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5th June 2013 Agenda

• Solutions4Health – Introduction • Heart Failure • IT & NHS Technology alignment • Partnership & MySelfCare • Telehealth But More Than Usual • Objectives & Outcomes Solutions4Health in Healthcare • Innovative company focused on delivery of high quality and cost-effective healthcare & telehealth services making a real difference to peoples’ lives

• Passionate about fixing health inequalities & accessing all communities particularly the ‘hardly reached’ groups • UK’s largest independent provider of stop smoking & health check outreach services in the UK • Delivering chronic disease self management (CDSM) services across the West Midlands • Technology division providing IT tools for healthcare services & telehealthcare solutions using ‘iTelehealth’ platform National Coverage We provide services nationally to -

Berkshire Bromley Buckinghamshire Camden Coventry Croydon Dudley Gloucestershire Heart of Birmingham Lambeth Medway Portsmouth Sandwell Shropshire County South Staffordshire Stoke-on-Trent Telford and Wrekin Walsall Wirral Worcestershire Wandsworth Offices

• Head Office – Green Park, Reading, Berkshire, UK • London Office – West Wing, St Pancras Hospital, London • London Office – Lansdowne Road, Croydon, London • Regional Office – Hawks Green, Cannock, Staffordshire • USA Office - 77 Water Street, New York City, USA • India Office – Santa Cruz, Mumbai Heart Failure – facts & figures

• Heart failure is more common than most cancers, including breast, testicular, cervical and bowel cancers

• 900,000 people suffer from heart failure in the UK

• Heart failure accounts for 5% of all emergency admissions to hospital (average cost £2,200)

• Heart failure accounts for 1 million inpatient bed days a year - 2% of all NHS inpatient bed days

• 25% heart failure patients are re-admitted to hospital within 3 months

• Heart failure costs the NHS £2.2Bn per year

• 40% of heart failure patients die within 1 year of diagnosis. We know that in healthcare we lag at least 10 years behind virtually every other area in the implementation of IT solutions. We know from a wide range of other services that information technology applications can radically revolutionise and improve the way we do things

Thomas Hendrik Ilves, President of Estonia, Chair of eHealth Task Force – 2012/13 NHS Alignment • High Impact Innovations • Digital First - reduce unneccessary face to face appointments • 3MillionLives – 45% reduction in mortality, 20% reduction in emergency admissions, 20% reduction in A&E visits • NHS Outcomes Framework • Overarching indicator – enhancing quality of life for people with long term conditions • QIPP - LTC Year of Care • Funding Model for 3 Million Lives • Three drivers for care model – stratification, integrated care, self management • Workstream engagement - IT systems for improved LTC Management What is this partnership going to do? • Develop a leading, innovative and proven telehealthcare solution for heart failure patients • Publish service evaluation papers providing evidence of successful service outcomes • S4H and Barts Health agree IPR and Licensing terms & conditions • S4H to market heart failure telehealthcare solution to UK NHS Trusts & other geographies Introducing MySelfCare • Patient monitoring of chronic conditions • Early detection of deteriorating conditions • Self management with clinical support What do you get with MySelfCare? • Remote monitoring of patients ‘vital-signs’ • Patient case manager for clinicians • Patient portal for viewing their own vital signs • Automated warnings & alerts • Setting & managing appointments • Secure online video & audio chat • Text & instant messaging engine • Sharing self-care documents, videos & links

• Supports multi-languages inc. sign language Basic mobile phone • Social media interaction when authorised • On PCs,Tablets,Smart & Basic mobile phones

Smart phone

Service Description

• Patients register with MySelfCare service • Post code and mobile phone number required • Take vital sign readings morning & afternoon • Text messages sent to remind patients to take readings

• Patient’s readings sent to HealthVault secure data storage • HealtVault conforms to NHS Information Governance rules • Patients can add other health readings to HealthVault • Patients own their personal health record (PHR) • Share PHR with clinicians, family, friends, etc

• Patient & Clinicians agree self management & service plan • Links to NHS LTC care plans, education videos, etc • Automated vital sign monitoring with warnings & alerting • Automated symptom/wellbeing questions sent by text msg Service Description

• Users receive control test questions on text/email • Total score & assessment sent to service user • Score is stored into HealthVault as part of health record • Score also displayed on user portal

• User logs onto MySelfCare and studies their readings • User can study the control test assessments in detail • User can use portal to add in health readings manually • User can print off results & questions for Clinicians

• Clinicians & service users agree alert/alarm limits • Service users receive warnings, adjust medication • Service users receive alerts, book clinician appointment • Message received suggests appointment date & time • Can choose visit to video chat Service Description

• Patients book an appointment with clinicians • Patients connect with clinicians over the internet from the comfort of their own home • Fresh readings can be taken & information shared • Consultation notes stored in electronic health record

• Self-management & behaviour change social platform • Program participation in a fun, engaging social environment • Building awareness for self management within community • Encourage young people through groups & role models • Set goals & enter readings through social apps

Standard Telehealth

• Physiological monitoring equipment (e.g. weighing scales, blood pressure monitor, pulse oximeter, etc) • Regularly recording and storing patient’s symptoms & vital signs • Some real time processing of patient data with automated algorithms for alerts/alarms when vital signs go beyond boundaries • Clinically-lead case management and triage process during work hours • No focus on self management MySelfCare adds the following -

1. The first programme in the UK to be accredited by the TSA telehealth code

2. Video chat between patients & consultants/nurses to answer questions, reduce stress & apprehension, & travel times

MySelfCare also adds the following -

3. The first programme to measure outcomes for the specialist nurses – e.g. satisfaction, case load intensity, etc.

4. Self management programme using NHS & Whipps Cross guidelines, tracking patient & carers wellbeing MySelfCare and also adds the following -

5. The impact mobile technology & web tools have on specialist nurse case management function

6. Use of mHealth tools to improve patient and clinician outcomes

Captures medical grade biomedical data from patients and transmits it through a mobile network to client devices (smartphone, tablet, PC, laptop) in the cardiologist's hands Service Objectives & Outcomes o Objective Introduce a telehealth & self management service for heart failure patients discharged from hospital o Location -> Whipps Cross University Hospital o Outcomes • Improve health outcomes for patients across chosen cohort • Reduce hospital admission & re-admission rates • Consultants/nurses more in control of their case loads • Technological innovation introduced into care pathway • Evaluate service effectiveness & offer Heart Failure telehealth solution to NHS trusts & other geographies Choosing the Cohort

Heart Failure • 50 patients with diagnosed Heart Failure • Being discharged from hospital • Criteria 3 ?? • Criteria 4 ?? • Criteria 5 ?? Self Management • Involving people in decision making & problem solving • Developing care plans as a partnership between service users and professionals • Educating people about their conditions & self-management • Motivating people to self-manage using targeted approaches & structured information & support • Helping people to monitor their symptoms & take action when needed • Helping people to manage the social, emotional & the physical impacts of their conditions • Providing opportunities to share & learn from others. Questions What is this partnership going to do? • Develop a leading, innovative and proven telehealthcare solution for heart failure patients • Publish service evaluation papers providing evidence of successful service outcomes • S4H and Barts Health agree IPR and Licensing terms & conditions • S4H to market heart failure telehealthcare solution to UK NHS Trusts & other geographies