doc@home, april 2014

doc@HOME Digital Care Platform

- Improving outcomes and efficiencies of managing patients

in the community An EU Success story - From an RTD Project to a delivered service Adrian Flowerday MD Docobo Ltd

28/04/2014 Copyright Docobo Limited

Not to be reproduced without permission

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Copyright © Docobo Limited Not to be reproduced without permission

doc@HOME – an FP5 RTD Project Transpond – an embedded OEM product provider

– Approached by Estonian Research group to join a project – proof of concept already developed

– €2m project – 50% funded

– 3 SME’s and 4 Clinical sites

– Technologists, clinicians and practitioners

Docobo Ltd - SME formed Sept 2001

– to commercialise the output – doc@HOME

– Self funded/project initiatives for development and validation

UK developer/manufacturer

– EN13485 BSI approved Medical Devices

EU Success Story

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Phase 1 Projects to Build Assurance RTD Framework 5 programme (initial development) – Design of home monitor and service infrastructure

– Demonstration of service delivery

DTI SMART Award - – Value added design to FP5 outcome – design adapted to market

– Focus on USP of Patient Self Care Empowerment and Motivation

Quality of Life Programme – REALITY - validation studies – Determine and demonstrate Socio-economic impact

– Qualify ethical aspects of deploying home monitoring

– Trial service delivery impact - 200 patients monitored over 12 months – Multi disease - create start of evidence base


Phase 2 to Establish Evidence

eTEN project – business case and market entry

– Validation study - virtual outpatient clinic for unstable diabetic patients

– Business case development - Roll out of services

Southampton COPD (Interreg III)

– COPD management in the community

– One of UK’s first successful Telehealth projects

Framework 6 project - (ENABLE)

– New approaches – assistive living – applied services

– Integration of smart sensors / data fusion / control / communications

– Next generation fall detectors

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Key Objectives – use case design lasted

Single and Multi-patient use

Configurable for all chronic diseases

Capacity to handle co-morbidities

Key vital signs – ECG, Respiration Rate, HRV, Aortic Pressure wave

Programmable alerts

Logs interventions

Messaging

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Phase 3 widen product range TSB ALIP1 PEACE and ALIP2 PEACEAnywhere – New product development – Develop Android based Medical device

– Develop new Web 2.0 based server

– Develop new comms options

Framework 7 project – (I Don’t Fall) – Falls prevention and rehab

– Interoperability between Telecare and doc@HOME

– Connectivity to external devices for secure data transfer

Framework 7 project - (eSMART) – Cross Europe Smart phone based symptom management for patients with

cancer

– Multi Language product range

Commercial success – Two major Tenders won in UK NHS – Yorkshire and Nottingham City - 1000

patients

– 10 other NHS customers moving to the new solutions

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Need-ability Index

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ArtemusICS™ - Intelligent Identification

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Secure Data

Warehouse

SUS Data

Primary Care Data

Tier II Data

GPSI Data

Risk Stratification Engine

Risk Score

ArtemusICS Processing

Engine

Community Data

Social Data

ArtemusICS • Statistically agnostic • Web Based LTC Dashboard • Drill down to CCGs and GP practices • Filter by disease group and/or Co-Morbidities • Commissioned by NHS Surrey • Predicted costs, vs actual utilisation • Indentify unknown costs

Identifies NEED

Intelligent Management • Medicine Optimisation • Condition specific optimisation • Intervention assignment • Regular refresh

• track change • benefits realisation

• Intervention tracking - data entry


ArtemusICS – single source of population health diagnosis and treatments

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Understanding Utilisation In Time

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Options to meet need and ability

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28/04/2014 Copyright Docobo Limited Not to be reproduced without permission 12

Patient & Care Giver

•Elderly •Poorly •Symptomatic

•IT Literate •Mild LTC’s Diabetes II Asthma

Case Management Wellness

CarePortal™ Smartphones

DocoboAPP

Encrypted and secure data Broadband, 3G, 4G

Tablet Browser

Telehealth: Access choice according to clinical need, nurse/patient preference and cost

TV

Clinical Database

doc@HOME®

Flexible question selection to enable management of all co-morbidities and clinical pathways for each patient

DocoboWEB™ (Email/SMS with URL + 2NET)

Health and Well being APP’s

NHS N3 Intranet


Clinicians View

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HVI and Rhythm Analysis

Sinus Rhythm Electrical vs mechanical activity

Wenkebach + Ventricular Beats

P-R wave gets progressively longer until P drops the followed by shortened P-R

Blood flow follows all typical QRS but is absent following Ventricular beat


doc@HOME supporting Care Homes in Sussex Developed with Sussex Community Health

Involves Community Matrons who are assigned to a set of Care Homes

Multi-Patient Unit set up in each Care Home

– Questions for UTI, Respiratory, Cardiac, Diabetes

– Different questions for each patient

– Care Home staff take tablet to each patient on Mon, Weds, Fri

– CM’s monitor remotely via doc@HOME and pick up negative trends

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doc@HOME supporting Care Homes in Sussex

Initial results – 3 months in – One Care Home that had one of the highest rates of admissions (22 in

2013) – now within the normal range (2 in last three months)

– Patients and their relatives are extremely satisfied

• Patients like the solution

• Patient’s families like the solution and asking for their parents to be put on the service and those that are using it don’t want it to stop

• Help identify the need for end of life care so the patients died in the place of their choice

– Care Home is over the moon!

• CQC visited a home using the solution and loved it. Ticks all the boxes from CQCs for patient involvement.

• Care Home staff are motivated, engaged and more confident

• CM able to educate Care Home staff

– CMs love the solution as it enables them to work closely with the home staff and patients

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AF Screening – Stroke Prevention

Clinical Assessment Centre

Attendance at Flu/other opportunistic event

– Patients over 65

– All patients have 20 second Vital Signs snap shot

• ECG lead I; Aortic arch blood flow; Respiration

• + Dependent variables

– All patients answer symptomatic data question set

– Patients have BP measurement if not recorded in the last month

– All patients identify concerns about falling

AF Screening - Results

Clinical Assessment Presentation

Docobo Assessment – 851 patients recorded vital signs over 4 weekend clinics – 3 life threatening conditions were identified and corrective

action taken – 23 patients with definitive Atrial Fibrillation identified – 16 patients with borderline Atrial Fibrillation – 8 confirmed by

12 lead ECG – 12 different arrhythmias identified

Post Study (6 months) – All patients reviewed and now on appropriate therapy – No incidence of Stroke reported so far – No deaths reported so far – 3 lives saved by prescription of pacemakers – All high BP patients being reviewed for optimum medication

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GPRS, 3G Broadband

Patient & Care Giver

•Elderly •Poorly •Symptomatic

•IT Literate •Mild LTC’s Diabetes II Asthma

Case Management Wellness

GPRS, 3G Broadband PSTN

CarePortal™

GPRS, 3G Broadband

Smartphones

DocoboAPP & DocoboWEB™ (Email/SMS with URL

Encrypted and secure data

Tablet PCs & Macs Laptop

GPRS, 3G Broadband

GPRS, 3G WiFi/Broadband

Telehealth: Access choice according to clinical need, nurse/patient preference and cost

TV

GPRS, 3G Broadband

Clinical Database

doc@HOME®

H2020 – what do we want to do H2020 development: Data analytics to detect short and long term trends and predict onset of degradation in health

H2020 Development Intelligent sensors

doc@home, april 2014

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