AxiPHYL | MedOnGo Smart Health Grid
Executive Summary
MedOnGo Health India Pvt. Ltd. and its Partners AxiPHYL Private Limited along with Jansankalp Foundation is
Smart Primary care Services Delivery Group catering to Primary Health, Public Health, Instant Care, and Home
care, Telemedicine, Patient Engagement and Continues Care. MedOnGo operates Pan India from with its staff
presence across multiple states including Mumbai and Maharashtra.
“MedOnGo”, platform was created as a single integrated system to address the health care requirements of
different health care sectors. The concept of providing Clinic Infrastructure, Technology infrastructure,, Human
Resources , cloud, mobile and connected devices for all healthcare related services developed as “Aapla
Dawakhana”. As the need of technology enabled Primary care along with accessibility of cloud services continues
to grow in the emerging markets, its integration with technology, AI and healthcare became inevitable.
Improvements in the speed and range of cloud integration now give patients’ the opportunity to access quality
and affordable healthcare all the time.
Executive Summary: Aapla Dawakhana – Revolutionizing Primary care with Technology Smart Clinics.
Problem Statement
The current healthcare system lacks efficiency and patient-centricity, resulting in a fragmented experience for patients. There is a need to streamline the entire consultation process and make it more focused on the patient’s critical needs. The usage of technology in conjunction with the behavioral patterns of Patients and the stress of Doctors, Nurses, and Health Workers and the ecosystem is key to success. Enabling Patients’ Rights and also protecting Healthcare workers and helping health workers to help patients better is corner stone.
Working Solution
Introducing the concept of Technology enabled, Single Doctor with two dedicated Nurses – one for pre-consultation and another for post-consultation activities. This Smart Clinics technology-enabled approach aims to optimize patient preparation, consultation, and follow-up seamlessly. MedOnGo, the inventor of this process, has successfully implemented it across India, serving over 200 million consultations.
Expected Value
By implementing the Single Doctor model with integrated technology, Aapla Dawakhana maximizes the value delivered to patients. It ensures a smoother consultation experience, reduces waiting times, enhances prescription verification, enables counseling sessions, and provides phlebotomy services. This comprehensive approach improves overall patient satisfaction and healthcare outcomes.
Impact and Next Steps
The success of Aapla Dawakhana has been recognized globally for its contribution to public health programs. By collaborating with government initiatives like Delhi Mohalla Clinics and private organizations such as Reliance, MedOnGo has demonstrated its commitment to bridging the gap between the public and private sectors in the healthcare industry.
Next steps involve expanding the reach of Aapla Dawakhana to serve more regions, both urban and rural, within India and potentially other countries. The focus will be on continuous improvement, leveraging technology, and maintaining a patient-centric approach. MedOnGo aims to revolutionize healthcare by making it more accessible, efficient, and personalized.
In conclusion, Aapla Dawakhana’s innovative approach of integrating technology, dedicated nurses, and a single doctor has transformed the healthcare landscape in India. With its proven success and recognition, this model is set to revolutionize healthcare delivery worldwide. By addressing the problem of fragmented care, Aapla Dawakhana improves patient outcomes and experiences. The expected value of this approach lies in its ability to optimize the entire consultation process, ensuring patients receive holistic care. The impact of Aapla Dawakhana is evident through its extensive collaborations with government programs and private organizations. Moving forward, the focus will be on expanding its reach, leveraging technology for further enhancements, and maintaining a patient-centric approach. Aapla Dawakhana’s mission is to make healthcare accessible, efficient, and personalized for all.
About AxiPHYL | MedOnGo | Jansankalp.
MedOnGo’s unique innovation in Urban Healthcare in India is role model for Developing and even developed nations. The combination of traditional Single Doctor Clinics with Health IOT and deep integration of processes with Technology and making them Smart Clinics and improving the clinics based on its individual signature coupled with chain of clinics in the block to area, division to corporation limits and sometimes extended beyond.
MedOnGo’s Smart Health Gird’s Smart Health Clinic model operates with a specific setup for primary care, where you typically have one doctor, one nurse, and one multi-purpose worker. This arrangement is part of a larger effort to strengthen the primary healthcare infrastructure. The guidelines for such healthcare setups are detailed in the Indian Public Health Standards (IPHS) 2022 Guidelines and MedOnGo has loosely adopted them with little modifications, which outline the various volumes of healthcare services mainly Sub UHC with a single Doctor a nurse, and a multipurpose worker.
Track Record
Aam Aadmi Mohalla Clinics (AAMCs) in Delhi NCR for the Government of NCT of Delhi
Aapla Dawakhana in Thane and Mumbai, Maharashtra.
UHWC Clinics for Reliance Foundation
Mobile Clinic for Reliance Foundation.
Launched India’s first complete digital clinic and automated pharmacy solution- Health ATM
Installed Health ATMs across India- Rajasthan, Uttar Pradesh, Madhya Pradesh Karnataka, Punjab & NCR in rural and urban regions
WISH Foundation, and Sukarma Foundation to name a few digitally operate their Clinics using our Smart Health Platforms Clinical Solutions
Implemented 347 CliniPort portable Tele-consultation modules with automatic Vital signs monitoring solution
Automation of Clinics in Sri Lanka
Currently developing the next version of Health ATM for International markets and Urban Areas.
The MedOnGo suggestions will outline the requirements for the clinic’s physical infrastructure.
Infrastructure
The Urban HWCs should be located preferably within 1 kilometer radius from the periphery of under-served population in urban slums, vulnerable pockets, and temporary settlements in cities and peri-urban areas, which are the prime focus in the urban areas. Section 8.1 of IPHC 2022 deals specifically for the same
Outpatient Services
A well-organized space for patient consultations and examinations.
Immunization and Pharmaceuticals
Designated zones for vaccine storage/administration and dispensing medications.
Diagnostic Facilities
Basic lab equipment for routine tests. IPHS 2022 guidelines for MedOnGo’s Smart Health Clinic Single Doctor Clinics specify mandatory diagnostic equipment to ensure basic diagnostic services can be provided. The list typically includes equipment for vital sign monitoring, basic lab tests like blood glucose and hemoglobin, urine analysis strips, and equipment for basic procedures.
Water and Sanitation
Clean water supply and hygienic restrooms.
Waste Disposal
Proper biomedical and general waste management systems.
Power and Maintenance
Reliable electricity with backup and maintenance protocols for medical equipment.
Health Education
Space for health promotion activities and patient counseling.
Accessibility
Features to accommodate individuals with disabilities.
MedOnGo’s Smart Health Clinic Staff
Staffing Requirements:
Medical Officer
Role: Primary healthcare provider responsible for outpatient services, emergency care, public health activities, and administrative tasks.
Qualification: MBBS degree with registration at the Medical Council of India or State Medical Councils.
Performance Metric: Handling approximately 75 OPD cases per day.
Staff Nurse
Role: Providing nursing care, administering medications, assisting in diagnostic procedures, and offering health education and complete pre consultation process of MedOnGo.
Qualification: Diploma in General Nursing and Midwifery (GNM) or B.Sc. in Nursing with State Nursing Council registration or equivalent or as approved by the customer.
Performance Metric: Managing around 150 patients a day.
MPW
Role: Engaging in post-consultation of MedOnGo, fieldwork for health promotion, basic medical procedures, assisting in public health campaigns, and collecting health data.
Qualification: Diploma or certificate in health worker training from a recognized institution.
Performance Metric: Managing around 150 patients a day.
Sanitary Staff and Security Staff (Part Time)
Role: Maintaining cleanliness and hygiene within the facility.
Qualification: Not applicable.
Additional Expectations
The guidelines allow states the flexibility to determine the level of ‘leave reserve’ to be sanctioned, recommending a leave and training reserve of 15% or as per the state rule for all staff in IPHS.
The performance metrics for the medical officer and staff nurse are based on an 8-hour shift with an assumed 75% productivity and efficiency, which translates into 6 hours of working time spread over 6 days a week.
This summary provides an overview of the staffing norms at Single Doctor Smart Health Clinics, including the roles and responsibilities, required qualifications, and performance metrics for each staff member as per the IPHS 2022 guidelines.
Service Delivery
For a single doctor MedOnGo’s Smart Health Clinic with a single nurse and a multipurpose worker (MPW), the expectations for service delivery in the Outpatient Department (OPD) according to the IPHS 2022 guidelines include:
OPD Service Delivery:
General Health Services
Provision of primary diagnostic, curative, and preventive health services.
Basic management of common illnesses and minor ailments.
Initial assessment, stabilization, and management of acute medical conditions before referral if needed.
Antenatal and Postnatal Care
Early registration of pregnancy, and antenatal check-ups including screenings for common conditions like hypertension, diabetes, and anemia.
Post-partum care and counseling for mothers.
Child Health Services
Immunization services, growth monitoring, and management of common childhood illnesses.
Nutritional counseling and support.
Family Planning and Reproductive Health Services
Contraception counseling and services.
Management of reproductive tract infections and sexually transmitted infections.
Non-communicable Diseases (NCDs)
Screening, referral, and follow-up for conditions like hypertension, diabetes, and common cancers. Lifestyle counseling and support for managing NCDs.
When to Serve in OPD
Patients presenting with common illnesses and minor ailments.
Routine health check-ups and preventive health services.
Antenatal and postnatal care.
Immunization and child health monitoring.
Basic management and follow-up of chronic conditions.
When to Refer
Cases beyond the scope of primary care or requiring specialized medical intervention.
Emergencies that require immediate higher-level care, such as severe trauma, acute cardiac events, or complicated deliveries.
Patients with conditions that require diagnostic facilities not available at the Single Doctor Smart Health Clinic
The MedOnGo’s Smart Health Clinic should have clear referral protocols to ensure patients are directed to the appropriate higher-level health facility efficiently and safely. The goal is to provide holistic, continuous care, leveraging the resources and capabilities of the MedOnGo’s Smart Health Clinic while ensuring that patients with complex or severe conditions receive timely and appropriate care at higher-level facilities.
Pharmaceutical Requirements at Smart Health Clinics
The IPHS 2022 guidelines include a comprehensive list of essential medicines that should be available at Smart Health Clinics. The list spans various categories of medicines, addressing a wide range of health conditions. Here are the categories and some examples of the medicines listed:
S.No. | Category | Medicines |
1 | Anesthetics | 1. Oxygen gas |
2 | Analgesics, | 1. Aspirin, |
3 | Anti-allergic | 1. |
4 | Antidotes and | 1. Atropine |
5 | Anti-convulsants, | 1. Magnesium |
6 | Anti-bacterial | 1. |
7 | Anti-fungal | 1. |
8 | Anti-malarial, | 1. As per |
9 | Intestinal | 1. |
10 | Medicines for | 1. Lactulose |
11 | Anti-anaemic | 1. Ferrous |
12 | Cardiovascular | 1. |
13 | Anti-hypertensive | 1. |
14 | Hypolipidemic | 1. |
15 | Medicines for | 1. Alprazolam |
16 | Dermatological | 1. Silver |
17 | Disinfectants | 1. Ethyl |
18 | Ear, Nose, | 1. |
19 | Gastrointestinal | 1. |
20 | Contraceptives | 1. Various |
21 | Medicines for | 1. |
22 | Thyroid and | 1. |
23 | Vaccines and | 1. As per |
24 | Medicines | 1. |
25 | Solutions for | 1. Ringer |
26 | Vitamins and | 1. Ascorbic |
27 | Ophthalmological | 1. Sodium |
28 | Diuretics | 1. Furosemide |
This list is intended to ensure that Single Doctor Smart Health Clinic s are equipped to provide a broad spectrum of basic healthcare services, addressing common and urgent health needs in the community. It’s important to note that this list might be updated or modified based on national guidelines, availability, and specific community health needs
Diagnostics and Medical Equipment
Multipara meter Monitor
Stethoscope for heart and respiratory checks,
Glucometer for blood sugar levels, and basic urine analysis strips.
Hemoglobin Check
Rest can be outsourced
Technology
The MedOnGo’s Smart Primary care Services Delivery Company is an easy to use portable and powerful clinics. It can be used for Patient Management, Clinic Management, OPD Management with online as well as offline data support. It is a management software to manage your Electronic Medical Records (EMR) with ease, and a comprehensive software solution for inventory management, invoicing and continuous patient care.
Solution ecosystem for SMART HEALTH, which appears to be a comprehensive framework for enhancing primary healthcare delivery. Here’s a breakdown of the technology elements, services, and their potential integration within a primary care setting by MedOnGo:
Technology Elements
Remote Diagnostics: Tools that can perform diagnostic tests and send results to healthcare providers remotely.
Automated Pharmacy Dispense: Machines that automatically dispense medications, reducing wait times and errors associated with manual dispensing (Optional)
Health Kiosk/Retail Health Clinic: Physical stations where patients can access healthcare services such as check-ups and consultations (Optional)
Tele-Medicine: A platform for remote care, allowing consultations and health services over the internet (Optional)
Symptom Analysis: Software for analyzing symptoms that patients report, possibly using AI to assist in preliminary diagnosis.
Health Analytics: Systems that process health data to provide insights into population health trends and individual patient needs.
Clinical Decision Support Systems (CDSS): Tools that assist healthcare professionals in making informed decisions by integrating patient data and clinical knowledge.
Health Internet of Things (IOT): Connected devices that monitor health metrics and send data to healthcare providers.
Patient Generated Data (PGD) and Family Data: Information provided by patients or their family members, which can be integrated into their health records for a more comprehensive understanding of their health (Optional)
Services Delivered:
Over-the-Counter (OTC) and Prescription (Rx) Services: Easy access to non-prescription and prescription medications.
Consultation: Doctor Consultations, which can be done in-person or remotely.
Remote Care/Tele-Medicine: Healthcare services are provided at a distance, which can include virtual visits and monitoring. (Optional)
Remote Consults: Consultations with healthcare professionals that do not require an in-person visit (Optional)
Remote Tracking: Ongoing monitoring of patient’s health status remotely, which can be crucial for chronic condition management (Optional)
Combination in a Primary Care Setting:
In a primary care setting, this SMART HEALTH framework could operate as Patients could use the health kiosk for initial symptom analysis and basic diagnostics. Based on the analysis, the system could connect them with a healthcare provider via tele-medicine for a consultation. The CDSS would support the healthcare provider by offering diagnostic and treatment suggestions, reducing manual errors. Prescriptions generated during the consultation could be automatically filled by the automated pharma dispense system. Health analytics would continuously analyze patient data for better service delivery and public health insights. Remote diagnostics and IOT devices would enable continuous patient monitoring, providing real-time data to healthcare providers. Patient engagement would be maintained through the Smart Health app, allowing patients to manage appointments, access their health data, and receive follow-up care instructions. The integration of these technologies and services by MedOnGo would create a cohesive healthcare delivery system that can provide efficient, accurate, and personalized care, making primary healthcare more accessible and effective.
Welcome Desk and Pre-Consultation
Patient registration with detailed information including Image captures.
Registration of family members.
Automatic generation of unique Identifier for patient as well as each family member.
Advanced multi-criteria search/categorization for registered patients.
Printing of patient id card.
Patient EMR
Fluid, fast and easy to use GUI to make data collection easy for the consulting doctors, nurses, assistants etc.
Complete clinical data repository.
ICD-11\SNOMED CT Codes for Diagnosis and Clinical Findings.
Laboratory reports, clinical procedure records, etc.
Inventory Management
Provide an extensive list of drugs available
Real time monitoring of medicine stock.
Accurate reporting of consumption details.
E-Prescription generation and printing.
Easy integration of medicine dispensing to MVM (Medicine Vending Machine) module.
Auto generates alerts when stock reached to its minimum level.
Analytics
Analyze data and provide site wise analytics.
Distribution plotting of diseases and provisional diagnostics
Daily/Monthly/Weekly reporting on multiple parameters like demographics, disease distribution, medicine usage etc.
AdHoc reporting of up to 3 types of parameter.
Various predetermined report formats are available. MedOnGo will generate custom reports as required. We will also auto-generate reports periodically and mail them to a predetermined list of recipients. In addition, ad-hoc reports are available.
Some of the sample reports that are available are as follows
Daily Patient Report UI | Follow-up Patient Report |
Daily Patient Report | Referral Report |
Disease Report | Prescription Report |
Daily Report | Test Report |
MPR Report | Screening Report |
Cumulative OP Report | Total Balance Stock Report |
Cumulative Data Count | Inventory Consumption Report |
Nutrition Report | Ad-Hoc Consult Report UI |
Feedback Report | Attendance Report |
Audit Reports | Bill Report |
Continuous care
Generate alerts for Follow-up patients for the current dates
Automated notification (SMS, Patient app) to patients for follow-up visits, preventive services etc.
Automated notification for preventive screening of patients
Mechanism to capture details of MCH patient and track, monitor and notify patient data abnormalities, missed testing, follow-ups
Administration
Comprehensive management of accounts, attendance etc.
Interface to enable add remove master data.
Easy export and import of data
Billing
Comprehensive bill generation based on the inventory and consumables used.
Billing is based on income category.
Billing is based on the cover amount.
Printed copy of the bills.
Architecture
MedOnGO architecture is a layered architecture consisting of a data source, a data layer, a service layer, a business process layer, a reports layer, and a presentation layer. Each layer performs a specific function and encapsulates all of the information needed to provide a complete service.
Presentation Layer uses HTML5/FTL, CSS 3.0, JavaScript, JQuery. AugularJS is used for specific patient engagement facilities. Business Process Layer is a custom built-in workflow engine to specifically handle workflows defined; all services in the Service Layer are REST Based using JSON/XML for communication. These services are built using Node or SPRING based. The data service layer using Hibernate or strong loop-based loopback.io Reports layers is mainly on Kibana, and Clicq(few cases we use Tableau). External systems can be interfaced using REST/JSON.
Security Scope
Automated Vulnerability Scanning: Automated Vulnerability Scanning of the application to identify obvious and common security holes – (Production replica/Test Environment)
Application Penetration testing: Tests will be performed with the intention to identify the possible internal and external abuse of the application’s sensitive information (Test Environment/Production replica)
A high-level approach for conducting Security testing of the Application.
Information Gathering: In this phase, the test team will make an effort to understand the target system to gather the data required for overall Security testing
Vulnerability Assessment: The objective of the phase is to uncover all the possible vulnerabilities in the Web Server and Application under test.
Penetration Testing: In this phase, the target system is subjected to attack and exploited manually with the information gathered in the previous phases of testing in order to confirm the identified vulnerabilities
Security Test Reporting: A security test report is produced with all the identified vulnerabilities for their implications and possible countermeasures
Service Delivery using Technology
MedOnGo’s multi-tab model delivers a full-fledged smart clinic experience even in areas with poor to no connectivity. Each operator in the clinic will operate on a tab with specific functionalities. The following picture briefly illustrates the workflow.
Pre Consultation (Registration and Help Desk)
The operations performed by the Health-worker in the Registration Tab are as follows. Determine whether the patient is an existing patient using the biometric authentication mechanism. In case of existing patient determine the reason of visit and create a consult with the doctor. In case of a new patient register the patient into the system, capture his medical history and create a consult with the doctor. The workflow can be briefly shown as below.
Consultation
The operations performed by the Doctor/Specialist consultant in the Consultation tab are as follows. Determine the availability of patients from the queue. Identify the patient as a New or Referral or Follow-Up patient. Consult the patient suing MedOnGo smart Consult Platform. Prescribe Labs and or Medication to the patient and handover the consultation printout to the patient. The workflow can be briefly shown as below.
Pharmacist and Laboratory (Multipurpose Worker)
The operations performed by the Pharmacist/Phlebotomist in the Pharmacist Tab are as follows. The pharmacist will be able to maintain the inventory of the pharmacy. Dispense medication to the patient. Monitor the administration of medication to the patient. Maintain the stock for consumables and other equipment’s in the clinic. In addition to this this tab can be used by the phlebotomist to manage sample collection and tracking for patients who have laboratory investigations prescribed to them. The laboratory workflow can be briefly shown as below.
Process Work Flow
At the time of consultation doctor may or may not prescribe lab test for the patient.
For each lab test prescribed by the doctor a unique identifier will be generated in the AAPLA DAWAKHANA Doc app. This identifier will be referred to as Lab_Test_ID
Once the lab test is ordered the AAPLA DAWAKHANA lab app will generate a sample collection page (on completion of consult, only for patients where lab test is recommended).
This page would list the following for each test or a group of test
One or more sample ID and for each sample ID,
Type of sample – urine, blood, stool etc
Color of the sample in which sample has to be collected
Amount of sample (optional)
The application will allow print of this page.
Phlebotomist will receive this print.
Phlebotomist will collect samples based on the list (matching vile and amount) provided.
Lab vendor would be providing pre-printed barcodes to the lab (at least two copies of each).
Phlebotomist will stick one of the bar code on the sample.
At the same time Phlebotomist will also maintain a register ( to be pre provided to Phlebotomist with clear wide space to stick bar codes). Phlebotomist will stick the App sample ID (from print received) and against it the other copy of the bar code.
At some point during the day, phlebotomist will have get the Tab from doctor and do the following data update.
Phlebotomist will be given a separate page to locate the patient for whom sample has been collected.
To locate the patient, Phlebotomist will enter the app sample ID from the register.
Once located, using the app, phlebotomist will scan the bar code against the sample ID.
Lab vendor on receiving the sample would read the bar code from sample and enter the barcode in his system as sample ID.
Once the OPD is done the lab vendor would be able to download a report from AAPLA DAWAKHANA clinic web portal on the list of samples with tests reported against each sample. This can be imported in his system .
On completion of test, the lab vendor should be able to share the mapping of sample ID & results as follows,
Sample ID -> lab test ID -> result -> min range -> max range -> notes
Service Delivery
Ballpark Budget
Human Resources
Sl No
Product Stage
U
1.
Doctor (MBBS or BAMS with 5 years’ Experience)
1
2.
GNM
1
3.
ANM
1
4.
House Keeping Staff
1
5.
Ground Technical Support Staff (Shared)
Shared (1 for 10 clinics)
6.
Supply Chain Management Staff( Shared)
Shared (1 for 10 clinics)
7.
Central Command Centre Staff ( Shared)
As per Program Clinics count and average Foot falls
Hardware
No.
Item
Quantity per Clinic
Specification
1
Android Tablet
4
PLATFORM Android 13, One UI 5.1
CPU Octa-core (2×2.2 GHz Cortex-A76 & 6×2.0 GHz Cortex-A55) or equivalent
MEMORY Card slot microSDXC (dedicated slot)
Internal 64GB 4GB RAM, 128GB 4GB RAM, 128GB 8GB RAM
MAIN CAMERA Single 8 MP, AF
Video 1080p@30fps or Higher
SELFIE CAMERA Single 2 MP or Higher
Video Yes
SOUND Loudspeaker Yes, with stereo speakers
3.5mm jack Yes
COMMS WLAN Wi-Fi 802.11 a/b/g/n/ac, dual-band, Wi-Fi Direct
Bluetooth 5.3, A2DP, LE
Positioning GPS, GLONASS, BDS, GALILEO, QZSS
NFC No
USB USB Type-C 2.0
FEATURES Sensors Accelerometer, proximity, compass
BATTERY Type Li-Po 5100 mAh, non-removable
Charging 15W wired
2
Printer
1
Print speed – 20 PPM and above for A4 Resolution – 1200X1200dpi Connectivity – Wi-Fi, USB 2.0(Optional)
Input Paper Capacity – 150 Sheets or more
Duty Cycle – 10000 monthly Compatible OS – Android ( Printers are recommended)
3
Router
1
Wireless 5G and 4G LTE Router
(Airtel 4G connections or FTTL lines are recommended along with Cisco Routers)
Technology Licensing
-
Sl No
Product Stage
Units
1.
MedOnGo Base Implementation
1
2.
Hosting Charges in MedOnGo Servers
AWS – Instance
3.
Custom Development
As needed by the Corporation
4.
SMS Costs
AS needed by the Corporation
5.
Training Costs *
Included
6.
Add On costs
To be discussed with Corporation
7.
AMC Costs per year (Payable at the end of First year) (Increase in AMC will be after 5 years)
To be discussed with Corporation
End to End Service Delivery Model
Sl No
Product Stage
Price
1.
MedOnGo SPCSD Product Mobilization Advance*.
This advance is to be amortized with the billing made during first few quarters.
To be discussed
2.
Additional Customization as required by Government (Additional Customization based on final requirements analysis) (Expecting not more than 5 or 6 person months.)
As per Government Norms
3.
Per Consult Charges
As per CGHS Rates