1. Margaret Parton CEO Stimulating Demand Pull Processes within the NHS

2. Background As part of the Lord Darzi NSR programme the Ministerial Medical Technology Strategy Group is exploring new mechanisms to generate ‘demand pull’ for improved technologies within the NHS. Two Workshops have been held in conjunction with the Northern and London Cardiac Networks. The Workshops brought together clinicians from across the whole pathway to debate and discuss - Technology Solutions currently in use - Which technologies were emerging but not yet fully adopted - Where there was clear unmet clinical need

3. Next Steps This presentation includes a breakdown of all 3 areas. The information is being circulated widely to industry and academic researchers who may have potential solutions or platforms which could respond to the unmet clinical needs. Responses to the information will be reviewed by the Cardiac Networks There will be 2 Follow Up Workshops to bring the clinicians together with invited industry and research groups to discuss potential solutions. - 18 June Excel, London - 19 June Park Plaza,Leeds

4. Where Are We Now ? Technologies Currently in use in Primary Care  Q Risk Tool  Spirometry  12 Lead ECG with expert analysis  BNP  Echo - mainstream

5. Where Are We Now Technologies Currently in use in Acute Care  BNP  Echo – Mainstream, Portable, Stress  Chest X Ray  Cardiac MRI  CRM  CP Exercise Testing  Angiography

6. Emerging Technologies In Trials or in early adopter phase  Rapid BNP  Point of Care Diagnostics  Myocardial Scintigraphy  Intra Aortic Balloon Pump  Ultra Filtration Device  LVAD

7. Emerging Processes/ Technologies  Remote Monitoring  Remote Device Monitoring  Data base to aid patient management and referral  Patient Assessment Tools

8. Unmet clinical needs? The discussions in these sessions were wide ranging and extremely productive. However 4 Clear areas were outlined with a list of requirements in each area.  Diagnostics and prognostics  Clinical Management Tool  Intelligent Devices  Regenerative Medicine

9. Diagnostics New technology required to enable  POC Diagnostics  CHD / HF Screening  Genetic Predisposition for CHD  Early HF Diagnosis  Prognostic for risk profile  Selection of patients for appropriate referral for CRT etc Core requirement  Inexpensive, fast accurate, sensitive, specific

10. Clinical Management Tool Enable effective management and referral Streamline care delivery across 1 o 2 o and 3 o care pathways Generation of autotriggers for specialist: –Assessment –Referral –Titration of Medicines

11. Intelligent Devices for Cardiac Rhythm Management The drivers for the thinking on intelligent devices were:-  Monitoring and reducing the number of inappropriate shocks that patients received.  Using the devices as a source of information to enable better patient management  Managing Device switch off appropriately

12. Intelligent Devices for CRM  Devices with multi steerable leads to enable optimum location  Devices with haemodynamic monitoring to reduce inappropriate shocks  Devices externally rechargeable  Remote Device management

13. Intelligent Devices for CRM  Remote Device Audit (e.g number of shocks and trigger points)  Device able to measure and communicate a range of physiological parameters in real time  Alert on imminent shock for patients  Leadless pacemakers  Deactivation with support

14. Replace or Regenerate? Artificial heart Stem cell therapy to implant cardiomyocytes Tissue Engineered valves Replacement hearts grown and stored for patients considered to be high risk

15. …and also Remote Patch device for non invasive impedance monitoring And……….. And………… And………….

16. Next Steps If you feel you have platforms, research interests or technologies that could support the unmet clinical needs outlined please respond with a 1 page non confidential outline by:- Monday 25 th May 2009 to Margaret.parton@cmft.nhs.uk

17. Any questions? Email: margaret.parton@cmmc.nhs.uk Telephone: 0161 276 5263 Website: www.technologyadoptioncentre.nhs.uk