Kelly Panariti

My first week in the Clinical Immersion Program (CIP) and Family Medicine department was quite overwhelming at first. For me, this is a completely new experience and my first time ever stepping into a clinical environment and interacting with patients and providers. I had the pleasure of shadowing and meeting family medicine doctors and social workers at the Miles Square Health Center Main and Cicero. Miles Square Health serves the most underrepresented groups in our community and does not deny care to patients, no matter their background. The moment I stepped into the Main and Cicero clinics, I could truly feel that every member of the clinic team is committed to delivering the highest standard of care, placing patients’ well-being at the center of everything.

As well, this week, I was able to meet many different patients, including young adults, seniors, adults, and infants, with varying diagnoses and reasons for their visits, including substance use disorder (SUD), alcohol use disorder (AUD), opioid use disorder (OUD), diabetes, hypertension, autoimmune diseases, and asthma.

Good Design: Comprehensive and Holistic Care

Upon the start of CIP and rotations in the clinic, I quickly noticed the Miles Square Health team provides a wide variety of health services to patients, including and not limited to, addicition medicine, family medicine, and lifestyle medicine. Miles Square Health Center is a place where interdiscplinary care takes place through the collaborative teamwork of providers with the goal of providing high quality care to patients. Providers take the time to discuss with one another patient cases after appointments and during focused meetings.

Activity (A): Working together with all providers and staff in order to provide patients with high quality care amongst a variety of health services.

Environment (E): Miles Square Health Center clinics, providing multiple different kinds of services to patients (can vary depending on the clinic location, example: MSHC Main and MSHC Cicero).

Interactions (I): Collaborative meetings and discussions between all healthcare providers (doctors, residents, nurses, social workers) about patients and different cases. As well as patient and provider communication.

Objects (O): Electronic charting technology (Epic), Medication (Buprenorphine, Suboxone, Methadone, etc.).

Users (U): Patients, family medicine doctors, nurses, medical assistants, nursing assistants laboratory staff, pharmacists.

Bad Design: Patient Waiting Time and Screening 

One thing that I began to understand this week is why there is often long patient waiting times within the clinic, which is something I had a difficult time comprehending previously since I had only ever been a patient before, rather than someone on the other side. Due to the harsh reality and systemic challenges created by health insurance, providers are expected to meet many patients within 15-20 minute blocks. These time constraints make it difficult to throughly evalute patients, while also providing patient education, building personal connections, and screening patients on determinant of health, such as housing and food, leading to longer waiting times. Efficient methods regarding screening and patient health information need to be consolidated in order to maxmize the patients and providers time.

Activity (A):  Understanding and asking how the patient has been doing and feeling (symptoms), noting how often and frequently they have been taking and keeping up with their medications, examining the lifestyle choices made by patients, providing patients with educational information on how to partcipate in their own care.

Environment (E): Patient often spend good chunks of time waiting in the examination rooms within the clinic, or the clinic’s waiting space.

Interactions (I): Limited time between patients and their providers.

Objects (O): Alot of time is spent by providers using charting technology and applications (Epic, Up2Date, Care Everywhere, Patient MyChart) during the appointment.

Users (U): Patients, family medicine doctors, nurses, medical assistants, nursing assistants laboratory staff, pharmacists.

In my second week in the Clinical Immersion Program, I continued to make observations and interviews in the family medicine clinic at Miles Square Health Center. During my time in clinic this week, I noticed while observing conversations between providers and patients, that there is a difficulty with detecting traces of fentanyl within bags that patients are using. A bag refers to the drugs that patients buy/use. It is possible for individuals to use their sense of sight and smell to detect fentanyl, but these methods are highly inaccurate and unreliable. Both patients and clinicans expressed that in our present day, patients never know what they are getting when they purchase a bag; this is due to the fact that fentanyl is actively being laced into everything and anything. This is very concerning as in our present day, fentanyl has become the leading cause of death in relation to overdoses. In order to supplement my primary research collected during clinic, I conducted secondary research by studying a peer-reviewed paper and examining a commerical solution/patent that are related to the observations that I obtained as a part of my primary research in the family medicine department.

Peer-Reviewed Paper: Following my primary data, I found a review paper that discussed modern day methods and technologies that can be used to detect fentanyl “in the field” [1]. These methods can be used by different operators/users in order to promote safety and harm reduction [1]. The paper went into great detail about multiple technologies, including automated colorimetric detection using smartphones, lateral flow assay test strips, infrared and raman spectroscopy, as well as, portable gas chromatography spectrometry, ion mobility spectrometry, and portable mass spectrometry [1]. However, while there are so many technologies, the paper highlighted the “pros and cons” of each method. It was demonstrated that colorimetric detection and lateral flow assay test strips are very accessible as they are cheaper, can quickly provide results to operators, and are overall simple to use. However, these methods are not as specific as other technologies and can result in false negatives, promoting inaccuracy [1]. Meanwhile, the paper examined that other methods involving spectroscopy and spectromery, are sensitive and specific, aiding in higher accuracy of test results, however these technologies are more expensive and more difficult to transport [1].

Commercial Solution/Patent:  Furthermore, following my primary data observations, I found a patent that focused on devices and methods that can be used to rapidly screen for commonly abused drugs and related analyes, such as opioids [2], which includes fentanyl. It was highlighted that there is a need for method that can quickly screen for various drugs, since current screening methods can be slow and are difficult to use in the field [2]. The patent presented screening devices, kits, and methods, for screening a sample for an analyte of interest at small concentrations [2]. The technology apart of these methods and devices specifically make use of competitive lateral flow assays [2]. The main device for which the patent discusses, is referenced to as “lateral flow strip.” The patent went into detail about the protocol used to create the device, the clinical tests conducted, the ultimate results, as well as the analytical sensitivity and specificity of the lateral flow strip [2].

References

[1] Crocome, R., et. al., “Field-portable detection of fentanyl and its analogs: A review.” Journal of Forensic Sciences, vol. 68, iss. 5, pp. 1570-1600. https://doi.org/10.1111/1556-4029.15355

[2] Devices and Methods for Rapid Screening of Drugs of Abuse and Other Analytes, by Wang, P., Li, Z., Chen, H., Liu, K. (2022, Aug. 18). US20220260561 [Online]. Available: https://patentscope.wipo.int/search/en/detail.jsf?docId=US371834319&_fid=WO2021011455

Primary Observation: Patient-Provider interactions via Telehealth/Telemedicine visits in the SUD clinic at Miles Square Health Center.

• Activity: Providers can communicate with patients via Telehealth visits. These visits can be used for therapy, medication refills, and check-ins. After the COVID-19 pandemic, the amount of telehealth visits increased significantly, and it is quickly on the rise. Telephone visits can be good options for patients as they do not have to travel to the clinic and are able to get the care they need, right from their home. However, this type of visit is not easily accessible for patients who do not have access to any devices or a safe environment.
• Enviornment: Clinic exam room, Clinic office space, Patient’s home/and or any safe environment with Wifi.
• Interactions: Providers interact with patients and vice versa via phone communications.
• Objects: Device capable of making and receiving cellphone calls, Epic charting software.
• Users: Doctors, nurse practioners, social workers, patients.

Secondary Observations: COVID-19 contributed to a 51% increase in telehealth usage amongst clinicians [1]. Telehealth education is being promoted and integrated into nursing and medical school curriculums [1]. Telemedicine is able to provide OUD treatment and medication access, with the potential of reducing the number of fatal overdoses [2].

Needs Statement: SUD (substance use disorder) patients in urban communities (Population) often have difficulty in tracking medication usage, vital signs, and symptoms (Opportunity), emphasizing the importance of a streamlined process/method for patients to log and communicate such important health information with their providers (Outcome).

Feasibility: 

US20180166176 – Systems and Methods of Automated Access into a Telehealth network.

• Telecommunication SIM card, whose activation in a device triggers an event to provide and access to telehealth services via interactive communications.
  • Provide healthcare information to patients, but does not provide any kind of remote patient monitoring for providers.

US7185282 – Interface Device for an Integrated Television-Based Broadband Home Health System

• Television device uses TV signal to connect a patient in a remote setting at home, to remote provider. Can use normal TV broadcast and change to a health session using audio or video.
  • Connects patients with providers, however it is not easy to access for all patients.

Viability:

The total of number of SUD patient diagnoses a year was used in TAM calculations as it includes overall includes AUD, OUD, DUD, etc. Furthermore, it was also necessary to utilize the number as it demonstrates the ongoing needs of these patients as overdose related deaths and abuse of substances continues to rise in the United States.

TAM: 48.5 mil patients/year * $8 = $388 mil (SUD patient diagnoses in one year with the Telehealth SIM card).

TAM: 48.5 mil patients/year * $250 = $12.1 bil (SUD patient diagnoses in one year with Telehealth TV).

References:

[1] Garber, K., et. al., “Telehealth Education: Impact on Provider Experience and Adoption.” Nurse Educator, vol. 47, pp. 75-80. March 2022.

[2] Gressick, K., et. al., “Telemedicine to improve access to medications for opioid use disorder in Illinois, 2022-2024.” Int J Drug Policy. March 2025.

Needs Statement (Revised and Updated)

After my observations in clinic this week, further secondary research, and peer reivew, I refined my needs statement and IDEO model relating to patient-provider interactions through telemedicine.

SUD (substance use disorder) patients (Population) struggle simultaneoulsy with, keeping track of their medication and utilizing exisiting technologies to conduct telemedicine appointments, (Opportunity), demonstraing the need of a proper platform for patients to interact with their providers and care plans in order to improve patient retention (Outcome).

Desirability

Over the last few years, beginning with the start of the COVID-19 pandemic in 2020, the use of telemedicine has drastically increased and expanded [1]. It has become a powerful tool for providers in order to provide care to patients from underrepresented populations, who normally struggle to gain access to care. The practice of telemedicine is able to eliminate transportation barriers and promote continuity of care amongst patients [1]. As well, during the pandemic, providers were quick to adapt telehealth services in order to continue SUD treatments for patients [2]. It is possible that telemedicine can “revolutionize” SUD treatment as it can address specific geographic and logistic issues that patients and providers are faced with [2]. Furthermore, telemedicine has shown to decrease the amount of no-show visits amongst patients, and promote patient satisfaction and continuity of care [3]. As well, studies have shown that telehealth can expand access to SUD treatment in underrepresented populations [2]. However, while telemedicine demonstrates great benefits, it is important to recognize other challenges that come with telehealth in general, highlighting spaces for improvement. These challenges include limited digital literacy amongst patients, as well as the fact that is no standard method for the way in which telemedicine is implemented [3].

Feasibility

Currently, the clinic at MSHC simply uses a telephone to make calls to patients and a computer with access to the patients chart in Epic. The patient needs to accept the providers call on a device that is capable of making telephone calls. There is also a way to conduct video calls through Epic on the providers side, while patients can access it through their MyChart. However, this video call option is a bit more challenging as patients would need to be able to understand how they can access such tools through their MyChart, as well be present in an environment where they feel comfortable taking a video call with their provider.

Furthermore, at the moment there is no standardized method for which telemedicine appointments can be conducted between patients and providers, while also providing a space for patients to keep track of their medications or care plans. This demonstrates the space that is available for engineering methods and knowledge to be used in order to implement a device or method that can standardize these factors in telemedicine. Since the patient population is large and telemedicine is quickly expanding, there is room for different solutions to meet patient needs.

Viability

As time goes on, the epidemic on substance abuse continues to grow. As well, the number of deaths related to overdose in the United States continues to increase every single year. There is about 40.3 million Americans struggling with an SUD in a year; this includes patients with OUD (opioid use disorder), AUD (alcohol use disorder), or multiple SUD’s. While many Americans struggle with addicition, only about 6.5% of those patients actually received treatment for their SUD, further highlighting a gap in care amongst SUD patients. There needs to be solution that can help patients get the care that they need.

TAM: 4,050,000 patients/year * $50= $202,500,000

In order to calculate the TAM, I used the total patients who struggle with an SUD a year, estimating that about 10% of those individuals will get treatment (I increase this percentage from the raw data/stastics as we realistically also want to provide care to more individuals). I estimated that a possible solution to the needs statement could be $50, which has alot of room for change depending on the type of solution (device, application, system, platform, etc.).

References

[1] Gajarawala, N., Pelkowski, J., “Telehealth Benefits and Barriers.” The Journal for Nurse Practitioners, vol. 17, iss. 2, pp. 218-221. Feb 2021. https://www.doi.org/10.1016/j.nurpra.2020.09.013

[2] Qeadan, F., et. al., “The impact of increased telehealth use on the treatment of substance use disorder during the COVID-19 pandemic.” SSM – Population Health, vol. 30. Jun 2025. https://doi.org/10.1016/j.ssmph.2025.101780

[3] Ezeamii, V., et. al., “Revolutionizing Healthcare: How Telemedicine Is Improving Patient Outcomes and Expanding Access to Care.” Cureus Journal of Medical Science, 16(7). Jul 2024.

Key: Yellow – Main Observation, Red – Pain Points, Orange – Objects and Interaction

Needs Statement: SUD (substance use disorder) patients who struggling with keeping track of their medication and utilizing exisiting technologies to conduct telemedicine appointments need a way to interact with their providers and care plans in order to improve patient retention.