Shaping UI and Cost Structure: Week 12

What a busy week!

We’ve used the preponderance of our time this week to buckle down on our UI while also implementing feedback from the army (see what I did there?) of folks who have helped us along the way. We’ve also been focused on understanding potential commercial markets for a dual use role, as well as shaping and developing a more accurate cost structure. Things are really starting to come together – stay tuned for exciting news!

As always, a huge shout out to our advisors, friends, and other folks out there who have helped us reach where we are today. We are extremely grateful for your time, energy, and advice!

Team 3

Doug Powell: Former 4BN 3SFG Surgeon; current Staff Intensivist, First Health Physicians Group
Pivot to explicitly focus on telemedicine consult is the right move.
– Importance of ensuring format of transcript resemble what receiving physicians are already used to hearing/ seeing.
– Demonstrated preference for segmenting “blood” and “fluids” on UI.

Roger Dail: Former 18D;  CEO & Founder – Ragged Edge Solutions
– Assessment of potential long-term opportunities and partnership between TUPAC and RES.
– Update on DHA’s (J-4) March 5th, 2019 SPEARPOINTS [Special Operations Command (SOCOM) Purposed Emergency Access Response (SPEAR) Point of Injury and Trauma Simulation (POINTS)] RFI and Statement of Objectives release, and TUPAC applicability.
– Invitation to observe future training lanes (International SOF and SOCOM) and test app and attend Special Operations Medical Association Scientific Assembly (SOMSA) in Charlotte (May 6-10).

Phil Cotter: 18A, 3SFG; SOFACC Graduate; Original problem sponsor
– Formal introduction to the team and TUPAC post deployment to Africa.
– UI needs a means of establishing next steps between user and physician, i.e. “contact at XXX time via XXX number.”
– Final pitch coordination and logistics.

TW (name withheld): 18A, SMU; SOFACC graduate
– Focusing on the telemedicine consult script is an easy, early win.
– UI is easy to understand, especially for those currently using PFC workflow.
– Demonstrated preferences for scrolling.

Jack Broaddus: CEO, Sunnyside Communities; broad PE/VC experience
– Successful strategies for pitching to investors.
– Importance of accurately assessing risk and understanding your capital structure.
– Telemedicine applications for aging in place services.

Richard Moon: MD; Medical Director,  Duke University School of Medicine, Hyperbaric Center
– Introduction to Duke Dive Medicine – Doctors for Divers and Duke University’s Center for Hyperbaric Medicine.
– Doctor for Divers 24 hrs telemedicine resources; early feasibility assessment of how an app like TUPAC might fit in.

Brian Dickens: MD; CEO & Founder, Missionary Telemedicine Organization
– Broad overview of organization, capabilities, and current efforts to create a telemedicine network for missionaries serving in areas like the Middle East, Africa, and South America.

HH (name withheld): Nurse Practitioner, Cigna Global Health Services
– Asked: “Would a tool for making telemedicine consults quicker have an impact on how you do your job as a coordinator for medical services to Americans traveling abroad looking to get connected with their American resources?”
– Summary of Answer: It wouldn’t make my specific job easier because I ensure that the patient simply gets hands-on care, whether it be in the country they’re in or back here in the US. However, for the teams who deal with initial telemedicine calls, then this will undoubtedly help. Having a script is a great thing to focus on.

TB (name withheld): Software Engineer, Lyft (Duke Alum)
– “This will be relatively easy to get off the ground- as I understand it, you’re creating a series (albeit long) of UI’s that simply collect data into a simplified format for sending on pre-existing networks. From a cost perspective, this is a great first move because you don’t require 1) any server space or 2) active platform management.”
– “Looking ahead, you have time to build out a baseline using just one smart developer, launch that prototype, and then have time to look at expansion to your Phase II (in-app messenger platform and web service) while your product markets itself in the military community”.

Joe Palermo: Corporate Pilot, Lowes Home Improvement
In case of in-flight emergency, Lowes currently contracts with MedAire (Part of International SOS group). Teleconsult was similar to military process where script is created verbally, to a nurse, and then consult was set up with doctor.
– There is a need for a more streamlined process that could leave the nurse out entirely and still get info to remote physician.

JK (name withheld): Sales Manger, Test I.O.
– Interview focused on testing procedures for different types of mobile applications, highlighting the process that we may want to consider of incorporating an iterative testing plan to the developer of our app. Later, when we have more capabilities and users, there are corporate solutions to outsource testing to experts (and this is what his company does).
– For us, we need to be careful of developer bias in testing. When we help them write a list of test cases, we need to make sure to not let their involvement in the development affect their testing decisions and outcomes. In fact, it might be good to have simple human testing done on initial prototyping before it hits customers to just “play around with the app” to make sure all of the functions are operational by the time it is ready to get in soldiers’ hands.

Extra Sleep, Bigger Pivots: Week 10/11


We’re back. Just like that, Spring Break has come and gone. Team 3 is returning to action with renewed vigor, suboptimal tan lines, and a new iteration of TUPAC.

Chief among our work over the last two weeks was thinning out an MVP based on feedback from our marathon day with SF operators during their Mountain Path training exercise. While medics were going through unpredictable prolonged field care exercises, we watched and reaffirmed that a primary need was time-efficiency. One untrained teammate who wasn’t a medic, for example, took nearly 15 minutes to execute a teleconference that should have taken a third of that time for two reasons: they didn’t have the right information in front of them and the support physician on the other end didn’t have their patient’s information readily available either. This is the situation our app will live in, but we also learned during Mountain Path that in order to do so, we had to be more user-friendly than it had previously been.

So, before conducting any beneficiary interviews over break, we set out to create TUPAC “V3”, the latest iteration of the telemedicine app with a central focus on building a “PACket” of information that will be compressible, comprehensive, and easy to create.

After building a new App, we ran a few key A/B tests around 1) messaging, 2) scroll capabilities, and 3) home screen layouts. The results of the latter two are not as consequential as the most former, so we’ll get right to it: We learned from multiple beneficiaries that our MVP is better off to first be deployed as a file-creator, where users can send concise scripts of patient information using a method of their choice, and not as an all-in-one app messenger like our previous versions had envisioned. This does not mean that we do not see that capability in the future, but along our theme of “thinning out” and gaining adoptability, we have decided to focus the experience around creating files that will be easily sendable through already mature communication habits like email.

We look forward to sharing more of our findings and work during the presentation, but also stay tuned for a new team name out of this group on the horizon – its time to make a business!

– Team 3

Roger Dail: Former 18D;  CEO & Founder – Ragged Edge Solutions
Determine a metric that demonstrates time saving between using TUPAC and “hand jamming” the information.
– “The enemy of good is perfect; anything better than what the guys use now is a win.”
– Ensure the PACket, once delivered to a physician, looks like telemedicine script they are used to using/ seeing.

Drew Hinnant: 18A; S3A, 3SFG
– Mountain Path AAR.
– Coordination for potential TUPAC demonstration for command-level leadership.
– Standardize “Medications” such that options reflect current issued drug and dosages.
– Scroll capability is nice; user preferences dictate; Build in flexibility for user.

RC (name withheld): 18D
– Add an ability to share profiles in the setting menu.
– Current debate on colloids and potential for the future; importance of ensuring app is up-to-date with current best practices in medicine.
– In Part 1 of app, merge fluids and bloods together; most medics consider them one and of the same.

Alex Wilson: Former 18D; current Fuqua student
– Importance of reflecting accurate resources available.
– Preferences for scrolling over page view.

Russell Dallas: 18D
– Relevant and up-to-date information on resources slide.
– Indicated preference for sliders and scrolling.
– Supported using other native apps (WhatsApp, Signal, etc.) as a means for sending PACket; in-app messenger not a necessity.

Sean Keenan: Former SF Battalion, Group, and Theater Surgeon;  pre-hospital care SME
– Importance of differentiating between “rank” and “position.”
– Importance of accurately recording certain vitals (i.e. blood pressure); get rid of sliders, or if kept, ensure they have a high level of sensitivity.
– Use the industry standard ADVISOR transcript as the framework for app, not the PFC workflow sheet; importance of ensuring the output mirrors what the ADVISOR docs are used to seeing.

Rich Salve: Former 18D; RN, DUHS;  Ragged Edge Solutions cadre
– PACket compression options.
– For patient history section, use S.A.M.P.L.E. format (industry standard).
– Drop-down option for medications would be easier and more efficient.

CM (name withheld): 18D
– Indicated preference for scrolling.
– Very receptive to using other native apps (WhatsApp, Signal, Wicker) to send PACket over.
– Z-out option is nice to have, not a necessity.

Beck Mitchell: TangoTango
– Discussion of PTToC options integrated w/ existing communication networks;
– Expansion of 5G LTE and high-level assessment of where TUPAC fits in.
– Potential resource for future development.

Mark Schultz: Orion Labs
– AI integration with existing PTToC, and use of bots to automate workflows like TUPAC.
– potential resource for future development.


Deployment: Week 9

This week, we got to experience the SF telemedicine use case first hand – by observing a live training exercise taking place across North Carolina known as “Mountain Path”.

Huddled in a dark wing of a fifth floor office renovation in Raleigh, we exchanged discussion points and collected key insight that will be shaping the next phase of our product development.

Of the major takeaways from this week, this “out-of-the-office” experience allowed us to realize, and then discuss, a point of iteration for our mobile telemedicine platform. In brief, we need to get deeper into the actual telemedicine needs and shift our focus around providing an all-out clinical care app. This epiphany is not yet considered a “pivot”, as our base ideas are still intact. However, we are walking away from this week of customer discovery with a sharpened problem scope and new design considerations for smoother SF telemedicine in remote conditions.

Below, we share some key takeaways from the people we met:

Interviews conducted at 3SFG “Mountain Path” Exercise:

Ryan Maves: SOCOM instructor; Associate Professor USUHS
– Telemedicine best deployed after team has stabilized the patient, after 2nd survey.
– Sometimes it is best for physician to follow patient’s vitals to stay ahead of the complications even when the team hasn’t called the physician.
– Small complications in routine procedures can complicate the treatment, and having a physician to guide the team through would be great.

Doug Powell: Former 4BN 3SFG Surgeon; current Staff Intensivist, First Health Physicians Group
– App ideally can be downloaded in the US that can then be uploaded onto a burner phone bought locally.
– Need a way for physician to monitor each action that the team has performed.
– Simplicity and usability is key.

Jeremy Pamplin: Deputy Director, U.S. Army’s Telemedicine and Advanced Technology Research Center
BATDOK will inevitably be successful; all other (working solutions) are a waste of time and resources.
– Focused on the “big Army,” enterprise level development, adoption, and integration of technologies.

William Vasios: Former command physician assistant, Special Operations Command – Africa
– Discussed his role in advancing the field of pre-hospital care/ critical care research.
– Discussed trends he has seen in previous PFC exercises, and areas of the exercise where our team might derive the most value.

Roger Dail: Former 18D;  CEO & Founder – Ragged Edge Solutions
Teams usually have the phone attached to their chest in landscape that they can then flip down to type and read.
– Current methods of paper and pen are inefficient because paper gets torn, ink gets washed off.
– BATDOK works great when used by the techs demonstrating its usability, but few people can use it after they leave.

Rich Salve: Former 18D; RN, DUHS;  Ragged Edge Solutions cadre
-BATDOK is improving usability and can select different capabilities in settings to limit the amount of phone capacity needed for usage.
– Very few deltas receive the training that we observed at Mountain Path
– Fewer use it as a refresher course.

DW (name withheld): Former 18D; Ragged Edge Solutions cadre
– Batdok usually fails after a few clicks and often freeze when all options are selected in settings, especially voice recording and voice recognition
– It is necessary to remember the specific steps needed to get to a specific function.
– Ideal would be to have redundancy in the buttons so that there are more than one intuitive paths to reach the same function.

PL (name withheld): 18D; SOMA PFC Working Group member
– History behind the drive to standardize PFC training, protocols, and resources (ADVISOR Line).

CK (name witheld): 4-3SFG Signals Detachment
– Any solution must meet minimum requirements that ultimately protect a units digital/ electronic signature.

Brad Hayes: Founder & CEO, Aerial Inspection & Mapping Images, LLC
– Provided insight into current efforts to leverage drone technologies during PFC scenarios; talked through strategies his company has taken to overcome the limited communication environment.

David VanWyck: 4BN 3SFG Surgeon; “Mountain Path” OIC
– Need to have a Batdok-like app that works
– Physicians provide advise at around hour 4-5 after injury
– Batdok wanted to test out usability with the deployments, but haven’t been as responsive

JW (name withheld): 18D; “Mountain Path” NCOIC
– Provided candid discussion on why SOCOM and Army Special Forces has stumbled when working to adopt different technological solutions.

Stacey Shackelford: Director, Joint Trauma System (Defense Health Agency)
– Discussed JTS’s role in navigating Title 10 and establishing joint requirements for medical training.
– Discussed JTS’s current efforts to standardize PFC scenario training across the different services.

Sean Kennan: Former SF Battalion, Group, and Theater Surgeon;  pre-hospital care SME
– What do these guys (medics) really need? Focus development on that; teams need an easy way to digitize the tele consult transcript.
– Don’t try and replicate BATDOK

“Kat”(name withheld): PA; 4-3SFG “Mountain Path” team leader
– Provided insight into operational considerations, clinical decisions, and personal feelings around her teams first tele consult experience.

JW (name withheld): 18X, 4-3SFG “Mountain Path” assistant team leader
– Provided insight into operational considerations and personal feelings around his teams first PFC exercise/ teleconsult experience.

NP (name withheld): 18X, 4-3SFG “Mountain Path” team leader
– Provided opportunity to observe and listen to actual tele consult between his team and ADVISOR line.

Other Interviews:

Michael Jelen: Director, Berkley Research Group; experience in software consulting
– Reviewed team progress on system architecture plan, advising new efficiency plan for communicating system needs during our final pitch

Matt McGuire: Software Architect & Developer, Protectwise, Inc.
Provided technical advice on different ways of building a back-end system for TUPAC, and some of the current commercial solutions available in the market.

Drew Hinnant: 18A; S3A, 3SFG
– Reviewed high-level plan for remainder of semester, including Mountain Path exercise and how we could grow from it.
– His outsider perspective of the event, but insider knowledge of how training exercises occur was a major part of our preparation plan.
– Discussed next steps for reconnecting with 18E’s as we build our system requirements document.