Saving The Next Five Billion

This post has been updated and the master copy is on acocoproject.org at https://acoco.org/2022/07/13/saving-the-next-five-billion-people/

The original is below for posterity.

What?

Only two or three billion people have mildly useful health records for life.

Most of our history is on paper and/or spread out across providers so learning from the past and improving future health is hard.

How and why do we help the rest and maybe make existing methods even better for everyone.

Health should be as connected, easy, fun and useful as gaming, gmail, airbnb and social media.

Think Outside Your Box

Have you ever travelled outside your country?

Many people travel for holidays or adventure or mobile work like digital nomads.

Many more people travel because of the need for money, work, water, food, safety, politics, discrimination or conflict. Theses are involuntary nomads, displaced or refugees. Most observers only highlight these numbers when they cross country borders but seasonal or permanent internal migration within countries is enormous globally.

Together these numbers are somewhere north of 500m people annually. Quite possibly a more accurate estimate would be double that number due to limited data ‘on the ground’.

Many more people don’t travel because they love their home or are trapped eg economically or politically but need and want to in order to reach freedom, better food, work, family, more life opportunities or of course better health care.

The Global Care Gap

After living and working again in various developed places like Australia, America, Singapore, Europe, United Kingdom, Canada etc I have been spending recent years getting back to the developing world.

Wow, it is different.

Five billion people in the world don’t have access to the basics often taken for granted in high GDP per capita countries. But they also have amazing ways of adapting and innovating that other countries could learn from everyday like lower usage of plastic and local grid electrification and health care based around distributed community collaboration not centralised resources.

One simple thing we can do (but for many perverse reasons have not) is help people care for themselves and the ones around them more easily. Make the existing (pervasive, efficient, accepted/trusted) models work much better.

Smarter health care in developed countries usually revolves around hospitals and general practitioners but in developing countries most care is provided at the local level with zero or few doctors or other professionals available unless you travel very long distances (hours, days and hundreds of kilometres or miles are common, often in difficult conditions).

This Community Collaboration (we say coco for short) is the key to local, context sensitive, affordable care. But it is often limited and contributes to long term issues or ineffective care relative to more advanced countries.

And the problem does not stop there, any travellers even those with money and resources from developed countries are often subject to the same challenges.

Because care is limited and distributed, records are non-existent, poor, paper or simply stored in different locations and formats.

So your caring nurse, family member or ideally doctor usually has no idea what happened before, not a great situation if you are unable to talk due to unconsciousness or other challenges.

And your local district health care workers have no visibility on trends developing such as a spike in particular health conditions.

Systems for health records nationally are expensive, often hundreds of millions of dollars or even billions. This money is often better spent in the short term on training, hospitals, medicines etc which is rational for developing nations especially.

But there is a better way, the developing country and travelling citizens of the world can have meaningful medical records for free (or close to it).

Together And With New Tools We Can Change The Game

Since 1994, the year the internet became truly commercially useful, we have had a global service to share information. Not long afterwards, we started sharing computers. Now those services are very mature and commonly called the cloud. We can get world’s best computing power and lots of wonderful extras like artificial intelligence and security and pay by the minute for exactly what we need.

What a wonderful world we could have. If we actually focused on helping people.

Better still, most of the world has mobile phones with web and app internet access to the cloud, cameras, colour screens, microphones, speakers, GPS (or proxies) even accelerometers to detect motion. And more sensors are coming.

These are the building blocks of smart health, we just need to use them and avoid the politics and find a simple way for sponsors to fund it.

Sponsors ideally would be -

• Philanthropists and Foundations eg MacKenzie Scott; Case Foundation; Gates Foundation
• Premium Users eg pays a small annual upgrade from the free plan for extra features
• Governments and NGOs — if they are not political or otherwise driving incompatible agendas which are common in health and increasingly also in health technology. eg UN Access To Health; Care.org; Save The Children Fund
• Community — early adopters and advocates and local ambassadors but even more importantly developers contributing to the open source software project. eg independent programmers or corporate under-utilised resources.

Motivation & Experience

For me this is a personal challenge and I am gradually realising it might be the hobby or (with support) the work for the remainder of my life.

I worked on the national health digitisation in Australia as one of the few senior innovation and technology leaders and we did an ok job, but spending billions and still having to subsidise people to use it and even mandating it legislatively because it is hard to use, incompatible with work flows and most privacy expectations — this is not a win win situation.

If a developing country was given the same billions of dollars in cash and other resources like professional talent, they would almost certainly have spent that money more effectively with shorter term return on investment.

Some of the issue here is the scar tissue developed countries have prevented innovation, surrounded by layers and layers of legacy expectations, processes and rules built up in many places by many stakeholders over many years. It is hard to thing fresh and move quickly.

But developing countries can’t afford such luxuries or inefficiencies. Life and death is much more immediate, regular, preventable deaths are an every day event and complexities are omnipresent.

I would argue neither can, but that is another conversation we can have in a decade when we have built a great global medical records service that meets developing AND developed country needs.

My older brother (whom I am very proud of) was recognised for decades of volunteer work in a developing country as specialist doctor and saved and improved many lives there and in our home country Australia and also developed many skills in the local professional communities that will save many more lives in years to come. He has also led global specialist professional health bodies. Inspiring to say the least.

My sister worked in a range of roles including pharmaceuticals and saw firsthand the impact quality science can have developed at country and even regional scale.

My other brother worked in a range of medical and related roles and contributed first hand to improving many lives and institutions.

My own work outside health has impacted tens of millions of people in dozens of countries and hundreds of thousands of small businesses across a handful of sponsoring institutions. Mainly in finance, investing, health and retail.

Some of our cousins and some of the next generation are also working in health and impact over the course of a life from each of them will be enormous in a handful of cities and towns.

We all continue to work.

My father and mother through their pharmacies and other community impact work of a commercial and volunteer nature directly touched the lives of tens of thousands of people through their careers.

Collectively this is an impressive life long community effort but it pales in comparison to the global nature of health challenges. How can we help more?

The Next Big Challenge — Global Apps

But now we can reach internet scale, beyond mere tens of thousands of people in a lifetime, the question is can we reach hundreds of millions of people and give them simple accessible tools that improve lives for their lifetime and multiple future generations?

It is possible, with some careful open strategy to craft solutions that could reach billions or even tens of billions people over a small handful of generations.

The good news is the technology is there and the role models (tech startups that have reached billions of people) are also there right now and both are improving daily.

The bad news is the ‘open’ internet is changing and even in some countries disappearing daily. So our window for reaching and helping people is not opening wider it is more possible but now has a sense of urgency.

We need to get the coco apps for clinics and individual citizens built and useful to the point of not being blocked by governments quickly. I would estimate at the current rate we have less than 3–5 years and maybe 10 if we are lucky unless there are dramatic other changes. Mesh networks and Starlink (thanks Elon) might help but I doubt they will stop the various autocrats of the world.

If we build a trusted neutral position with all stakeholders that places us in the useful and easy (not annoying or threatening) bucket then we will be like Switzerland historically has been in finance, neutral enough that other countries permit interoperability. Most global leaders do want to understand health trends and spend more wisely. Doctors do want to be more productive. Patients and carers do want an easier path to health.

Imagine a world where gmail or email/smtp was largely banned, it is unlikely because it is 1:1 (not mass influencing like social media), personalised, neutral (used by all sides of politics), useful, easy, inexpensive and not annoying or threatening (there are many bigger problems). So it ‘flys under the radar’ as community and government accepted ‘plumbing for work and personal life’, and so it should, there is no political or other agenda here and that is a core tenet of how coco should and always will operate.

Health and retail and most jurisdictions around the world have a huge variety of standards eg for security and interoperability. All coco patient and provider records will interoperate and be secure by design from day one. However global compliance with all standards (there are many levels of security standards for example your school locker vs a bank) is likely to dramatically drive cost and delays that are problematic for low budget developing countries. We must prioritise ‘free’ over ‘fat’ when it comes to this key difference at least initially. We will prioritise functionality and simple but meaningful security first followed by meeting global security standards and thereafter progressively looking to meet global health standards for interoperability.

It is our hope and plan that from a careful design perspective that Coco will actually be better than many / most legacy developed country systems in terms of individual privacy and business efficiency by using auto information sharing designed in from day one.

How Does It Work?

So we have A Coco Project as the umbrella creating initially a small handful of meaningful apps that help -

Coco Card — a personal app backed by a shared service for individuals to keep track of their lives and health personally and for family and friends. All the phases of the health and retail life cycle. Discover, book, prepare, checkin, receive service/product, track, followup, learn, repeat. Every patient has their own records and can selectively share with providers (personally or collectively w family/community) or directly openly share.

Coco Clinic — a provider/professional/business app backed by a shared service for retail SMEs, clinics, hospitals and other organisations for their patients that improves provider doctor productivity and quality of treatment. Each clinic unit is self administering eg medicine or equipment inventory and financially and has a distinct type eg dental, general practitioner, radiology, pathology, physiotherapy, other wellness. A collection of clinics becomes a hospital and a collection of hospitals becomes a district health system. Every business has their own records and with patient/family/community permission care received shared information. Individual Clinics/Organisations/Units have their own distinct data ownership and configuration and can be ‘rolled up’ for visibility into larger Organisations

Coco Insight — better individual patient and population level insight from local districts to national and transnational pictures. Anonymous. Simple analytics in near real time for major and pinpointed change. The same tool can be used for larger groups of organisations to analyse metrics, financials and data across and within organisations while maintaining anonymity and privacy.

Doctor Productivity

Today most consultations start with walk ins or bookings. Then the patient sits down and the doctor interviews and perhaps refers to previous consult notes on paper and rarely computer.

Our view is we can improve this in five ways —

1. More up to date information because the patient has access near instant telemedicine or booking face to face or care/advice discovery and to their personal records and it is jointly owned. Patients have ultimate past and future ownership and control but clinics always keep historical records and billing etc just like today.
2. More easily shared information, by simply checking in (GPS and QR), walking in, or booking with a clinic they auto share (or a promoted to share) limited latest information. This can be extended to wellness and other forms of care and even retail as a means of making it more comprehensive and correlating lifestyle data and subsidising the platform so more people get it free.
3. Doctors and other professionals see the latest both as shared clean text (as opposed to proprietary notes) and mosts importantly visually in 3D with a walkthrough. this is like a personal video of the injuries / conditions / treatments for the patient over years compressed into a (configurable) minute or two of personalised video like watching youtube on fast forward.
4. Doctors and other professionals can dictate or type or write notes so sharing is easier. Operational processes then flow more easily like detecting notes about next visit to promote a follow on appointment. Or prescription medicine or billing or referrals.
5. Population level health insights are shared anonymously with most parties, patients know there are major issues in their area, professionals are proactively forewarned about demand by type, regulators and district leaders are enabled to be more forward thinking and better targeted with policy and wider action.

Technology

So how are we going to build this thing?

We have been exploring technologies and currently are tending towards the AWS cloud by Amazon or the GCP cloud by Google.

For the end users eventually and for maximum coverage it must be available as web and native apps on mobile, tablet and desktop devices. For practical reasons we will built central services with APIs at planetary scale and then offer a web and small number of native mobile phone apps initially.

If our strategy of open source eventually is going to be achievable we must build using open source. But if our goal of reaching billions is going to be achievable that needs to be be best in class which is not always the case so careful architecture, security, scalability, cost base, ongoing innovation and talent availability decisions are required now and ongoing.

We love the power, improving efficiency and reach of javascript and new open source libraries like ThreeJS and being able to support full 3D without slowing down user experience -

• computer mouse/pad/stylus/keyboard manipulated 3D human images,
• animated motion like walking / exercise for limited range of motion, disability/ability and treatment implications
• and eventually personalisation like posture, skin tone, body type and showing past treatment eg skin cancer on bald head or broken femur vs proactively identifying local common issues too
• markups of injuries and treatments temporally (over selectable time frames and ranges) and colour coded
• eventually even simulate conditions and treatments

3D markups and high speed replay done well could save 15–30 minutes a day for doctors which means 1–2 more patients per day or 10,000–20,000 extra patients over their lifetime. Something that goes directly to our mission and frankly is a huge motivating force to make that much impact.

But there are other technologies we are looking at like Flutter/Dart an open source framework and language led by Google. This cross platform environment lets developers write code for all platforms eg web and native as well as

Think Ahead. Save Time. Save Lives.

So as we have seen above … thinking ahead about design, community collaboration, scalable enabling technology, saving lives and saving time go hand in hand. The same applies for preventative care and proactive care and general health and wellness and education.

Example 3D humanoid figure built using ThreeJS

Would you like to help?

Community collaboration (coco) is at the centre of what we do.

If you’d like to help build A Coco Project native apps and open web such as Coco Clinic, Coco Personal or Coco Insight please get in touch.

If you’d like to be a friend of Coco (the easiest way to help) or even contribute a little time/skills or contacts as-

• an informal advisor (technical or marketing or liaison) or
• an advocate for your city/country or a city/country you care about
• an open source software developer/contributor/maintainer volunteer
• a volunteer designer (UI/UX/CX/graphics/animations)
• a volunteer channel specialist (answer email/chat/web queries in spare time)
• a volunteer specialist architects either technical architect (full stack geek who knows how the computers work today and in future) or community builder/architect (fully immerse in local behaviours how the humans work today and are evolving)

Please also get in touch using the contact us link on the website or reach out to me personally on social media, links on this page.

Local advocates and carefully selected country ambassadors are crucial to out long term plan, especially those with community and university relationships regardless of industry vertical or school/faculty.