Better health care awaits
Healthcare around the world awaits a great disruption. Doctors are in short supply and burnt out, insurance is broken and refuses payouts, drugs are too expensive to develop ($2.6 billion per drug) and cost more than anyone pays, and finally, the breaking point I read last month: out-of-pocket care cheaper than insurance.
A patient was charged less without insurance, paying fully out of their own pocket, than with insurance. This means insurance negotiation is so completely broken that it costs more for a patient to use their health insurance to cover a healthcare bill, than without insurance at all. This case was in the US but other nations aren’t far behind. US is just ahead of the curve in broken health insurance.
Enough whining. I was whining almost 2 years ago when I was first exposed to broken healthcare in the US. I said I’m inserting companies into every facet of healthcare to disrupt it fully. A new vision of health care. This vision is slightly clearer 2 years later.
This vision begins with a question: what can a computer do for a doctor?
A computer can show a patient’s complete medical history. This is basic and solved by many EHR systems. There is a user experience (UX) lag because it’s not simple to view a patient’s medical history, but the core problem is solved in developed countries. It is unsolved in India so ONITO helps healthcare professionals easily access complete medical histories on web, mobile and tablet.
A computer can run diagnostic tests. Component machines run lab tests and a computer collates data from them into lab diagnostic reports. Expensive specialized equipment runs tests. Theranos tried building a lab-at-home but failed spectacularly, and now no one wants to touch lab-at-home. A computer, with the addition of sensors, can run specific diagnostic tests at home. Examples are glucometers, BP monitors, oxygen level sensors and weight machines.
ONITO is developing PPBag, a urine collection bag for at-home urine tests including urine routine, urine culture and urodynamic study. Patients with a urinary catheter frequently need these tests, so PPBag does these tests at home with automation collecting real-time lab-grade data.
A computer can analyze large datasets to find correlations. Doctors acquire the ability of recognizing correlations across symptoms with medical training and patient experience. A computer cannot understand medicine because it has no real-world experience with patients. Doctors see, hear and touch patients to understand what’s wrong. Doctors then read reports and pattern-match in their brains to diagnose patients. Computers cannot do this yet, though rudimentary implementations of pattern-matching exists in medical machine learning (disease prediction) using pattern-matching in static medical datasets. ONITO is building a repository of patient data, updated in real-time, to teach computers medicine. The maximum data possibly acquired of patients is acquired by ONITO.
A computer can book you a nurse visit at home. As populations age, nurse demand increases. Today, nurses are called from agencies. ONITO is developing “get a nurse in 15 minutes” on its mobile application so elder patients hire nurses without hassle. Training nurses is much faster than training doctors, and nurses do medical procedures like catheterization and sample collection. Home care is poised to grow so ONITO is expanding its footprint in home care delivery.
A computer can control the manufacture of therapeutic drugs. Large bioreactors producing medicine today are controlled by computers analyzing them in real-time and executing control over them. This control layer optimizes conditions for bioreactors to produce medicine. Medicines are made by cells in the case of biologics, and by specific chemical reactions in the case of small molecules.
A computer can design drugs. AlphaFold and ESM-3 protein structure modeling software are used to design biologic drugs to target proteins to switch them off, capture them or join them with other proteins. Molecular simulation software like Schrödinger are used to simulate protein interactions with drugs or other proteins. Other emerging software study properties of cells in the presence of drugs, like RNA sequences, cell physiology with spatial imaging, and DNA sequences. All these tools provide data relevant to therapeutic design. These data fall into 2 categories: drug modeling and cell modeling. Drug modeling simulates the drug itself to visualize how it can be designed. Cell modeling models cellular behavior in the presence of drugs. Both techniques inform drug development, primarily in the drug design phase. It is important to note that both these techniques suffer data loss. Simulation software is not perfect so certain drug categories cannot be designed well. Acquiring cellular data is a lossy error-prone process.
ASBL combines drug design and manufacture in one machine by ASBL (Automated Synthetic Biology Labs). Lab automation executes biological protocols with program commands. Repeatable biological tasks, like PCR or sequencing preparation, are done with lab automation today. Program a lab automation machine once and it will execute the same protocol again and again, used for experiments and protocols repeated in a biological laboratory like DNA or RNA sequencing. ASBL machines simplify programming lab automation machines into a code based language called ASBL Machine Protocol. Users chain instructions in Machine Protocol using a keyboard and ASBL terminal screen. Chaining these instructions designs new biological experiments, executed on ASBL machines. An ASBL is a closed-loop machine to design, execute and analyze experiments. Some experiments create biological matter like bioengineered cells. ASBL machines can manufacture new biological matter repeatably. Drugs can thus be designed and manufactured on an ASBL.
Health care experience I am targeting is: as much as a computer can do for a patient is done with ONITO, from diagnosis to treatment planning to therapeutic design. ASBL plugs into ONITO and takes designed therapies to manufacture them. Today, many humans exist between diagnosis and therapeutic delivery. Hence, ASBL and ONITO are designed to work with doctors and scientists, providing a simple user interface to analyze, diagnose, and treat patients.
Noorul Ali
founder, ONITO
founder, ASBL