Better health care awaits
Healthcare around the world awaits a great disruption. Doctors are in constant 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 is paying, and finally, the breaking point I read last month, out-of-pocket care is 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 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 UX lag because it’s not simple to view a patient’s medical history, but the core problem can be considered solved in developed countries. It is unsolved in India so my company ONITO helps healthcare professionals easily access complete medical histories on web, mobile and tablet.
A computer can run diagnostic tests. Component machines run the actual tests but a computer collates data from them into lab diagnostic reports. Labs have specialized equipment to run specific tests. Equipment are expensive. Theranos tried building a lab to keep at home but failed spectacularly, and now no one wants to touch the steaming pile of s*** called lab-at-home. A computer, with the addition of sensors, can run specific diagnostic tests at home. Glucometers, BP monitors, oxygen level sensors and weighing machines fall into this category.
ONITO is developing PPBag, a urine collection bag for at-home urine tests like urine routine, urine culture and urodynamic study. Patients with a urinary catheter frequently need these tests, so a device running these tests at home to provide real-time data seems useful.
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 perform pattern-matching in their brains to diagnose patients. Computers cannot do this yet, though rudimentary implementations of this pattern-matching exists with static medical datasets used for machine learning. ONITO is building a repository of patient data repository, updated in real-time, to teach computers medicine. The most data that can be acquired for patients are acquired by ONITO.
A computer can book you a nurse visit at home. As populations age, nurse demand increases. Today, nurses must be called from agencies. ONITO is developing “get a nurse in 15 minutes” on its mobile application so elder patients can hire nurses without hassle. Nurse training is much faster than doctors, and nurses can 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. The best large bioreactors producing medicine today are controlled by computers analyzing them in real-time and executing control over them. They optimize 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 these techniques provide data to inform drug development, primarily in the 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, an Automated Synthetic Biology Lab. Lab automation is used to execute biological experiments with electronic commands. This has been used to conduct repeatable biological tasks, like PCR or sequencing preparation. Program a lab automation machine once and it will execute the same task again and again. It is used to tasks that are done many many times 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 allows scientists to craft new biological experiments that are executed on the ASBL machine. An ASBL is a closed-loop machine to design, execute, and analyze experiments. Some experiments require creation of biological matter such as new types of 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