Opportunities & Regulatory Challenges Opportunities & Regulatory Challenges of the Spread of e-Healthof the Spread of e-Health

Dr. Sikder M. ZakirTelemedicine Reference Center Ltd. (TRCL)

Beyond Scaling UpIDS, Brighton, UK, 24-25 May 2010

e-Health is Revolutionizing Healthcare Relationships

for Bangladesh and beyond

Background of TRCL TRCL was Incorporated in 1999 in Bangladesh

Partner of University of Nebraska Medical Center, Omaha, NE, USA

Business Operations in 15 countries through its partners in USA, India, Malaysia, UAE, Saudi Arabia and West Africa

Provides consultative and project execution services to governments, NGOs, public and private corporations

Owner and operator of the Internationally Awarded “HealthLine” (Dial 789) project serving medical needs of 23+ Millions Grameen Phone subscribers

Designed and introduced 1st Mobile Health system in Asia - AMCARE for chronic patient management

Current & Future Projects of TRCL• AMCARE: Chronic Patient Management System

• Diabetes, Cardiac, Hypertension, COPD, etc.

• Rural Health Care• Pilot project to be carried out in partnership with ICDDR,B and Future Health

System using Integrated Rural Health Information System (IRHIS) of TRCL.• Nationwide Accredited Physician Program

• 550 Doctors at sub-District (Upa-Zilla) level will be trained, equipped and managed under central system to be stationed in each Upa-Zilla. Project is jointly funded by World Diabetes Foundation, Diabetic Association of Bangladesh and TRCL.

• International Medical Call Center for Expatriates• Medical Call Center Platform of TRCL will serve medical needs of 11 Million

expatriates in Middle East and in Malaysia• TRCL - Novartis Pilot for Anti-TB Adherence Program

• To prevent drop outs from Anti-TB treatment and for prevention of MDR-TB

Number of Inhabitants Per Doctor

How Technology Changes Us…..

CD Player in a Waffle Toaster…

e - Health• e-Health

– is used for delivery of conventional healthcare to people, where health is pushed up by a small “e”.

– “e” helps to create health information in digital format to make all information sharable between stakeholders

– “e” allows creation of connected healthcare communities for administrative, reporting, monitoring, evaluation and planning purposes

– “e” also allows online and offline clinical consultation, i.e. Teleconsultation at distance

– “e” is a catalyst creating efficient management techniques to manage people’s health

– “e” is an enabler for behavioral modification of providers and patients alike.

– “e” is the ultimate “Relationship Tool” for stakeholders

Bangladesh Experience (7.5 Million Users/3 Y)

10

Traditional healthcare = limited options

FEW FORMAL HEALTHCARE PROVIDERS...• Only 70 health personnel per 100,000 ppl• 26% vacancy, 40% absenteeism among rural government doctors

WHAT’S AVAILABLE IS POOR QUALITY...• More than 50% of visits are to unlicensed doctors and “quacks” (traditional healers, drugstore salesmen etc)

HEALTHCARE PERSONNEL (per 100,000)

POOR CHOICES DRIVE PEOPLE TO US!• To know whether they should see a doctor• When they have been waiting hours to see the doctor• After they’ve seen the doctor and want another opinion• To get advice on chronic health issues, since few specialists are available

2010: Build capacity to sustain relationships

# of patients

Depth of relationship

s

PROVE CONCEPT (1999-PROVE CONCEPT (1999-2009)2009)

• Proved “call a doctor” demand, Proved “call a doctor” demand, established market leadership established market leadership

and reputationand reputation

BUILD FOR SCALE (2010)BUILD FOR SCALE (2010)• Robust data capture, analytics and integrationRobust data capture, analytics and integration• Exploit contract opportunities with significant Exploit contract opportunities with significant partners (Diabetes Association, Novartis, etc.) partners (Diabetes Association, Novartis, etc.)

• Expand capacity of core teamExpand capacity of core team• Formalize interest expressed in new marketsFormalize interest expressed in new markets

EXPANSION (2011 - )EXPANSION (2011 - )• Build domestic patient base on core productsBuild domestic patient base on core products• Transfer existing offer to new markets Transfer existing offer to new markets

• Grow international capacity in target marketsGrow international capacity in target markets• Explore new products and services to increase Explore new products and services to increase value of relationship for patient and providersvalue of relationship for patient and providers

Business Model

Concept developed from market needsPiloting for proof of concept

Formal deployment through partnership with stakeholdersLow revenue, volume market

Opportunities & ChallengesOPPORTUNITIES: SIMPLE AND EASY TO USE...• Any form of communication device can be used for service deliveryEXTREMELY LOW-COST...• 15 taka for first 3 minutes, 5 taka each add’l ($0.20 on average)AVAILABLE ANYTIME, FROM ANYWHERE...• People call right when they need to – saves unnecessary visits (esp. for rural callers)• Up to 40% of callers just need to be reassured, and don’t need treatmentEASY REACH TO PATIENT POPULATION...• People call right when they need to – saves unnecessary visits (esp. for rural callers)• Up to 40% of callers just need to be reassured, and don’t need treatment

CHALLENGES: 1. LACK OF POLICY / REGULATIONS...2. SOMETIME NO REGULATION...3. COMPLEXITIES WITH OTHER INDUSTRIES... (Mobile operators, banking...)4. LEGACY (TRADITIONAL) SYSTEM AT HEALTHCARE PROVIDERS’ END...4. AWARENESS...5. SCALING UP...