1. Miniaturisation – unlocking the future Tabinda Rashid-Fadel QIPP Clinical Pathways Lead 27 th November 2014

2. Technology The last decade has seen tremendous advancement with technologies Communication – mobile phone and intranet New technologies allowing near patient testing - diagnostics Data storage and accessibility – electronic patient records Access to results from central points Global reporting 2

3. QIPP and clinical pathways The use of technology to improve clinical pathways and quality of services and improving efficiencies. Cardiac physiologist – HCS training – technology and device based training and role. Cardiology- use of technology in diagnostics and intervention - procurement, introduction and evaluation of use Sharing the learning from cardiology - BHI with other centres Sharing the opportunities from cardiology in other areas of Specialised commissioning 3

4. ILR project This project has taken an introduction of technology to review the current location of the service and the change in location was able to provide key benefits to patients and providers. 4

5. Pilot - BHI experience NICE guidance 139 – primary care and community – infection control BHI – outpatients on level 5 -treatment room Pilot : 20 Patients received the LINQ device All patients completed a questionnaire Review the resources and capacity from the providers perspective 5

6. Post implant and review Very small scar – 1cm No wound issues Very clean signals One patient has already received a PPM following asystole One patient’s device showed tachy arrhythmia prescribed beta blocker – waiting review 6

7. Remote follow up All patients are able to receive a remote follow up of their device – face to face once a year as per HRUK guidelines Automatic and manual transmissions 7

8. comparative Reveal LINQ Advantage/disadvantage Wound/scar Larger scar and implanted device Small scar – pre loaded injectable device Reduction in complications Price of deviceCheaper device More expensive – new technology Disadvantage Staff required 1x doctor 1x physiologist 2x nurse 1x radiographer 1x doctor 1x physiologist 1x admin Advantage to provider Facilities Specialist catheter lab Outpatient treatment room Advantage to provider and commissioner efficiency 6 per day (2 sessions) 6 per sessionAdvantage to provider Follow upFace to faceremote Advantage to patient provider and commissioner Impact on capacityRequires catheter lab Allows the procedure to be undertaken in outpatients setting Advantage to patient, provider and commissioner tariffAttracts EA03Z single chamber pacemaker or implantable loop recorder device ?Advantage to the commissioner 8

9. ILR - BHI experience New technology Pilot at BHI – within outpatients Agree tariff – EA03Z Elective activity in OP and community hospital – south Bristol Non elective care in MAU/ED – no admission and develop fast track clinic Extended role for physiologist/arrhythmia nurse Supported by patient questionnaire findings, and service redesign 9

10. Project : Optimisation of Devices – maximising benefits A national project currently reviewing the purchasing of high cost devices and their use Main focal points Ensuring best value from suppliers – transparency on pricing Ensuring the reimbursement value back to NHS providers is also transparent and auditable Assurance that patients are getting best value from devices – optimisation 10

11. Cardiac devices – ICD and CRT Physiologist programs these devices and follow up clinics. There is a move towards remote follow up of a number of devices where technology allows this to happen – huge benefits from capacity and patient experience Devices are optimised for energy conservation Devices are optimised for therapy delivery 11

12. Physiology day SCN has supported a physiology day for the south west which has allowed 14 trusts to come together (27 delegates) Reviewed current variation in practice and agreed to formulate a regional follow up protocol for device follow up ensuring optimisation The physiology services are also in the process of obtaining accreditation of services through IQIPS this will ensure quality for future commissioning models. The region is currently is engaging in this process 12

13. Next steps This work is being presented to and ratified by the Society for Cardiac Physiology to ensure that best practice is shared This is an example where we can start with cardiology devices and review the services and practice and share this across other areas e.g. neuro and renal 13

14. Summary Ensuring we review opportunities of new technological advances Support the patients experience and expectations Ensure best value for the NHS is effective use of recourses Share best practice through the CRG teams 14