If a national health system paying for care for all Americans were enacted today, existing resources would be unable provide the necessary care.

Altering the medical payment structure alone, often the central component of many reform proposals, will not result in affordable, accessible and safe care. President Barack Obamas health plan calls for the adoption of state-of-the-art health information technology systems to ensure patients receive the best possible acute care, prevention and chronic disease management. Lifecom has developed the technology which has proven to be the center of this state-of-the-art reform technology.

In keeping with those goals, implementation of the Lifecom technology can satisfy those goals and also provide the infrastructure and care delivery model needed to support a sustainable universal access system serving the needs of all under-served Americans.

Lifecom's advanced software system forms the backbone of an evidence-based care delivery model that can provide affordable, accessible and safe care. This patented software, developed by Lifecom, Inc. provides the only scalable technology that is capable of bringing knowledge, quality assurance and safety to medical practitioners at all skill levels.

The combination of a non-MD clinician and the Lifecom analytical software forms the enhanced team described in this proposal.



Rationale for the Enhanced Team Concept
The diagrams below illustrate the clinical and economic rationale for the use of an enhanced medical team. Figure 2 shows the typical normal distribution of case complexity seen in primary care. Easily diagnosed conditions are to the left (area 1) while near impossible diagnoses appear at the right (area 3). On average, the MD will be able to diagnose or manage a larger percentage of total cases than a non MD (area 2). Area 3 represents conditions that are problematic even for the MD's - an often neglected reality.



In the current model most conditions, even those patients amenable to management by non-MD's, are handled by a physician. This is clearly not the most efficient use of the MD. Safety concerns often preclude the use of non-MD's in less supervised circumstances. Or they limit use to only physician assistants (PA's) or nurse practitioners (NP's) whose training more closely matches the MD's. This is because MD's can be expected to identify a greater percentage of clinical outliers (areas 2 and 3 in fig. 2) than non-MD's. Clinical outliers are those conditions that either mimic more common ones, are variant presentations of worrisome conditions, or which require greater skill to differentiate from benign conditions. This remains the primary technical limit to the use of medical teams in primary care.




Subsets of conditions not requiring a physician skill level to safely diagnose or manage create an opportunity to improve efficiency and access while reducing costs with existing clinical manpower.

Safe handling of outliers is the problem. Instead of spending large sums of money to train a huge number of clinicians in advanced diagnostics, the Lifecom solution would use a fraction of that cost to create a single software system usable by all levels of clinicians. This system allows the non-MD clinician to operate at a level comparable to (or better than) a level that could be achieved through individual training.

It is the Lifecom software which enhances the non-MD clinician's ability to identify and manage outliers. Additionally, this software will eliminate deleterious variability's in performance by holding users to an elevated best practices standard both in delivery of care and documentation.

Figure 3, above, illustrates the potential impact of a care team equipped with advanced analytical software. If the software allows a non-MD to safely identify and manage a reasonable subset of patient conditions, healthcare costs can be reduced (area 1).

The software can accurately triage presenting patients to the appropriate level of care giver, therefore efficiency and throughput are increased. The software can identify circumstances that should elevate the patient's care to another level, therefore safety is increased (area 2).

Lifecom has proven that these goals can be achieved. Affordable, accessible and safe care can be provided using Lifecom's technology and enhanced team model.

Phases I and II of the Lifecom Clinical Trials demonstrated the technical feasibility of this model in a controlled set of patient presenting complaints.

In phase I, Lifecom software was successfully used by Medical Assistants to achieve a diagnostic concordance rate with a physician blinded to their findings of ~ 93%. The MA / software reports generated in phase I included the final physician diagnosis in their differential diagnosis in 99% of cases.

Keep in mind, that MA's are currently not trained to perform detailed histories of present illness and cannot perform any diagnostic tests or physical examinations due to current scope of practice barriers. Despite these restrictions clinical performance was excellent. The MA's in the tests also documented 2 to 3 times more relevant patient data in a comparable period of time compared with MD's not using the system.

Phase II is a test of the appropriate sensitivity for triage functions useful in determining the need and/ or optimal time to elevate a patient from one care level to another based upon their condition.

Before discussing quality of care impact, a brief description of the technology is helpful.