1. Improving outcomes and
efficiencies of managing patients
in the community
Adrian Flowerday
Managing Director

2. Enabling Technologies supporting
Community care
• Telehealth – Managing patients
– Self care
– Risk Stratification
– Professional care
• Care delivery logistics – Managing Staff
– Staff self management
– Performance management
• Assisted Living – Managing the elderly and vulnerable
– Social isolation, fragmented families, digital divide
– Son/Daughter responsibilities
– Access to support and wider world
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3. Issues Surrounding Home based Care Delivery
• New Providers
– Vertical and Horizontal Integration, Private providers
– New ways of working need to be introduced now
– Virtual Wards and Virtual Rounds
• Home based healthcare
– Typical district nurses, health visitors and therapists
– PLUS complex nursing care (Hospital at home – reduce LoS and
outpatient visits)
– PLUS LTC and elderly management (avoidance, empowerment, self
management)
– Increasing Social Care issues
– Multi-Disciplinary team working
• In Ireland
– Approx 10,000 complex and symptomatic LTC patients (CHF, COPD)
– High demand on services and hospital beds
– Approx 80,000 Diabetics
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4. An independent BBC video

5. What did Stan tell us
• Patient experience
– He’s doing it from his lounge in his usual chair
– He has become an expert patient; knowing when vital signs are
high
– He is confident and able to live in his own home with his wife
– He’s no longer grumpy!
– His wife’s quality of life has improved
• Productivity / Efficiency / Burden reduction
– The nurse has reduced the number of visits per week by 4 enabling
her to visit other needy patients
– Stan is empowered – no longer anxious – reduced calls on Health
Service
• Climate / Environmental
– Reduction in unnecessary home / clinic visit

6. doc@HOME® Infrastructure Overview
• Clinical decision
3rd Party
support
•Case Co-ordinators Analytics •Trending
Browser doc@HOME®
•Clinical Teams Web Services
3rd Party
Web •Clinical Teams
eHealth •Call Centres
Application vendors
Clinical
Scheduling
Database Engine •Tailored to
Prompts and
needs of patient.
questions etc
•Self Management
•Medication
Service Provisioning management
GPRS, 3G docoboWEB™
Broadband
GPRS, 3G Email / SMS
Broadband with URL
GPRS, POTS
CarePortal® HealthHUB® Tablet Apps
•IT Literate
•Elderly
•Mild LTC’s
•Poorly Case Management Patient & Care Giver Wellness Diabetes II
•Symptomatic
Asthma
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7. Features:
• Simple to use – fit for
purpose for demographic
• Handheld cradle based –
used anywhere, no wires
• Timeslot questions –
when the patient is ready
• Built-in LEAD I ECG and
BioZ – Rythym, AF, HRV
and respiration
• Class IIa Medical Device
– data collected can be
used for diagnosis
• Anytime and friends
questions – capture events
and impress friends
• Unique 4 week display -
empowered
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8. CAREPORTAL® – Assisted Living
• CAREPORTAL® a multi-media Android
based, simple to use, platform with
colour touchscreen, camera, WIFI,
Broadband ,3G and phoneline
connectivity.
• Designed to be able to give an older or
less technically capable user access to
social networks and services
• User group involvement – they
specified the look and feel, and they
love the result
• The purchaser will typically be child,
relative or partner who wants to
opens access to a virtual world
• Sold through mobile retail outlets and
other community organisations
CAREPORTAL® is a Class IIa Medical Device Platform
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9. Clinicians View
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10. Example stored ECG (lead 1)

11. HVI and Rhythm Analysis

12. Efficiency savings 1
Prior to doc@HOME With doc@HOME
Jan 2006 – Oct 2006 Nov 2006 – Mar 2007
Emergency Admissions 23 2
A&E Attendances 12 0
Hospital Admissions 16 2
Unscheduled Out of calls 55 3
Estimated costs >£54,000 <£6,000
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13. South East Essex
• 999 calls – the average number of 999 calls made per month by the
patients whist using the Telehealth service reduced by 72%.
• GP visits – the average number of visits made by the patients per month
to their GP whilst using the Telehealth service reduced by 56%.
• A&E visits – the average number of visits made per month to A&E by the
patients whilst using Telehealth reduced by 75%, meaning a saving of
£1091 for 53 patients per month, equating to a total saving of £13092 per
annum for 53 patients.
• If Telehealth was implemented for 1000 patients the equivalent savings on
A&E admissions would equate to approx £247k per annum.
• Hospital admissions – the average number of hospital admission per
month for the patients reduced by 83% indicating a cost saving of £44892
for this group of patients using Telehealth per month. This equates to a
saving per annum of £847k.
• If Telehealth supported 1000 COPD patients this could equate to a
potential cost savings in A&E attendances and hospital admissions of
£10.4m per annum.
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14. New Directions... Consumer power
• Current doc@HOME service is mainstreamed in many organisations, with
over 85% of customers ordering additional product.
• But, established Healthcare providers (NHS) limit potential and supply
– Funding incentives not aligned
– Clinicians are gatekeepers
– Keep the Status quo
• Consumer becoming more informed
– Aware of what can be done
– Aware of failings of current provision (Care Homes , care of elderly in hospital)
– Want a “Cohesive, Co-ordinated Care Service” for mum, for them
– Its more then just healthcare
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15. Its more than Health.......
Older/vulnerable people Complex LTC
(poorly and
symptomatic
- Independence COPD and CHF etc)
- Social Isolation
- Fragmented Families Medium LTC
- Digital Divide (Less symptomatic )
- Support for Daily living
activities
- “Soft Assistance” Mild LTC
(Type2
Diabetes, Asthma, Hypertension
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16. Independence Infrastructure Overview
BeTogether™ Assistance
Services
Family Web Delivered Telehealth
access
concierge@HOME™ Meals Other
Community groups: Services
• Diary
• Photos • 3rd sector
• Local volunteer Web Other
Peer to • Private providers Browser Health IT
Peer Systems
groups doc@HOME®
Social 3rd Party
Contact Community Services
BeTogether™ Assist
Web
Browser
Community Clinical
access Teams
eNABLE™ Service Provisioning
Email / SMS
with URL
GPRS, 3G
CarePortal® GPRS, 3G
Broadband
Broadband
Tablet Apps docoboWEB™
Location Environmental
Services Controls
Interface
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17. ComCare – Management of Community Care
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18. Wound Management
 Can record multiple wound locations
 Each wound retains its own history and
progress
 Graphical representation of the wound
healing progress against the system specified
healing parameters (best practice)
 History of wound products used during the
healing process
 Defines the regions of the wound and
calculates the area of the wound regions to
create the healing graph
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19. Productivity Improvements
More than 60,000 hours of
savings
Target Saving = 5,100,000 klms
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20. Efficiency Savings
A days nursing activity at one location
after optimisation…..
62 hours of travel reduced to 27 hours
3708 kms reduced to 1620 kms
A typical nursing round
after re sequencing…..
Saving = 1 hr 42 mins and 53 km
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