XPRIZE Healthcare Everywhere

I would recommend you have a look at how the worlds armed forces have their field hospitals & clinic systems set up for these " Health Care Everywhere" modular systems. They do a pretty good job and they are not just for trauma if you have not already looked into that.

@MachineGenes, @addy_kulkarni, @Lee, thank you for your feedback on this prize idea!

The advice we got from our founder and chairman, Peter Diamandis, is that this prize, as currently written, is too broad. He suggests we should make it narrower and more concrete.

His suggestions included:

  • Test for infectious diseases.
  • Test and diagnose top X diseases.
  • Support pregnancy/natal care.

What is your take? When thinking about healthcare needs in developing countries and rural areas, how could we make the biggest impact?

@pglass, @shamakarkal, I know you previously advised on our Frontline Health Prize Design. You may have thoughts on this idea for a prize competition as well. Please join the discussion!

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I also commented in the Frontline health prize design. I agree Healthcare Everywhere is a good idea, but needs a focus so that it becomes feasible because improving healthcare everywhere is extremely difficult. The focus I like to see is not in dealing with X number of diseases, rather building the system that can deliver some care improvement into rural and underserved regions initially and can be expanded to deliver more and more care continuously in the same system. Such system-level innovation will be more productive than disease-focused approach. I think, “Healthcare Everywhere” prize can put in a reusable, extensible and scalable system in place first, from which more innovations and improvements can be enabled on an ongoing basis.

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Thank you for the feedback, @ajchenx! That sounds intriguing, could you elaborate a bit for me? What exactly would we challenge teams competing in such a prize to build?

You may challenge them to build a system connecting rural clinics and city teaching hospitals on which they can deliver high quality disease screening, clinical prevention, doctor referral, disease early detection, real-time clinical collaboration, patient education, etc. to rural doctors.

Several key requirements include:

  1. re-usable system: It can gradually deliver services for more and more diseases. we can’t repeatedly build different dissemination systems because it’s too expansive. [cost-effective system for assisting most aspects of primary care]
  2. highly automated system: for example, AI-based cancer risk prediction capability on the system for rural doctors to use daily, and at the same time, teaching hospital can continuously improve the AI model from data without sending doctors to rural clinics. [no big need for doctor-resources from city hospitals]
  3. driving force from city hospitals: City hospitals must have incentives to connect with the rural clinics and drive the services on the digital system. Without hospitals’ driving the “healthcare everywhere”, it is hard to sustain. [sustainable network]

Such system will be difficult to build, but it will have much higher chance to succeed compared to all the approaches we have seen so far. It’s a big challenge. Someone may come up easier ways to achieve it.

Given that the At-Home Testing prize will probably be a blood test, we don’t want to focus this on infectious diseases. Top X diseases in a region might also be a little superfluous, given that some of the top killers in Sub-Saharan Africa and South Asia can be detected with a blood test.

We have alternatives:

  1. Cheap, portable MRIs. The most innovative product I could find it is the mobile MR imaging system sold by Hyperfine for $275,000. If we can make something much smaller and much cheaper, it could be a huge breakthrough. Although the challenges there are a) interpreting the results for diagnoses - who’s going to do it? and b) what’s “cheap”? @RahulJindal points out that even a $1,000 device would be unaffordable in remote parts of low- and middle-income countries.
  2. Addressing unmet surgical needs. There are models for cheap and effective eye surgery. Are there other unmet surgical needs you would recommend we focus on? What would be the most impactful?
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I have visited some well-known models of cheap and very successful eye care in India. So why duplicate what is already known. If you wish to concentrate on eye surgery, perhaps, replicate one of the models into even cheaper version.

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Another issue with a ‘very cheap’ MRI would be overuse, over diagnosis and misdiagnosis. This would result in anxiety for the patients and their families. An example is the controversy about the age for mammograms. The guidelines for mammography have changed frequently and there is lack of agreement between the radiological societies of different countries.

My group from India has shown that ‘unmet surgical need’ varies from country to country and even within a vast country such as India. Even within a big metropolitan city, unmet surgical needs can vary between different income levels. Our work in a slum of a metropolitan city showed that the unmet needs were: extremity injuries/wounds, kidney stones, cataracts, abdominal pain including external hernias, and menstrual disorders (heavy menstruation). See - https://link.springer.com/article/10.1007%2Fs00268-020-05502-5

My group is doing a similar study in a high-income and mid-income area of the same city and the unpublished results show a significant variation of the surgical unmet need.

So to summarize, the first part of the competition would be for a group to define and study the surgical unmet need and then devise solutions for those unmet needs.

Thanks for your comments, @RahulJindal!

Looks like eye surgery doesn’t need an XPRIZE, based on the links you’ve shared.

I’m skeptical of a competition that allow teams to pick different unmet surgical needs. Then it will be difficult for judges to compare their solutions. Usually the competition defines the problem.

Ideally we would select one problem (for example, untreated kidney stones) where there isn’t a lot of innovation, but where a relatively low-cost solution could make a big impact on the lives of many people.

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There may be a case for a ‘Surgical PEPFAR’ - as you may know, the US government’s https://www.state.gov/pepfar/ program has been one of the most successful efforts worldwide, unlike other programs which are riddled with inefficiency.

It may be impossible to have ONE SURGICAL condition/disease for the X-Prize. I understand that may not be glamorous to have a ‘basket’ of surgical conditions.

In that case, eye (cataracts), or eye & hernia may work for the committee. Kidney stones are now generally treated by ESWL - https://www.kidney.org/atoz/content/kidneystones_shockwave which is an expensive proposition similar to the cost of MRI.

If you think of breast cancer as a prize, you have gigantic systems spending vast amounts of dollars on this problem such as MD ANDERSON, SLOAN KETTERING, AMERICAN CANCER SOCIETY, TATA MEMORIAL to name a few.

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Perhaps a different way to think about turbocharging ‘ Healthcare Everywhere’ is to look at existing attempts to overcome last mile resource limits and low infrastructure to challenge how they might be elevated to a radically new level of outcome and impact. For example, the Health Center by Phone (https://www.villagereach.org/impact/ccpf/) and Drone Delivery Systems (https://www.villagereach.org/work/drones-for-health/) in Malawi have had a substantial impact on health in that country and are being introduced in DRC and other countries. Imagine what could be achieved with those platforms if the ubiquitous broad band phones, now prevalent in even remote villages, had sensors (perhaps scanners and sniffers) that could detect signs and symptoms of a range of diseases or conditions. Using AI, networks and trained clinicians at the hubs, tying in health centers nearest to the patient, using fast delivery (drones if necessary) to deliver confirmatory tests or treatments, monitoring results with the remote sensors and aggregating data to detect infectious outbreaks would be a game-changer in achieving the equity, quality and affordability of universal health coverage .

I’ve spent fifty years or more thinking about delivering health care. Rural health care delivery is one of the most challenging issues we have even in the United States. The problem begins interestingly enough with technological advances over the past fifty or more years. As we make advances we also create the need for more specialization. The general doctor who came to my house when I was a kid sixty odd years ago is not a thing of the past. But it is rare and especially so in rural areas. Doctors want to practice in groups. This actually makes for better medicine. With records now computerized you can give high quality care without the need for a deep connection between doctor and patient. That is the good thing. But that comes at a cost. How can you put a practice of eight or more doctors for example in the middle of the Yukon or the Texas Panhandle? (I use these as examples based on my imperfect knowledge of those areas. My sincere apologies to anyone offended). Really, some of Nick’s ideas such as AI may prove to be quite effective solutions (and I generally look askance at high technology solutions for many social problems).

Let’s talk about AI for the moment. AI is rapidly advancing. It does not seem far fetched to me to imagine rural health care centers with “barefoot doctors” linked by fast communication (via satellite) to major health care centers) and also having AI equipment/robots to do simple surgeries in the not too distant future. And “barefoot doctors” are an innovation that has been around a very long time. These native people in low income remote areas of the world can do wondrous things in the area of preventive medicine, monitoring of patients after treatment, etc. I think the combination of AI and “barefoot doctors”, a marriage of low technology and very high technology may be a good route for the future in many remote parts of the world and even in cities. Why cities? Actually the reason is very simple. Cities such as New York have large populations of people (e.g. Caribbean peoples such as Haitiians, Dominicans, Salvadorans, Guatemalans, Hondurans etc.)who are familiar with folk medicine and comfortable with the idea of being treated by shamans or other folk healers. Furthermore, they are unable to afford high co=pays for western prescription medicines and physicians. So between distrust of the western medicine, familiarity with folk medicine, low income, and the unwillingness of physicians to practice in such communities, barefoot doctors with AI helpers might just be the way to go.

Thank you for your comments, @mfree and @boblf029!

The more we talk about this, and the more I’m looking into it, I’m learning there’s a) a lot of activity in this space, particularly around AI and telemedicine, and b) there’s no “silver bullet” solution to bring top-quality healthcare to far-flung regions.

Rather than try to do too much in one prize competition, we’re considering focusing on a narrower issue, in particular cheap and portable imaging technology. There is some innovation in the sphere, but it might just be an area where an XPRIZE can really catalyze a market.

This would shift the focus from poor and hard-to-reach areas to hospitals.

Although cheap imaging devices are needed, I would still think efficient information systems enabled by AI that connect clinics and hospitals at different levels will make bigger import to bring high quality care to rural areas.

We have chosen to focus this prize on affordable imaging technology.

There are only ~40,000 MRIs in the world. Most are in rich countries. Just 84 MRIs serve a population of 370 million in West Africa, and most of those are of low-field strength, or 1.5-tesla, meaning they can’t detect the onset of Parkinson’s or Multiple Sclerosis. Two-thirds of the world’s population have no meaningful access to medical imaging at all.

There is an added complication, which is that helium, used to cool the MRI’s superconducting magnet, is scarce. 75% is produced in just three locations: Qatar, Texas, and Wyoming. Helium is also used in rocket fuel and to cool quantum computers; two sectors that are likely to see growth in coming years.

Our prize would challenge competitors to design a lightweight, low-cost imaging device that meets the high-resolution standard of a 3-tesla MRI without using liquid helium as a coolant.

Their solutions would be judged on:

  • Cost: Retail price must be lower than the cheapest 1.5T MRI on the market at prize launch. (GE Signa EXCITE 1.5T sells for ~$100,000.)
  • Coolant: Uses no liquid helium.
  • Electricity use: No higher than current MRI machines. (Average is 15 kWh per scan.)
  • Resolution: 3T or equivalent.
  • Non-invasiveness.
  • Noise: TBD
  • Weight: Lighter than the lightest MRI on the market at prize launch. (Philips Panorama 1.0 weighs 15,000 lbs, or 6,800 kg.)

MRI machines can generate ~110 decibels of noise: the same volume as a rock concert. Some 3T scanners generate up to 130 dB of noise! The recommended limit for acoustic noise levels is 115 dB. GE’s Silent Scan reduces noise to 77 decibels, but it adds $100,000 to $150,000 to the cost of a machine. Philips’ ComfortTone and Siemens’ Quiet Suite each reduce noise by about one-fifth. Philips’ 3T Ingenia Elition X generates ~75 to 80 dB.

Should we take that as a benchmark?

Here’s the close-to-final version of this prize sketch. As you can see, we’re still debating the precise imagine-a-world statement as well as the prize purse. Please weigh in while we still have time! All prize sketches will be pitched to XPRIZE benefactors and donors on the weekend of Nov 12-14.

The global challenge

MRIs provide life-saving insights into a patient’s health, yet there are only ~40,000 in the world. Most are in rich countries. Just 84 MRIs serve a population of 370 million in West Africa, and most of those are of low-field strength, or 1.5-tesla, meaning they can’t detect the onset of Parkinson’s or Multiple Sclerosis. Two-thirds of the world’s population has no meaningful access to medical imaging at all. This makes it highly unlikely that the sustainable development goal of universal health coverage will be achieved by 2030-35.

Helium, when cooled at -269°C, is the only medium powerful enough to cool the MRI’s superconducting magnet, which generates its high-resolution images of the body. But helium is scarce. 75% is produced in just three locations: Qatar, Texas, and Wyoming. In addition to MRIs, helium is used in rocket fuel and to cool quantum computers; two sectors that are likely to see growth in coming years. In 2019, a helium shortage caused prices to spike to $50 per liter. Laboratories were forced to shut down superconducting magnets.

There is an urgent need…

Bringing affordable imaging to low- and middle-income countries, and enabling regular check-ups for patients around the world, would save lives and cut costs. A scale-up of imaging could avert 2.5M cancer deaths by 2030. A scale-up of imaging, treatment, and care could avert 9.5M deaths. Early detection of Alzheimer’s could save the US alone $7T in long-term healthcare spending.

Finding an alternative to liquid helium is critical to making MRIs more accessible and more affordable.

Imagine a world…

Options:

  • Anyone, anywhere can get an MRI scan anytime.
  • Medical imaging technology is available to everyone, everywhere.
  • Medical imaging technology is available around the world.
  • 3T MRI, or equivalent imaging modalities, are available to most regions of the world.

Core problems
(i.e. the market or systemic failures blocking a solution)

  • Innovations in imaging tend to either focus on raising quality regardless of cost or on lowering costs at the expense of resolution.
  • Because high-field MRIs are so expensive, there are fewer of them, which means they are used in fewer studies, which means fewer biomarkers are flagged with high-field MRIs, which keeps demand low.
  • The liquid helium shortage isn’t so acute that manufacturers must find an alternative short term. Nor do GE, Philips, and Siemens — the three largest manufacturers — have an interest in undercutting their own market.

The winning team will…

Design a lightweight, low-cost imaging device that meets the high-resolution standard of a 3-tesla MRI without using liquid helium as a coolant.

Prize purse

$50-80M

Timeline

5 years

Testing and judging

  • Cost: Retail price must be lower than the cheapest 1.5T MRI on the market at prize launch.
  • Coolant: Uses no liquid helium.
  • Electricity use: No more than 15 kWh per scan. (The current MRI average.)
  • Resolution: 3T or equivalent.
  • Non-invasiveness.
  • Noise: No more than 110 dB. (The current MRI average.)
  • Weight: Lighter than the lightest MRI on the market at prize launch. (Philips Panorama 1.0 weighs 15,000 lbs, or 6,800 kg.)
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Healthcare services is essential for all. We need to boost the internet connectivity in the healthcare sector for successful operations.

A camera and video system(Cammedis) may be possible for scanning with Krypton instead.

Is it possible to check our temperature with mobile telephone.