1. stitch.md Turn Flowcharts into Apps

2. Overview stitch.md Problem 1: Safety Problem 2: Quality Problem 3: Quantity Secret Sauce

4. stitch.md We help untrained health workers ACCURATELY IMPLEMENT practice guidelines by simplifying the navigation of complex guidelines into single Q&A screens.

6. Why tackle this problem? Because it affects the safety, quality, and quantity of healthcare

7. People hate being sick Health worker jobs – Assess patients – Formulate diagnoses – Create management plans – Take Action Limitations – Technology – (Tele)Communication – Time – Training

8. Problem 1: Safety First, do no harm

9. Australian

10. Swiss Cheese Model

12. Horsham

14. Solution 1: Clinical Pathways

16. “We don’t have the ability or money.” stitch.md brings checklists and clinical pathways to mobile, affordably

17. Examples of stitch.md Use Acute STEMI Acute ischaemic stroke Pre-operative screening Post-operative management

18. Safety of Care Well thought out Standardized Optimized Reduce error Reduce variability Reduce wasted resources

19. Problem 2: Quality (and cost-effectiveness)

26. Australia’s healthcare is great! We need to make it more cost-effective.

30. Solution 2: Task Shifting

33. Nurse Practitioners Common IllnessesSkin ConditionsVaccines AllergiesAthlete’s footDTP (diptheria, tetanus, pertussis) Bladder infections (females) Cold soresFlu (seasonal) BronchitisDeer tick bitesHepatitis A (adult) Ear infectionsImpetigoHepatitis A (child) Pink eye and styesMinor burnsHepatitis B (adult) Sinus infectionsMinor skin infections & rashes Hepatitis B (child) Strep throatMinor sunburnMeningitis Swimmer’s earPoison ivyMMR Flu diagnosisRingwormPneumonia (Oct – Dec) MononucleosisWart removalPolio (IPV) Pregnancy testingTD (tetanus, diphtheria) Conditions managed by MinuteClinic

35. INTERNET NURSE DR WITH STITCH.MD

36. Examples of stitch.md Use ED triage Outpatient clinics GP rooms Nurse practitioner clinics Allied health – Physiotherapy – Occupational therapy – Dietician Mental health services

37. Quality of Care Better – Leveraged expertise – Information dissemination Enables – Safe task shifting – Push mechanism for delivering evidence- based best practice

38. Problem 3: Quantity

39. INTERNET NURSE DR PT DR PT DR PT INTERNET PT NURSE INTERNET PT NURSE DR STITCH.MD PT

40. Capturing ideas How doctors think about problems

41. Enabling Technologies Mobile DevicesSensor proliferation Cloud Computing Quantified Self Standardized platforms iPhone Android Pebble Google Glass iWatch Etc… Plugins or standalones HR Pulse oximetry BP monitoring BSL checks Point-of-care labs Etc…

42. Solution 3: Automation Traditional Model – Sessional assessments – Interval assessments – Limited feedback – Patient Passivity Future Model – Continuous assessments – Risk based assessments – Rich analytics – Patient Engagement ULTIMATELY

43. Examples of stitch.md Use Management of chronic conditions – Diabetes – Hypertension – Congestive cardiac failure Disease Prevention – Fitness – Diet

44. Secret Sauce

46. Disruption = Trend of convenience = elimination of limitations stitch.md uses technology to eliminate the – Limitation of time – Limitation of training – Limitation of (tele)communication

47. Medicine is about people

48. stitch.md EMPOWERS people by DECOUPLING Knowledge from Practice

50. stitch.md Turn Flowcharts into Apps

51. Questions? info@stitch.md

52. References http://www.npr.org/blogs/health/2013/09/20/224507654/how-many-die- from-medical-mistakes-in-u-s-hospitals http://www.abc.net.au/worldtoday/content/2013/s3778256.htm http://www.oecd.org/els/health-systems/Health-at-a-Glance-2013.pdf http://grattan.edu.au/publications/reports/post/budget-pressures-on- australian-governments/ https://www.mja.com.au/journal/2004/181/8/using-checklists-and- reminders-clinical-pathways-improve-hospital-inpatient-care http://healthcare311.com/news/?p=2321 http://blog.healthecareers.com/blog/medical-careers/report-finds-hiring- nurse-practitioners-and-physician-assistants-a-smart-decision