Reinventing Patient Navigation Program embedded with trustworthy Technology for Healthy Ageing

In the fast changing world, the elderly population remains the most unattended and faces a host of mental and physical health issues. In 2050, the world's senior population (>60 years) is predicted to reach more than 2 billion people. While the general population has grown by 18 per cent in 2001-11 and 12.4 per cent in 2011-21, the elderly population has grown by 36 per cent each in the two decades (National Commission on Population, 2020). The ever-changing social structure and cultural system of society because of modernization, urbanisation, and migration in Indian society has made life difficult for the elderly population. In the last 50 years, India, the world's second most populous country, has seen a tremendous demographic shift, with nearly a tripling of the population over the age of 60 (i.e., the old) (Government of India, 2011). UN has declared (2021-2030) decade as a decade of healthy ageing with main focus of bringing together community, governments, international agencies, academicians to help support elderly by providing them long-term integrated care. Therefore, the idea of care becomes crucial for their healthy ageing. On the other hand navigating the healthcare system is complex for both patient and family members-suboptimal outcomes when transitioning from hospital to home and/or homecare. Patient navigation has been introduced as a model of care to integrate care across care environment in many parts of the world. There is no best practice guideline for designing and implementing a patient navigation programme (health care needs, accessibility). Thus, tech-driven interventions can play a pertinent role for early detection of health issues which would lower the costs of living and help ease the physical and mental burden on family members and geriatric care workers. This includes any technology that supports healthcare delivery and provides information-based solutions to make the healthcare services better, accompanied by lowered costs. Apart from this, I think it is equally important to map patient need, journey, and experience with valuing the clinical experiences when developing a tech-care service or looking at the existing programme. I think we should come up with is actually feasible care model not only for our average patient but also for our patients who maybe don't have the highest health and digital literacy or additional resources to try and navigate something really difficult. Through integration of embedded and trustworthy AI, sensor based technology and natural language processing, this project is to focus on how health care systems can approach care from the patient's perspective considering the clinician experience and cognizant of how we can preserve healthcare resiliency and their ability to be empathetic and deliver the kind of care that they really want to deliver to their patients.

We aims to, based on WHO Integrated Care for Older People (ICOPE) framework, design a patient navigation programme featuring with easy accessibility and open communication amongst healthcare system, characteristics of the patient navigator, etc. that improve healthcare transition from hospital to home and assistive technology through user centred design (UCD) and participatory research (PD). These methodologies are designed to help researchers to understand better the social environment in which future technologies will be utilised, as well as how present end-user habits and attitudes may influence the design and appropriation processes of the ultimate product. To investigate elderly care needs and reinvent new models of healthcare in homecare setting and improve navigation programme through digitally, the study would initiate by interacting with elderly visiting the PHC and understanding their perspectives about technology use in health by Observation, Focus Group Discussions, In-depth Interviews and Workshops. The focal point of discussions would be queries about their digital literacy, health concerns, ability to adapt to new technologies. It is important to consider their individual needs, abilities and desires throughout the process. Elderly people generally fight with loneliness and other diseases and need someone to talk and care for them. Since adults are busy in jobs and home responsibilities, it would be crucial to bring in children to interact with the elderly. Focus group discussions would be done with students (Class 7-10th) to understand their perspectives about elderly care. Once the needs of the elderly people have been assessed through participatory research, User Centred Design will be used to design technologies for their health care such as a tool where patient can easily access healthcare system and information through AI-voiceover, privacy preserving fall detection which can raise alarms in the event of falls, develop non-invasive AI based apps to detect the intensity of depression for AI assisted mental health analysis (The system uses audio and facial features to analyse a person’s data and categorize into a patient or control and later predict the intensity), AI Assisted Audio-Visual bots - for accessible and easy to understand knowledge sharing with the elderly synthetic human avatars based bots will be created. After designing, we will test the feasibility of the technology with target users for user feedback to improve tech design. In the next phase, we will deploy technology in the community for acceptability testing for a certain duration. The generated data will be analysed and disseminated. We will look forward to local stakeholders for up-scaling of the technology and supporting the implementation of assistive technologies in the larger settings. 

• Leveraging health research and technology for healthy aging • Elderly engagement through participatory research to co-design assistive technology • Empowerment of elderly through tech-supported health services • Developing and upgrading user-centric assistive technology to support elderly needs

At the end of this project, we will have developed several health and IT solutions that could be leveraged into a digital infrastructure that would support the elderly. • We aim to alleviate social isolation amongst the elderly by providing them a support group. • The participants will have solutions to manage their chronic health issues • The project will bring awareness amongst the elderly regarding the latest technologies available to support their everyday needs

Dr. Duggal has over twenty years of rich training and research experience at top-ranked institutes in India and the U.S. Her research work has focused at the intersection of implementation science, public health Informatics, and clinical intervention research to improve access to care and outcomes in resource limited settings. Over the last decade, she has been successful in developing multinational research teams and received funding for various healthcare projects in India. Some of her research led to groundbreaking national policy decisions and interventions in India. Ms. Sarkar currently focuses on understating digital healthcare technology through the lens of patient experience and perspective and aims to leverage technology to enable an innovative care model. She has experience in digital health and knowledge of epidemiology, biostatistics, social data science, and programming. The team has a core public health background and has acquired knowledge in epidemiology, digital intervention, and research design methodologies, and also has developed a unique and insightful understanding of identifying and addressing the diverse health needs of different groups within the community. The team has a data scientist engineer and field investigator who can collect data in the field. The team members deeply understand the local context, regulations, and challenges. This proximity to the community allows us to design a relevant solution tailored to their needs.

The advisor and her collaborative team members already conducted studies on various issues, such as diabetes, falls, and cancer among the older population. Therefore, they have evidence and expertise to extend this study for designing a new healthcare model through patient navigation programs a home settings. However, in this study, we have an approach for user-centred design and participatory research methods. The emphasis is on involving the community as an equal partner and collaborator throughout research design, implementation, and various dissemination stages. To design fully usable and inclusive products, prior experience and other aspects, such as the context of usage and the environment of interaction, must be taken into account as they are crucial considerations in usability testing. In recent years, gerontologists and academics from related fields have been conducting extensive community-engagement-related research to promote and support healthy aging along with health and illness prevention.

User Centred Design (UCD) and Participatory Design (PD) can be used to create the best solutions for a particular target group. These methodologies are designed to help researchers to understand better the social environment in which future technologies will be utilised, as well as how present end-user habits and attitudes may influence the design and appropriation processes of the ultimate product. Community Participatory Research improves the quality and quantity of research by equitably involving both community and researcher partners in an action-driven investigation without losing sight of local community values. (Israel 2000; Minkler 2005). Equal cooperation between research and communities would improve the likelihood of a successful project by creating trust, ensuring and facilitating ethical conduct

The development of trustworthy assisted socio-tech for older adults is yet to be designed based on the findings of the need assessment study.   

Our patient navigation program is powered by technology and aims to address urgent concerns related to older adult physical and mental health challenges. We are applying because we share a common goal of addressing pressing community issues using digital health or technology solutions. We are seeking $150,000 in funding to develop technology and implement the technology in community and also to identify new strategies to overcome barriers for reinventing patient navigation programme and healthcare at home. Despite our team's knowledge and expertise, we have limited technical expertise in technology development. Our main focus is to design technology embedded with ethics and trust so that user can use technology without hindering their privacy. Therefore, we look forward to the MIT team, who will support us in developing trustworthy technology. We would appreciate support in the technical domain for designing an effective solution and user adoption/growth. We also want to build our capacity to scale this solution quickly and efficiently.

Methodologically: As we have mentioned above our study approach is based on UCD and PD that not involves patient, family members and community but also engage healthcare providers, developers, researchers, ethical expertise in designing patient navigation programme.

Localization and Culturally Tailored Solutions: our solution is aims to tailor with local needs and culturally driven healthcare services at home that ensures improve overall health quality and wellbeing and user experience. Our solution aims to improve digital literacy of older adults.

Trustworthy Technology: The pace of change and deployment of AI accelerates significant opportunities and profound risks to AI actors- individuals, groups, organizations, communities, and society. These systems are inherently socio-technical in nature and related to how a system is used, its interactions with other AI systems, who operates it, and the social context in which it is implemented. However, governmental agencies globally advocate the need for responsible AI applications and a nuanced understanding of the effectiveness and efficiency of AI solutions from an ethical and sustainability perspective. Our solution will focus on ethical and responsible considerations such as algorithmic bias, privacy, data ownership conflicts, lack of transparency, and operational and deployment challenges.

Partnerships and Market Platform: Our solution is poised to catalyze broader positive impacts among the older population through strategic partnerships with global agencies for long-term societal change. By demonstrating the viability and improvement of older health, our solution can influence health and ethics standards and encourage wider adoption.

UN has declared (2021-2030) decade as a decade of healthy ageing with main focus of bringing together community, governments, international agencies, academicians to help support elderly by providing them long-term integrated care. An analysis of morbidity patterns by age clearly indicates that the elderly experience a greater burden of ailments (National Sample Survey Organisation defines as illness, sickness, injury, and poisoning) compared to other age groups). There is an urgent need to provide better health facilities to the elderly as the population has no medical insurance, and there is high cost of private sector health care. There is also lack of trained manpower in geriatric care. In purview of these reasons there is a growing need to digitise health care for the elderly, provide assistive technologies for their use. And in order to make it more user centric, there has to be community involvement from the beginning. Assessing the needs of the target population is very important to provide workable technical solutions for their health care. The World Health Organization’s ICOPE framework focuses on the following goals: 1. Improving musculoskeletal function and mobility 2. Maintaining sensory capacity 3. Preventing cognitive decline 4. Promoting psychological wellbeing 5. Managing age associated and other chronic conditions 6. Preventing falls 7. Supporting the family. Effective interventions to support self[1]care include education and information, help to develop goals and plans, monitoring and managing symptoms to inform decisions, support for interaction with the healthcare team, developing emotional coping skills, connecting to community based resources, and providing social support for the patient and their family.

Activity 1: Investigate elderly care needs at home care setting and navigate from hospital to home – outcome - Needs Assessment for technology designing

Activity 2: Design and develop elderly health care technologies – outcome- Assistive health care technologies

Activity 3: Test the feasibility of the technology in lab –outcome - User feedback, improving tech design

Activity 4: Test the feasibility of the technology in community –outcome- In-field deployment of the technology

Activity 5: Support the implementation of assistive technologies in the larger settings –outcome- Stakeholder meetings for up-scaling of the technology

Goal 1: We will design patient navigation programme that could be leveraged into a digital infrastructure that would support the elderly.

Indicators: development of trustworthy assisted technology and ethically deployment of technology at home to improve health

Goal 2: We aim to alleviate social isolation among the elderly by providing them with a support group

Goal 3: The participants will have solutions to manage their chronic health issues

Goal 4: The project will bring awareness amongst the elderly regarding the latest technologies available to support their everyday needs.

Indicator: we will conduct a survey to understand their experience and health outcome post deployment of technology at home 

Our assisted technology solution relies on a combination of technology to power our solution, ensuring efficient delivery of new healthcare models for older population at home and ease to navigate and access healthcare services. We aims to utilize computational techniques, sensor based technology and data analytics and visualization techniques to smoothly implement research. Data analysis engine will allows us to organize and analyze data on patient demographics, health outcomes, and need assessment surveys, providing valuable insights into the effectiveness of our services. PowerPoint helps us create visually engaging presentations to communicate our program's impact and share key findings with stakeholders.

Furthermore, our solution will be equipped with registration and clinical technology to support the delivery of care. We will develop or utilize an existing platform for electronic health records, ensuring that patient information is securely stored and easily accessible to our clinical team. This system streamlines our workflow, allowing us to efficiently document patient encounters, track health metrics, and coordinate care across multiple providers. 

Overall, our use of technology is essential to the success of our patient navigation program. By leveraging these tools, we are able to provide high-quality, culturally competent care to older individuals and their families, improve health outcomes, and promote equitable access to healthcare services in our community.

Dr Mona Duggal 

Debarati Sarkar 

Dr Anshul Chauhan 

Dr Garima 

Sonam Kumar 

Mayank Gupta (Data Science Engineer) Part-time 

Mitesh (Field Investigator) 

Sikha (Field Investigator) 

The core team members have had solid professional relationships for more than 7 seven years. They have been working on this solution for a year to obtain a grant. The core engineer will work as a consultant. 

Our dedicated team comprises professionals with expertise in medical, public health, social data science, and digital health research and a core data science engineer and community health workers. Our goal is to establish a welcoming, secure, and career-focused work environment. We make decisions collaboratively rather than by consensus to allow everyone to positively impact the work. In order to give prospective employees the best chance to decide whether or not to apply for a position with us, we are an equal-opportunity employer that is completely open and honest about our compensation plan and job duties.