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.
THE CHATBOT WILL HELP YOU GO THROUGH THE PROJECT
HI, I'M MANJU.
I HAVE BEEN PROGRAMMED TO GUIDE YOU THROUGH THE PROJECT. IF YOU HAVE ANY QUESTIONS, PLEASE DON'T HESITATE TO ASK MY PROGRAMMER.
I WOULD LIKE EVERYONE TO WITNESS MY BIRTH PLACE.
NOW LET'S START THE TOUR BY TALKING ABOUT THE PROJECT BRIEFLY.
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 disease not only accessible and accountable but also more affordable for the patients by delivering quality care.
FOR THOSE OF YOU WONDERING HOW THE SERVICE BENEFITS THE CURRENT HEALTHCARE INFRASTRUCTURE, LOOK BELOW.
-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.
-Customized 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.
I THINK IT'S TIME FOR ME TO TELL YOU WHAT COPD IS. DISCLOSURE; IF YOU'RE A SMOKER, PAY EXTRA ATTENTION
Chronic obstructive pulmonary disease (COPD) is a common lung disease. Having COPD makes it hard to breathe.
-Smoking is the main cause of COPD. The more a person smokes, the more likely that person will develop COPD.
-Exposure to certain gases or fumes in the workplace.
-Exposure to heavy amounts of secondhand smoke and pollution.
-Frequent use of a cooking fire without proper ventilation.
COPD is a chronic condition that worsens over time. Because it is slow to onset, the symptoms may not be noticeable until they are severe enough to interrupt daily activities. Currently, there is no cure for COPD. However, COPD can be controlled with proper treatment and management.
Treatment for COPD vary depending on the severity of the disease. Treatment may include medication, pulmonary rehabilitation, oxygen therapy and/or surgery.
It causes serious long-term disability and early death.
THIS IS HOW COPD AFFECTS YOUR BODY AND DISRUPTS YOUR EVERYDAY ROUTINE.
Having COPD makes it hard to breathe because less air flows in and out of the airways in your lungs. This happens when:
Airways become thick and inflamed.
Airways and air sacs lose their elastic quality.
Lung tissue is destroyed.
Too much mucus is made and blocks (obstructs) airways.
When you’re getting less air, less oxygen gets into body tissues and it gets harder to get rid of the waste gas carbon dioxide. This results in shortness of breath during everyday activities. People with COPD can experience fatigue, chronic cough and frequent respiratory infections as well. COPD patients are also at a high risk for other health problems including heart attacks, strokes, and lung cancer.
HERE ARE FEW FACTS TO GIVE YOU AN IDEA ABOUT THE NEED FOR THIS SERVICE.
‘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’
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 WITH
THE NEXT STEP WOULD BE TO UNDERSTAND THE USER JOURNEY BEFORE I WAS BORN.
In the current scenario, the patient begins by visiting the nearest General Physician and taking symptom based treatment. Later, when the condition worsens, he visits various physicians; both government and private sector. The treatment is based on the results of Pulmonary Function Test, Arterial Blood Gas Test, Sputum Test, Multi Drug Resistance test, Blood test, Urine test and Chest X-Ray. After the tests being conducted, the patient is further admitted in the hospital and put on either Bronchodilators, antibiotics, oxygen cylinder, BIPAP, VENTI-VIPAP.
THE PATIENT AND THEIR FAMILY
Patients in the rural and urban-rural sector travel miles in a weak and vulnerable state to get to the hospital equipped to provide them desired treatment.
While, the patient receives treatment, the family sits beside and sleeps in the hallways. Repetitive hospitalization disrupts the family schedule, most of these people are daily wage earners, hence while assisting in the hospital there’s a lot of expense but no regular income to support that.
‘WE HAVE PATIENTS WHO HAVE BEEN COMING HERE SINCE PAST 20 YEARS, THEY ALWAYS COME BACK WITH A WORSENED CONDITION’
TB Sanitorium hospital, Jaipur
‘EVERY WEEK AROUND 10 PATIENTS ARE ADMITTED FOR COPD’
Rajiv Gandhi Institute of TB and chest diseases,
NOW LET’S TRY TO PUT THE CURRENT USER JOURNEY IN PERSPECTIVE OF THE CURRENT HEALTHCARE INFRASTRUCTURE.
In the current scenario, the treatment is restricted within the hospital premises. After being discharged from the hospital, the patient only has Bronchodialator to rely on at home. Thus, even with a slightest of weather trigger the condition worsens and the patient is taken to the hospital in a weak and vulnerable state.
Most of the Government hospitals fail to meet the demand and requirement for these machinery due to affordability and hence, fail to accommodate a large number of patients with proper immediate treatment. BIPAP being an expensive machine is often out of reach in hospitals.
Taking the example of the biggest government hospital in Rajasthan, they claim to have 12-15 COPD patients out of 50 patients admitted in the general ward at all times. One BIPAP machine is shared amongst the COPD patients of 6 such wards. Hence, one BIPAP machine is assumed to be shared amongst almost 100 people.
There were also many cases where the ownership of the BIPAP machine in a hospital was missing, The treatment was only available for two extreme situations.
‘A CYCLE HAS BEEN CREATED, THE PATIENT GETS ADMITTED IN TRAUMA, THEN MOVED TO
GENERAL WARD AND ONCE HE GOES HOME, THE NEXT TIME WE SEE HIM IS IN TRAUMA AGAIN’
Victoria Memorial hospital, Bengaluru
‘THERE ARE COPD PATIENTS IN EACH WARD BUT WE DON'T OWN A BIPAP. THEIR TREATMENT IS DONE THROUGH BRONCHODIALATORS AND STEROIDS'
Jayanagar government hospital, Bengaluru
WHAT THE PROFESSIONALS HAD TO SAY.
‘THIS CAN DEFINITELY HELP THE PATIENTS TO LEAD A QUALITY LIFE’
‘REGULAR ADVOCATE INJECTIONS CAN DEFINITELY REDUCE HOSPITALIZATION’
‘MANAGEMENT OF COPD CAN REDUCE THE CHANCE OF HEART FAILURE’
‘THIS WOULD DEFINITELY PROVIDE COMFORT TO THE PATIENT AND THEIR FAMILY MEMBERS’
NOW YOU’LL READ ABOUT HOW CARBON DIOXIDE IN BLOOD PLAYS A MAJOR ROLE IN DICTATING THE
TREATMENT FOR COPD.
The level of Co2 in the blood is a major factor determining the treatment for the patient. The escalation of Pco2 can have severe complications like coma, hypercapnia or Hypocapnia. ABG (Arterial Blood gas test) is done to find out the PCo2 count in the blood based on which the patient is either put on BIPAP, VENTI-VIPAP or INVASIVE VENTILATION.
45 is the perfect Pco2 count. For COPD patient it fluctuates from 45-100. Currently, when the Pco2 count is 80 or above the person is put on Non-Invasive ventilation like BIPAP and VENTI-VIPAP. but when it it touches 100, the patient requires Invasive Ventilation.
BIPAP and VENTI-VIPAP are supportive breathing machines. They provide water pressure support which helps the airways to open for the patient to exhale out all the Co2 trapped inside the lung creating dead space.
ON YOUR RIGHT IS HOW THE PCO2 COUNT IN THE BLOOD DETERMINES THE DURATION AND TERMS OF THE SERVICE.
PCo2 count of the patient helps in detemining the duration and the need for the service. The requirement varies from patient to patient but with the help of electronic medical history, the case of each patient can be evaluated and treated accordingly.
The service is initially scheduled based on the doctor’s recommendation and previous health records which are majorly dependent by calculating the history of pco2 counts. Later, the chatbot comes into play for reminding the patient to book another appointment to avoid worsening condition. Both escalation and reduction in the pco2 count can have adverse effects.
If the patient in between two schedules reports uneasiness and discomfort, the chatbot recommends to prepone the schedule. This information is also saved on patient’s file for the doctor to get an informal history.
If the BIPAP treatment is provided in the Pco2 ranging from 45-70, it reduces sudden excalation and worsening of the patient’s condition and also reduces the need for invasive ventilation.
A regular check of the blood gases help in controlling and predicting the patients health. It also indicates if specific precautions are to be taken to manage the condition beforehand.
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 hospitalization, the requirement for invasive ventilation and facilitates an up gradation in the lifestyle.
NOW LET’S DISCUSS AND ELABORATE THE TANGIBLE AND INTANGIBLE
COME TOGETHER TO FORM THIS SERVICE.
-The existing devices; BIPAP machine, ABG machine and the oxygen cylinder
-Anti-biotics and bronchodilators
-Electronic medical health records
-App connected to the cloud server and Tele-health that helps the patients and the doctor to constantly monitor and manage their condition.
LET’S GET TECHNICAL AND BREIFLY UNDERSTAND BIPAP
BIPAP machine is a Non-Invasive ventilator. It’s a support breathing which prevents your airways to collapse. It works by providing water pressure while inhaling and exhaling.
This particular machine is by Respironics; Philips healthcare. The cost of the machine is 70,000. In case of COPD, it also requires a qualified technician to operate the machine settings keep on changing depending on the Pco2 count blood.
‘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
THE TECHNICAL PART ISN’T OVER YET; UNDERSTANDING THE ARTERIAL BLOOD GAS (ABG) MACHINE.
Arterial blood gas test is blood test done to find out the oxygen count, carbon dioxide count and the PH of blood. In this context, it is done to to check how well your lungs can move oxygen into the blood and remove co2 from the blood. In context to COPD, the hospital conducts this 2-3 times in a day to examine the patient’s response to the BIPAP treatment.
This machine costs around 5 lakhs. in government hospitals, the subsidised rate for conducting one test is 200 rupees.
In the service, the technician would have to sterilize the injection site, use a new needle and draw a small amount of blood from the artery. The blood taken from the artery has to be dipped in the probe within 15 minutes for accurate results. The result comes within the next 6 seconds. It’s a very low risk procedure.
Philips healthcare does not manufacture an ABG machine, but through this service it provides a new platform for the existing products to reach people and in future a scope to further redesign the machinery based on the convenience of the user and the provider.
HOW TELE-HEALTH AND ELECTRONIC MEDICAL/ HEALTH REPORT COMES IN THE PICTURE.
Tele-health in simple words is medicine/medical guidance through tele communication. In this service Tele-Health comes in picture if the technitian faces some challenges in prescribing a BIPAP treatment or if there’s a need for a doctor consultation.
Electronic Medical/Health record is making it’s way in the current healthcare scenario. The intial challenges faced were to get EMR in the rural healthcare scenario but through the changes being done
government aids and services, it’ll soon make it’s way through.
In this service, EMR plays an important role as the treatment is highly dependant on the history of the patient. The first step; to apply for this service, one needs to update his files through the service provider in the office. Later, it keeps updating after every scheduled appointment, this also makes the technitian liable for the prescribed BIPAP setting and also, keeps a track of the anti-biotics being provided.
Since there is a network created which has doctor’s access, it makes it easier for him to provide Tele-medicine and hence, serving more people while sitting far away.
NOW LET'S TALK ABOUT THE SHORTAGE OF ACTUAL CREDIBLE PULMONOLOGISTS IN INDIA. HENCE, TASK SHIFTING IS REQUIRED.
There is a shortage of Pulmonologists in our country. The concept of a Pulmonologist is often blurred with a Chest physician. To be a pulmonologist, it requires 14 years of medical study. Majority percentage of pulmonologists are working in private sector but through tele-medicine and tele-health this treatment can reach the rural india.
Task shifting plays an important role, the entire service is being conducted by the person on field; the technician, under the order of a pulmonologist. Tele-health and Electronic Medical History adds efficiency and reliability to the entire system.
‘THE TECHNICIAN IS WELL EQUIPPED TO DO THE BIPAP SETTINGS ACCORDING TO THE ABG REPORT. SOMETIMES EVEN THE FAMILY LEARNS HOW TO OPERATE THE MACHINE ON A CONSTANT SETTING.’
TB Sanitorium, Jaipur
TIME TO TALK MONEY
The calculations till now show that the service has to earn roughly around 2000 per day to break even in the first year. The actual demand couldn’t be calculated as the hospitals couldn’t provide the data on the number of patients in a locality.
HOW MUCH DO THE PATIENT PAY IN ALL SCENARIOS
Earns 2,00,000 per month
300-500 per patient charge depending on the city
(Jodhpur has the base rate of 250)
Have two ABG machines - of Roche brand
21 ventilators (All have BIPAP mode) 4.5 lakh each
have patients generally from the lower strata
One time registeration- 100 rupees.
ward- 1500 rupees per day
ICU- 4000 rupees per day
ABG test (200-300) generally done twice or thrice a day per patient depending on their condition.
TB hospital- 10 rupees per day for general ward
200 rupees per day for ICU
Rajiv Gandhi Hospital- 1,000 rupees per day
Tele-health bridging the gap. Low availability of Pulmonologists.
The BIPAP treatment provided in the service would be for shorter duration as it’ll be done on regular required intervals.
Philips is a multi product brand.From lighting to kitchenware to healthcare (All under one name)
Publicity in all domains. currently these philips devices are only
popular with doctors
The BIPAP’s that they manufacture today are just popular amongst doctors, with this service Philips can reach people
A NEW MARKET
This service is providing a new market for Phillips product.
-make it more compact
-Ease to use
MONOPOLY IN THE NEW MARKET
Machine--> Recover in 3 years
Cost of vehicle --> recover in 10 years
Straight line depreciation (every year)
Cost of machinery
Oxygen cylinder (7,000)
Advised Service Interval
Number of technicians?
Male or Female?
15,000 (base salary per month) + Traveling allowance + Dearness allowance (since this is a field job)
Fee of the driver= 13,000
CTC per month + Dearness allowance
TC= cost to company
Vehicle maintenance is 5000 for 3 months.
Petrol = uber system
Maintenance of the app can be outsourced as a CSR (Corporate Social Responsibility)
IT’S MY FAVORITE PART OF THE TOUR, BECAUSE
I GET TO BRAG. NOW
LET ME TELL YOU WHY
The chatbot would be a part of the app to provide assistance to the patients and their families. It would enable them to educate themselves about the disease and seek help with even a slightest bit of dis-comfort.
It also empowers them to know and keep a tab of their condition and the chatbot also helps them take a well informed call on their disease by suggesting the next schedule for the service.
(INQUIRY ABOUT UNEASINESS
LOOK ON YOUR RIGHT FOR MY MULTI-TASKING,
I LIVE BY THE SAYING
“A FRIEND IN NEED IS A FRIEND IN INDEED”
PHYSIOTHERAPY (EXERCISE AND COMFORTING POSITIONS)
EVALUATE MEDICAL HISTORY
PROVIDE INFORMATION ABOUT THE DISEASE AND OTHER PROBLEMS RELATED;HEART ISSUES.
DIFFERENT STAGES OF USING CHATBOT
-EVALUATING MEDICAL HISTORY AND RECOMMENDING THE SERVICE INTERVAL ACCORDINGLY
-REGULAR ASSISTANCE/ IN-BETWEEN GUIDANCE
NOW WE HAVE SCALED UP. LOOK AT THE JOURNEY MAP.
Journey map 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
Is either put on:
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:
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
-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.
DON'T MISS OUT ON THE ACTION, LOOK FORWARD INTO THE STORYBOARD.
Storyboard takes you through an illustrated journey of the target audience and integrating them into the system.
NOW YOU’LL GET TO KNOW THE HOUSEHOLD AND THE PEOPLE I’LL BE WORKING WITH; THROUGH THE PERSONA
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.
-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
-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.
A STEP-BY-STEP PROCESS OF THE AUDIENCE'S
JOURNEY IN MY OFFICE;
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.
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.
NOW WE HAVE THE BLUE PRINT , I DON'T KNOW WHY THE HUMANS CALL IT THAT, IT'S NOT EVEN BLUE.
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.
THIS WAS AN OVERVIEW OF THE PROJECT, IF YOU WANT TO VIEW IT IN DETAIL, PLEASE GO THROUGH THE DOCUMENTATION BOOK, IT'S BEEN CREATED WITH A LOT OF HARD WORK AND HOPE.
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.