draft

1.
G3
System Technologies
(G3ST)
Eddie Tapper
PO Box 7070
Kansas City, MO 64113 816200-6557
etapper@kcdesignbuild.com

2. Table of Contents
Executive Summary ...................................................................... 1-3
Business Description and Vision ..................................................... 4
Description of the Products and Services ................................... 4-5
Definition of Market and Analysis .....................................................5
Organization and Management ........................................................ 6
Marketing and Sales Strategy .......................................................... 6
Additional Benefits ........................................................................... 6
G3ST Solutions ............................................................................. 7-9

3. Executive Summary
Phase 1 Phase 2 Phase 3 -
G3 Electronic Triage
G3 Information Validation
G3 Offsite Technologies
This business plan will briefly outline the development of a system that will assist in
saving lives, provide better healthcare and insure that our environments are as safe as
possible.
Information is essential to insuring the positive outcome of individuals experiencing a
medical emergency. Unfortunately many of the healthcare providers have no way of
knowing how an injury may have occurred or what the conditions were at the time of
injury. Gathering the right information at the right time is not currently possible but may
be possible in the near future using G3 technologies.
Example:
A car accident occurs involving 4 cars and 10 individuals, all with injuries. Ambulances
arrive at the scene but the paramedics cannot treat all the injured at once so standard
triage of patients occurs with all attempts made to care for the most injured first. The
patients are transported to area hospitals where they are healed to the best of the
doctor’s and nurses’ ability and then the patients are sent home to finish healing.
A Better Example:
A car accident occurs involving 4 cars and 10 individuals, all with injuries. Ambulances
arrive at the scene but the paramedics cannot treat all the injured at once so standard
triage of patients occurs with all attempts made to care for the most injured first.
PHASE 1 – G3 ELECTRONIC TRIAGE
The ambulance driver “deputizes” four passersby who have been trained in the G3
systems which could be taught with CPR courses. The passersby obtain a G3
package from inside of the ambulance. These would contain a touch pad, ear piece
and wired / wireless connectors which will monitor the vitals and status of each of the
patients from an offsite location.
The touch pads are wirelessly connected to either receivers located throughout the G3
wired community or to the ambulance which then transmits the information via satellite
or wireless connection.
Since the connection to the offsite doctors/nurses can be two-way communication, the
nurses may ask the injured person questions regarding who they are, how they are
feeling, what their medical history is and who they should contact to inform of the
accident. The one-on-one connection can also be calming and reassuring to an injured
person. After connecting the injured to the touch pad the deputized passerby will also
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4. raise and rotate the touch pad 360 degrees to fully video the current status of the
accident scene and provide offsite medical personnel with critical facts related to the
injuries. If directed by offsite personnel the passerby can also take specific images of
the injuries or other relevant information and provide stabilizing and shock reducing
care.
Offsite personnel will have the ability to hear, see and monitor the patient and accident
scene. They can also communicate directly to the paramedics to assist in the triage of
the injured and inform the paramedic if an patient has a change in condition. If
required, additional doctors, surgeons or specialists may be electronically tied into the
accident scene from anywhere in the world to give assistance in determining care. In
addition to the medical personnel having two way contact, family members may be tied
in to the conversation to assist in providing background medical histories and translating
if required. Hearing a loved one’s voice may also be calming. The connection to the
injured also assists in directing the relative to the appropriate hospital and if other
situations must be managed for instance picking up children from school.
PHASE 2 – G3 INFORMATION VALIDATION
Information from all touchpads as well as a 360 degree videos from the ambulance are
downloaded and available to assist in determining the cause of the accident. This
information may be shared with a wide variety of entities.
Roadway designers may view the information to determine if a section of road is
inherently dangerous and should be redesigned to be safer. Accidents nationwide
could be analyzed to determine the safest possible way to design roadways. Car
designers may view the data to better understand how vehicles react to impact and how
the forces of the impact are inflicted on the passengers inside the cars. Safer cars can
designs can result.
Healthcare providers can review the information to gather better data on how the
injuries occurred and what the best course of action may be. Doctors currently do not
know how accidents occurred and how the trauma was inflicted especially if the injured
are unconscious or if the sheer number of injuries cloud the paramedics dissemination
of information to hospital staff.
The touchpad may continue to be assigned to the patient while they are in the hospital
all the while recording every minute of care (electronic, video and audio), who did what,
what medications were given and when as well as the constant monitoring of vitals.
This information is continuously relayed to a central storage facility where it can be
monitored and reviewed. On-call doctors and specialists may access the stored
information and real time information to better ascertain actual condition of the patient
and immediately direct on-site personnel.
Insurance companies could also access information to determine fault.
The combination of multiple cameras should allow for a virtual accident scene which
can be viewed in real time or at a later date.
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5. PHASE 3 – G3 OFFSITE TECHNOLOGIES
The touchpads can then be assigned to healing individuals when they leave the hospital
so current health status and information can be transmitted back to the central storage
unit where it is monitored every second of every day. Recording and transmission of
electronic, video and audio information can be triggered by a change in condition or
other event. Offsite personnel can connect with individuals to find out if they are ok or
are having a health emergency. Monitoring of all vitals, confirmation of the taking of
medication and recommended care and immediate assistance in case of emergency all
will contribute the fastest recovery possible.
G3 locations can also be set up throughout the city to allow individuals to connect to
medical or emergency personnel. The individual’s medical history may be viewed in
conjunction to current condition and the patient’s primary medical caregiver may be
electronically informed and tied in.
This concept can be expanded to monitor injured individuals after either man-made or
natural disasters. Medical assistance and expertise from all over the world may be
focused and directed to assist in major disasters or events relieving immediate
healthcare providers from becoming overwhelmed. If individuals are already tied into
G3 systems then locating them and communicating with them can be possible, ie under
a building or other inaccessible location.
In wartime soldiers may be equipped
with G3 systems to assist in the coordination of efforts, saving lives and the ability to
learn from the analysis G3 information detailing successes and errors.
G3ST provides information in real time or for review at a later date that will save lives
and promote safer environments. Offsite medical personnel will instantly be able to
virtually tour an accident site, ascertain the most critically injured, direct onsite medical
personnel, monitor the vitals of the injured in real time and most importantly have the
ability to understand what happened, how it happened and when it happened. All of
these will contribute to making the best decisions in treating the injured and promoting
the fastest and most complete recovery.
Kansas City Missouri and Kansas are in a historically unique position to develop and
implement G3ST, a revolutionary system of delivering medical care due to the following:
1.
G3 Fiber Network
2.
Advanced Hospitals and Research Facilities
3.
Preeminent Medical Staff
4.
Integrated Ambulance and First Responder Network
5.
Market Leading Medical Software, GPS and Communications Companies
6.
Strong Entrepreneurial Support System and Spirit
7.
Educated and Highly Productive Workforce
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6. Business Description and Vision
G3ST’s vision is to evolve and grow into an entity that can serve the entire Kansas City
Metropolitan Area quickly and expand to other G3 markets as soon as they become
available. This escalation would be a challenge for any new company with limited
resources. The formation of a health services public private partnership (PPP) may be
the best option to leverage the purchasing power, funding sources and oversight of a
government agency with the innovation and cost control of private companies.
Although initially started as a private entity G3ST may transform into a PPP which
would be owned by a public / private partnership including the Cities of Kansas City,
Missouri and Kansas City, Kansas along with the private sector health, technology,
software and manufacturing companies who have a vested interest in working together
to provide core competencies in operations, technology, funding and technical
expertise.
Health service PPPs have increasing been relied upon by many communities as a
viable alternative in developing new healthcare infrastructure. As detailed in Build and
Beyond: The (r)evolution of Healthcare PPPs published by Health Research Institute
“PPPs can evolve to bend the cost curve. Across the globe, these partnerships are
being crafted to make government and private industry more accountable for
maintaining each nation’s most precious national resource: the health of its citizens”.
Description of the Products and Services
Tablet / smart phone hardware
G3ST software will run on multiple tablet and smart phone platforms including G3
Tablets and Apple iPads. Emergency personnel tablets will meet the FDA Quality
Systems (QA) Regulation / Medical Device Good Manufacturing Practices (CGMP
Practices) to reduce the potential for pathogen transmission and reduce the potential for
human use error through clear input/output guidelines. Human Factor Engineering will
be implemented in both G3ST hardware and software. Wireless monitoring devices and
A/V connections may be single use.
Network Software
The network and standalone software for G3ST will include upload and download
encryption and will additionally meet all current HIPPA security requirements.
A “light” version of G3ST is planned for consumer download which will allow consumers
to upload medical histories, monitor vitals through connected/wireless devices and
transfer information to and from medical providers. Emergency personnel will have the
ability to upload G3ST Light essential data from the consumer’s device
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7. Data Repository
G3ST is currently reviewing available data repository options and the requirement for
dispersing medical data across regional lines. If possible local data repositories on the
Kansas City G3 High Speed Fiber Network will be utilized and / or developed.
Cloud computing through systems similar to G3 Health, The Direct Project and
Microsoft Healthvault are also under consideration.
Data Subscriptions
Encrypted data management, dissemination and privacy controls will follow all
applicable local, state, federal and international rules and regulations. Data subscription
access will be tiered controlling what information is available to whom and for what
purpose.
Examples of available data requests may include:
 First responders training may include actual virtual accident scenes
 A drug company would like to know how patients respond to their drug.
 An insurance company would like to better understand what happened to cause
an accident
 Traffic designers would like to understand why a specific intersection has so
many accidents
 A university would like information to determine how specific events
 Automotive companies may want to know how their car responds to impacts in
certain weather conditions
Definition of the Market and Market Analysis
The American Hospital Associations listing of 5,795 registered hospitals includes
944,277 staffed beds admitting 37,479,709 patients who had received over
$726,671,229,000 of care in 2009. This market represents a significant portion and
focus of the G3ST Market. This however does not however include the 48,384
ambulance vehicles manned by 840,669 EMS personnel working for 15,276 ambulance
services or the approximately 800,000 police officers who currently serve communities
throughout the US and would also benefit from G3ST services.
Beyond the current medical and first responder fields a new supporting industry is
potentially available. This industry will not only provide additional jobs for the hardware
manufacturing and sales, software development, sales and logistical support but also a
new virtual G3 based emergency medical network of the best doctors, nurses,
specialists, tacticians and first responder support systems. Patients will literally receive
the best health care the world can offer at a significantly reduced cost.
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8. Organization and Management
G3ST is in a research and development stage. The ownership and management of
G3ST will be primarily divided among the communities and businesses that assist in its
development and implementation who will also share in the financial benefits of the
venture. Initially businesses and organization wishing to participate would be
encouraged to locate offices in Kansas City and by doing so creating job opportunities
in Missouri and Kansas.
It is the intention of G3ST that those organizations that assist in the development and
testing of the systems will receive long term benefit. For example if the Kansas City
MAST ambulance service is instrumental in the development of G3 (G3 Emergency
Triage) then MAST would receive residual income if the system was implemented in
Taipei.
Marketing and Sales Strategy
Given the collaborative infrastructure consisting of both public and private institutions
that must be created in order to develop G3ST, the enlistment of a public
relations/marketing firm with broad experience in the health care and information
technology sectors, is essential for success in bringing together the experts, key service
providers and other stakeholders necessary to move the project forward. This firm
would be tasked with branding, creation of presentation materials, market research and
focus groups, and convening of the local leadership in all relevant sectors required for
development and implementation of G3ST. They would also be responsible for the
public messaging and media relations throughout the development process. At the
point of implementation, the firm would then guide a marketing consortium comprised of
all participating institutions so as to leverage the consumer marketing expertise of the
local healthcare providers at the point G3ST begins to serve the public.
Additional Benefits
G3ST data and resources will lead to an unprecedented amount of medical information
that could benefit researchers for years to come and spin off educational, business and
social service opportunities we cannot even comprehend today.
G3ST could become a stepping stone in the development of a health care delivery
system that is primarily owned by the general public and incentivizes the best and
brightest businesses to continue to develop the highest quality service at the most
economical rate.
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9. G3ST Solutions
The success of G3ST is dependent on the ability of the system to solve current
problems, increase the level of health care and reduce the cost to provide that care.
Our research has identified specific industry problems which have been documented in
peer reviewed publications. Here is a brief synopsis of a few of those problems and
how we are positioned to solve them.
1.
Overcoming Pre-hospital Communication Errors
“Problems with communications are a frequent source of disaster scene and triage errors in
small MCIs. In a study of pre-hospital triage and EMS communication performance, prospective
data from resource physicians and retrospective data from tape recorded pre-hospital
conversations were collected for 45 consecutive MCIs over a 9-month period.1 Most of the
MCIs were motor vehicle accidents and most patients were treated at a level 1 trauma center.
Frequent errors included having multiple communicators on site (38%), misidentifying the
number of victims (56%), and having unclear information for the resource physician (43%). Only
38% of events had pre-hospital triage information that was deemed entirely appropriate.”
Communication: The Indispensable Part of Emergency Medical Services
The Norman Wood Bridge Incident: A Turning Point
Michael J. Reinhart, D.O., F.A.C.E.P. Sr. V.P. & C.F.O., Lancaster Emergency Associates
Ronald D. Baier, E.M.T.-P EMS/Communications Center Manager, Lancaster General Hospital
G3ST allows direct communication between patients and the treating nurses and
physicians. Emergency personnel will be able to see, speak to, monitor and evaluate
patients anywhere from anywhere. If questions occur after the accident or if additional
training is necessary the emergency scene may be replayed virtually.
2.
Overcoming Emergency Room Communication Errors
“This study observed the communication patterns of 20 staff members in the pediatric and adult
ED areas of a regional hospital trauma center over the course of 39 hours (including day and
evening shifts). Most communication was face-to-face, short (less than 1 minute to 3 minutes),
and frequent (an average of 49 communication events per hour). However, the frequency,
duration, and mode of communication differed among ED providers. For example, paramedics
and triage nurses didn't communicate often with ED attending doctors. This suggests that the
attending doctors received most patient handoff information secondhand.”
"Emergency department communication links and patterns." Annals of Emergency Medicine
Fairbanks, R.J., Bisantz, A.M., and Sunm, M. (2007, October).
“Conclusion: Academic EDs present unique challenges to effective communication. In
our study, the physician patient encounter was brief and lacking in important health
information. Provision of patient centered care in academic EDs will require more
provider education and significant system support.”
Resuscitating the Physician-Patient Relationship:
Emergency Department Communications in an Academic Medical Center
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10. G3ST allows doctors and specialists to quickly review all the patient’s information
directly through still photos, videos and audio, date stamped and indexed. All
medications and the provider of those medications would be time/date scanned into the
system with notifications of possible drug interactions and dose level, frequency or
allergy checking. A low frequency reader (RFID 125kHz) within the G3ST hardware will
monitor the medical employee badges to identify who assisted in the care of the patient
and the standard patient monitoring devices can be coupled with EKG Units, Glucose
Analyzers, Blood Analyzers, Infusion Pumps, Ventilators or any other monitoring
devices to allow a overlay of patient response to medication or assistance.
3.
Overcoming Patient Transfer Communication Errors
“During an episode of disease or period of care, a patient can potentially be treated by a number
of health-care practitioners and specialists in multiple settings, including primary care,
specialized outpatient care, emergency care, surgical care, intensive care, and rehabilitation.
Additionally, patients will often move between areas of diagnosis, treatment, and care on a
regular basis and may encounter three shifts of staff each day—introducing a safety risk to the
patient at each interval. The hand-over (or hand-off) communication between units and between
and amongst care teams might not include all the essential information, or information may be
misunderstood. These gaps in communication can cause serious breakdowns in the continuity
of care, inappropriate treatment, and potential harm to the patient. Breakdown in
communication was the leading root cause of sentinel events reported to the Joint Commission
in the United States of America between 1995 and 2006 (1) and one USA malpractice insurance
agency’s single most common root cause factor leading to claims resulting from patient transfer
(2). Of the 25 000 to 30 000 preventable adverse events that led to permanent disability in
Australia, 11% were due to communication issues, in contrast to 6% due to inadequate skill
levels of practitioners (3). Hand-over communication relates to the process of passing patientspecific information from one caregiver to another, from one team of caregivers to the next, or
from caregivers to the patient and family for the purpose of ensuring patient care continuity and
safety (4). Hand-over communication also relates to the transfer of information from one type of
health-care organization to another, or from the health-care organization to the patient’s home.
Information shared usually consists of the patient’s current condition, recent changes in
condition, ongoing treatment and possible changes or complications that might occur. Patient
care hand-overs occur in many settings across the continuum of care, including admission from
primary care, physician sign-out to a covering physician, nursing change-of-shift reporting,
nursing report on patient transfer between units or facilities, anaesthesiology reports to postanaesthesia recovery room staff, emergency department communication with staff at a receiving
facility during a patient’s transfer, and discharge of the patient back home or to another facility.”
World Health Organization
Patient Safety Solutions
volume 1, solution 3 | May 2007
G3ST will be the patient’s healthcare navigator, advocate and early warning system. If
appropriate the patient may review educational videos or documents that will assist the
patient in understanding what is needed, why and what the potential risks are.
Schedules for medications, procedures and patient involvement will alert the patient
when specific medications must be taken and if exercise is needed keep track thru GPS
of distances walked. If the patient’s vital signs extend beyond set limits they are
informed and the medical staff is notified of where the patient is and what assistance
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11. may be needed. G3ST may also open up direct audio and video communication
between the patient and the care giver.
Physicians may access individual patient’s history and have a clear understanding of
the patient’s current and historical status even before physically meeting the patient.
Since vitals are monitored before, during and after every drug or procedure occurs the
physician may gain significant knowledge on the best course of action. The Physician’s
G3ST portal will deliver emergency notifications, full records, prognosis and scans both
offsite and onsite. On call doctors will have unprecedented information to draw upon to
make informed recommendations and directives.
4.
Overcoming Discharge Communication Errors
“Being discharged from the hospital can be dangerous. A classic study found that nearly 20% of
patients experience adverse events within 3 weeks of discharge, nearly three-quarters of which
could have been prevented or ameliorated. … Systematic problems in care transitions are at
the root of most adverse events that arise after discharge. Discontinuity between inpatient and
outpatient providers is common, and studies have shown that traditional communication
systems (such as the dictated discharge summary) generally fail to reach outpatient providers in
a timely fashion and often lack essential information. Patients frequently receive new
medications or have medications changed during hospitalizations. Lack of medication
reconciliation results in the potential for inadvertent medication discrepancies and adverse drug
events—particularly for patients with low health literacy, or those prescribed high-risk
medications or complex medication regimens.”
Adverse Events after Hospital Discharge
Agency for Healthcare Research
US Department of Health & Human Services
If appropriate G3ST may monitor patients condition, medications and directives
informing both the patient and medical personnel of a change in condition or missed
medication. Patient information will be delivered in whatever language or ability level
required insuring complete understanding and participation.
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