The Dox4All Toolkit works like this:
- volunteer physicians are recruited (they donate hours)
- physicians are credentialed for quality assurance
- a master schedule is created from volunteered hours
- they are accessed by on-ground Navigators
- Navigators 'present' patients to physicians with smartphone app
- diagnosis and treatment plan rendered and deployed through Navigator
This method has MANY advantages:
- Physician travel is minimized. Travel is associated with lost production, family disruption, security risks, reduced volunteerism, and high travel costs. Physicians will be inclined to donate time over their lunch hours and days off since doing so will be minimally disruptive to their domestic operations.
- Telemedicine technology is used to deploy the physician asset. Telemedicine is already at use in the developed world with its attendant boosts in patient access and reduced overhead. Smartphone based telemedicine requires functioning digital cell networks which are available in many communities in need of medical relief.
- Navigators are used to transact the patient encounter. Navigators are language and culturally attuned to the patients and can therefore support adherence to the physician-deployed treatment plan. Navigators will receive training that allows them to serve their communities in an enduring way, even without the Dox4All smartphone connection
- Dox4All will not attempt to recreate on-ground presence in countries of need; we will simply collaborate with established NGO's and existing aid workers, putting access to a doctor literally in their hands.
- Dox4All does not aim to address EVERY disparity between disease burden and doctor supply. BUT, we will not let perfect be the enemy of good in the advancement of health for as many people as we can reach.
This Method of Care Delivery
The Dox4All method is the product of Tim Ryschon, who developed the operating concepts over a 14 year period of federal service, 5 years at NIH and 9 years in the Indian Health Service. In both settings, he was struck by a basic flaw in the design of western medical systems. Though many HCO’s and clinics touted "patient-centered" care, it seemed that most if not all systems required the patient to go to the system of care. This was true for both NIH and the Indian Health Services (IHS). Though NIH was a giant in research, it required patients with specialized diseased to travel to the Bethesda campus for their care. IHS, often touted as a model public health system, had a long history of building hospitals in the middle of reservations - making the system of care equally distant and inaccessible for all patients. This geographical disparity is even more apparent with remote and distressed communities outside of the U.S. where there are even greater burdens of poverty and disease. Clearly, a non-traditional approach to care delivery was needed - one that is truly patient-centered.
While in the IHS, Ryschon contemplated the complex challenge of how to deliver specialty care to his beneficiaries who lived hundreds of miles from tertiary centers that house specialists congregate. The specialists were willing consult on the patients, at a reduced rate inconsideration of the iHS budget reality, but the distance to these doctors obviated the actual consultation. The outcome was the same as if either the system did not offer the consultation or there was no recognition of a need for the consultation. That outcome: patients just get sicker, suffer more deeply, and pass on prematurely. To cross this seemingly unbridgeable geographic gap, Ryschon deployed customized telemedicine network that permitted volunteer specialists in Rochester, NY, Peoria, IL, and Beverly Hills, CA to consult on patients in rural South Dakota, facilitated most importantly by telemedicine coordinators at both ends of the pipeline. It worked well for all kinds of specialty care including complex areas involving real-time ultrasound imaging of pregnant patients in need of perinatology consultation.
After this incredible experience, Ryschon entered the private sector committed to re-map these methods using new technology to further reduce cost of delivery while enhancing access. The revolution in smartphone technology was the game changer, permitting the creation of software portals that operate on a smartphone, allowing an information-rich encounter between the doctor and patient, at a location convenient for the patient, at an out-of-pocket fair price. This method of medical encounter is the bedrock of the Dox4All medical toolkit that can be used by aid workers in distressed communities to deliver physician evaluation and treatment.