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The Medical Concierge Group Annual Report 2018i

Shs Shs

ANNUAL REPORT

2018

UGANDA I KENYA I NIGERIA

Digital Health through the integration of Artificial

Intelligence and Physical

Clinical Care

The Medical Concierge Group Annual Report 2018ii

Telemedicine will become the core methodology of healthcare

delivery in the future. That is where we are going to get the

efficiencies we need to provide affordable care.

Yulun Wang,President of the American Telemedicine Association

2014-2015

The Medical Concierge Group Annual Report 2018iii

010203

0913

242731

34

38

Acknowledgements

Message From The Managing Director

Products & Services

Live Telehealth ConsultationsChatbot Telehealth Consultations

Mobile Laboratory & Medicine DeliveryDigital Health Projects

2018 in Numbers

Special Projects

Artificial IntelligenceHIWA

USAID RHITES NORTH, LangoFamilyConnect & EMR

HIV Self-Testing Mobile Health

Research

Conferences & Abstracts

Corporate SocialResponsibility

40 40 Medical CampCancer Communique

Team

Board of DirectorsTeam

2018 Financials

Statement of Comprehensive IncomeStatement of Financial Position

Contents

04060708

1416182122

3536

39

40

3233

We at The Medical Concierge Group would like to greatly appreciate our clients and beneficiaries of our various services for their continued trust, support and feedback, which has helped to push us to greater heights in providing the best quality health products and services.

This 2018 annual report was compiled with the help, effort and unconditional support of various stakeholders. Special credit goes out to the staff of The Medical Concierge Group (TMCG) and its partners for their hard work, exceptional talent and unwavering diligence which have greatly contributed to the growth and success of the company, its projects, products and services.

TMCG compiled this report to highlight the progress and achievements of the company in the 2018 financial year. It also brings to the foreground the goals and plans the company is working to attain in 2019.

Acknowledgement

Special credit goes out to the staff of The Medical Concierge Group (TMCG) and its partners for their hard work, exceptional talent and unwavering diligence

The Medical Concierge Group Annual Report 20181


Shs Shs

Message from the Managing Director

It is with great pleasure that I present to you our 2018 annual report themed “Digital Health through the integration of Artificial Intelligence and Physical Clinical Care”

2018 was a year of great leaps in progress for The Medical Concierge Group (TMCG). For the first time in Africa, TMCG integrated Artificial Intelligence into primary health care with the creation of ‘Mirembe’, a health chatbot designed as a symptom checker to make triage recommendations and provide first line care advice integrated with an on-demand option for a live telemedicine encounter. This has seen phenomenal adoption and access to healthcare amongst our telehealth clients. We believe efficient and value-based healthcare of the now and future is ‘virtual-first’.

TMCG made the leap to ‘Phigital’ healthcare. This refers to the merging of the physical and digital aspects of healthcare with the launch of the on-demand pick up of laboratory samples and delivery of medicines.

This advances our mission to build an end-to-end healthcare value chain for our telehealth clients by merging the magic of digital experiences with the necessity for physical clinical services.

TMCG also moved office to a bigger and better home for our ever-increasing family of exceptionally talented staff that choose to be a part of TMCG’s mission and vision. Our new location at the Mirembe Business Centre in the leafy suburbs of Lugogo, Kampala, provides the right vantage point of TMCG’s vision.

Our mission today is sharper than it has ever been. Everyday, we continue to pursue the design and development of innovative digital solutions that are value based and efficient to achieve the best outcomes throughout the healthcare value chain.

I am eternally grateful to our staff, partners, clients and users for believing in us and our journey to become Africa’s leading world-class digital health company.

DR. DAVIS MUSINGUZIManaging Director


The Medical Concierge Group (TMCG) uses its mission as the north star to guide development and deployment of products and services that make access to professional healthcare credible and proficient. Traditional approaches to health care are costly for most socio-economic groups, limited by the distance to health services and the inequitable distribution of medical professionals. Even when health services are accessed, they are often of widely varying quality.

TMCG offers solutions that eliminate or significantly diminish many of these constraints and deliver more equity to healthcare service delivery.

Products& Services

1.

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This service provides virtual medical consultation with a telehealth doctor and pharmacist available 24/7. It can be accessed through voice and video calls; Messaging such as SMS, WhatsApp, Facebook Messenger; social media such as Facebook and Twitter. Users incur routine costs on calls and internet data.

TMCG’s live consultations are conducted by licensed, experienced, specially trained personnel. The service is available in multiple languages. A fully equipped and staffed telehealth contact centre ensures privacy to provide the best quality consultation.

These encounters can result in remote resolution of health inquiry, laboratory sample pick-ups and assessment, prescriptions and medicine delivery and where necessary referrals to imaging and specialist care.

Live Telehealth Consultations

Accessed through voice and video calls; Messaging such as SMS, WhatsApp, Facebook Messenger; social media such as Facebook and Twitter.

TMCG has integrated Artificial intelligence into their telemedicine services to provide faster and more accurate clinical decision support to reach even more people. “Mirembe”, the name of the health chatbot carries the personality of a female personal health advisor offering triage and care advice to health symptoms within Facebook Messenger.

Mirembe answers the questions, “Do I need to see a doctor? “, “How serious might this be?”, “When and where should I go for care?”. It also covers numerous classified symptoms and disease conditions as well as the confidentiality of all users’ responses and personal information is fully guaranteed.

A human touch was added to complement “Mirembe” by providing a ‘request-call-back’ option at the end of the encounter. This is a solution to cases where a user may not be satisfied

and needs more information because they have not

understood the chatbot recommendations and also where “Mirembe” does not capture the users’ symptoms.

Chatbot Telehealth Consultations

TMCG’s 24/7 telehealth medical doctors and pharmacists will receive a notification, review your submitted information and call you back to discuss your health symptoms further and recommend laboratory investigation, referral needs and/or a treatment plan.

m.me/mirembebot

6

A creation founded in the demand from TMCG telehealth clients is the mobile laboratory sample pick up and medicine delivery service. Lab samples can be collected from wherever the telehealth client is, run at high quality laboratory facilities and have their results delivered electronically without having go to a lab. This is conducted by licensed, experienced and specially trained laboratory technologists who ensure safety, privacy and timeliness throughout the process of collection, transportation, processing and results dispatch.

Medicines are also delivered to clients at their convenience of time and location by licensed, experienced and specially trained pharmacists. This is available to both acute care patients that have an immediate need due to untimely illness as well as chronic care patients who need regular

Mobile Laboratory and Medicine Delivery

medicine refills, for example diabetes and hypertensive patients. This offers the value of reliable supply of safe, quality medicines conveniently at the time of need and closer monitoring of outcomes.

STEP 1:Call or WhatsApp our

doctor for Medical Consultation.

STEP 2:Our doctor will order

the right lab test.

STEP 3:Our professional lab technician will come

to you anywhere.

STEP 4:The Lab

Technologist will do the test.

STEP 5:Results will be promptly sent to the patient electronically

medicine delivery

7


TMCG consults for governments, non-profit organisations, academia and private healthcare organisations on research, needs analysis, conceptualization, prototyping and development of appropriate digital health solutions.

Digital Health Projects - Public health, Research & Enterprise Software platforms

Mobile health applications

Population health surveillance platforms

Electronic Medical Records (EMR)

Data Visualisation Tools

Call centre software

chatbots AI


2018 in Numbers

2.

The Medical Concierge Group achievements, reach and engagement in 2018

The Medical Concierge Group Annual Report 201810The Medical Concierge Group Annual Report 201810

Telehealth Contact Centre Reach

Call Centre Performance in 2018.

Total number of calls

17,440

Total WhatsApp consultations

24,446

Total SMS reach

1,306,642


Mirembe Chatbot

From October 2018 to December 2018,Mirembe chatbot achieved the following;

Top 5 common conditions

Total Users: 3,316

Gender:

Male

47%Female

53%

Abdominal pain

Head pain (headache)

Face Redness(or Rash)

Rednessor Rash - Localized

Back Pain Fever


TMCG has had an increasing social media presence and following from its various social media platforms due to the creation of new, better and affordable health solutions.

Social Media Engagement and Reach

FacebookTotal Reach

Twitter Total Impressions

490,40014,120,222


2018 was a year of tremendous impact across a range of special projects. We managed to accomplish their respective objectives and targets with the help of our driven partners and the dedicated project teams at The Medical Concierge Group in the care and management of HIV, TB, Malaria, Maternal, Neonatal, Child and Adolescent Health, Sexual and Reproductive Health

Special Projects

3.


Artificial Intelligence

TMCG has integrated chatbot Artificial intelligence into their telemedicine services to provide faster and more accurate clinical decision support to reach even more people working with Health Navigator, a company that provides evidence based clinical content that improves patient care.

The use of artificial intelligence (AI) and personalization in healthcare has proven to have a positive impact on healthcare for patients and providers. This has led to growing interest in technologies that integrate seamlessly into telemedicine platforms and digital health applications, like the Health Navigator clinical content and

diagnostic engine.

HELLO

Chatbot Integration

Jeffrey Schwartz, MD,President at Health Navigator.

It involves Natural Language Processing (NLP), so a chatbot is able to understand natural language typed directly into its interface. Natural Language Processing is a subfield of Artificial Intelligence that is focused on enabling computers to understand and process human languages, to get computers closer to a human-level understanding of language.


Ada is a digital application that uses Artificial Intelligence (AI) to help arrive at a diagnosis based on symptoms. It dynamically generates questions that probe a given symptom and finally suggests possible diagnoses depending on the client’s responses and provides a summary of the client’s interaction including symptoms present & absent symptoms, risk factors for the telehealth clinical officer to make a final diagnosis for the client.

TMCG integrated Ada’s web version into its telehealth workflow in November 2018 as part of a pilot program in Uganda. The aim of the pilot was to understand the feasibility of Ada supporting the health professional cadre of a clinical officer in the delivery of a quality teleconsultation resulting in a likely diagnosis and care management. Two clinical officers were dedicated to handling Ada-assisted teleconsultations through out the pilot. The pilot is still ongoing

ADA Health

Strengths

Ada lists possible causes / diagnosis at the end of the assessment to support clinical decision making.

A wholesome view of the patient.Ada requests for associated risk factors like chronic illnesses e.g. diabetes and lifestyle habits e.g. smoking.

Comprehensive symptom assessment. Ada assesses each presented symptom in detail by asking questions to rule-in and rule-out any associated factors.

Ada provides a summary at the end of the clinical assessment of the symptoms present and absent, as well as possible causes.


The HIV/AIDS and Health Initiatives in Workplaces Activity (HIWA) Project came to a close in October 2018. This was a USAID funded Project implemented by World Vision with The Medical Concierge Group (TMCG) as the Digital Health lead along with other consortium partners that included RTI International, Uganda Health Marketing Group (UHMG), The AIDS support Organization (TASO) and Eco-Trust.

The HIV/AIDS and Health Initiatives in Workplaces Activity (HIWA)

ARUAGULU

HOIMA

MASINDI

NEBBI

KASE

SE

MBALE

BUSIA

TORORO

WAKISO

MU

KO

NO

KABA

ROLE

RU

KU

NG

IRI

LIRA

MBAR

ARA MASA

KA

JINJA

KEY

Gulu - 66Hoima - 77Kabarole - 56Mbale - 99Mbarara - 78Mukono - 71Kasese - 51

Arua - 103Jinja - 114Masaka - 165

Wakiso - 277

Rest of thedistricts

Kampala - 1257

Busia - 28Lira - 27Masindi - 35Nebbi - 20Tororo - 49Rukungiri - 24

Between51 - 100 calls



Below 20 calls

Above 1000 calls


TMCG) took lead on the design, implementation, monitoring and evaluation of digital health interventions to improve health outcomes of the Uganda Police Force (UPF), private security guards (PSG), Uganda Wildlife Authority (UWA) staff and staff in selected hotels affiliated with the Uganda Hotel Owners Association (UHOA).

MAP OF UGANDA SHOWING THE NUMBER OF INCOMING CALLS HANDLED PER DISTRICT


Beneficiaries by gender

32%Female

Male68%

Highlights on HIWA (FY16 to FY18)

37,576 beneficiariesreached with mobile based behavioral change communication (BCC) messaging that covered areas of HIV prevention, medical male circumcision etc.

2,350referralswere made & followed up during the period of 2016 to 2018 Majority were on accessing HIV testing, family planning, medical male circumcision etc.

Inquiries on Contraception

89%retentionin care of supported HIV positive patients.

90% Referral & follow up completion rate.


653


In April 2018, The Medical Concierge Group as part of a consortium including AMREF, CUAMM, Another Option led by John Snow Inc was awarded a 5-year USAID funded project known as The Regional Health Integration to Enhance Services (RHITES)-North, Lango Region (RNL). The RNL project aims to attain high impact, evidence-based HIV, TB, malaria, nutrition, Maternal and Child health and WASH (Water and Sanitation) outcomes. It operates in 9 districts located in the Lango sub region of Northern Uganda. The districts covered include Lira, Dokolo, Apac, Amolatar, Oyam, Otuke, Kole, Kwania. TMCG’s role is to design, develop and deploy mobile health (mHealth) technologies to strengthen health systems and improve health outcomes. RHITES-N, Lango utilizes e-health across the

RHITES NORTH, LANGO

various project areas including HIV prevention and treatment, driving demand for various project services. This includes 24/7 access to licensed medical doctors for remote consultations and engagement through a toll

The RNL project aims to attain high impact, evidence-based HIV, TB, malaria, nutrition, Maternal and Child health and WASH outcomes. It operates in 9 districts located in the Lango sub region of Northern Uganda.

free hotline (0800107070) and a free two-way SMS platform for information dissemination and follow up via a prepaid short code 8884.


This is easing access to health services via remote consultations using a 24/7 call center service, improving adherence and supporting completion of health facility cascades among HIV positive clients among others.

Incoming calls by gender

Access to health services through remote consultations via a 24/7 call center service.

54.8% 45.2%

FemaleMale

SMS Platform

21,108A total of 21,108 beneficiaries received mobile SMS content.

Inception and work-plan meeting for the various consortium partners on the RHITES-N Lango project held at Serena Hotel Kampala in February 2018


40 5020 3010 35 4515 2550Percentage of inquiries

Percentage of users

Cat

egor

ies

of in

quiri

esA

geCategorization of incoming calls by age range

Categorization of incoming calls by reason for call

4020 3010 3515 2550

HIV/A

IDS

STI/S

TDS

MEDI

CATIO

N SA

FETY

SEXU

AL R

EPRO

DUCT

IVE

HEAL

TH

FAMI

LY PL

ANNI

NG

ACCI

DENT

S & EM

ERGE

NCIES

OTHE

RS (G

IT/RT

IS, SK

IN)

ANTE

NATA

L CAR

E

AND

PREP

VMMC

HIVS

T

PREP


0-10

21-30

41-50

11-20

31-40

51-60

Over 60


Through UNICEF and Health Enabled, The Medical Concierge Group developed a web app for interoperability between UgandaEMR, the electronic repository for HIV patient records, with FamilyConnect, a rapidpro SMS messaging service that delivers automated reminders to HIV patients to attend appointments and adhere to Antiretroviral Therapy. This is rolled out countrywide in Uganda to strengthen the attainment of the 95% UNAIDS goal among patients.

FamilyConnect and UgandaEMR

A rapidpro SMS messaging service that delivers automated reminders to HIV patients to attend appointments and adhere to Antiretroviral Therapy.

User-centre design sessions for EMTCT web portal in Mbarara


The Medical Concierge Group supported LVCT Health and PS Kenya with deploying Digital Health tools for an HIV self-testing campaign across Kenya by providing affordable HIV self-testing kits to the public through pharmacies.

HIV Self-Testing Mobile Health Project

The Medical Concierge Group supported LVCT Health and PS Kenya with deploying Digital Health tools for an HIV self-testing campaign across Kenya.

Within this project, TMCG developed a Facebook messenger chatbot, a helpline, an Interactive Voice Response (IVR) and an SMS based application. This was to reach and support the target beneficiaries with real time information, counseling and to monitor the usage as well as linkage to treatment and impact of the HIV self-testing.

TMCG suppoprted:


Achievements

Call center:Set up a call center where users could call to receive information, assistance as well as attain counselling.

SMS system:Set up an SMS system based on Rapid pro and CasePro for feature phone users to get information and assistance.

Electronic Medical records:Built a secure Electronic Medical records system (EMR) for data access, storage and analysis.

Intelligent chatbot:Set up an intelligent medical chatbot to provide automated assistance to users who have internet access and smartphones.



Research4. Research is a key component at The Medical Concierge Group, we focus in research aimed at improving healthcare provision as well as influencing policy in the digital/health sector. As such a number of research projects.


Research title:A Pilot Test of a Technology-delivered HIV Self-Testing Intervention in Kampala, Uganda

Purpose of the study:The purpose of this project is to assess the feasibility, acceptability and preliminary impact of a novel HIV self-testing (HIVST) intervention that is delivered centrally around telehealth centre support.

Technology-Assisted HIV Self Testing

Research title:Reproductive Health Empowerment throughTelehealth.

Objectives of the study:1. Through a user-centred design, develop

mobile-based reproductive health content targeted for men through SMS, interactive voice response and Facebook messenger.

2. Design and document the implementation of a pilot Men’s Telehealth Information Package (mTIP) among men aged 18-55.

3. Assess the feasibility, acceptability and preliminary impact of the Men’s Telehealth Information Package (mTIP) on uptake of reproductive health services like Contraception, STI screening and supporting their spouses during pregnancy.

Reproductive Health Empowerment through Telehealth

Partnering Organisations



Research Title:Men at Gaming Centers: Point of Care HIV and STI Testing (MeGaPOC)

Objectives of the study:1. To test the acceptability and feasibility of same

day testing of HIV and syphilis testing, test result notification, prevalence of HIV and syphilis as well as proportion linked to care among men attending at gaming/betting centers.

2. To identify the proportion of men involved in other self-reported risky behaviors such as hazardous alcohol intake, illicit drug use, men having sex with men and having multiple sexual partners.

3. To test the diagnostic performance of an HIV-syphilis point-of-care test.

Men at Gaming Centers: Point of Care HIV & STI Testing (MeGa-Poc) project


One of the MEGA-POC exhibitions in Mbale district.


The team took part in numerous conferences locally and globally which yielded tremendous growth and exposure for TMCG. Below are some of the conferences attended;

The American Telemedicine Association Chicago, USA, International AIDS Society Conference Amsterdam, Netherlands, The East African Community Regional e-Health & Telemedicine Workshop, Ministerial Conference and Trade Exhibition, Kigali, Rwanda.

Conferences & Abstracts

5.


Conferences

American Telemedicine Association Conference

Joint Annual Scientific Health Conference.


East Africa Telemedicine and eHealth Conference.

Global Digital Health Forum

Uganda Diabetes Association Scientific Conference.


Abstracts

Mobile And Telehealth: Scalable Platforms For Supporting Efforts Towards Meeting The 90-90-90 Targets In Uganda.

Sports Betting Centres And Mobile Health Engagement: How To Find, Link and Retain Men for HIV prevention Or Treatment.

Regulations And Operating Standards For E-Health Services; Lessons From The Medical Concierge Group (TMCG), Uganda.

Digital Health Platforms for Continuous Medical Education and Patient Management Among Low Cadre Workers In Uganda; A Retrospective Review Analysis

High mobile phone ownership but low internet access and use among young adults attending an urban HIV clinic in Uganda.

1

2

3

4

5



Corporate Social Responsibility

6.

TMCG participated in a number of community projects in 2018 to create awareness and improve community living.


40 40 Medical Camp

The Medical Concierge Group partnered with 40 Days Over 40 Smiles to participate in an Open Community day that was held in Kabalagala, Kikubamutwe, Kisugu and Kibuli areas which saw close to 1,000 residents benefit from this medical outreach. TMCG particularly provided free services to the people that included medical consultations, pharmacy services, hepatitis B and HIV testing and screening.

TMCG doctors during the open community day in Kabalagala (left) and Kisugu (right).

Some of the children that benefited from the open community day in Kibuli.


TMCG partnered with Cancer Communique, an organistion whose goal is to create awareness about cancer through digital media. This partnership was for breast cancer campaign entitled “Pink Friday”.

Cancer Communique

These photos were shared on digital media with the hashtag #Pink Friday with information on where to get free breast cancer screening. Coupons for the free breast cancer screening were also given to people who participated in sharing the message widely online.

TMCG partnered with Cancer Communique, an organistion whose goal is to create awareness about cancer through digital media.

In this campaign, TMCG employees wore pink outfits and took photographs in solidarity for those who suffer from breast cancer as well as create awareness and deliver telehealth support.

Some TMCG employees in pink during the“Pink Friday Campaign” for breast cancer awareness.


Team7. TMCG has a diverse and multi talented team with experience and skills in Technology, Finance and Administration, Public Health, Research, Clinical medicine, Data Science, Communications and Marketing.


Dr. Davis MusinguziManaging Director

Dr. William LubegaDirector

Ms. Fiona NuwamanyaDirector

Dr. John Mark BwanikaDirector

Dr. Hope AchiroDirector

Mr. Arron ClearyDirector

Board of Directors


The Team


Digital Health through the

integration of Artificial Intelligence

and PhysicalClinical Care


Shs Shs

Kenya OfficeYork Palace, Muthangari Gardens, LavingtonP.O. Box, 102978-00101 Jamia, Nairobi, Kenya [email protected] +254 718 380870

Nigeria Office215 Ademola Adetokunbo Crescent, Abuja, [email protected]+234 818 0790150

Uganda Office (HQ)Plot 46, Lugogo bypassMirembe Business Centre, Level 2, Wing BP.O. Box 4036, Kampala [email protected] +256 417 747000

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