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Supporting Self-Management & Self-Care
Tuesday 23 June
#selfmanagement
Welcome & Introduction
Deborah EvansManaging DirectorWest of England AHSN
#selfmanagement
10:20 - 10:40 Setting the Scene The Health Foundation
10:40 - 11:00 Supporting Patient Independence in North
Somerset
North Somerset Community Partnership
11:00 - 11:30 Refreshments and Networking/ 1:1 partnering/Exhibition area
11:30 - 12:00 Building programmes for technology enabled
supported self-care
Philips Research
12:00 - 12:25 Company introductions
12:25 -12:45 ‘Diabetes: mHealth – Self-management in a
digital world‘
West of England AHSN
12:45 - 13:45 Lunch & Networking/1:1 partnering/Exhibition area
Programme
13:45 - 14:05 Patient Decision Aid Case Study West of England AHSN & Bayer
14:05 - 14:25 Brain in Hand Case Study Brain in Hand
14:30 - 15:30 Q&A panel debate
15:30 - 15:55 Company Introductions
15:55 - 16:00 Wrap up and close
16:00 - 16:30 Opportunity for Networking/1:1 Partnering/ Exhibitions
Programme
Supporting people to manage their own health and careAlf CollinsClinical Associate in Person Centred CareHealth Foundation Visiting Professor in Person Centred Care, Coventry University
#selfmanagement
We face unprecedented challenges
People who live with LTCs face multiple challenges (and make daily
trade-offs)
See (for instance):• ‘This does my head in’- an ethnographic study of people who live with diabetes: http://www.biomedcentral.com/1472-6963/12/83•‘Treatment burden/minimally disruptive healthcare’ literature: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0125457
The system also faces multiple challenges
Challenge 1Multimorbidity
Cost rises exponentially with number of conditions
Challenge 2. Fragmentation
10% of population
25% of population
Challenge 3. Approx 35% of the population has low
or no confidence to self manage
Self management is usual care
Hours with NHS / social care professional = 3 in a year
Self management = 8757 in a year
Challenge 4We have a reactive, biomedical, disease-
centric, hospital centric, unaffordable system
The House of Care: proactive and person-centred
Engaged, informed
individuals & carers
Engaged, informed
individuals & carers
CommissioningCommissioning
Organisational & clinical processes
Organisational & clinical processes
collaborative care and support
planning
collaborative care and support
planning
Health & care professionals committed to partnership
working
Health & care professionals committed to partnership
working
Care and support plans and care and support planning
Care plans- outputs not outcomes
The House of Care in value to people with LTCs:
The House supports National Voices ‘I’ statements
My goals/outcomes e.g.• All my needs as a person were
assessed and taken into account.
Communication e.g.• I always knew who was the
main person in charge of my care.
Information e.g.• I could see my health and
care records at any time to check what was going on
Decision-making e.g.• I was as involved in
discussions and decisions about my care and treatment as I wanted to be. Care planning e.g.
• I had regular reviews of my care and treatment, and of my care plan.
Transitions e.g.• When I went to a new
service, they knew who I was, and about my own views, preferences and circumstances.
Emergencies e.g.• I had systems in place so
that I could get help at an early stage to avoid a crisis.
Engaged, informed individuals & carers
Engaged, informed individuals & carers
CommissioningCommissioning
Organisational & clinical processes
Organisational & clinical processes
collaborative care and support planning
collaborative care and support planning
Health & care
professionals committed
to partnership
working
Health & care
professionals committed
to partnership
working
Measuring success
Dorothy
1. How do we make sure thatthe system puts Dorothy first? In
everything it does? Always?
2. What is the system trying to achieve?
Primary purpose: the system should support Dorothy to develop the
knowledge, skills and confidence to manage her own health
Eg: The Patient Activation Measure•A 13 item tool that measures knowledge,skills and confidence•4 levels of activation
10% of population
25% of population
Approx 35% of the population has low or no confidence to self manage
People at low levels of activation tend to:
• Feel overwhelmed with the task of managing their health
• Have low confidence in their ability to have a positive impact on their health
• Not understand their role in the care process• Have limited problem solving skills• Have had a great deal of experience with failure in
trying to manage, and have become passive with regard to their health
• Say they would rather not think about their health
As compared to people at low levels of activation, people at higher levels tend
to:• ‘Be engaged’
– Come prepared– Ask questions– Make decisions– Have less unmet needs (nb inequalities)
• Have improved clinical outcomes (including mental health)
• Enjoy an improved quality of life • Use less healthcare resource• Feel satisfied at workWhy Does Patient Activation Matter? An Examination of the Relationships Between
Patient Activation and Health-Related Outcomes. Jessica Greene and Judith H. Hibbard Journal of General Internal Medicine, published online Nov. 30, 2011
Activation as a mediator of other indicators
Tailored interventions can support people on their journey of activation
Thus tailored interventions improve all other ‘downstream’ indicators
People with Lower Activation Associated with Higher Costs; Delivery Systems Should Know Their Patients’
‘Scores’
Build the House
Engaged, informed
individuals & carers
Engaged, informed
individuals & carers
CommissioningCommissioning
Organisational & clinical processes
Organisational & clinical processes
collaborative care and support
planning
collaborative care and support
planning
Health & care professionals committed to partnership
working
Health & care professionals committed to partnership
working
For Dorothy
www.personcentredcare.health.org.uk
Alf Collins WEAHSN, June 2015. Twitter: @alfcollins
Supporting Patient Independence in North Somerset
Jane Impey and Caroline Sawyer North Somerset Community Partnership
#selfmanagement
Wi-Fi Network - Public Wi-FiNo code required
Key Note Address
Cees Van BerkelDirector of InnovationPhilips Research
#selfmanagement
Wi-Fi Network - Public Wi-FiNo code required
Slides have been emailed to you separately as a PDF
Company Introductions
#selfmanagement
Wi-Fi Network - Public Wi-FiNo code required
Steve Treadwell PhD Computer Communications
Who we are
Specialise in websites and online services for Primary Care organisations
In business for over 10 years Have processed over 2 million online patient
requests for GP Practices and Health Centres
The problem
Reducing demand on Primary Carewhile:
– Improving patient satisfaction– Improving practice efficiency
Our approach
Give more ownership to the patient Essential to be topic specific3 Tier Filter1.Guide patients to solving their problem
themselves2.Then, use online requests where possible3.Finally, direct them to the most appropriate
clinician
Decision Tree
A series of simple questions, topic specificResults in:
– The patient dealing with the issue themselves– or, completing an online form– or, advising that they need to see a
professional.
An example: Renewing contraception
Patient self-assesses their risk online Enters their own blood pressure readings Decision tree decides whether:
• Appointment required with a practice nurse• or their prescription can be renewed without
visiting the practice
Wide range of decision tree topics
Asthma reviews Hay fever Back pain BP monitoring Referral requests Sick notes And many more..
Presented by Janet Jadavji, CEO and Founder, YECCO
Mobile Solutions for Supporting Self-Management & Self-Care
Digital Inclusion- in Leeds
Participant YY, 58, said: “It’s great because you can have conversations with people who have had the same experiences as you and most importantly it’s fun.”
Participant XX, 73, said “I think it’s wonderful and has made a real difference in helping us connect with each other. I’d never used an iPad before, some of us are better with technology than others but we all support each other, come in for a cup of tea and learn together.
[email protected]+44 203 176 6840www.yecco.co.uk
@teamyecco
www.facebook.com/yecco
www.linkedin.com/company/yecco
PainSenseTwo Digital Assets for an Integrated Digital Pathway
for Persistent Pain(Pain Toolkit App and Pain Management Plan App)Commissioned by NHS England with SBRI Funding
Supported self-care – linking smartphone basedself-care apps to GP systems• Proven interventions- delivered digitally, Integrated clinically,
Integrated technically = Digitally enabled service improvement
5M people with persistent pain present to health care every year in the UK. Most are managed with analgesics including opioids , or referred
to medical specialists … now viewed as mainly ineffective high cost, low value interventions, cause dependence and fail to improve health .
IASP stresses pain is a disease of the person, requires effective interdisciplinary care, graded fitness programmes, medicines
management and CBT focused self management skills. This is neither generally delivered nor available. Our proposal, Pathways through
Chronic Pain will use integrated digital resources to make the recommended treatment available to all those who need it
Pain Toolkit App
Assessment Tools:
Health Need Assessment, Body Chart, DoloTest and Self Efficacy PSEQ Reports.
With the Pain Toolkit app patients learn more about:•Accepting pain so you can begin to move on the pain cycle’ – and how to reverse it.•Pacing and relaxation skills.•Learning to go easy on yourself.•Setting goals and overcoming setbacks.•Get involved - building a support team.•Learn to prioritise and plan out your days.•Be patient with yourself. •Learn relaxation skills. •Stretching & Exercise. •Keep a diary and track your progress. •Keeping it going...practising these tools.
Pain Management Plan App
The Pain Management Plan App takes this further, with a set of practical tools for self management that include:•Target setting tools and ways to stay on track. •Pacing, prioritising and goal setting including lots of tips on helping you deal with anger, frustration, moods and anxiety along with much more besides. •The Pain Management Plan app also allows clinicians to access patient information through the InHealthcare platform to generate reports on patient progress, and utilise the insights gained to work more effectively with patients
PMP Reports Goal Setting, Targets etc. Case management / assessments.
N3, Integration & Heath EconomicsN3 Secure NHS Commissionable Service•Integrated technology enabled pathway•Supported by e-Learning•Clinical Pathway Focussed•Significantly improves outcome for patients•Data collection
at source
Health Economics•Cash releasing savings from reduced prescribing (up to 20%)•Reduced hospital costs (27% reduction in onward referrals to secondary care)•Reducing primary care activity (50% reduction in hospital consults)•80% more patients saying personal goals in managing pain were met
Source: North Kirklees Health Economy
Enabling self care ADI-Health training
partners Patrick Hill (Clinical Health Psychologist) and Eve Jenner (Specialist
Physiotherapist) have extensive pain management experience and have worked together for 7 years
• One full day Pain Management Plan workshops are provided for a wide range of clinicians experienced at working with patients with persistent pain.
• Two day training introduces health & social care professionals to the techniques they need to engage and support people to self-manage persistent pain and other long term conditions
• Bespoke training programmes can be arranged for whole services or teams
• For further details and dates of forthcoming programmes, please email [email protected]
02/16-1142365-0000 Date of Prep Feb 2015
Why MSD
67
In the UK, MSD places great importance on the development of service solutions which add value
to the NHS. We currently provide a diverse portfolio of service offerings that are adding
value to the NHS while transforming MSD into a true healthcare company
MSD is a global healthcare leader working to address unmet health needs. We provide innovative medicines, vaccines and animal health products to help improve health and well-being. We work with customers in 140 countries to deliver broad-based healthcare solutions.
Why MSD
68
Our Healthcare Services offer Solutions Beyond the Pill
1998-present
We have developed an LTC clinical change management programme proven to support Primary Care to implement NICE guidelines and improve confidence of care across their multidisciplinary teams
We support the patient directly through our self-care service that activates patients through Health Coaching while keeping them out of hospital through Remote Monitoring
2008 -present
2013 -present
MSD provide informatics solutions that impacts 33% of the UK practice population enabling Health professionals turn information into insight
Insight through Analytics
Enabling Patient
self-care
Changing Clinical Behaviours
more about……
Our Remote Patient Monitoring service has helped change the lives of acutely unwell patients with long-term conditions. Closercare uses the latest monitoring technology combined with patient coaching techniques to embed patient self-care. We assess impact on the patient by using the PAM algorithm.
www.closercare.co.uk
Remote Monitoring
Care Integration
PatientOptimisation
ProfessionalEngagement
Our approach: whole system
Closercare Case Study
Harrow CCG, Heart Failure and COPD
12/16-1139624-0000 Date of Preparation December 2014
Overview
• Patient monitoring began in February 2014 with the objectives:– Establish an active care plan for patients with COPD or HF monitored from 1st
February 2014– Reduce COPD/HF related avoidable admissions– Support patient confidence in self management, independence and quality
of life– Support community service productivity by reducing travel time of nurses
and frequency of visits
• 134 patients monitored - 64% COPD- 36% HF
Closercare-Harrow Outcomes (cost benefit)• Calculation of net savings and Return on Investment
– Where recruitment is targeted to patients with >1 cardiorespiratory admission in the previous 12 months (n=61)
– Monthly cost of service monitoring £181 (monitoring one patient for one month)
Mean monthly non-elective cardiorespiratory admission costs, based
only on patients with ≥1 cardiorespiratory admissions in the 12 months before
intervention (n=61)
Criteria Gross Monthly Cost Saving
Net Monthly Saving Return on Investment
Patients with at least 1 cardiorespiratory
admission in the year before closercare (n=61)
£468 £287 159%
Results
For more information:
• www.closercare.co.uk• 01992 455400• Email: [email protected]
Reference: Telehealth in Harrow, Early Findings & Cost Benefits; David Barrett, University of Hull, September 2014
Technology for independence
© Inclusive Media Solutions LTD 2015
Who we are?
• Founded in late 2013 by William Britton• PGCE – SEN post 16 lecturer teaching ICT, Media and graphics• Assistive Technology specialist • BA (hons) – Video Production
• Accolades Start up of the year 2014 finalist, North Somerset 2015 ‘making a difference’ business award, BBC Radio 4 the Doctors Dementia
• Our current clients include Brandon Trust, South Gloucestershire Council, North Somerset ‘Think Autism’ Project, Weston College, SGSC College, Knightstone Housing Association and Macintyre Charity.
About us!
“Inclusive Media Solutions LTD believe mobile technology can provide solutions to independence for people with
cognitive disabilities”
© Inclusive Media Solutions LTD 2015
Who we are?
• Cognitive difficulties such as Learning Disabilities, Dementia and associated difficulties
• Daily struggle to achieve tasks independently• This support is currently provided by people• This comes at a great cost to the Government, Educational providers, NHS,
Local authorities and many other organisations and costs billions• Autism costs ‘32bn a year’ in the UK – BBC News (http://www.bbc.co.uk/news/health-
27742716)• Dementia care costs the UK £26.3bn a year – Alzheimer's Society
(http://www.alzheimers.org.uk/dementiauk)
• These will continue to rise!• Why the rising costs of social care cannot be ignored – BBC News
(http://www.bbc.co.uk/news/health-31001151)
The barriers to independence people with cognitive difficulties face
© Inclusive Media Solutions LTD 2015
Who we are?Our Solution
The worlds largest library of
instructional videos for
people with cognitive
disabilities
Our unique QR code system
enables users to scan ANY item with a smart device and it
plays a video of how to use it
Q-View“I think Q-View is brilliant, I was really encouraged and thrilled to see such things existed because I am very computer literate myself… as I progress, not deteriorate, they will be very valuable and important to me to help remind me how to do things because we forget simple things”
Dr Jennifer ButeDiagnosed with Dementia
“Q-View has been amazing! My 19-year-old son has used a number of the videos; he follows them with ease and is able to operate the iPad without support. The pride he feels in completing the task is evident for all to see in the huge smile when he presents his drink/snack”
Penny Cutbill – Parent CarerSon with Down syndrome
“Q-View has been a valuable tool for both in class for my independent living sessions and for the students to use independently during their time staying residentially. Using Q-View frees up staff that would normally spend time overseeing students whilst giving students a sense of ownership of their independence. The visual impact is hugely important to our students who find following written instructions difficult”
Leigh MurrayAutism Specialist Tutor – Weston College
© Inclusive Media Solutions LTD 2015
New subscribers receive a staff
training session
Ensure all staff have the skills and confidence to support their
patients
Staff Training
Who we are?Supporting our products
0117 205 0654
Available during the working
week to answer any questions
and support our products and
services
Over the phone
YouTube videos
We also provide free online ‘How to’ videos, many clients and staff
use these to refresh their
memory and/or show new
patients – cost effective
Online
© Inclusive Media Solutions LTD 2015
Reports
Monthly tracking data provided to clients, if
required these can be put into presentations and/or graphs
showing outcomes
Data tracking
Technology for independence
Thank you for listening
© Inclusive Media Solutions LTD 2015
Challenge Launch Diabetes: mHealth: Self-Management in a digital world
Elizabeth Dymond Deputy Director of Enterprise and Translation West of England AHSN
#selfmanagement
AHSN’s Mission
• Building a culture of collaboration and partnerships
• Speeding up adoption of innovation into practice
• Creating wealth through co-development testing and early evaluation and spread of new products and services
Driving Innovation by making the NHS a Lead Customer
Challenge led approach
AHSN Challenges R4H
National scene
“We want to see patients and carers involved in decisions about their care, receiving appropriate structured education to support self-management, having more control and managing their own health, care and treatment.” Act for Diabetes 2014 NHS England
Provide staff and patients with access to high-quality tools for structuring and recording care-planning and shared decision-making. Kings Fund 2014
The NHS Five Year Forward View committed to developing a National Diabetes Prevention Programme. A delivery group from NHS England, Public Health England and Diabetes UK is currently leading the design of the programme.
Challenge ProcessSoft Start Innovation
Content slide heading
Our Members
• “By working with the AHSNH we would be able to access technologies and providers that otherwise we would not be aware of but neither would we have the internal resource to procure.” (South Gloucestershire CCG)
• “Together we are leading on redesigning the clinical pathway for our patients with Diabetes and are consequently very interested in this project.” (BANES CCG)
• “I was interested to read about the diabetes mobile and web based work in the West of England AHSN newsletter. We would be keen to be involved in testing and evaluation of products if you are looking for this.” (North Somerset CCG)
Opportunities for company applicants
Your innovative product will be used & evaluated in a real world setting.
You will submit a quotation rather than a tender as we are looking to evaluate a number of innovative solutions with the costs of each one less than £50,000
You will receive a report on the evaluation which will also be shared with West of England AHSN members who commission and provide healthcare services
across our region with a population of 2.4 million people.
You have the opportunity to develop your products in line with commissioner and provider requirements.
Increased potential for sales in West of England healthcare providers.
Increased potential for national sales as the 15 AHSNs across England share
case studies.
Registration on national portals to receive alerts on further relevant public sector procurement opportunities.
What if ……healthcare records were shared
between the person with diabetes and other people
and services that the person wishes to share
that record with? Viewing, inputting and editing rights
are controlled by the person with diabetes and records are available in
real time.
What if ……healthcare records were shared
between the person with diabetes and other people
and services that the person wishes to share
that record with? Viewing, inputting and editing rights
are controlled by the person with diabetes and records are available in
real time.
What if….. services were set up so that
healthcare professionals and patients can email,
text and phone each other?
What if….. services were set up so that
healthcare professionals and patients can email,
text and phone each other?
What if ……services were truly joined up to be person-centric and personalized to account for many
people with diabetes having
another long term condition?
What if ……services were truly joined up to be person-centric and personalized to account for many
people with diabetes having
another long term condition?
What if ….we can enable every citizen to self-care in their
own way to the benefit of their health,
both physical & mental?
What if ….we can enable every citizen to self-care in their
own way to the benefit of their health,
both physical & mental?
Diabetes
139 per cent more likely to be admitted to hospital with angina 94 per cent more likely to be admitted to hospital with
myocardial infarction 126 per cent more likely to be admitted to hospital with heart
failure 63 per cent more likely to be admitted to hospital with a stroke 400 per cent more likely to be admitted to hospital for a major
amputation and 817 per cent more likely to be admitted with a minor amputation
272 per cent more likely to be admitted to hospital for renal replacement therapy (ESKD)
http://www.hscic.gov.uk/nda
mHealth
• ….also known as mobile health, covers medical and public health practice supported by mobile devices
• Mobile phones• Patient monitoring devices• Apps• Wearables• Health information• Medication reminders
Self-Management
99% of diabetes care falls to self-management.
Shared decision making: clinicians and patients working together to
– clarify treatment, management or self-management support goals,
– share information about options and preferred outcomes
to reach mutual agreement on the best course of action
Key Dates 2015
• 23rd June – Launch• 22nd July – Deadline for submissions• 27th July – Prepare shortlist – in scope?• 31st July – Review panel & interviews• August – Due diligence• September – Project set-up• October onwards – Projects & evaluation go
live
Application Process
Our Application Process is in two stages:If you are not already registered on the MultiQuote portal, please contact our procurement partner, Royal United Hospitals Bath Foundation Trust to register on the portal and receive further documents and [email protected] You will submit a quotation and complete a short application form as we are looking to evaluate a number of innovative solutions and their cost implications; indicative pricing will aid the evaluation process. Responses are to be submitted via the MultiQuote RFQ by 17:00 hrs 22nd July 2015.
Patient Decision Aid Case Study
Sarah White Karen Cooper
Date of Preparation June 2015. L.GB.NPM.06.2015.11613
Project Development
NICE CG180
Quality Improvement Team develop the project in 3 phases
In conjunction with key stakeholders we develop a range of products
Patient Decision Aid is created using NICE PDA
Working with Industry is a key objective
Joint Working Agreement is developed
The Rationale for Joint Working
Initial MEGS approach
Why is there a need for Joint Working?
Evolved (and evolving) project support
Supporting resourcing of Don't Wait to Anticoagulate in order to drive the project forward
The Patient Decision Aid PrototypeBooklet with AF information and FAQs
Risk Score Sheets
Used by Healthcare professionals and patients
Tested by 11 Innovator Practices
PDA Testing in Phase 1
Tested in 11 Innovator practices over 3 months
Task and Finish Group
Task and Finish – Learning from FeedbackPatient Feedback and Healthcare Professional Feedback
Relative Risk sheets
Numbers Needed to Treat (NNT)
Risk over time
Adding new OAC
Medical Communications Expertise RequiredFurther development needed to review and redefine the DWAC products
Support and expertise is required
Initial meeting with Medical Communications Experts
Now in tendering process to create the web portal for patients
Next Steps
Joint Working has been extended to cover Phase 2 facilitating the roll out of DWAC over 83 practices in Gloucestershire CCG
PDA will be available online for all AF patients to benefit from
By working together we aim to prevent 200 strokes in AF patients across the WEAHSN area, through empowering patients to make informed decisions about their anticoagulation by using this Patient Decision Aid
Brain in Hand Case Study
Andrew Stamp and Tom PittwoodBrain in Hand
#selfmanagement
114
An Information System
115
• Description• History• Opportunity• Enterprise Model
Guided independence in day-to-day livingWhere decision-making and response is compromised
• Smart technology: phone & cloud
• Patient-Centre:User driven + help on demand
• Grounded in Clinical practiceSupports established approaches
• Enables:• Users; and• The people who help them; and• The funding organisations 116
Description
How does Brain in Hand help?
117
Personalise activities and & coping strategies
On your phone in your pocket
Instant help “on the go”
Data for continual improvement
Mood monitoring
Description
16© Brain in Hand 2013
Online diary syncs with the smartphone or tablet
118
Description
18© Brain in Hand 2013
Mentor support - help when you need it most
• Alert when reds pushed or 3 ambers in a row
• Alert is by text and dashboard
• Mentor - call, text or meet
119
Description
120
Timeline• Alexander Project 1997-2009
• Home Intervention Programme (Alexander Stamp)• Clinically Supervised, ISO9001 quality standard
• Southampton Childhood Autism programme (SCAmP) 2000-2006• Peer-reviewed Research
• Autism Diagnostic Research Centre (2007)• Spinout from Southampton University• Advanced Interdisciplinary Clinic• Funded by Roger Brooke Charitable Trust• Registered Charity
• Brain in Hand Ltd (2009)• Seed Funding from Roger Brooke Charitable Trust • Commercial Company• £1.2 million raised up to end 2014
History
Mental HealthAnxiety
BPDAgeing
MCIAlzheimer
(early stage)Brain InjuryABI
StrokeEpilepsy
Autism
Asperger/HFA
………a much bigger opportunityOpportunity
122
Kings Fund:Existing approaches no longer sustainable…….….but there is a technology opportunity
• By 2018 3 million people with three or more long term conditions • 1 million extra care workers needed over the next 10-12 years; • Requires step changes in productivity.
But
• New medical and information technologies:• enable different ways of working, including • enhanced roles for patients
• Most have mobile access to the web
Source: The Kings Fund: NHS and social care workforce: meeting our needs now and in the future?
Opportunity
123Source: Ernst & Young
http://www.ictliteracy.info/rf.pdf/mHealth%20Report_Final.pdf
Can Technology Help?
Opportunity
3© Brain in Hand 2013
SAP Specification
• Create a patient-centered model of care
• Equip patients and caregivers with tools to use on the go
• Connect patients and caregiversto the medical community in the cloud
124
(http://www.forbes.com/sites/sap/2013/04/09/3-ways-technology-can-make-a-dent-in-autism-research/)
Louis Bridgman, Media Relations & Strategic Industries, SAP June 2013
Opportunity
Enterprise Model• Licensed Implementation (Annual Charge)
• “Enterprise Solution” not “an App”• Clinical benefits• Social benefits• Productivity and financial benefits
• Technical Compatibility• Existing Information Systems• All major mobile platforms• IG Compliant
• Demonstrate “Real-World” Efficacy• Collaborative Trials• BiH Mentoring Service
• Effective Implementation• People System• Proven Path• Operating Standards• Review and Accreditation
• Target organisations where change is imperative: Not just NHS• Social care• Education • Employment• Rehabilitation
125
27
Enterprise Model
27
Implementing People Systems:The critical factor
126
Enterprise Model
27
Implementing People Systems:The critical factor
127
Enterprise Model
Current Deployment
• Tavistock and Portman NHS Trust• Leeds and Yorks NHS Trust• MenCap (6 sites)• National Autistic Society• Dame Hannah Rogers Trust• 3 x Autism Alliance (Wirral, Burgess, Norsaca)• FE Colleges
Totton College, Fareham College, Sussex Coast College, Petroc College• 5 x Secondary Schools• Hampshire County Council• Doncaster (mental Health)• Warwick• Solihull• 3 Universities
128
27
Enterprise Model
27
129
June 2015 News
Q&A Panel Debate
#selfmanagement
Questions from the Panel
What conflicts or difficulties come up
with working so closely with
Pharma Industry
What conflicts or difficulties come up
with working so closely with
Pharma Industry
How have patients been
involved in developing and
shaping the Patient Decision
Aid
How have patients been
involved in developing and
shaping the Patient Decision
Aid
How easily do patients & staff move to shared
decision making?
How easily do patients & staff move to shared
decision making?
What are the issues?
How do we make it easier for everyone?
What are the issues?
How do we make it easier for everyone?
Development of new technology based
approaches to care carries risk
If the public sector is too risk averse to support
development, should we be bringing in the private
sector?
Development of new technology based
approaches to care carries risk
If the public sector is too risk averse to support
development, should we be bringing in the private
sector?
Research by the Kings fund suggests that with current approaches to care a million more carers will be needed
in the next 10 years. This is unaffordable, so would you:
- raise the bar so that fewer people qualify for care
- adopt new approaches?What do you think is happening at
the moment?
Research by the Kings fund suggests that with current approaches to care a million more carers will be needed
in the next 10 years. This is unaffordable, so would you:
- raise the bar so that fewer people qualify for care
- adopt new approaches?What do you think is happening at
the moment?
Company Introductions
#selfmanagement
Patient INR self-testing using the Roche CoaguChek XS
Matt Marshall – InhealthcarePhil King - Roche
Who are NHS Health Call?
• Joint venture between Inhealthcare Limited and County Durham and Darlington NHS Foundation Trust.
• Joined forces in 2013 following the successful roll out of a number of digital health services.
• The vision is to help redesign care pathways across the UK, whether that is providing warfarin patients greater freedom to self-test from the convenience of their own home or helping health professionals manage undernutrition at scale.
What is Health Call INR monitoring?
An automated phone call system is used to collect the INR reading
Thank you. The INR reading you entered is 2.0. If this is correct,
please press 1. If this is not correct, please press 3.
Please enter both digits of the INR result using the star key on
your keypad as the decimal point. When finished, press the hash key. For example, if your INR
result is 2.5, please press 2 star 5, followed by hash.
NHS Health Call provide warfarin services across County Durham
• 2,648 registered warfarin patients– Any Qualified Provider (AQP) funded
• Service locations– Outpatient clinics– Satellite clinics– Home visits for the house-bound– Telehealth (self-testing)
• Serviced by– Anti-Coagulation Nurses (Band 6)– District Nurses (Band 5)– Healthcare Assistants (Band 3)– Pathology Assistants (Band 3)– Administration (Band 2)
Existing warfarin patients were recruited onto an INR self-testing study
• Number of Patients• Referred: 200
• Patients withdrawn: 17• 2 moved area• 4 died (non-related
reasons)• 5 had difficulty due to
frailty• 5 stopped warfarin• 1 returned to clinic
Patient feedback was almost universally positive
• Some patient responses on the perceived benefits of the service:
• Reduced time attending clinics• Less impact on work disruption
and money lost from taking holiday or no pay to attend clinic
• Money saved from travel costs and parking
• Able to test whilst working away from home or on holiday
• Flexible around me
Clinic staff were also very supportive of the service
Patients across both cohorts saw significant improvements in their TTR
compared with pre-study TTRINR Self-Testing
Cohort 1INR Self-Testing
Cohort 2
Number of patients 100 100
Recruitment Selection CriteriaNarrow
Most were hand-picked by staff
BroadMost were recruited from
ads
TTR - 6 months before study 60.4% 59.0%
TTR - 3 months before study 58.9% 59.0%
TTR - 3 months after study 72.8% (+13.9%) 71.0% (+12%)
TTR - 6 months after study 74.4%(+15.5%) 75.0% (+16%)
Summary• Patient-centred: It is a simple and efficient solution that has taken
away the need for patients to travel to clinic.• Safe: Clinicians were involved in designing the system and
processes.• Increased patient satisfaction: Fewer trips to clinic mean less travel
expenses and less disruption to daily life.• Increased clinic capacity: Fewer patients unnecessarily attending
clinics should create capacity for those more complex cases who require face-to-face care. At scale, this will help address the problem of INR clinics that are currently bursting at the seams.
• Improved outcomes: Improved INR control means patients have a reduced chance of stroke or haemorrhage thus reducing demand on acute services.
Thank you
Visit our website
www.nhshealthcall.co.uk
Follow us on Twitter
@NHShealthcall
Oviva: remote provision of dietetic patient care
June, 2015
COPYRIGHT OVIVA AG 2013-2015
West of England AHSN: supporting self-management and self-care
147
Obesity and its comorbidities are a massive burden to society
Obesity 3rd largest burden to society
2.8% of global GDP (direct and indirect costs)
Drives major comorbidities including diabetes and cardiovascular disease
SOURES: McKinsey Global Institute, 2014; Risk factors for Diabetes and Coronary Heart disease; BMJ; 2006
148
Our approach builds on extensive clinical evidence for remote care in the treatment of obesity
Approach Westenhoefer et
al.
Findings
▪ People adopting “lean habits” have significantly higher chances of loosing and keeping off weight long-term; adopting multiple lean habits is significantly stronger than individual ones
▪ Examples are regular mealtimes, taking time eating, conscious eating and healthy food choices, no “forbidden” foods, regular physical activity
OutcomesAppel et al.
▪ Remote coaching supported by digital tools was as effective as traditional, face-to-face counseling (6 months counseling, 24 months observance period) in a comparative clinical trial
Source: LJ Appel et al., New England Journal of Medicine (2011) 365 (21); N Scheuing, Ernährungsumschau 21.10.2014; J Westenhoefer et al., International Journal of Obesity (2004) 28, 334-335; TA Radcliff et al. J Acad Nutr Diet. Sep 2012; 112(9): 1363–1373.
Cost-effectivenessRadcliff et al.
▪ Telephone based-program had a lower cost, but similar outcomes compared to the face-to-face format
Photo-Food-LogScheuing et al.
▪ Study participants prefer photo-food-log over a food weighing log (86% agree / fully agree)
▪ Photos are accepted over a longer period of time and can be more accurate than food weighing log
149
Face to face dietetic counseling, the gold-standard medical approach for dietary lifestyle change, has shortcomings
The problemLow availability of dietitian for day-to-day challengesLack of accountabilityTime consuming physical meetingsLimited, and low quality, data collection on behavioral change
Traditional approachPrescribed by physicianInfrequent face-to-face meetingsHand-written food and activity diaryLots of scientific facts and tips
150
Oviva’s remote care model drives improved effectiveness through frequent interactions, whilst increasing efficiency
Value proposition▪ Daily tips, motivation and accountability▪ Simple and effective data logging: food with
photos, weight and activity with wireless trackers▪ Efficient for patient and dietitian
151
Value proposition▪ Daily tips, motivation and accountability▪ Simple and effective data logging: food with
photos, weight and activity with wireless trackers▪ Efficient for patient and dietitian
Communication & CRM System – not an app!
Oviva’s remote care model drives improved effectiveness through frequent interactions, whilst increasing efficiency
152
Results for self-paying clients with weight-loss goals
Days between first and last weight log; average weight loss in lbs
SOURCE: Oviva, April 2015, N=62, average starting weight 170 lbs
14-30 31-60 61-120 121-360▪High patient engagement, sending on average 2.9 messages per day▪Good retention rates, with clients spending an average of 16 weeks with Oviva
Our initial outcomes in simple obesity are very encouraging
Other key metrics
On average, Oviva patients lose ~7% of total body weight by 4 months of treatment, and maintain this up to 1 year
153
Superior patient experience
Cost efficiencies
Improvedpatient access
Substantially reduced waiting times Rapid responses to patients’ questions and issues Enhanced patient engagement through daily tailored advice
A multi-cultural and multi-language offering Flexible coverage for any subspecialty dietetic skills gaps No travel or transport requirements, and out of hours service
availability A ~15% saving on face-to-face care; ~35% saving on locum provided
care Lower DNA rates and reduced demand on outpatient clinic space Oviva can help in implementing the latest, cost efficient care
pathways Robust outcome assessments, detailing patient engagement and
knowledge Assessment of patient activation, a key metric for chronic disease
mgmt. Flexible symptom monitoring to allow for early intervention if required
Effective outcome measurement
Source: Oviva expert dietitians and KOLs
Overall, Oviva drives quality, is well established, and integrates seamlessly into standard care pathways
Oviva’s remote model offers four key benefits to the NHS
Overview of DiabetesCareFinder
Jens Birkenheim
FounderXperio Health Ltd
Copyright 2015. Xperio Health Ltd
4 locations
35+ total hours£50+ travel expenses
7 of 9 NICE care processes received
16 diabetes ‘touchpoints’
12 years without an annual care plan
18 month wait for structured education
0 digital ‘interactions’
Copyright 2015. Xperio Health Ltd
Inconvenience of Care
Value to CCGs
SERVICE NAVIGATION
USER ENGAGEMENT
SERVICEINSIGHTS
Copyright 2015. Xperio Health Ltd
Copyright 2015. Xperio Health Ltd
Patient trialApr 2015
Public launchQ4 2015
XH
“This could be a fantastically useful tool to enable people with
diabetes to find the best care near them and ultimately to raise
standards of care”
“Love the site! Great interface and think the
concept is brilliant!”
Copyright 2015. Xperio Health Ltd
[email protected] | @dcarefinder | diabetescarefinder.org
THANK YOU
