key: cord-0174028-c500fek2
authors: Liu, Shaoshan; Huang, Yuzhang; Shi, Leiyu
title: Autonomous Mobile Clinics: Empowering Affordable Anywhere Anytime Healthcare Access
date: 2022-04-11
journal: nan
DOI: nan
sha: fcd700b58fea4ffcf46e4399ccb0c074f8206e91
doc_id: 174028
cord_uid: c500fek2

We are facing a global healthcare crisis today as the healthcare cost is ever climbing, but with the aging population, government fiscal revenue is ever dropping. To create a more efficient and effective healthcare system, three technical challenges immediately present themselves: healthcare access, healthcare equity, and healthcare efficiency. An autonomous mobile clinic solves the healthcare access problem by bringing healthcare services to the patient by the order of the patient's fingertips. Nevertheless, to enable a universal autonomous mobile clinic network, a three-stage technical roadmap needs to be achieved: In stage one, we focus on solving the inequity challenge in the existing healthcare system by combining autonomous mobility and telemedicine. In stage two, we develop an AI doctor for primary care, which we foster from infancy to adulthood with clean healthcare data. With the AI doctor, we can solve the inefficiency problem. In stage three, after we have proven that the autonomous mobile clinic network can truly solve the target clinical use cases, we shall open up the platform for all medical verticals, thus enabling universal healthcare through this whole new system.

Healthcare is arguably the most fundamental human right. What matters more to one besides health? Health is like oxygen; you take it for granted, you don't feel its existence until the day you lose it, then you will do whatever it takes to get it back.

But we are facing a global crisis today as the healthcare cost is ever climbing, but with the aging population, government fiscal revenue is ever dropping [1] . This creates growing friction between different governments and their citizens. The people demand better and more affordable healthcare, but this becomes more and more unreachable with the current healthcare system.

Under the current situation, there are only three options left for each government, higher taxes, worse healthcare services, or a more efficient healthcare system. From the perspective of human rights, there is only one viable option, a more efficient healthcare system.

According to a joint study by the World Bank and the World Health Organization, primary care is an effective way to reduce overall healthcare expenditure and, at the same time to improve healthcare service quality [2]. This theory has been proven in numerous developed countries, but access to healthcare, especially primary care, is difficult in many less developed countries. This problem further exacerbates in the current COVID-19 situation [3] .

To create a more efficient healthcare system, we can start by enabling affordable anywhere anytime healthcare access through technological innovations, starting with primary care. Three technical challenges immediately present themselves: The first challenge is access itself; people get denied access to healthcare services for various reasons, including lack of mobility, particularly for disabled people and elderly, unpleasant user experiences, especially for countries with overloaded public healthcare systems, etc. We believe that an autonomous mobile clinic that comes to you by order of your fingertips solves the access problem. We have successfully demonstrated the effectiveness of autonomous vehicles in addressing mobility problems, especially for the elderly and the disabled population [4] .

The second challenge is equity; while mobility enables access, it does not guarantee equal access. The reality is that healthcare resources are unevenly distributed [5] , and this distribution is often strongly correlated with wealth distribution. The equity problem again can be solved by technology; telemedicine on the mobile clinic connects the patient to medical experts worldwide [6] , for the first time in human history, disrupting the uneven distribution barrier to truly enable equal health care access. In our real-world autonomous vehicle deployments, we have encountered and provided a reliable solution to the connectivity problem [7] .

The third challenge is efficiency; as the overall healthcare cost is climbing, people have high hopes for new technologies to improve healthcare access and quality while minimizing costs. We can consolidate clean health monitoring and diagnostic data through autonomous mobile clinics to train an AI doctor for the first time, which has been proven to be highly cost-efficient [8] . An AI doctor will handle most pre-screening and diagnostics tasks in primary care, freeing the human doctors for more sophisticated tasks. 

To address the aforementioned challenges, we advocate that autonomous mobile clinics provide a revolutionary and effective way of healthcare service delivery. The idea of autonomous mobile clinics is not new, concept products such as Toyota e-Care [9] have emerged in recent years, but only stayed in the concept stage. As shown in Figure 1 , to enable a universal autonomous mobile clinic network, a three-stage technical roadmap needs to be achieved: In stage one, we focus on solving the inequity challenge in the existing healthcare system by combining autonomous mobility, telemedicine, and primary care. In stage two, we develop an AI doctor for primary care, an AI doctor that we foster from infancy to adulthood with clean healthcare data. With the AI primary care doctor, we can solve the inefficiency problem. In stage three, after we have proven that the autonomous mobile clinic network can truly solve the primary care problem, we shall open up the platform for all medical verticals, thus enabling universal healthcare through this whole new system.

Autonomous mobile clinics also bring along multiple immediate clinical benefits. First, especially under the current COVID-19 situation, autonomous mobile clinics provide a perfect environment for Point of Care Test (POCT), which refers to multiple clinical tests carried out at the point of care near the patients, rather than from clinical laboratory. When dealing with patients of infectious diseases, lab tests such as White Blood Cell test and C-reactive Protein are of the utmost importance. Autonomous mobile clinics provide an isolated environment for POCT at the location where the patients reside, effectively constraining the spread of infectious diseases.

Under COVID-19, medical resources become even more scarce and many patients suffering from serious health conditions, such as Myocardial infarction, Stroke or Diabetes fail to get proper testing, such as creatine kinase myocardial band (CK-MB) and blood glucose, let alone treatments [10] . The multiplex POCT model includes regular gases of bloods, metabolites, as well as patient's electrolytes, and various immunoassays [11] . By following the multiplex POCT model to integrate the medical instruments in the autonomous mobile clinics, we can greatly reduce the lag time on transferring blood sample to laboratory as well as enhancing the diagnostic efficiency.

Taking Acute Myocardial Blood Marker Test as an example, it has been confirmed that POCT introduces a mean reduction of 110 minutes of test result turnaround time compared with traditional laboratory testing methods [12] , the same benefit has been observed in the Emergency Department as well [13] . The second benefit of autonomous mobile clinics is the combination of the multiplex POCT model with telemedicine to carry out online healthcare consultation services to patients. With this capability, remote doctors can review patient's lab test results in realtime, hence the doctors are able to perform consecutive screening, monitoring, as well as to provide simple instructions on treatment process. These all take place on the point of care without having physical contact with the patients, greatly reducing the risks of contracting infectious diseases. We summarize the potential benefits of performing a few POCTs on autonomous mobile clinics as follows:

Reduction of 60 min of result turnaround time.

Increase of diagnosis and treatment efficiency.

Reduction of 120 min of vital analysis time, especially for emergency patients.

Enhanced rescue efficiency and potentially reduce mortality.

Reduction of 90 min of diagnosis time, especially on patients with diabetes co-morbidity, such as hypertension, renal disease, cerebral vascular disease.

Shorten time on accessibility of related medical resources; increase diagnosis precision; reduce misdiagnosis on complications.

Reduction of 120 min of waiting time.

Enhance early Diagnosis of acute and chronic conditions.

A bold technical roadmap also exposes many legal and policy challenges, including autonomous vehicle safety, data security, data privacy, medical service delivery, and many more. One imminent challenge is that each of these areas is regulated separately. Take the U.S. for example, the National Highway Traffic Safety Administration (NHTSA) regulates autonomous vehicle safety, the Federal Trade Commission (FTC) regulates data security and privacy, and the Food and Drug Administration (FDA) regulates medical service delivery. Besides regulations, standard bodies like IEEE and ISO develop standards for applications of emerging technologies, such as the autonomous mobile clinics. Navigating through this regulatory matrix would be extremely challenging, as reported by many artificial intelligence projects [14] . Given the enormous potential benefits brought by the autonomous mobile clinics, we strongly advocate starting with a pilot project to launch the autonomous mobile clinics in selected cities, and then use the pilot project data to construct policy and regulatory framework to promote the universal adoption of autonomous mobile clinics. 

Aging Population Continuing to Drive National Health Spending

Well-designed Primary Health Care Can Help Flatten the Curve during a Health Crisis like COVID-19

Autonomous vehicles lite self-driving technologies should start small, go slow

Inequalities in health care use and expenditures: empirical data from eight developing countries and countries in transition

Setting the framework for car connectivity and user experience

Communication Challenges in Infrastructure-Vehicle Cooperative Autonomous Driving: A Field Deployment Perspective

The impact of artificial intelligence in medicine on the future role of the physician

Fair allocation of scarce medical resources in the time of Covid-19

Multiplexed Point-of-Care Testing -xPOCT

Decreasing lab turnaround time improves emergency department throughput and decreases emergency medical services diversion: a simulation model

Benefits of point-of-care testing in the Emergency Department

Dilemma of the Artificial Intelligence Regulatory Landscape