Project Duration: 4 months | 2017

CORD: COPD Management Service for Rural India

The project involves a healthcare service that provides Management, Monitoring, Preventive measures and Physiotherapy through trained attendants/technicians, vaccinations, lab tests, Medical equipments, Doctor consultation and Chatbot. They aim to make the management aspect of COPD (Chronic Obstructive Pulmonary disease) not only accessible and accountable but also much more affordable for the patients by delivering quality care.

Special thanks to James Mathew, Nithin Jerath, Shreyans Baid and Mayank Singhi

Thesis project for Philips Respironics;

  • Conducted secondary research to understand the nature of the disease and symptom based treatment

  • Conducted primary research (interview, observation, shadowing) in different medical settings; Primary care clinics, Hospitals and local community

  • Mapped patient's journey and barriers in accessing care

  • Co-designed with stakeholders

  • Developed service blueprint and a journey map

  • Developed a Chatbot prototype and wireframe of the app

 

STAKEHOLDER ENGAGEMENT THROUGH THE PROJECT

A quick overview of all the stakeholders I engaged with throughout the project.  The following research was conducted in both Government and private hospitals;

  • Yelahanka Government Hospital, Bangalore

  • Saptgiri Hospital, Bangalore

  • MS Ramaiah Hospital, Bangalore (both in-patient and outpatient setting)

  • TB Sanitorium, Jaipur (both in-patient and outpatient setting)

  • Sawai Man Singh Hospital, Jaipur

  • Santorba Durlabji Memorial Hospital, Jaipur

  • Rajiv Gandhi Institute of TB and Chest Diseases, Bangalore

  • Jayanagar Government Hospital, Bangalore

  • Victoria Government  Hospital, Bangalore

  • Medipulse Hospital, Jodhpur

Pulmonoligists

General Doctors

Other Medical Practitioners

(Nurse, Technicians, Interns)

Patients

Local Communities

Patient's Family

Hospital Administration

UNDERSTANDING THE CURRENT CONTEXT

ABOUT THE DISEASE

COPD is a chronic condition that worsens over time. Currently, there is no cure for COPD but can be controlled with timely treatment and management. COPD patients are also at a high risk for other health problems including heart attacks, strokes, and lung cancer.

‘60 PERCENT OF THE CASES ARE IN RURAL SECTOR’

‘MORE THAN 10 MILLION CASES PER YEAR IN INDIA’

‘IT IS A LIFE LONG DISEASE WITH TREATMENT AVAILABLE BUT NO PERMANENT CURE’

‘COPD PATIENTS ARE GENERALLY OF 50 AND ABOVE IN AGE’

IDENTIFYING THE PROBLEMS: There's a a loop of hospitalisation

ABOUT THE CURRENT

PATIENT JOURNEY

The current COPD patient journey is circular in nature. The patient is rushed to the hospital due to COPD flare ups which can be triggered even by the slightest of weather change.

‘WE HAVE PATIENTS WHO HAVE BEEN COMING HERE SINCE PAST 20 YEARS, THEY ALWAYS COME BACK WITH A WORSENED CONDITION’

TB Sanitorium hospital, Jaipur

60 percent of the COPD patients live in rural India; Most of these patients travel around 70 kms to receive the required treatment in a very vulnerable state.

Given the social construct, the entire family travels with the patient and most of the family members are daily wage earners, hence uprooting their only source of income

A CYCLE HAS BEEN CREATED, THE PATIENT GETS ADMITTED IN TRAUMA, THEN MOVED TO
GENERAL WARD AND THEN HOME. WE KNOW THE NEXT TIME WE'LL SEE HIM WOULD BE IN TRAUMA AGAIN’


Victoria Memorial hospital, Bengaluru

‘I HAD A PATIENT IN A CHRONIC CONDITION WHO WOULDN’T HAVE SURVIVED ANOTHER DAY IF IT WASN’T FOR BIPAP, HE HAS BEEN REGULARLY ON BIPAP FROM THE PAST 10 YEARS’

Rajiv Gandhi Institute of tb and chest diseases, Bengaluru

Current BIPAP machine costs 70,000 INR and the target audience need bank loans in order to buy an oxygen cylinder which costs 10,000 INR

8 out of 10 COPD patients require BIPAP machine. Even the biggest hospital in the state had one BIPAP machine amongst 90 COPD patients

HOW MIGHT WE MAKE BIPAP ACCESSIBLE FOR ​PATIENTS FOR THEM TO RECEIVE THE DESIRED CARE?

COPD management service

SINCE COPD IS A LIFELONG DISEASE, THE SERVICE AIMS TO IMPROVE THE LIFE EXPECTANCY ALONG WITH A QUALITY LIFESTYLE BY PROVIDING TIMELY AND REGULAR TREATMENT

In order to make the treatment accessible and affordable, we came up with a service solution which decentralises the treatment and provides timely care to the patients. The tangible and intangible elements of this service are:

  • The existing devices; BIPAP machine, ABG machine and the oxygen cylinder

  • Antibiotics and bronchodilators

  • Technical assistant 

  • Electronic medical health records

  • App connected to the cloud server and tele-health that helps the patients to connect virtually with the during during consultation

  • Chatbot

THE PCo2 in the blood determines the duration and need of the service. The service can only be referred by a pulmonologist. 

This intervention at an initial stage not only prevents the patient’s condition to worsen with time but also intervening at a regular interval helps them enhance their quality of life. It avoids regular hospitalisation, the requirement for invasive ventilation and facilitates an up gradation in the lifestyle.

HOW THE SERVICE FITS IN THE CURRENT CARE JOURNEY...

  • Adds efficiency to the existing healthcare scenario

  • Provides another platform for the already existing products (BIPAP and ABG machine) to reach people making these devices more accessible and affordable for the target audience

  • Customised medical care by providing A-Z patient’s medical history

  • Avoids the worsening of patient’s condition by regular intervening

  • Avoids the need for the patient to travel in a vulnerable state

  • Regular advocate injection because low immunity

  • Eliminates the burden on hospital beds

  • Insures timely treatment

JOURNEY MAP

It takes you through the step by step process designed for the target user in correspondence to the actions of the technician and other tangible and intangible aspects of the service.

Gets diagnosed with COPD.
Gets various tests done
-PFT
-Blood test
-Urine test
-MDR
-ABG

Is either put on:
-Oxygen cylinder
-BIPAP
-Venti- VIPAP
-Antibiotics

The doctor needs to examine the patient 2-3 times for him to understand his condition and further refer him to the service with a specified service interval.

Based on the doctor’s consultation, while discharge advices the patient for this service. 

Hands over the file and the doctor’s recommendation to the front office service guy - gives information(personal details) - subscribe - further info on how to schedule an appointment.

Confirms the appointment via text message on the registered phone.

Meets them and inquires about the patient health after leaving the hospital from the patient himself and the family.

Inserts the needle in the artery to extract a sample of blood to get the ph and Pco2 count in the blood.

The technitian uploads the ABG result on the patient’s electronic file.

Contacts the doctor if any trouble. Interpret the ABG report and accordingly upload the recommended settings and the time duration.

The technitian manages the BIPAP machine, based on the prior interpretations, sets specific mode, EPAP and IPAP.

Puts the mask along with the oxygen supply Also checks for any leakage and comforts the patients.

The technitian can help them about physiotherapy/self help.

Based on the prior records, give them specific doses of antibiotics to prevent them from getting sicker.

The person is charged based upon:
-Distance
-ABG
-BIPAP
-Oxygen
-Antibiotics
App notifies the patient and hence, provides transparent transaction. 

- Gets notified about the appointment
- Details of the family are shared with the technitian and vica versa.

- Prepps up the machinery, refueling of the vehicle.
- Double check everything

Can go through the file before hand; gets a code (while being notified about the appointment) to log into the patient file on the server

-On the way chit-chats with the driver.
-Can call up the family for exact location.

-Logs into the patient’s file.
Reaches and asks a set of questions:
-Any difficulties in between.
-Any other problem
-Six minutes walk- make notes

-Takes a new syringe
-Sanitize the area
-Takes sample
-Dips it in the probe
-Disposes the used syringe

Uploads the ABG result on the patient’s electronic file.

Contacts the doctor if any trouble. Interpret the ABG report and accordingly upload the recommended settings and the time duration.

Gets the BIPAP machine in the house along with the oxygen cylinder

Manages the BIPAP machine, based on the prior interpretations, sets specific mode, EPAP and IPAP.Puts the mask along with the oxygen supply Also checks for any leakage and comforts the patients.
Gets verified by the doctor or the chatbot.

Based on the history of the patient the technitian prescribes preventive antibiotics.

- Steralize the area
- Uses a new syringe
- Disposes the used syringe.

-Based on the treatment taken and registered, the patient is charged for the service.

-Collects the amount from the patient and confirms payment.

Suggests regarding the next appointment and ends the trip.

-On the way back checks if any other appointments.
- writes a report
-submits the service charges to the person in charge.

The persona was created by understanding the living standard, expectations, desires, problems and habits of the target audience. The persona helped me with reasoning and narrowing down my project according to the needs of the patients and their families.

The journey maps, the wire-frame, storyboard and lastly the blueprint was a result of understanding and observing the target audience in multiple scenarios.

PATIENT PERSONA

-Widow

-Lives with her son and daughter-in-law

-Has two grandchildren

-Son is the only bread earner in the house; works as a labor painter

-Doctor has recommended an oxygen cylinder

-Got the cylinder at rent; 7000 per month

-Has a bank A/C. Got it only to get a loan on the cylinder. No one in the family has insurance.

-Surrounded by neighbors and relatives 

-lives in a community space.

-Keen on watching TV | Eat-Watch TV-Sleep-Eat-Watch TV-Sleep

-Gets full time electricity

-Doesn't own a cellphone; only son has one in the house (Micromax)

-Uses Facebook and Whatsapp

-The grandson know how to operate the phone very well.

Geeta (70)
Female

 

-Used to cook on chula


-COPD patient since the past 4 years
 

-Has to go to the hospital in every 2 months
 

-Stays there for nearly one week
 

-Son takes her to the hospital in an auto
 

-Daughter and relatives visit but son stays there

during the night; sleeps on the corridor
 

 

-Has to leave his work for few days
 

-Had pneumonia the last time she went to the hospital
 

-Spends around 5000 in one hospital visit
 

-Seeks treatment in a government hospital

The Wireframe of the app shows different functions provided in the mobile which is a part of the service. It includes patient's medical history, personal details, assistive bot (Manju). The app has been sketched out according to the convenience of people, keeping in mind the geographical constrains.

WIREFRAME

CHATBOT

This is where the Chatbot comes into play. It's a combination of in-between assistance, Physiotherapy, medical history, immediate help and lastly it also schedules your appointment based on your need and inquiry.

CHATBOT

PHYSIOTHERAPY (EXERCISE AND COMFORTING POSITIONS)

EVALUATE MEDICAL HISTORY

PROVIDE ASSISTANCE

PROVIDE INFORMATION ABOUT THE DISEASE AND OTHER PROBLEMS RELATED;HEART ISSUES.
THUS, PREVENTIONS

PATIENT

TECHNICIAN

CHATBOT

DOCTOR

PHYSIOTHERAPIST

AMBULANCE

DIFFERENT STAGES OF USING CHATBOT

-EVALUATING MEDICAL HISTORY AND RECOMMENDING THE SERVICE INTERVAL ACCORDINGLY

-REGULAR ASSISTANCE/ IN-BETWEEN GUIDANCE

-IMMEDIATE HELP

BLUEPRINT

The blueprint is the map of the entire service. It includes the step by step work done at every level, onstage as well as backstage. All the pillars of the service also come into play to display their individual responsibility.

FEEDBACK FROM THE EXPERTS

‘THIS CAN DEFINITELY HELP THE PATIENTS TO LEAD A QUALITY LIFE’

‘REGULAR ADVOCATE INJECTIONS CAN DEFINITELY REDUCE HOSPITALISATION

‘MANAGEMENT OF COPD CAN REDUCE THE CHANCE OF HEART FAILURE

‘THIS WOULD DEFINITELY PROVIDE COMFORT TO THE PATIENT AND THEIR FAMILY MEMBERS’

The documentation books covers the entire project in detail. It includes introduction of respiratory diseases, countless hospital visits; in Bengaluru and in Jaipur, Recorded interview with the pulmonologists, general physicians, machine dealers, hospital staff, ambulance drivers and most importantly the patients with their families. The book also includes a study of a number of healthcare services, government aids and potential tie ups.