NHS Stoke on Trent 270,000 registered patients, 54 GP practices 2 new GP practices and GP led Health Centre planned for 2009 Some of the most deprived wards in England, 5 PBC clusters closely aligned with the Local Authority neighbourhood areas Flo telehealth: a key element of integrated care Professor Ruth Chambers OBE, GP & Clinical Telehealth Lead, Stoke-on-Trent CCG and Phil O’Connell, NHS Innovator of the Year Staffordshire and Lancs CSU

I see it hasn’t taken you long to get up to speed with the new mobile telehealth service

It’s about the basics improving delivery of best practice care 3 Best clinical practice & shared management Tech Improved QUALITY of clinical care

Simple Telehealth developing the eco-system 4 Simple Telehealth & Florence Apps & digital DevicesIP Licensing Clinical Community Professional services Clinical systems Telehealth Partners = NHS enabler

simple & instinctive, helping patients to help themselves 5 Readings & answers Opt-in/out, prompts, questions, feedback, advice, education all my teams clinician smartphone web patients mobile phone Alerts if needed Closed loop £ free to txt

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Working with industry Designed for collaboration 7 Enabling an industry & academia eco- structure, building on the core

Behaviour change techniques via Flo across patient pathways individual feedback on personal health measures social support – ‘Flo’ information on consequences of behaviour information on tailoring behaviour tailoring – selected messages to patient, timing, frequency goal setting (behaviour, outcomes) relapse prevention follow up prompts clinician overview – giving assurance, titrating treatment prompted self monitoring of behaviour ( Free C, Phillips G, Galli L et al. The effectiveness of mobile-health technology based health behaviour….. PLOS Medicine 2013; 10 (1) )

Asthma/COPD inhaler reminder protocols x 2 (key elements): Inhaler reminder (adult- asthma or COPD) x 2 reminders per day Inhaler reminder (child/parent) x 2 reminders per day (Phase 2 when NHS team confident – poor control asthma (adult); poor control (child/parent); COPD (support and trigger standby rescue medication if early warning of deterioration): all interactive for 3 months + health promotion information messaging

That’s Flo reminding me to give you your inhaler. Now, if only she could sort out your gym kit and packed lunch, too...

Risk profiling your COPD patients Level 3: High Complexity Case Management Level 2: High risk Disease/Care Management Level 1: 70-80% of LTC population Self care support/management Low cost, large-scale: ‘simple telehealth’

Flo says my oxygen level’s normal today, so I think I’ll have a fag...just kidding!

Supporting people at home Enhanced support at home Manage Crisis Effectively Specialist acute input How Flo Simple Telehealth can support the whole patient pathway Enhanced support at home Supporting People at Home Manage step down from acute effectively Crisis AcuteTrf of care Home Support* Support Long term hypertension Smoking Cessation Long term vital signs monitoring Care Homes Pain Mment Medicines Management “Worried Well” INR Weight loss motivational messages Health self assessment Sexual health Unstable Hypertension Newly diagnosed hypertension Medication Reminders for: - Hypertension / Ashma inhaler / pain management Paediatric ashma COPD Diabetes (type1& 2) Heart Failure Palliative care carer support/wellbeing Falls prevention Virtual Wards Intermediate care Step down facilities Unstable vital signs monitoring Medication management As * Pregnancy induced hypertension Gestational diabetes COPD CHD Diabetes physiotherapy Monitoring of pre op patients to reduce cancelled operations Out patient acute specialist follow up DNA management Support early discharge EMAS unstable vital signs monitoring Oncology Neurology Speech therapy Alcohol support Learning disabilities Mental health behaviour Mental Health appt & medication reminders/ supportive messages Daily living/ medication reminders for people with Aspergers/autism Long term hypertension Smoking Cessation Long term vital signs monitoring Care Homes Pain Mment Medicines Management “Worried Well” INR Weight loss motivational messages Health self assessment Sexual health

Palliative Care Cardiac Rehab R apid Access CP Clinic None Pharmacological Interventions Inpatient Care Out patient Cardiol ogy A/E Education Patient Self Care Weight Management Fluid Restriction Symptom Monitoring Lifestyle Changes Primary Care Core GP Service Tier 3 Service MDT HF Nurse Education/Training/Support Individual Management Plans Worsening Symptoms Despite Treatment Home SC Diuretics Consultant Assessment Accredited GP/ PN HF Nurse Support Individual Management Plans GP Community Matron Practice Nurse District Nurse Urine Analysis Full Blood ECG BNP CXR Drug Therapy History Examination Manage Co-morbidities ECHO Manage Co-morbidities Organise Follow-up

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Any risks from increased focus on remote monitoring of clinical conditions? Enriching self care as agreed shared management The Flo effect: helping people to help themselves – as agreed with their clinicians – throughout all tiers of care

Personal responsibility & self care Integrated care: right treatment, right delivery, right time, right team, right intensity

What can AHSN investment achieve by March 31 st 2014 (midnight!) via Flo Telehealth exemplar? Model, trial & disseminate Flo across patient pathways for asthma – self care, schools, general practice, acute care, community care settings, includes: * inhaler reminder * step up Rx * step down Rx Model, trial & disseminate Flo across patient pathways for COPD – self care, care homes, general practice, acute care, community care settings, includes: *inhaler reminder *trigger standby rescue medication *lifestyle advice Model, trial & disseminate Flo across patient pathways for hypertension – self care, care homes, general practice, acute care, community care settings, includes: * opportunistic findings of raised blood pressure * enhanced control of hypertension eg pre-operation, after myocardial infarction