Presented by:

Dr Liz Mear Chief Executive

House keeping

• In case of emergency

• Mobile phones

• Twitter #NWCEcosystem

• Wifi: Wifi Name: AintreeGuest

Wifi Passcode: Welcome2032

Programme 10:00 Openings & Welcome - Dr Liz Mear, Chief Executive, NWC AHSN

10:15 International Network of Connected Health Ecosystems

Why an Ecosystem?? - Brian O’Connor, European Connected Health Alliance

10:30 International Case Study Examples from Health and Business

Ecosystems in Action! - Professor George Crooks, NHS 24

Collaboration as a Design Principle - Chris Roche, Aridhia

11:00 Questions to the Panel

11:15 Coffee & Networking

11:45 Introduction to the North West Coast Ecosystem

ILINKS Informatics Transformation Programme - Kate Warriner & Dr Craig Gradden Healthier Lancashire Digital Health Work Stream - Declan Hadley

Digital Health – The Mi Programme - Dave Horsfield, Mi Programme

12:45 Questions to the Panel

13:00 Lunch, Networking & Exhibition

14:00 Eat More Chips! - Don Cowling, Proteus Digital Health UK Ltd

Alere - Sumit Nagpal, Alere Accountable Care Solutions

15:00 Breakout Sessions

16:00 Next Steps - Dr Liz Mear, Chief Executive, North West Coast Academic Health Science Network

16:15 Close, Networking & Coffee

Innovation and Health Connected

Presented by:

Dr Liz Mear

Chief Executive

Aims and objectives of AHSNs Innovation, Health and Wealth • To spread innovation at pace and scale across NHS

• To promote and integrate the strengths of higher education, the NHS, industry, third sector

• To improve health of individuals and communities • To focus on the needs of patients and local populations • To speed up adoption of innovation into healthcare • To build a culture of partnership and collaboration • To create wealth

AHSNs, AHSCs and the research and innovation landscape

INVENTION EVALUATION ADOPTION DIFFUSION

Research Councils – set the agenda

CLAHRCs

AHSCs AHSNs

NHS Patient Care

NHS Patient Care

CLRNs

Funding bodies and research centres

Current thinking “We’re never going to be the country that pays the highest prices, or that adopts new treatments regardless of how well they work – just so we can say we’re ‘innovative’. We’ll happily leave that accolade to others. But what we should be is rigorously pro-science, pro-research, and pro-the rapid spread of useful improvement. That’s where AHSCs and AHSNs have such an important role. If we get our act together, what the NHS potentially has to offer – that many other health systems don’t – is a unique combination of biomedical research, population-orientated primary and specialist care serving diverse patient groups, longitudinal data (to allow matching of phenotypes

with genotypes), an aligned financing system,

and a rigorous focus on value creation.”

Simon Stevens, CEO, NHS England

Definition of Innovation

• Service improvement

• Incremental change

• Teaching and training

• Area wide strategy implementation

• Applying existing service developments into a new area

The introduction of new ideas, devices, or methods, accomplished through more effective products, processes, services, technologies or ideas

Campaign example 1 Medicines optimisation/ digital health

• Evaluations in primary care • RIF bid with specialist Trust • Engaged with patient group to

gain insights into problems with medication specific to the group to inform future trials

• Identification of partners for assessment of potential applications

Campaign example 2 Reducing health inequalities – focus on stroke due to Atrial Fibrillation in 2014/15 and NICE compliance

• Working in partnership

• Community testing for AF using POC devices from SME

• Personalisation of medication

• Evaluation/ comparative study

• Expert advice on prescribing and treatment

• Roll out of learning

• Improvement of patient outcomes

• National launch event with European Brain Council

Campaign example 3 Intelligent Data

• Working in partnership – iLinks and Lancs Digital

• Co-ordination of projects to suit local needs

• Development of a Patient Health Record

• ‘Interoperability’ of systems across the region

• Data ‘footprint’

• Prediction of future needs and treatments

• Improvement of patient outcomes

Know your customer Will it deliver cost benefits to the NHS?

– Reduce LOS / reduce admissions

– Redesign current pathways

Will it increase patient safety and prevent disease?

Will it deliver improved diagnosis, treatment and / or care?

Will it improve the patient experience and quality of life?

Will it increase life expectancy?

Why is it better than the current solution?

Wealth Creation Working in partnership – LEPs, NHSA, AHSNs, fund managers

• Attract an investment fund to the region for health technologies

• Job creation

• Spin out companies

• Companies moving into the region

• Grants, local, regional and European funding

• Promoting our region through UKTI and Healthcare UK

Working with industry • Focus on SMEs within region and those with solutions to key

priority areas

• Some bigger company partnerships

• Strong focus on med tech due to longevity of AHSNs

• Forming a Northern Industry Group with NHSA and 3 other NHSAs

• Working through a range of partners to develop a culture of innovation and evidence based practice within the NHS

Working with industry • Evaluation of technologies

• Introductions to clinical specialists

• Facilitation of trials

• Collaborative bids

• Procurement of innovative technologies

• Some bigger company collaborations

• Strong focus on med tech due to longevity of AHSNs

• Forming a Northern Industry Group to align agendas to drive growth across the north

Connected Health Ecosystems ECHAlliance Connected Health Permanent Ecosystem

Patients must be at the centre of the Ecosystem as the users of connected health

services. Patients will help to drive the design and innovation in connected health services and in so doing take more control over their conditions for better health and quality of life.

Why an Ecosystem?? Brian O’Connor

Chair

European Connected Health Alliance

Why Ecosystems?

Brian O’Connor, Chair, European Connected Health Alliance

Who are we?

• Europe’s largest Connected Health membership organisation

• Not for profit, community interest company

• Connected Health is an umbrella term for eHealth, mHealth, digital health, telehealth etc

What do we do and why?

• Deliver leadership for Connected Health

• Help develop Connected Health markets

• To transform health, wellness and social care delivery

• Create economic growth

The Challenge

The opportunity

BUT ECHAlliance Network of Connected

Health Ecosystems is breaking down silos within regions and between

regions

ECHAlliance Connected Health Ecosystem

Another network or cluster?

• Brings all the stakeholders together across connected health spectrum – eHealth, mHealth, Digital Health, telehealth, telecare

• Breaks down the silos

• Specific focus on connected health

• Permanent

• Political buy-in

• Part of an international network

An international network Current Ecosystems exist in :

Northern Ireland, Oulu – Finland, Catalonia – Spain, New York, Manchester – England, North West Coast - England, Scotland, Athens – Greece

Additional ecosystems under development in: France, Spain, Republic of Ireland, Estonia, Sweden, Italy… and beyond Europe

• Countries and regions share similar challenges and are often seeking to address the same problems

• Learn from each other, share challenges and identify common solutions

• We don’t have to reinvent the wheel

Examples of priority areas

• Medicines management

• Development of eHealth strategies

• New business models: innovative procurement, risk sharing, pre-commercial procurement

• Horizon 2020

• Electronic care records

European Commission welcomes Irish EU Presidency declaration on

development of ecosystems May 2013

Neelie Kroes, Vice President of the European Commission, Digital Strategy

"eHealth ecosystems could be the answer to the strain our social security systems are undergoing. If we work together and we use the enormous potential technology has to offer us, we can ensure top healthcare for all in Europe”

Principles of Working Together in an International Network of Connected Health Ecosystems (2013)

This paper provides guidance for Ecosystems in the international network on how they should work together and includes governance, communications and stakeholders.

31

ECHAlliance Methodology: Creating a Connected Health Ecosystem (2013) The ECHAlliance International Network of Permanent Connected Health Ecosystems is expanding very quickly due to the high demand from those wishing to break the silos and develop lasting collaborations to create better patient care, at lower costs and creating economic growth. Recognising the challenges that establishing an Ecosystem can pose, we have responded by developing an ECHAlliance methodology for creating a Connected Health Ecosystem.

Almost 1000 people participating in ECHAlliance Ecosystem meetings across Europe in June:

• 11 June: Oulu

• 19 June: Manchester, England

• 20 June: Northern Ireland

• 23 June: Scotland

• 26 June: North West Coast, England

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June 2014 is a busy month for the International Network

There’s never been a better time to be part of an ECHAlliance Connected Health Ecosystem

Brian O’Connor, Chair

European Connected Health Alliance

brian@echalliance.com www.echcalliance.com

34

www.echalliance.com

@ECHAlliance

-

ECHAlliance

Ecosystems in Action!

VIDEO

Professor George Crooks

OBE Medical Director

NHS 24

Collaboration as a Design Principle

Chris Roche

Chief Commercial Officer

Aridhia

Questions to the Panel

Refreshment Break

ILINKS Informatics Transformation Programme Kate Warriner

Deputy Director, Informatics Merseyside

Dr Craig Gradden

Medical Director, Liverpool Health

Craig Gradden, Medical Director, Liverpool Community Health NHS Trust and

Chair, Clinical Informatics Advisory Group

Kate Warriner, Deputy Director, Informatics Merseyside

Background

Across the North Mersey local health and social care economy there is a driving ambition to deliver, at scale, shared information and to move to a culture where ‘we share’, questioning ‘how do we?’ rather than ‘why can’t we?’ by default.

Our Vision

Over the past 12 months we’ve been busy getting

our ‘ducks in a row’!

Communication

with stakeholders over past 12

months

Many organisations

and individuals involved in shaping

the programme

Unanimous enthusiasm and

support for shared information across

the economy

Strategy Signed Off

Wheelie Bin Syndrome

The Information Exchange…

…is a health and social care record

centred around the whole person …includes the

ability for individuals to

access and contribute to their

own record and person centred

care plans

…to a clinician looks and feels as though it is one

system

…gives a new layer of intelligence

through analysis of data from across

various organisations

…complements partner

organisation systems and

strategies and can be seamlessly

integrated

…delivers combined datasets

delivering an enhanced level of

intelligence for risk stratification and

operational planning

…is entirely customisable and

role based providing different

default views dependent on role

...gives a specific view across health

and social care providing an early warning for child

protection

Strategy Objectives and Outcomes

To create and deliver an information exchange across health and social care

To ensure informatics system-wide coherence and strategic leadership across health and social care

To exploit the benefits and investment of existing and future technologies and processes

Appropriate electronic information made available 24/7 to practitioners

Information is relevant and available at the point of care in real-time

Individual/ client access and contribution to electronic care record

A paper light health and social care economy

Underpinning the delivery of this strategy is…

A set of 12 Guiding Principles:

- Cultural - Leadership - Technical

Digital Maturity Framework

- Using HIMSS model - 8 stages

- Individual and economy assessment of IT usage

and maturity - Incremental approach

Top Priorities

Tackling Information Governance

Identifying what information needs to be shared

Delivering the technical requirements of the information exchange

Governance

££ Investment

decisions, set direction & priorities

Clinical Informatics

Advisory Group

All organisations represented incl. Local

Authority Informatics Reps & CCIO/ Clinical Reps

South Sefton CCG Finance &

Resource Group

Southport & Formby CCG

Finance & Resource Group

Liverpool CCG Healthy Liverpool

Programme Programme

Board Each CCG:

Programme Reports Risks/ Issues

Benefits Decisions

Health & wellbeing

Boards

CCG Governing Body

CCG Governing Body

CCG Governing

Body

ILINKS Transformation Programme Board

The eyes of the individual…

The eyes of the health and social care professional…

Summary

The scale of ambition is big, the potential benefits extremely exciting and the result - delivering a vision, which will make a real difference for our population and our

practitioners.

Healthier Lancashire Digital Health Work Stream

Declan Hadley

Digital Health Lead

NHS England (Lancashire) Local Area Team

Healthier Lancashire

Digital Health Work Stream Presented by Declan Hadley

NHS England (Lancashire) Jun 14

78

The case for change

A Digital Health

Ecosystem

What are we trying to achieve?

Better health outcomes

Improve the experience of care

Improve efficiency

What changes are we proposing?

Increasing digital literacy

Sharing digital records

Building a partnership for

connected health

Who will be involved?

Citizens & Professionals

Commissioners & Providers

Industry & Academia

How will we know we’ve done it?

Digitally empowered Citizens

Digitally engaged workforce

A supportive digital ecosystem

Project Overview

Shared Records Platform (HIE)

Personal (Life-long) Wellbeing Record

Commercial Partnerships

Voluntary Sector

Social Enterprises

CharitiesFamily & Friends

Personal Fitness

Assistive Technology

Mobile Apps

Remote Consultation

Remote Monitoring

Social Services

Hospitals GP Practice Ambulance Research

Tier 1 Sharing – Public Sector, secure, relevant & proportionate

Tier 2 Sharing – Individually owned & shared on request

Share

Empower Enable

Digitally

Pan-Lancashire Development work

Risk profiling

Planning

Predicative Analytics

Population Health

Big Data

Digital Health – The Mi Programme

Dave Horsfield

Mi Programme Manager

Liverpool CCG

Digital Health: The More Independent Programme

26 June 2014 NWC AHSN EcoSystem

dave.horsfield@liverpoolccg.nhs.uk

Who is ?

• Consortium led by LCCG and funded by Government Technology Strategy Board

What does Mi do?

Community

Smart Economy

Technology

Innovation & Development

Technology – towards self care

• Telehealth

• Telecare

• New technology

• Retail & Advice

• Pathway Development

Community

• Community Champions

• Digital Champions

• Digital Hubs

• Active @ 60

• Livetime Team

• House of Memories

• Federated Membership

Economy

• Liverpool Vision eHealth Cluster

• ERDF Funding

• H2020

• EU Reference Site

• SME Engagement & ‘Hack’ Days

Innovation & Development

• Technology Development & Sensors

• Brainport, Eindhoven

• Person Held Record (PHR)

• Apps – NML/Digital & Social Inclusion

• EPG

• Insight

• Service Design

• ECDL for AL

Mi Activity

Questions to the Panel

Lunch Break (1 hour)

Eat More Chips!!

Julian Bradwell

General Manager

Proteus Digital Health UK Ltd

Every Thing is Going Digital… Things on The Internet

2000 The Internet on Things

Now The Internet is The Thing

2010

Familiar Business Models Fundamentally Changed

Will Health Care Be Any Different?

THE WORLD’S FIRST INGESTIBLE SENSOR

CE Marked and Available to Use Without Restriction on Age or Medical

Condition

Digital NDA Ingestible Sensor approved as medical device - Unlimited use by patients ingesting up to 30 sensors per day Approval pathway agreed by agency leadership for adding sensor to existing drugs - No additional safety or efficacy data required - No bioequivalence data required for similar formulation - Approval standard: manufacturing data package (e.g., stability) - Opportunity to shorten timeline for future products Pathway confirmed in meetings with agency review staff on specific digital medicines Initial indications favorable for similar path in China and Japan

Developing Use Cases In Three Care Settings

Hospital

Home & Community

GP Surgery

GP Surgery • Enable physician data gathering • Monitor adherence, activity • Make correct prescribing decision • Slow progression of disease • 2 week use case

HOSPITAL • Quality: enable daily panel triage • Check on adherence, lifestyle • Prevent re-admission in 30 days • 45 day use case

HOME • Enable family collaboration and teamwork approach • Monitor adherence, activity • Slow progression of disease / therapy • 90 day plus use case

54% of Previously Uncontrolled Hypertensive Patients Controlled

Within Two Weeks

All patients with a history of uncontrolled hypertension 2 week system use-case with integrated blood pressure measurement on Day 14 Data from 164 patients

Need Further Testing 10% (N=17) Missing BP measurements or less than 6 days of use

Controlled with Therapy 54% (N=88) Controlled Hypertensive Systolic BP <140 mmHg Diastolic BP <90 mmHg Adherence>=70%

Need Adherence Support 13% (N=21) Adherence<70%

Need New Therapy 23% (N=38) Uncontrolled Hypertensive Systolic BP >=140 mmHg or Diastolic BP >=90 mmHg Adherence>=70%

Powerful New Metrics, Unprecedented Insight

Circadian Pattern Based on Posture Medication Taking Behavior

Supine Sitting Standing Patch not worn

Circadian Pattern

Time of Day

Da

ys

0 2 4 6 8 10 12 14 16 18 20 22 24

10

20

30

40

50

60

Pill Taking Behavior

Time of DayD

ays

0 4 8 12 16 20 24

10

20

30

40

50

60

0 1 2Pills Taken in Day

Da

ys

Taking Adherence

0 2 4 6 8 10 12 14 16 18 20 22 24

0

20

40

60

80

Time of Day

De

gre

es

Average Circadian Pattern (+-std)

0 4 8 12 16 20 240

5

10

15

20

Time of Day

# P

ills

Timing Adherence

*

*

*

Dose Taken

Patch not worn excluded session from %

Data for 84-Year Old with Mild Dementia Reveals His Stable Activity and Medication Pattern Son Now Knows This and Checks In Only When Needed

Circadian Pattern

Time of Day

Da

ys

0 2 4 6 8 10 12 14 16 18 20 22 24

5

10

15

20

25

30

35

Pill Taking Behavior

Time of Day

Da

ys

0 4 8 12 16 20 24

5

10

15

20

25

30

35

0 5Pills Taken in Day

Da

ys

Taking Adherence

0 2 4 6 8 10 12 14 16 18 20 22 24

0

20

40

60

80

Time of Day

De

gre

es

Average Circadian Pattern (+-std)

0 4 8 12 16 20 240

2

4

6

8

Time of Day

# P

ills

Timing Adherence

Data for 90-Year Old with Mild Dementia Reveals Unstable Activity and Medication Patterns Son Follows Up Frequently to Make Sure His Dad is Doing Okay

Circadian Pattern Based on Posture Medication Taking Behavior

*

Dose Taken

Patch not worn excluded session from %

*

*

Supine Sitting Standing Patch not worn

Enables Interventions Driven By Real World Data

Proteus Provides Opportunity for Benefit In Numerous Areas

Medicine optimisation

Realise value from prescribed medications

Goals Reached with fewer drugs = Reduced cost

Reduced overprescribing and inappropriate poly pharmacy

Less Meds Wastage

Reduced unnecessary escalation to more expensive drugs

Optimisation of primary care service use

Reduced Appointments with Health Care Professionals & usage of NHS services

Reduced monitoring

Enables focus to remain on right meds

Collaborative experience for patient and provider of care.

Link to current packages of care by monitoring real time behavioural patterns bringing a sense of ‘security’ and support to patients careers and HCPs.

Provide motivation to a patient via encouragement and reinforcement of positive behaviours

Personalised medicine –individually tailored management

A Time to Eat More Chips ?

Sumit K. Nagpal

President & CEO

Alere Accountable Care Solutions

Alere

Breakout Sessions

Next Steps

Dr Liz Mear

Chief Executive

North West Coast Academic Health Science Network