By Kathy Gibson – Of the many lessons learnt from the Covid-19 pandemic, perhaps the most important is that the centuries-old model of in-hospital patient care doesn’t scale well, is expensive to maintain, uses scarce resources and still doesn’t necessarily give patients the required level of care.
These problems certainly aren’t new, although the pandemic helped to bring them sharply into focus, and healthcare professionals have been trying to find solutions for some time.
As far back as 2018, local digital healthtech start-up Quro Medical started tackling the problems associated with trying to look after thousands of patients in hospitals battling to keep up with demand.
Dr Vuyane Mhlomi
It seemed obvious that the best place to receive care, from the patients’ point of view, is their own homes, says Dr Vuyane Mhlomi, co-founder and CEO of Quro Medical. This started the company’s quest to develop the technology and resources to provide just that.
“We saw a real opportunity to change the status quo,” Dr Mhlomi explains. “Quite apart from the expense, hospitals are just not the best place to look after patients. The earlier we can shift patients away from them, the better.”
So Quro developed a comprehensive healthcare solution that combines in-home care with virtual visits to deliver remote patient monitoring. “As a result, we can offer patients care in the safety of their own homes, with everything that happens in a hospital now taking place remotely,” Dr Mhlomi says.
These services include clinical oversight, patient monitoring, medication and oxygen administration, laboratory and other services – all underpinned by rapid response in the event of an emergency.
“Now the doctor’s care doesn’t have to end when the patient leaves hospital. We can start to move the hospital away from being a building, while helping doctors be more efficient when delivering safe care for their patients.”
The foundation of the Quro system is the patient monitoring technology. An easy-to-apply monitoring patch about the size of a sticking plaster is attached to the patient’s chest. This discrete, multiparameter biosensor monitors heart rate, ECG (electro-cardiograph), respiratory rate and core body temperature, as well as measuring patient movements like steps taken, body position and fall detection.
Additional hardware is employed to do realtime, intermittent monitoring of patients’ oxygen and sugar levels.
All the clinical data from the various devices is sent to the Quro Medical command centre hosted on AWS via a relay device with the backing and support of mobile operator MTN, which ensures uninterrupted service and no downtime.
Any anomalies or danger signs trigger an alert, and a network of relevant emergency personnel will be dispatched to the patient’s home immediately.
Dr Mhlomi explains that, because the monitoring is constant, it can pick up warning signs and anticipate danger signals much quicker than nurses in a hospital typically would.
The monitoring system communicates with the central system, which in turn integrates with the patient’s doctor, emergency services and laboratories – as well as back to the patient for two-way communication.
For instance, laboratory integration means the Quro system can receive patients’ blood test results as they become available and healthcare team can initiate immediate action if results fall outside of the prescribed limits.
Joost Pielage
“This way there is a single source of the truth,” says Joost Pielage, chief technology officer at Quro. “Because all the information is in one place and is completely accurate and up-to-date, better patient care can be provided.
“In fact, Quro provides ICU-level monitoring for patients at home or in the general ward.”
The Quro Medical system was designed by the Quro Medical tech team, using Typescript and React, and is hosted in the AWS public cloud.
Because it was developed using Fast Healthcare Interoperability Resources (FHIR), a level seven international standard for electronically exchanging healthcare information, exchange of information is standardised and simplified.
So patients can rest assured that the clinical data is protected, Pielage says. He explains that data about vital signs is stored and encrypted on AWS in Timestream, and is kept separate from patient data.
“Patient data has to be safe, so we’ve ensured that the platforms are as secure as Fort Knox.”
Developing and hosting in the cloud has allowed the team to keep the cost of the systems down, which makes it possible to deliver quality healthcare that is affordable, he adds.
And the tools available in a platform like AWS make the addition of artificial intelligence (AI) and machine learning (ML) possible so the system can constantly learn and improve.
Patients and doctors have access to the system via web and mobile applications on their smartphones. Doctors have access to only their own patients’ data, and two-factor authentication adds further security and privacy.
Patient data is stored locally, although anonymised data could be held offshore; and all data is backed up in the cloud.
There are a host of regulations around patient data, Pielage adds, and the Quro system complies with all international and local legislation.
By developing, hosting and running the system in the public cloud, Quro has been able to keep costs down. “And the team spends a lot of time ensuring that the service remains cost-effective,” Pielage says. “Our mission is to reduce the cost of healthcare.”
In the past, one of the biggest stumbling blocks to sending patients home was economic, with many medical aids paying up only until the patient is discharged. Now, recognising the value of home-based hospital care, many of them will cover Quro’s home-based services as part of their in-hospital benefits.
“The fact is, it is cost efficient to look after patients at home, and we can provide better quality care that is often safer than in the hospital,” Dr Mhlomi points out.
The fact that it is supported by 90% of South Africa’s medical aid schemes and the medical insurance market speaks volumes about the level and quality of medical and clinical care the company provides patients, Pielage believes.
In addition, by freeing up resources at expensive and well-resourced hospital facilities, better care can be provided to those patients who really need it, he adds.
While private healthcare providers and medical schemes are the target market now, the Quro team is looking to a time when the system will be able to scale out and support the public sector as well.
“We are learning as much as possible so that when we are ready to embrace the public sector, that rollout will be quick.
“There are massive changes happening in the healthcare space, and we believe we have developed an excellent model for delivering value-based care in a global market,” he adds.
The solution has already received $1,1-million in funding.