ARPA-H to create medical trucks for health care access in rural areas

The U.S. Advanced Research Projects Agency for Health (ARPA-H) has published draft plans for PARADIGM, a new miniaturized, truck-installed CT scanner that would bring health screenings to people in rural parts of the nation.

A new federal initiative aims to take health care on the road to reach people living in rural areas around the country.

The Platform Accelerating Rural Access to Distributed & Integrated Medical (PARADIGM) care program was announced this month by the administration of President Joe Biden, the U.S. Department of Health and Human Services (HHS), and its Advanced Research Projects Agency for Health (ARPA-H).

The new program “is designed to combat the dire health disparities prevalent in rural regions,” according to the official announcement. Draft documents show a new, miniaturized CT scanner on wheels that would bring health screenings to people who don’t have easy access to hospitals.

“Telehealth revolutionized access to primary care and mental health services.​ PARADIGM will do the same for advanced hospital-level care,” ARPA-H PARADIGM Program Manager Bon Ku, MD, MPP, said in a news release. “We need to fundamentally shift how care is provided to rural Americans, and PARADIGM intends to do this by creating a scalable health delivery system outside the walls of a hospital.”

Rural residents have higher mortality rates from leading causes of death when compared with urban residents, according to HHS. Yet in the last 10 years, more than 100 rural hospitals have closed and another 600 “teeter on the brink,” reducing access to care. That leads to more lung cancer, higher death rates from heart disease, respiratory disease, cancer and stroke, along with more maternal and infant mortality.

PARADIGM will develop a platform that improves clinical, diagnostic and essential medical services, enhancing early detection and management of disease and chronic conditions, according to HHS. The program will employ “a multifunctional, rugged electric vehicle platform that integrates many different medical devices,” called a Care Delivery Platform (CDP). It will use software to connect on-board and remote medical devices to electronic health record (EHR) systems.

Plans could include mini CT scanners and digitally enhanced real-time training tools to improve the skills of health care workers.

HHS published a draft program solicitation with a proposer’s day next month, an anticipated proposal due date of April 26, and an estimated start date on Sept. 24 this year. A five-year development plan includes prototypes refined and optimized for large-scale manufacturing, and a miniaturized CT scanner approved by the U.S. Food and Drug Administration, ready for market by 2029.

The vehicle would have at least 600 square feet of usable space, with an internal height at least eight feet, width at least seven feet, and payload of at least 2,000 pounds. Size and weight are limited by the constraint to not require any special license to operate it, such as a commercial driver’s license.

In medical imaging, the draft program solicitation noted ultrasound and MRI have been miniaturized in recent years. CT scanners are one of the most common devices used for medical imaging – more than 80 million scans are performed each year in the United States. But body scanning devices have not shrunk their size, weight and power requirements in the past 50 years.

The new CT scanner will have a footprint no larger than 32 square feet and maximum weight of 500 pounds. It will be ruggedized to hold up to jostling on country roads, and must withstand temperature changes when parked overnight, according to the draft specifications.

Along with the human cost, there is a financial element involved with rural health care problems. The draft proposal said if 500 CDPs with CT scanners were deployed, PARADIGM would save an estimated 14,000 lives and recapture $3.8 billion of economic productivity every year just from lung cancer. Deploying 1,500 CDPs to rural and suburban areas, or one for every two counties, lung cancer screenings could save up to 41,000 lives and save $11.4 billion a year in economic productivity.

“Imagine being able to offer advanced imaging tests, multi-cancer screenings, perinatal care, and essential medical services in a mobile medical platform that meets patients where they are at,” ARPA-H Director Renee Wegrzyn, PhD, said in the news release. “This would allow so many Americans who can’t get to a hospital to be treated for many different illnesses and conditions. The program’s impact has the potential to resonate far beyond the boundaries of a map, reaching into the lives and well-being of countless individuals across the nation.”