There are 1 billion people in the world who will never see a doctor in their lifetime. Neha Goel, Amal Afroz Alam and Emily Eggert teamed up at Johns Hopkins through the Center for Bioengineering Innovation and Design to build a solution to the massive gap in global healthcare, with an initial focus in India. While urban cities in India have modern hospitals and full medical staff, the rural population is left with the absolute bare minimum when it comes to medical resources and access to doctors. Neha, Amal and Emily decided to create a tech product that not only improves access and quality of health care in rural areas, but also empowers educated villagers to become community health workers themselves. Intelehealth is the first telemedicine company to build a backend knowledge engine to support community health workers in thoroughly addressing the needs of patients.
Last week we chatted with Neha about the inspiration for Intelehealth, patients who have been positively impacted thus far, and the long-term vision for leveraging tech to improve health care across the world.
What is the mission behind Intelehealth?
Intelehealth is a platform that empowers community health workers to deliver better health care to their communities. In countries like India 70% of the population reside in rural areas, but only 2% of the doctors in the entire country serve these heavily populated areas.
Because of the scarcity of doctors in rural areas, 1 billion people in the world will never see a doctor in their lifetime. For people living in rural areas, seeing a doctor requires spending about a month’s wages for transportation to a city and the subsequent medical care. That’s a lot of financial pressure on families whose yearly earnings are the equivalent of what we earn in a few days in the U.S. This creates a vacuum of healthcare. Intelehealth is a tech tool that enables people living in rural communities to become community health workers through training and support from the Intelehealth platform, which connects these health workers to doctors in urban areas to provide care. Intelehealth empowers nonprofit organizations and hospitals to fill the gap in health care in hard-to-reach communities lacking adequate supply of doctors by enabling community health workers to address initial issues with patients and then connect with a doctor for a full consultation. Our mission is to bring a doctor to every village and grow the medical expertise of health workers in rural areas.
How does the Intelehealth platform work?
When we go to a doctor’s office in the U.S., a nurse fills out an intake form to pass on to the doctor. The Intelehealth app is like a more robust, digital version of that intake form. It actually covers 80% of common primary care conditions. The app codifies this data into a decision tree that guides the health worker through specific prompts to perform the right physical exams. We’ve collected all the information that the community health worker needs, essentially making the app the eyes and hands of a doctor codified into an app. We call the knowledge engine that supports the app KECI (Knowledge Enabled Clinical Information). This supports patient registration, tracking, and follow up. The app also connects with a backend health tracker system to help track disease surveillance which provides invaluable data for health systems. Our application also addresses health education through videos covering important patient information around areas like hygiene, sanitation, and proper nutrition counseling. We are currently working with our India-based partner, JSV Innovations, to pilot our platform at two telemedicine clinics in rural West Bengal.
Where does the connection to the doctor come in?
Community health workers connect with the doctors through an audio call, not through the app. The app uses a tablet based mobile network that simply requires a SIM card and a data connection. A phone call happens in parallel to connect with specific doctors. The community health workers are trained and managed by health NGOs, so we interface with these organizations and partner with them to deliver care. There is already a dedicated doctor for each clinic, which helps the community have a deep connection with their healthcare provider. We built the app keeping the social dynamic between a patient and their health care provider top of mind. We wanted to keep the human aspect of this alive so patients feel they are receiving good quality care. When patients go to government hospitals they commonly only receive two minutes of a doctor’s time. With Intelehealth, they’ll get about 30 minutes with a health provider. We’ve designed our app to deliver dignified care and ensure patients feel well taken cared for.
What was your inspiration for launching Intelehealth?
I’ve always been interested in social issues personally. I grew up in India and both my parents are doctors. When I was in undergrad I started a social enterprise that taught women in urban slums to make bags out of newspaper to sell to local shop keepers. My interest in social good grew stronger and I spent a year traveling through rural India working on a project around voting issues and rights for those who are disenfranchised. When I later started working as a biomedical engineer, seeing all these gaps in healthcare instilled in me a desire to do something to change things.
Do you plan to focus on geographies outside of India too?
Absolutely. There are countries where the doctor to patient ratio is even worse. This is a global problem; 400 million people lack access to essential healthcare.
What makes Intelehealth unique from other telemedicine tools?
Intelehealth task shifts duties typical of a doctor to community health workers in rural areas. Our app empowers health workers to take on the duties of a doctor, such as handling patient history and physical examinations. Other telemedicine apps are more surface level, only enabling health workers to collect info like height and weight which they then pass over to the doctor. Intelehealth provides a much stronger connection between the two people providing and receiving care. We are empowering health workers to do more than the status quo, and widening the diagnostic process. Overall we improve the quality of the teleconsult and the care that’s being provided.
What has been the greatest challenge so far?
Creating a culturally appropriate solution. Initially we had very low patient flows and were wondering why that was. We were building this product that was delivering a missing piece of healthcare to villages, but what we realized was that we could not be successful if we only focused on the technology. Our holistic health care platform is also about the way in which services are delivered. That requires a human component that technology cannot provide. Now we have created a product built on robust tech framework that also allows for the human connection to come through.
What has been most rewarding about running Intelehealth?
For me, it’s being able to wake up every day and know that I’m doing something I absolutely love. We were in India last month and I found out there was a 9 month old baby boy with spina bifida. Ideally that gets diagnosed and treated easily, but in the village there was no one to diagnose the baby. However, using the Intelehealth app one of the community health workers was able to collect the right information and the boy was referred to a facility where he received treatment and then was taken back to his village for follow on care. If that hadn’t happened the boy may not be able to walk or live a normal life. Stories like that inspire me. We had another patient who was about 60 years old and was constantly dealing with health complications. Through Intelehealth, he found out he actually had diabetes. He had no idea before, and now that he’s been diagnosed he has a much higher quality of life. That improvement in the quality of people’s lives is extremely rewarding to me. The empowerment of health workers, particularly the women who work at these clinics, is also incredibly rewarding. These women have undergraduate degrees and yet are sitting in their villages without jobs. Intelehealth enables them to build a career, and find a sense of fulfillment, purpose and confidence from becoming a community health worker. Harnessing that human capital blows me away. Some of our health workers in Bali in the Sunderbans of West Bengal had never stepped off the island – their entire worldview was confined to their tiny island. Now they get to travel to the city for training where they earn the respect of doctors. Women in rural areas have been disenfranchised and undervalued. In spite of the sacrifices they must make to undergo training to become a CHW, especially if they have children, it is worth it for them to earn the respect of their community and know they are helping to change the perception of women in society.
What’s one surprising thing you’ve learned running a tech nonprofit?
The nonprofit piece has been an amazing learning experience. I’ve always worked in the for profit sector until now. Having to explain to people that we are a tech company and are not for profit raises eyebrows. The interesting learning has been making the marriage of those two work. The learning experience for us has been understanding that we follow the nonprofit ethos in terms of prioritizing our impact goals. Previously my worldview was you start a company and you make money. This was totally new to me.
What’s your 5-year company vision?
We would like to have a doctor for every village. We want to help organizations set up these telemedicine programs and then give them the opportunity to scale up. In 5 years we would love to have helped at least 100 organizations not just in India but in several different countries – Pakistan, Kenya, Nigeria, Ethiopia, Nepal to name a few. We want to make a strong change in policy. We want policy changes to transform the way telemedicine is viewed and make this a more integral part of public health programs.
What’s the best entrepreneurial advice you’ve ever received?
Understand that if you are an entrepreneur you have to be a little unreasonable. Push the boundaries of what you think is possible and jump outside your comfort zone into that place of risk, while maintaining pragmatism and a healthy dose of practicality. Be ready to answer people who tell you what you do is not and will never be possible – don’t listen to them. As an entrepreneur you don’t have to be fearless, fear is good in a small and healthy dose. You continue working towards your goal in spite of the fear and the risk.