The Challenge
Finding a Solution
The Sklodowska gang began by putting various problems from our respective points of interest to a vote in order to quickly focus on a problem. This exercise did not take into consideration the technologies we had available, we were focused on this year’s UNSDG #3 ‘Health and Wellbeing’. The potential problems we explored included remote medical eye care in East Africa, geriatric care in Spain and post-natal and breast-feeding support in Brazil. We eventually voted to focus on addressing problems with geriatric care in the Western Balkans, which was brought to our attention by Tamara (our Serbian teammate). She is a native of the area and raised many issues with the public health system in Serbia that she had experienced. We then began trying to narrow this very broad challenge down so that we could create maximum impact in the region. The problem that we decided to focus on morphed over time and was reframed significantly in light of findings from our research, interviews and validation process.
Research
Professionals
Research
People from the Balkans
Reframing the Problem
Once we decided on an initial focus area we started considering the technologies we had available and began to analyse how they could best be applied, and which one was most relevant to our cause. This exercise of deep diving into how the Attract technologies could be leveraged disrupted various routes we had imagined our project would be taking. For instance, we were very excited to find that the POSICS-2 technology could be used to detect osteoporosis and was less expensive than an x-ray. The issue of trauma and trauma prevention had come up many times in our research and we thought the ability to detect osteoporosis would allow patients to maintain mobility and independence for longer. However eventually we discovered that there was an adequate substitute for osteoporosis diagnosis on the market using very different and much less expensive and invasive technology, so we found ourselves back at the drawing board. While starting to develop a solution to detect osteoporosis, we began to develop a service to make the detection easier.
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We realized that there were many more systemic roots to our problem than we had previously realised, but that the service we had started to design would help to address a lot of them. With this in mind we decided to try to break out of our tunnel vision by adopting a losing attachment to the technologies and looking back to some of the systemic issues we had discovered in our research. This very naturally lead to our new focus - Cardiovascular Disease.
Reframing the Solution
In the very broad ranging problem area of cardiovascular disease, we knew we wanted to bring a service that considered all of the problems that our research had shown us the people of the Balkans face, in particular the aging and often marginalised elderly communities, particularly so in the remoter rural areas. Our solution was to be built around raising awareness of the endemic levels of heart disease in the area and to develop a very prevention-based approach in order to extend people’s active lives and generally improve patients’ quality of life.
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We looked first at lower cost models for detection using angiography imaging technology which tends to require a contrast dye being injected to analyse the flow of blood through blood vessels on the heart. This raised barriers to the solution being effectively implemented as there was a distinct lack of trust already placed in health care providers which we had being trying to solve. We knew our solution had to be as non-invasive as possible in order to increase its potential reach and therefore injections and apex medical assessments or interventions were not desirable. It was this journey that brought us to our final specific solution which was to use Posics2 scanning tech to screen for atherosclerosis (the build-up of plaque on the blood vessels) which is one of the main causes of heart attacks and CVDs in general. Along this journey we made discoveries and edited our solution and implementation techniques etc and found that what we had was a solution that could address the same problem in so many parts of the world as it addresses problems that health services face everywhere such as the lack of trust, a lack continuity in health care and low accessibility to medical screening of this kind.
The Service
Much of our ideation was systems based; how would we address the low levels of awareness, how would we lower the barriers to this screening, how would we gain communities’ trust, could other technologies be leveraged alongside Posics 2 to create a continuous and accessible system of cardiovascular screening?
All of this in the nuanced backdrop of the Western Balkans.
Some of the principal mechanisms that we employed to address the specific issues affecting our pilot programme in Serbia:
Awareness: tackling this on a local basis and not relying to heavily on technology as in many rural parts of Serbia particularly with older generations there is a low level of digital literacy. Therefore, flyers going out in local community centres and follow up communications being conducted over the phone are some of the methods we will employ initially to engage these patient groups.
Accessibility: Public health in rural areas is generally low and many people rely on pharmacies for most of their medical needs, therefore we are looking to partner with pharmacies. The relatively lower cost of Posics 2 scanning equipment is something that massively improves the availability of this screening. By combining it with our AI diagnosis we are able to increase access without strain on the public health system.
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Trust: The pharmacy approach is a valuable tool in addressing this issue along with the follow ups being conducted by local physicians and the relatively non-invasive patient experience, with no injections required and a relatively short scanning period required.
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Continuity: Technology plays a massive role here with a web app geared towards preventative measures and lifestyle changes along with the archiving of patients’ medical profiles going forward, our approach prizes continuous health care and prevention which we hope will obviate the need for medical intervention in many cases.
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Accuracy: Again the technologies we are supporting our service with are the main tools in achieving a greater level of accuracy, for instance the machine learning we plan to use to assist diagnosis via AI algorithms trained to analyse scan imagery will not only increase the speed and accuracy but perhaps in the future may remove the need for an expensive expert to validate the AI assisted diagnosis which would in turn increase the reach of this solution even further.
Validation
There are 2 pillars supporting our solution that require continuous validation; the technology, and how it will integrate with the communities we serve (the service). Our validation process led us on a far reaching and sometimes convoluted journey with insights from many experts among the medical community including international health care consultants such as Montreal Medical International, medical NGO experts such as Dr Gillian Holdsworth and Jeff Mecaskey and senior doctors from the Cardiology Society of Serbia among many others. (our full list of interviews is detailed in the relevant Miro Board section.)
Positive Validation
The feedback coming from most of these parties was that our technology and the mechanics of our service could address the significant gap in the provision of cardiological screening and preventative medicine in Serbia, but also globally. We discussed the technical solution with POSICS-2 technology who said that our solution was not only plausible and effective, but it would also likely reduce in costs over the coming years.
To validate the service and its relevance, we relied heavily on the native Serbians themselves. For this we had a very valuable tool in the form of a native Serbian speaker Tamara. We were able to better understand the views of the people affected by this issue, whose insights helped further develop our ideas. The interviews we held with the Serbian people validated our assumptions that pharmacies were a good location and that there was a need and a desire for a way to improve heart health in Serbia.
Negative Validation
We did have some negative validation in respect of our previous problem/solution which was to address the issue of osteoporosis in geriatric patients. This feedback was the driving force which led us to reframing the problem and our approach to how we could leverage the Attract technologies in a more relevant way. Ultimately this negative validation supported us in rounding down on the endemic issue of heart disease which was flagged up from among the local Serbians that we spoke to as being a much more disruptive issue to the health of Serbians.
Ongoing Validation
This mixture of area specific feedback and the wider view concerning programs of this nature and their possibilities, plus the potential pitfalls related to them, were a key guide as to how we developed our service solution but also how we arrived at the final fit for Posics 2 scanning technology.
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It is our mission to roll out Visionary Health Services on a global scale, and to achieve this we will require validation from more doctors, national and international healthcare consultants, specialists and experts in general. But also, on a region-specific basis; from people who currently live with a deficit in their healthcare systems which affects the quality and extent of their active lives. Of particular concern is the amount of trust in the region’s public healthcare system and the preferred method of care in each region. In addition, we need to determine the percentage of patients that would need continuous care and how that region would manage the influx. Based on the understanding we have gained from our research and the process of reaching out to the people that have made it possible, we view this as an achievable challenge.