ArogyaCare ( KMES )

Phase I of Kolkata Medical Emergency System & Services (www.kmes.in), providing availability information of ICU beds and Curated, verified Ambulance information is launched by US Consulate General launches KMES on 26th February 2014 ( The Telegraph Link in English , Anandabazar Patrika Link in Bengali)

KMES is the Rockefeller Foundation Centennial Innovation Challenges Winner
KMES bagged runners up prize for EMS innovation at EMS-IEH 2013 at AIIMS,New Delhi

Media Mentions:

With increasing urbanization in Low and Middle income countries in the absence of a Government-owned 911-style system, the medical emergency services are provided by multiple, isolated providers (government, semi-government, private for-profit, NGOs) with varying capability, resulting in an inefficient & fragmented emergency management system which frequently result in serious delay in treatment. Often the patient needs to wait for ambulance and/or is transported without proper paramedic support in public transport, and after reaching hospital, shuttles from one hospital to another due to unavailability of the required critical care unit (e.g.: NICU, CICU) as not all hospitals have all facilities. Finally, when a specific emergency product is required (e.g.: Blood), nobody knows where to obtain it, as most of the hospitals are always short on the product. As such, the patient often doesn’t receive the life-saving treatment during the golden-hour of emergency, resulting in several loss of lives. 
The above issues are multiplied exponentially during any disaster, large or small (e.g: a fire in a public area, train accident, terrorist attack) that affects people’s health. Currently, there is no central, real-time system for medical emergency in our pilot city, Kolkata, India, making coordination between disaster recovery agencies and public health services nearly impossible.
Due to the absence of regular, proactive health check-up among general public, including individuals who can afford, early intervention & management of chronic diseases are severely lacking, the impact of which is quite significant among the geriatric group. This often results in sudden critical health emergencies, where the same process of ‘delayed presentation’ as explained above, repeats itself but with a higher probability of mortality, morbidity and disability

Current approaches:
In most of the LMIC cities (including India), the route usually taken to solve the medical emergency problem is to introduce a new Ambulance fleet without fulfilling the pre-requisites, such as paramedic workforce, real-time information from facilities etc. Setting up a city-wide Ambulance system is financially prohibitive (huge capital investment is required) and logistically difficult to implement (competes with existing services, local political issues). Plus, to maintain the quality, they either have to charge heavily or need to be funded by the government, failing which these services soon become unsustainable.
The "Ambulance only model" cannot be the solution for a central medical emergency system for a diverse country like India. While the 108 model (Public-Private partnership, where Government pays and private organization operates) is a gold mine of corruption/scam (thus public exchequer flowing out freely) and government in-effectiveness making it completely useless, the new Private ALS ambulances model has proved to be very costly to operate and difficult to sustain due to local competitions and political tug-of-war. Outside the "Ambulance only model", the other effort need to be mentioned is introduction of Urgent Care centres, which also being a new, parallel, isolated service has all the issues explained above (e.g.: Competition with existing Hospitals, Sustaining and Scaling the operation is financially costly and logistically difficult and reaching the urgent care under proper care not available due to shortage of skilled paramedics etc). 
We recognized the fact that in a mega-metropolis like Kolkata, government or private, no-one can do this alone. It is financially not feasible and sustainable also. So, while other emergency service providers have launched different types of services (such as ALS Ambulance, neighborhood critical care unit), we are not introducing any brand new emergency service. Instead, we are integrating the existing services for better utilization and enhancing / strengthening the services, as required with the proper toolset (Toolset is defined as Product, People or Processes – e.g: Providing Paramedic training, GPS enabling etc.) 

While the project is inspired from North America's 911 system, the situation is way different: While in US emergency healthcare is standardized & government financed, emergency healthcare in India is varied, ranging from free, but inefficient govt. healthcare to responsive but costly private services. As such, the operational & business model of our project is drastically different than 911.
We propose to integrate and enhance the isolated emergency providers in urban area, both public & private, to create a standardized, centralized, integrated, interoperable, real-time Medical Emergency System that seamlessly connects the “Sense”, “Reach” & “Care”, the three cardinal pillars of medical emergency care. The system will be easily accessible via internet, SMS and phone and operated by a state-of-the art emergency control room.
We will be implementing this project first in Kolkata, India, the most congested metropolitan city in India with an overburdened Healthcare system. Currently, we are developing the Kolkata Medical Emergency System(KMES) Phase I to manage availability of Emergency Healthcare Facilities & Products. In partnerships with Kolkata’s primary hospitals & blood banks, KMES is gathering and broadcasting the fundamentals of urgent care, the availability of Critical Care Unit(CCU) & blood products, to all, irrespective of social & economic status. Healthcare providers, emergency responders, disaster management agency all will get the same information. Next, in Phase II, we will integrate, enhance, strengthen & organize the existing ambulance services in Kolkata, which is primarily a small fleet of independently operated private ambulances along with few government/police ambulances. First, the ambulances will be equipped with GPS tracking software to capture real-time location & availability information. Next, paramedic training will be provided to the networked ambulance staff as they currently lacks it. We will also create a pool of paramedics from which ambulances, hospitals, police & fire can recruit. Finally, a state-of-the-art multi-lingual emergency response centre will provide 911 type coordination by dispatching the nearest networked ambulance & paramedic, who after stabilizing the patient will transport him/her to the nearest facility. Further, when an elderly patient staying alone suddenly falls sick, he/she can use a mobile phone and/or a wearable device (prototype being designed) to send an alert to the medical emergency centre for emergency retrieval.

As explained above, KMES relies on a very simple assumption – Instead of competition let’s collaborate. And not only collaborate among institutions but bring general public in the mix – when proper toolsets (such as information) is provided to the general public they can do wonders. The idea is instead of introducing new emergency service, we will like to enhance & strengthen ALL the existing medical emergency services, integrate them under a common emergency response centre and empower citizens with information for crowd-sourced quick response to cater critical patients within golden hour of emergency in an innovative yet practical and feasible business model.

Broader Impact.
In India, there are two distinct HealthCare systems that divide society: one is the minimal cost (or free) public health system, and the other is high-cost, fee-based private hospital system. The poor and lower middle class flood the public health system, as they cannot afford the high cost of private hospitals. During medical emergencies, these populations do not seek out private hospitals. The affluent population who can afford the private hospitals, never access the public hospitals, though it may be just a block away. In fact, even among the private hospitals, there are tiers based on amenities provided, rather than the actual quality of medical care. Often it is a status symbol among this population to be admitted to a specific hospital because it is perceived to be “high-end.” This cultural, social, and economical doesn't serve anyone in an emergency. KMES disrupts this process by providing the same data to everyone that allows them to act in their best interest.

We believe that KMES can address the bias by improving the low-hanging fruit in the medical system, which is “medical emergency and critical care”. It is a specific medical condition that has the ethical backing to effectively bridge the disparity in the Healthcare system. Our project is the first step in that direction.

Specifically, we hope our project will bring the following significant changes in this unequal system:
  • With a centralized system where public and private hospital data is exposed to the general public without any restriction the perception of divided HealthCare system will change
  • Every citizen with this information will feel empowered to help a fellow citizen, whatever their respective social status
  • And every citizen will feel comfortable going to either a public or private hospital based on proximity and availability, the most important criteria during medical emergency
The byproducts of the KMES project will be: the FOSS (Free and OpenSource Software) platform, and the best practices for implementing an emergency medical system in densely populated urban areas. These two outcomes increase the potential impact of KMES on poor and vulnerable populations worldwide. The software platform will be published under OpenSource licensing, and as such any organization will be able to use the software free of charge and change it as they see fit. With minimal changes it is likely that the system can be implemented in other cities in India as well as across South-East Asia, Africa, and Latin America. KMES can help other civic bodies and governments to implement this system in their respective cities based on the best practices learned during the pilot implementation. Along with a comprehensive FOSS Medical Emergency System, the developed software code will be contributed back to the base OpenSource frameworks (OpenMRS and DHIS2), thus strengthening the symbiotic relationship among the OpenSource communities. This is the key differentiating factor between “OpenSource & OpenData” movement compared to “Proprietary & Closed data”.
With the high cell phone penetration across all strata of society and public media’s popularity among the poor in all developing countries, we hope that an emergency management system that depends on mobile phone and public media will be able to reach over 90% of the population directly or indirectly. As such, KMES contributes to the broader change of a growing movement that leverages technology to increase awareness, reduce disparity in public health, and above all empowers the poor and vulnerable populations, resulting in social justice and equality.