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Amazing Technology Is A Must. But Never, Never, Never, Sufficient. What Else Is Needed?

In an ever-evolving world where technology often takes center stage, there is a transformative force that is key for a successful telemedicine program. It's driven by the unwavering belief that healthcare should know no boundaries and that every individual deserves access to quality medical care regardless of location or circumstances. Read how Ram Fish underlines three vital pillars beyond the technology, as we have seen in Oaxaca, Guyana, and each customer we work with. Watch his full presentation here.

Redwood City, CA – September 5, 2023

Real-time remote ultrasound in Oaxaca streamed to Jamaica

The day prior to Ram’s presentation, 19Labs facilitated a remote ultrasound session of a pregnant patient in rural Oaxaca to be streamed in real-time to Jamaica, the location of his discussion. After witnessing this display, many commented on how marvelous it was.

Undoubtedly, it was, but in his discussion, Ram shifted focus to three pillars that allow amazing technology to truly provide solutions in telemedicine.

The primary lesson he discussed may come as a surprise for some.

“I've been building products since I’ve been working with Apple, Samsung, Nokia, and multiple startups. So yes, I'm a technologist”, said Ram.

The three pillars he laid out demonstrated that amazing technology is a must but never, never, never sufficient.


Developing the need to focus on people versus technology, Ram said: “Because in the end, it’s all about people. And you need to start to talk much more about the people and less about the technology. And that’s where we’re going to start.

“What do we need to do to make telemedicine work in rural settings?

“Many talk about the doctors, … but I want to take it a step away and toward the community worker who is, more than anything, the key.

“In telemedicine, we connect between two locations. And it’s a connection in which the ‘brain’ is the doctor on one side, and the ‘hands and the heart’ are the community worker. The 18-year-old, usually a young woman, sits over there and holds the hands of the patient.

And yes, you absolutely need the doctors, but if the community worker is not energized and confident, it will not happen."

"Most times, the community workers are the most amazing people I have met.” - Ram Fish
Ram, inducted into the Wai-Wai, during an eClinic deployment visit

Ram then gave his experience of being inducted into an indigenous tribe on the Brazil/Guyana border called the Wai-Wai during a visit for an eClinic deployment.

Among them was a remarkable community worker named Devina, a young mother of 2. Witnessing how someone like her could bridge the gap between her community and healthcare professionals was truly eye-opening. She was empowered to care for her neighbors, even playing a crucial part in saving a three-month-old baby’s life. This woman, who had rarely left her community, was now empowered to care for her people and had gained access to the world of healthcare and beyond.

“Suddenly, those communities are visible. They are visible in the hearts and minds of the health administration and the minister of health. You bring connectivity, you empower them, and that really changes the story of telemedicine.”, continued Ram.


Ram acknowledged a comment made by a presenter at a previous event: the Government must pay. You don’t do a trial if they don’t pay.

Though a valid point, beyond financial support, strong leadership is essential.

Ram described the leadership that makes a successful telemedicine program: "It requires a health minister who says, ‘I want to get this done, and I will remove the obstacles.’ And there will be obstacles, more than you can ever imagine.”

They must consider various aspects: What should be done? How should it be done? Are they sure they want to do it?

It's not just about politics; it's about intentions. Strong leadership is a prerequisite.

Additionally, building strong relationships within communities is crucial. You need leadership individuals in the local communities and educators capable of rallying community support.

Again, drawing on personal experience during a deployment trip, Ram gave the example of a potentially ruined installation and investment. “We checked ahead of time: “Yeah, we have solar power. Everything is ready for you. Come in.” We land. No solar power. How am I supposed to install a satellite with only four hours before the [plane] takes off? I need to get solar power. You figure it out. You get the leadership [to make a call, and] within one hour, we had a generator and a couple of solar panels relocated from the school temporarily. Strong leadership is absolutely a must to make it happen.”


“If you can’t measure it, you don’t know what’s happening. This is how you find problems. This is how you find issues. Quantify what’s happening,” stated Ram when beginning the discussion of the third pillar.

Without the ability to measure progress, you remain in the dark about what's happening. A comprehensive dashboard is a must. It helps identify problems and challenges, allowing you to quantify and understand the situation, leading to necessary adaptations.

Even the best deployments can be improved, but only if there is a way to know where and how the improvement should happen.

Creating an effective feedback loop is fundamental to keep a telemedicine program running efficiently and be of real benefit.

Amazing Technologies Is A Must

Shifting back to technology, Ram called back to the remote ultrasound demo done the day before: “You saw this yesterday, and it looks so smooth and wonderful. But what did we see? You saw video sharing, which is not easy to do. Audio quality you could actually hear, which is not always the case. And you saw it in the condition of rain [from a hurricane in the area] in the community, which usually kills the satellite. So, you had a very low bandwidth connection, and you had it working.”

Breaking down the details and levels of technology involved, Ram listed just some of the components that made the demonstration work.

Drawing attention to the video call and screen sharing used by the GALE platform, he stated: “The technology in here is all based on Zoom. Why? Because I like relying on a company that has spent billions of dollars and is absolutely dedicated to creating the best video conferencing solution.”

“The doctor showed up on time. How did it happen? Because we integrated WhatsApp and notifications from WhatsApp”, continued Ram, focusing on the details that make everything run smoothly.

Now taking it a step beyond smooth operations and into the patient experience, he called out the detail of integrated virtual backgrounds: “You don’t even know that the doctor is at home because there’s a virtual background. And it shows the logo of the Ministry of Health. Now you are the patient who sits over there in the rural community, looks at the doctor and sees a logo, and sees the name of the doctor.”

Speaking of the provider experience during the call, he elaborated on the benefits of the integrated Insights AR feature: “Let’s go on the other side of the screen. You saw what the doctor gets to see. He sits there on Zoom on the tablet, on the phone, or on the computer, and without doing anything else, not another side panel, not another browser, not another tab, all the patient information is displayed in real-time. They look at it for one second and say, ‘Hi Maria,’ and the patient thinks, ‘Wow, he knows my name!’. And the [patient’s] allergies are displayed all the time. So ‘Oh, I’m not going to mess it up’ and give them something they’re allergic to.”

"Small things, but they make a huge difference!" - Ram Fish

Amazing technology is a prerequisite. It simplifies complex tasks, making them appear seamless and reliable.


There's been considerable discussion about devices in the telehealth and telemedicine field.

While devices like stethoscopes, blood pressure cuffs, and examination cameras are important, different locations require different devices.

To that point, Ram stated: “You need a deployment management that you control what you put in one community, which is an advanced kit with ultrasound, versus a different community where you have to ship different types of devices because something broke.”

This approach reduces the need for on-site IT personnel, resulting in cost savings.

Beyond devices, consider incorporating hearing and vision tests into the telemedicine platform, especially for rural communities.


Let's be clear: This isn't solely about cost savings. It's about fulfilling the government's obligation to provide healthcare for all, not just a portion of the population. This is a challenging task. One we, as 19Labs, are dedicated to solving, addressing both people and operational aspects, and harnessing the incredible technologies required.

While technology is a cornerstone, its effectiveness relies on the three pillars:

  • People: empowering community health workers to transform healthcare access.

  • Leadership: a strong one, is vital at all levels of the community or country of the telemedicine program.

  • Dashboards: measure, quantify, understand, and adapt.

While amazing technology is required, but never sufficient. Instead, it must be seen as a tool to empower these pillars.

Slides From Ram's Presentation

Watch The Full Presentation

About 19Labs

19Labs is the creator of GALE, a Next Generation Point-of-Care platform for pharmacies, schools, workplaces, and rural communities. GALE brings together cutting-edge diagnostic technologies from industry leaders like Zoom, Elo, Amwell, Samsung Mobile, MIR, Omron, Viasat, EchoNous, PAP Link, and many others in one smart, efficient, and cost-effective platform. It was designed from the ground up to be operated by non-healthcare professionals in locations with limited infrastructure and optimized for low bandwidth and intermittent connectivity. To learn more about GALE, please visit


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