1. Docobo Implementing the doc@HOME telehealth service in the NHS Adrian Flowerday Managing Director, Docobo Limited

2. Docobo Introducing Docobo Background and people –Docobo started in 2001 UK Company based in Leatherhead, Surrey Technologists, clinicians and practitioners –Vision Development of eHealth technologies to eventually provide cradle to grave health monitoring –Development process Research and development – EU support EU, 4 centre – 3 country social economic evaluation study Develop service implementation, validation and roll out –Recognition – WHO – EU – NHS (PASA) –UK design, development and manufacture

3. Docobo doc@HOME Infrastructure …A tool that enables clinicians to manage patients in their own homes… Patient Centric – questions customised for each patient – reaches a wide population of patients and chronic diseases; Encouragement of self-care; Automated alerts for negative trends Enables preventative practice Care Amplifier; low-cost, medical device directive compliant operation.

4. Docobo The Docobo HealthHUB Optimised for Patients –User friendly - large buttons, clear display, ease of use –Small footprint –Easy to integrate into daily life –Use anywhere, anytime Optimised for communications –Storage of acquired data –Automatic dial-up modem – via free phone 0800 –server connectivity via the Internet Optimised for information –Integral lead-I ECG –Vital Signs – physiological monitors (e.g. SpO2 – PEF – FEV1 – BP) –Symptoms and side effects –Life style measures –Quality of Life factors –Programmable Optimised for security –High level data encryption –Data protection directive compliant –qualified as a Class IIa medical device

5. Docobo In Surrey…. In Surrey –Rolling out upto 30 units with the support of the PTG –Covering COPD, Heart Failure and Falls History –Spent months at various random events regarding telecare in Surrey –Discussion with Surrey CC telecare lead indicated that some PTG money may be available for health if a convincing proposal was made –I tracked down a community matron in North Surrey –I was then pointed to the head of Intermediate care Presented doc@HOME Presented the potential of funding from PTG Enthusiastic team – took the batton –PTG funding approved Then came contracts “to protect the public purse” A delay of upto 12 months was about to be added, with a cost in staff time and resources of over £25K and half a rain forest PASA Telecare Framework – saved the day! – PO faxed over the next day –Training – against our gut feeling –Units in patients homes……slowly Clinician preconceived notion – “maggie couldn’t use this” Thought it would only benefit the very ill, the frequent flyer Time taken …. 20 months

6. Docobo Telehealth barriers in UK Home monitoring – a disruptive technology –Changes to working practices and epidemiologies –Not trusted –Need to educate the market –worry about technology Care delivery structure –NHS – fragmented business units – constant change - positive discouragement to work together –Targets force behaviour detrimental to patient care –Minimal co-operation between health and social care –Patient care rarely discussed Call for evidence –Can it deliver? Other results not trusted or respected Small pilots with zero resource – limited data Confusion –Who can it be used for? Based on targets not patient care (i.e “reduce admissions” = high fliers = only a few) –Who pays? - How is telehealth re-imbursed

7. Docobo Lessons Question sets Training Patient recruitment –Clinician time –Patient response –Installation Workflow issues –Telehealth leads –Medicarers Project management crucial

8. Docobo Actions to overcome the barriers Training and awareness for clinical staff –Telehealth module within clinical training –Medicarers – a new workforce – a good idea! Evidence capture –Funding stream for successful projects –Controlled and organised –Recognised by national bodies Changes in epidemiology –In the light of evidence “we can measure BP everyday and it is the only way to be sure of a persons true BP – stop killing people with medication!” –In the light of cost/burden reduction Change of focus from targets to patient care –Focus on patient wellbeing, symptom management, and quality of life –Consider wider benefits – to QoL of carer, family and clinician Customer needs to be integrated and interoperable –Who will buy an integrated and interoperable system? Social services or PCT or Acute?

9. Docobo Interfacing to the rest of surrey

10. Docobo Thank you Barriers to mainstreaming personal eHealth implementations in the UK Adrian Flowerday adrian.flowerday@docobo.co.uk Skype: adriandocobo

11. Docobo Clinicians Patient list

12. Docobo ‘Window in time’ display

13. Docobo Doc@HOME Nursing Home Hub

14. Docobo Doc@HOME Multi-patient Hub

15. Docobo © Docobo (UK) Ltd 2005 Telecare Integration Regionalised response and false alarm confirmation Co-ordinated, localised care delivery Increased contact with carer and relatives