Tuesday, April 17, 2012

MediQ: Elixir to Medical Management

AIIMS Delhi, March 31, 2012 11:30AM, NRD and I were looking at multiple gigantic queues -- Queues to get appointments to doctors of their concerns, or to get some sort of medical help. What even more surprising was, that some of these guys were queued for more than 8 hrs – since 3AM!

Varanasi, Dr Hatwal, known expert of Thyroid related problems. He has a unique system. Patients write their name on a paper and put it under the brick. A Friggin Brick! The brick is not guarded by anyone. On a windy day, an innocuous lift of brick, to put one’s paper-slip, can just literally blow everyone else’s application. Come on doctor, you can do better. He wouldn’t hear, or at least pretended not to.

Saraswati Heart Care, Allahabad. I call in from Varanasi to get an appointment, three days in advance. I can’t. I will have to come to the hospital – be physically present there in the morning to get the appointment; which, the receptionist says, wouldn’t be much trouble as everyone does that. I, be assured, will get the appointment for the day.

In India, we are use to of queues. Starting from our college days – queues for fee deposit, queues for admission, queues for food, queues for enquiry, queues for deity, and queues for shitting – literally. While some queues are cut short by advent of information technology (IT), most of them are not. The queues – that are solved by IT, are mostly profitable entities for upper/medium upper classes – movie tickets, club tickets, air tickets, train tickets… off the top of my head.

Why can we not have a universal queuing system for medical/doctors’ appointment and patients’ history keeping? Let’s call it MediQ (yeah, I have googled and this domain name is not available and already owned as a firm’s registered name.)

The Story: I like to think in stories. So, let me tell you a story of a Mr. Hardbody. Hardbody did not have a healthy life as most stories’ protagonists do; but he is a smart person. For last three days, he had this chronic pain in his eyes. So he requested an appointment to his eye doctor from his smart phone which turned out to be a week ahead. He thought he could wait. But suddenly the next day, he had so excruciating pain that he just looked into MediQ for the nearest available eye doctor with closest open appointment, reserved it. It was in next 30 min, a 7 min drive from his home. The doctor made some temporary relief to Hardbody but suggested a surgery as soon as possible. Hardbody called his insurance agent who sympathetically declined that the particular procedure was not covered in the insurance, sorry. Hardbody will certainly loose a major fortune if he paid for the bills. So, he searched for the lowest cost surgery over MediQ. It turned out to be a doctor in India. He looked at the recommendations for that doctor, and talked to the patients who had recently undergone through the surgery by him. It was a good deal, affordable including flight costs and little tourism. He requested the doctor in India to look for his case, over MediQ. Doctor promptly replied, since all the reports from pathology and previous doctor were automatically available to the doctor. Hardbody packed his stuffs and left. He had gone through surgery successfully. The doctor, looking at previous history of Hardbody on MediQ, figured out that some medicine’s causes him acidity, so he prescribed the alternatives. MediQ analyzed the post-surgery medicines were available in stores in nearby Hardbody’s house. Hardbody came back home happy. Posted a review of the surgery and provided his rating for the doctor over MediQ. He can be found in MediQ discussion groups with people having similar issues. And his history is updated in MediQ.

Fundamental Requirements: These features are the core of the idea. It can’t be compromised. MediQ must
  1. reliably manage appointments
  2. be free on the patients’ end
  1. People can make appointment to doctors via internet, via smart phones, or via SMS
  2. There is going to be only one appointment list. So, any appointment made by calling the doctor, or by going physically to the clinic, or by any means that is not mentioned in #1, has to be entered in the MediQ by the operator/receptionist.
  3. On unavailability of slots on request date and time, MediQ should automatically suggest the closest available appointment schedule.
  4. MediQ should also manage cancellation of appointment by the doctor or by the patient.
  5. MediQ should manage doctors’ schedule, so that it does not allot appointments on the doctor’s day off.
  6. MediQ should be able to make two way communications between doctors and their patients so that patients can be communicated about the upcoming appointment X hours ahead, or a sudden cancellation by a patient should push the candidates behind, one slot ahead, or an emergency request shot up to top priority irrespective of its position in the queue.
  1. Like any new system, doctors – specially, the government hospitals, the biggies, would not embrace MediQ with open arms. So, we need some ground work done beforehand, in convincing people.
  2. Awareness – people should be aware of the system so that they can request appointments by themselves; ask for appointment number when appointment made by physically going in or over phone call.
  3. Funding is a minor roadblock, but it is as real as it gets.
Nice to have:
  1. Medical History: MediQ should manage patients’ history.
  2. e - Clinic: Things that do not require patients to be physically present to doctors can be taken care over MediQ. This includes upload of reports, and suggestions by doctors.
  3. Integratability: This is revolutionizing. An integrated system which is hooked with pathology labs, emergency systems, medical stores, various doctors and research centers, and with people having same form of illness.
  4. Sociable: MediQ creates a society of people connected over internet. People can talk with others with same symptoms; doctors will have millions of case studies to go through.
  5. Location tied – Location Free: A search will get you to nearest available doctors and closest available appointment slots to them. You can get medical expenses that might cost for a surgery anywhere on the globe. So, if you find that your insurance does not cover laser eye surgery, and it costs a fortune to you in USA, while the same treatment with equally good doctor in India is much cheaper (including your air ticket) – just make an appointment. 


Jake_Sully said...

AvvESOME! A few points just off the top of my head though. I too will tell a story.

- Mr. TECH ILLITERATE is suffering from the same problem as Mr. Hardbody. He too has excruciating pain in his eyes and wants to go see a doctor immediately. He knows there is a hospital in the vicinity. He reaches there somehow just to find that the doctor he needs to see is packed with patients who have prebooked the appointment through MediQ. Once again he curses himself for not paying attention to studies and decides that he will make his kids tech savvy. But, what should he do about his pain? What are his options? Should he take an SOS and come back later? What if he does not have enough money to bribe the attendant? Will MediQ manage the immediate and prebooked cases in the same way as PVR does?

- Will there be an appointment quota for each doctor? What if, for certain doctors, appointment cases are more than the immediate cases? Will the doctor have a say as to what part of his patients will be appointment ones?

- How is MediQ going to manage the consultation time for each patient? Say for instance, a few patients have just minor problems and the consultation time for them is a mere 5 minutes. The next appointment is scheduled after another 10 mins. What does the doctor do? Say, after catering to 25 patients the time-difference has become 2 hrs. Should the next patient's appointment be preponed? Is it possible for the patient to have an option like "Consider for auto-upgradation/preponing"?

- Will there be a preference given to senior citizens and the handicapped? If yes, how to manage them?

We will keep the thread on. Expect a few more points coming your way.

Nishant Neeraj said...

Ludwig says, "God is in the details" but it would just stretch the blog. So, I kept it as brief as I could.

1. Mr Illiterate does not need to curse. He would just go to the doctor tell him or the receptionist that it's urgent. Since receptionist uses MediQ (see functions#2), he will file an appointment as urgent. And it will shoot up to just after the last the emergency case. If it's not urgent. He will get the closest appointment date as in regular system.

2. If it's a medical place where you can bribe to jack your case up, it will deteriorate the doctor/hospitals credit in MediQ. No one will want that.

3. I do not know how does PVR handles immediate vs pre-booked cases. What is it? I was envisioning IRCTC mechanism to have some slots open just for that day's bookings.

4. While registering a doctor/medical center, it will have to specify how many patients it can attend on which location. The system will allot X% (say 90%) of total until 24 Hrs before the doctor's timing. And last (100-X)% in last 24Hrs. I will come to X% next.

5. After each appointment the doctor will have to mark the patient, attended. If there are cases where # of patients per session started overshooting, causing to push some patients after the session time limit or to the next day. MediQ will slowly decrease the # of patients that can be taken by the doctor. It will notify the doctor about this. Also, if someone is having free time after the last patient the patients-per-session will increase.

6. On the same lines of #5, if we find the appointments marked urgent is causing overload. The pre-booked quota will be decreased.

7. Busy doctors usually limit by numbers. So, I think I would stick to numbers. At least initially, or until I see a real reason to do that.

8. If you could send and read SMS, you are at par with others. We can make a dedicated device that will make emergency calls to your doctors, ambulance, relatives. But I really did not think about it, just made it up.

Let me know if see more things in this reply.

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