1. Warrington CCG Population Health Jason DaCosta - Warrington CCG

2. © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 2 Warrington Population approx. 208,000 A process of clustering services around a geographically co-located population Eight ‘groups’ of GP practice with each group having population ranging around 20-35k Clinical time allocated to appointment ‘slots’ of 10 minutes provided to patients on an ‘as and when’ basis Demand on clinical time is greater than current capacity.

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4. © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 4 Inputs: B/P recordings, weight and life style updates are recorded Medications reviewed Therapeutic decisions made or continued Face-to-face consultations take place with: Nurse specialists Health Care Assistants GPs Some or all of these professionals may be involved in a single appointment

5. © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 5 1. Blood pressure recordings impacted by: Recent by activity (walking into the surgery) The Iatrogenic effect 2. Recordings are a snap-shot They record ‘now’ May skew the clinical perception of the patient, interpretation of the patient’s B/P status 3. Appointments absorb clinical time But may not result in a change in current management

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7. © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 7 Using: Self applied diagnostic equipment … Recording data, transmitting telemetry … Linked to secure internet services … Storing data in an anonymised database … Displayed within a clinical (web) portal … Sharing data with GP systems These technical solutions are offered by: Cisco (Clinical portal and integration services) Third Party Telemetry Devices

8. © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 8 Pilot Practice:Greenbank Surgery Patients cohort characteristics: Primary hypertension Selected from hypertension register Volunteer, consenting patients Severity range: SI to SIII Male-female mix Across the adult age range With internet access Able and willing to record blood pressures, weight and activities over the internet

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10. © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 10 Cisco Extended Care is a personal health and wellness collaboration platform, enabling patient engagement and care team interactions at any time and from anywhere. The solution provides: Enhanced and efficient care coordination Secure messaging Appointment calendar and scheduling Questionnaires Real time video collaboration Anywhere access to care team consults Personalized content sharing Video platform to drive health and wellness awareness and education Open APIs to embed into and enable 3 rd party applications and environments Cisco Extended Care Driving Health and Wellness

11. © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 11  Anytime access to appointment information  Streamlined workflow for appointments – Single click Appointment initiation

12. © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 12 On Call Scheduler Scheduled Appointments Provider Group Schedules Patient Type Grouping Nurse Notes, Surveys

13. © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 13  Ability for users to take pre- appointment questionnaire  Saves total clinical time for an appointment

14. © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 14  Empower the patient wellness by providing education information  Provide videos of how to use the system – reduces support cost and enhances patient satisfaction

15. © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 15  Ability for the patient to keep track of his or her wellness device readings  Visual trends display for ease of view

16. © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 16  Utilizes Cisco Jabber SDK technology for remote video consults  Removes the need for purchasing separate video endpoints

17. © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 17 GP & GP Practice Focused Benefits Patient-Focused BenefitsOverarching Outcome 1. Increased clinical efficiency – GPs only intervening with Hypertension patients that need an intervention 5. Time saving for the patient* – fewer or no attendances, appointments at the Practice Enables enhanced management and control of patients with Hypertension Increases capacity in Primary Care - up to c600 appointments from our 300 patients – or 120 clinical hours 2. Releases time, provides capacity for clinical staff to manage ill and more complex patients (Links to above) 6. Provides for a high level of patient autonomy and self-management 3. Simplifies and informs medication reviews 7. Increases patient’s understanding of hypertension, factors and therapies, activities impacting blood pressure 4. Increases potential for practice to meet Hypertension QOF targets 8. Potential for increased medication concordance 9. Improved control – seeing Blood Pressure readings has potential to influence patient behaviour (links to self- management above) 10. Potentially fewer hypertension, hypertension therapy related incidents * Patients managed via the technology have the potential to save, avoid 2 GP practice appointments per annum. At Greenbank Surgery, there are 300 patients with Hypertension only (no recorded comorbidity) on the Hypertension Register. A saving of 600 appointments equates to approx. 120 clinician hours pa, based on a mean 12 minutes per appointment

18. © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 18 Integrate with a wider pool of telemetry devices Build and share the care plans Risk stratification to identify other patients who will benefit -Psychiatry liaison -Complex Care Management -Risk of readmission using LACE scores

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20. Thank You and Questions