase in the number of women using the model.
2. Improved utilization of solution functionalities
3. Reduction of attention times by recognizing problems.
4. Complete profiles for better follow-up. 
5. Generation of prediction models of diseases that contribute to maternal mortality.

Long-term results

1. Increased access to healthcare 
2. Improve early detection of pregnancy complications
3. Reduction of costs to the health system
4. Increased emotional well-being and quality of life
5. Improvement in the overall health of pregnant women and their newborns.

Telehealth actions (teleorientation and telemedicine) will be carried out through a mobile application that allows video, voice or chat to communicate with medical and paramedical personnel. 

The data will be captured through surveys self-filled by the users. On the other hand, vital signs will be captured through a remote plethysmography technique through the camera by computer vision methods. 

The registration of clinical variables by the medical and paramedical staff will be available through Mi Historia Clínica during the teleorientations carried out to the patients. 

All data derived from this tracking will be incorporated into our NetuxCloud platform that allows data storage, regardless of the source in which the data was captured.

With the available data and health results we will be able to train Artificial Intelligence models for the early detection of risks.  Seeking to anticipate the main problems of pregnant women such as Preeclampsia, Gestational Diabetes, and Preterm Birth, among others. 

Netux promotes inclusion, equality, and diversity from different areas of the organization, starting with the deepest such as organizational culture, which is based on values such as individual freedom, moral equality, and hospitality. Individual freedom is understood as the individual sovereignty or property of an individual over himself, in which each one can decide autonomously on the essential questions of his life, becoming responsible to society for the consequences of his decisions. Moral equality, according to which all team members, regardless of their role within the company, must be treated with the same dignity. We are all colleagues, colleagues, members of a team, we are members of Netux. And hospitality, through which Netux employees identify themselves as caring, generous and kind people. 

Based on these values, in Netux we have a well-being model for our members, which enhances inclusion by creating the right environment so that everyone is welcome, feels supported, and happy in the company. The wellness model is centered on people and their habits, promoting strategies for people to train, take active breaks, monitor their health, enjoy days off, and share in virtual spaces with all members about the progress of the company, and its products.

In terms of equity, in our leadership team, there are more women than men, with 10 women and 8 men. And in the total number of employees, 53% are women and 47% are men. 7% of workers belong to an ethnic group, 1% are migrants and 4% have only a high school education.

We did a study with our members to know their opinion about their satisfaction in the organization and 93% recognize that their work is recognized, 88% see themselves growing in the organization and 96% feel that their task has a purpose.

Our proposal is a telehealth intervention, focused on the orientation and continuous care of migrants through information and communication technologies. Our beneficiaries are pregnant women and their families who migrate through our country, in addition, the general society and the government benefit from the solution since it could reduce negative indicators such as maternal morbidity and mortality. 

Our value proposition focuses on continuous care during pregnancy, which allows mothers to have confidence in their health, know when to ask for help, and have a safe pregnancy despite the adverse conditions they face. Pregnant migrants seek to reach their final destination in the best conditions, with our solution we safely facilitate their transit, reducing the difficulties of access to health services. 

Our solution is digital, which can be used in cell phones of low specifications, monitoring physiological variables such as answering questions about your health does not require a synchronic Internet connection. For orientation services via videoconference or real-time chat, pregnant women will be able to connect in public accesses offered by the Internet in most parks in all municipalities of Colombia, in the same way, we make alliances will be sought with data service providers so that our services can be accessible at no cost. 

As a for-profit company, we hope in the future to sell products and services to local governments, which must take care of all people, regardless of whether they are in a fragile context or not. 

Additionally, private insurers in our country could offer value-added services in continuing care in groups of patients with chronic non-communicable diseases with populations that can pay for a differentiating service. 

Finally, due to the decrease in the birth rate in our country. Pregnancies are becoming increasingly valuable, so we could directly encourage women who can pay to purchase a service that ensures ongoing care for their pregnancy. 

Finally, capital will be raised for our innovation and development process through grants interested in artificial intelligence, interoperability, telehealth, and telemedicine developments, which will allow us to exponentially improve our solutions and be more competitive in the market. 

Our company has had in its DNA research and development, in search of solutions that contribute to improving people's health. Since 2006 we have been able to say that we have managed more than 300,000 USD in Grants and 400,000 USD in investment funding we raise. This has been able to generate a return on investment of more than 6.5M USD throughout our history, which you can know in this link: https://www.netux.com/es/nosot...