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Idea Description
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Innovation 'Elevator Pitch':
BVI technology is an innovative and easy to use, mHealth service to determine the percentage and distribution of visceral fat using a mobile device (tablet) or a smart phone.
Overview of Innovation:
The Body Volume Indicator (BVI) is a new measurement for healthcare and obesity. After eight years of successful and innovative validation from scientific collaborators around the world, BVI is now undergoing final testing prior to a full launch later in 2017.

Using 3D technology, BVI calculates risk factors associated with a person's body shape, by measuring weight and body fat distribution, with particular focus on the abdomen; the area associated with the greatest risk.

BVI is designed to be a long-term addition to the Body Mass Index (BMI); the current recognised standard for measurement of obesity. The intention is for the Body Volume Indicator to become a Body Volume Index by 2020, by which time sufficient data will have been collected globally. Using smartphone technology, BVI data can now be collected anywhere with web or internet access.

Body Volume, as an indicator of health, offers a potential long-term solution as a measure of individual health risk.

BVI was developed in the West Midlands and collaborators have included Heartlands Hospital, Aston University, Mayo Clinic and the Medical Research Council. The application was patented in the US in 2012 and throughout Europe in 2015.



Current Status
In 2012 Select Research obtained exclusive use of the largest and most comprehensive collection of Body Composition Data (BCD) of visceral fat data from MRI scans in the world. This has been used to develop an App which will be used to scan/photograph lightly clothed patients and then comparing their BCD database to predict their body fat and visceral fat.

Further research and development is being undertaken with our current BVI (Body Volume Index) tool, to provide additional evidence and to validate the efficacy, and appropriateness of this BVI application in real-life environments. Through a ‘real-life’ project work with WMAHSN will provide clinical validation for the underpinning methodology, thus making potential users (Clinicians, patients & public) aware of the benefits (social and economic) of utilising the service.

Thus our current BVI application is to be incorporated into the existing patient pathways currently used by Health Exchange Health Trainers in the West Midlands.

NB: The application has been patented in the US in 2012 and throughout Europe in 2015 and covers all measurements of part body volume for healthcare from a 3D scan. Body fat is a part volume of the human body.

Please assist us with our 5 min Survey http://BVISurvey.SSIsurveys.com
Stage of Development:
Evaluation stage - Representative model or prototype system developed and can be effectively evaluated
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Initial Review Rating
3.93 (3 ratings)
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Innovation 'Elevator Pitch':
BVI measures body proportions and fat distribution avoiding the need for costly techniques such as MRI and CT scanning for visceral fat measurements. Funding is being sought to undertake a region wide trial prior to NHS national deployment.
Overview of Innovation:
For over 20 years, Select Research have been pioneers in 3D measurement of the human body and over the last 10 years have developed a novel method of measuring human body volume in 3D, derived from 2D images. Released initially as a Body Volume 'Indicator' or BVI, the aim, once enough data has been assembled worldwide, is for the 'indicator' to become a Body Volume 'Index' by the year 2020. The BVI technology is patented in Europe and the US and is currently being used in professional healthcare, fitness, academic research on an iOS platform with an android version scheduled to be completed by April 2018; well in advance of the requested April 2018 date for potential national deployment under the ITP award, where BVI has been shortlisted by NHS England.
The Body Volume Indicator (BVI), unlike BMI, creates a 3D image of a patient’s body, enabling body proportions and fat distribution to be accurately measured for each patient, avoiding the need for costly, intrusive and time-consuming techniques such as MRI and CT scanning for visceral fat measurements. Furthermore, this provides professionals with a more accurate measurement of patient health, which in turns leads to improved diagnosis and therefore better clinical outcomes. This produces a patient specific BVI number, developed over 10 years by Mayo Clinic, which ranges from 0-20 and is based upon the ratio of abdominal volume to total volume, relative to that person’s age, gender and ethnicity. BVI will enable NHS professionals to identify where there is increased risk to patient health, wherever BMI is currently used throughout primary and secondary care with patients.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Wellness and prevention of illness / Digital health
Benefit to NHS:
Obesity worldwide is measured today using the Body Mass Index (BMI) tool as the global health indicator for risk. Invented in 1824, the BMI tool uses just height and weight, and therefore doesn't differentiate between people with the same BMI reading who have different body shapes and weight distribution, such as people with athletic build or those with more abdominal volume. BMI was originally intended by the Belgium statistician, Adolphe Quetelet for general population measurement, so is not suitable for use anymore in the modern age where personalised medicine is the framework for healthcare delivery, and does not consider factors such as age, lifestyle or ethnicity. In addition, a recent study by J. Gómez-Ambrosi, et al found that BMI is miss-classifying up to 29% subjects with increased cardio metabolic risks, suggesting that the patient groups with the highest needs are being failed, treatment is being delayed and a significant unnecessary cost is burdening the NHS which could be avoided if body volume distribution was accurately measured. The NHS currently spend £12.4 nationally on data collection. BMI is used today in healthcare not out of choice, but by default, as no viable alternative has been available; BVI now provides the NHS with a unique opportunity to innovate and change.
The Body Volume Indicator (BVI), unlike BMI, creates a 3D image of a patient’s body, enabling body proportions and fat distribution to be accurately measured for each patient, avoiding the need for costly, intrusive and time-consuming techniques such as MRI and CT scanning for visceral fat measurements. Furthermore, this provides professionals with a more accurate measurement of patient health, which in turns leads to improved diagnosis and therefore better clinical outcomes. This produces a patient specific BVI number, developed over 10 years by Mayo Clinic, which ranges from 0-20 and is based upon the ratio of abdominal volume to total volume, relative to that person’s age, gender and ethnicity. BVI will enable NHS professionals to identify where there is increased risk to patient health, wherever BMI is currently used throughout primary and secondary care with patients.
BVI Pro has successfully passed the review stages of the NHS ITP programme and is now with Simon Stevens, CEO of NHS England for review. Confirmation is expected in February 2018.
 
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
In the West Midlands almost seven out of every 10 people are overweight or obese, whilst 81 per cent are unaware about the link with cancer. Health chiefs have warned Birmingham could be forced to spend more than £2 billion EVERY YEAR to tackle a growing obesity crisis unless urgent action is taken.
Dr Andrew Coward, chairman of Birmingham’s Childhood Obesity Steering Group, said the link between obesity and cancer is now as serious as the cancer and smoking links of the past. The GP made the striking comparison as it emerged obesity will cost the city £2.6 billion a year by 2050 if something isn’t done to tackle the problem. In the West Midlands almost seven out of every 10 people are overweight or obese, whilst 81 per cent are unaware about the link with cancer.
The easy use of the BVI Pro app means patients can conveniently measure themselves at home or in as part of a health check at a GP surgery, negating the need for invasive manual measurements to be taken.. With NHS choices currently receiving 1.5 million visitors a day, BVI Pro could be incorporated, leading to more patients able to measure their BVI, reducing time spent with healthcare professionals; enabling patients to take a more active role in managing their healthcare.

BVI Pro could provide part of an online NHS system, through which patients could access other healthcare apps, health records, and book appointments, providing patients with convenient access to their BVI data, using the unique Patient NHS Number. This would produce a more comprehensive NHS service on obesity data for policy and prevention programmes. 
The app creates a 3D patient avatar, enabling parametric measurements. Patients have been shown to be more motivated to treatment plans when presented with their own ‘avatar’ (Boelcart et al. 2008.) Leading to an improvement in lifestyle management, resulting in a reduction in cost to the NHS. Once two patient images are captured, BVI and fat distribution can be measured in less than 30 seconds. These results can be integrated with medical records, via the BT enabled N3 ‘spine’ network, providing doctors with a holistic and unparalleled databank for patient health.


 
Current and planned activity: 
BVI has been through 4 stages of the NHS England Innovation Technology Payment programme and is in review with Simon Stevens with a view to being phased in, starting with one area of the country before rolling out.
We are looking at fast track access to the NHS through The Academic Health Science Network and have applied for a H2020 grant to roll out BVI across Europe. AHSN have recommended BVI for deployment. We are awaiting confirmation. See attachments.
Most of the validations have been undertaken by The Mayo Clinic and the University of Westminster. We are requiring more data on a wider range of ethnic origins and the West Midlands is a perfect place to start as it has such a diverse population.

 
What is the intellectual property status of your innovation?:
The BVI technology is patented in Europe (EP1993443 B1) and the US (US8374671 B2) and is currently being used in professional healthcare, fitness, academic research on an iOS platform with an android version scheduled to be completed by January 2018.
 
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
1 year
Ease of scalability: 
Simple
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Innovation 'Elevator Pitch':
Changing Health address signficant barriers to access by providing X-PERT diabetes education on line together with personalised evidence based telephone coaching to enable sustained behaviour change leading to improved clinical outcomes.
Overview of Innovation:

Changing Health offers the 1st evidence based digital education and personalised support programme for people living with Type 2 diabetes. Our digital diabetes prevention programme is currently under evaluation by Public Health England to be launched in September.

Our high quality service is based on evidence gathered from research led by Prof. Michael Trenell’s team at Newcastle University and the Newcastle Hospitals NHS Foundation Trust, conducted over 8 years and funded largely by the NIHR and MRC. This background has been licenced to Changing Health and combined with other state of the art structured education.

The service has been reviewed by NHS England Right Care, Public Health England, as well as other national stakeholders. Furthermore, it has undergone cluster based control trial, reviewed by NHS England and NICE, and submitted to be included in the first wave of approvals for mobile digital services.  Exclusive instant online access to X-PERT, the only Type 2 diabetes education programme proven to have clinically meaningful impact on weight and glycaemic control, together with ongoing learning via a referenced knowledge base. Re-designed for delivery through mobile and web apps, content is delivered in a variety of formats - including cartoon animations, interactive exercises and article text - supported by a personal coach.

Key features:
  • Evidence based behaviour change tools, including: the ability to create goals, make specific plans and self-monitor by tracking physical activity directly from the phone, record food intake, weight and other important data.
  • Communication with a personally assigned coach trained in evidence based behaviour change techniques, with the ability to book coaching sessions over the phone.
  • Online education modules in behaviour change for healthcare professionals, accredited by the Royal College of Physicians, equipping them with evidence based tools to help their patients better self manage. These modules are designed to be used alongside the aforementioned patient-facing tools, enabling HCPs to hold informed dialogue.
Recognising important cultural and linguistic diversity, Changing Health has collaborated with the South Asian Health Foundation and Diabetes UK to make services available in English, Punjabi, Gujarati (Bengali/Urdu dialects) and Polish languages.

The service is offered by the Modality Vanguard and is ready for wider adoption.



Evidence & Research
https://www.changinghealth.com/evidence.html
 
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Education, training and future workforce / Digital health / Innovation and adoption / Person centred care
Benefit to NHS:
Type 2 diabetes is characterised by progressive weight gain, driving the worsening of glycemic control. Changing Health directly targets this by providing evidence based weight management services through a digital platform. Excess weight is the greatest factor influencing the development of Type 2 diabetes, with over 80% of people overweight or obese. In the first five years post-diagnosis, a person with type 2 diabetes has a twofold increase in their risk of a stroke. They also have an ongoing risk of CVD twice that of a person without diabetes - and CVD is responsible for 52% of deaths in people with Type 2.

Changing Health’s service creates value for money by:
  • Delivering better health outcomes: Audit results demonstrate that X-PERT provides a sustained reduction in HbA1c (-6mmol.mol) and weight (-4.4kg).
  • Reducing spend: Over the first 6 months, X-PERT has been shown to generate an 8.3% reduction in prescribing costs equating to average savings in prescribing costs at £131,052 per 1,000 people attending, per year.
  • Improving care quality: Reducing variation in care through a standardised and proven approach, coupled with personalised coaching.
  • Opening access: Reducing barriers to access by making our services available anytime, anywhere, in English as well as the five most prevalent foreign languages.
  • Engaging patients in self-care: Providing patients with the education and tools to self manage their diabetes.
  • Supporting commissioning: Tracking outcomes easily and efficiently.
  • Providing the opportunity for effective investment of resources.
  • Supporting care teams: Providing evidence based online education modules, and freeing up healthcare professional time - such as enabling DSNs currently providing education to provide care and support to colleagues as well as patients.
  • Helping people early with their diabetes: The younger someone is diagnosed with diabetes, the greater their lifetime cost of their condition. This younger group are also more likely to access digital tools, creating an optimal method of engagement.
Online Discussion Rating
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Initial Review Rating
5.00 (2 ratings)
Benefit to WM population:
Public Health England estimate that there are 433,000 people with Type 2 diabetes in the West Midlands.

At current levels of attendance for education, there is a substantial unmet need addressed by our services for people with Type 2 diabetes. Today there is little, if any, coaching support to empower people to achieve the changes in behavious which are proven to improve outcomes. Changing Health offers the facility to address this need by substantially improving access: it has the capacity to do so across the West Midlands region.

Changing Health addresses signficant barriers to access of supported self management for patients with Type 2 diabetes, making information and evidenced based support available anytime and anywhere and in 6 languages, including 5 South Asian Languages (2 Bengali dialects, Punjabi, Gujarati and Urdu) and Polish. These will be phased in during the 4th quarter of 2017.

Changing Health is currently being used in Birmingham in conjunction with the Modality Vangaurd, working with the Connected Care Partnership https://modalitypartnership.nhs.uk
 
Current and planned activity: 
Changing Health's innovative service is currently deployed in 7 georgraphies including West and East London, Birmingham and Manchester.

Our prevention service is currently being evaluated by Public Health England and is expected to be deployed in September 2017.
What is the intellectual property status of your innovation?:
The intellectual property of our behaviour change techniqes has been licenced exclusively to Changing Health by the NIHR and MRC.

X-PERT Health has exclusively licenced its programme to Changing Health to be made available in a digital format accessbile via a mobile, tablet or computer.  
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
Simple
Regional Scalability:
Our ability to scale has been recently & satisfactorily tested by Public Health England. The digital elements of our service are designed for scale. We have capacity to provide personalised coaching services for up to 500,000 people.
 
Public Health England estimates 433,000 people with Type 2 diabetes in the West Midlands. At current levels of attendance of education, there is a substantial unmet need addressed by our services for people with Type 2 diabetes. Today, there is little if any coaching support to empower people to achieve the changes in behaviour which are proven to improve outcomes. Changing Health offers the facility to address this need by substantially improving access: it has the capacity to do so across the West Midlands. 
 
Together with Diabetes UK & the South Asian Health Foundation we are currently translating our modules into 5 South Asian Languages: 2 Bengali dialects, Punjabi, Gujarati & Urdu as well as Polish. These will be phased in during 4th quarter 2017
Measures:
Changing Health would report process and output measures:
  • Referrals received
  • Patients enrolling
  • Patients completing
  • Complaints received/resolved
  • Patients empowerment scores
  • Patient experience questionnaires
For people with Type 2 Diabetes would like clinicians to gather and report:
Weight and Hba1c at referral, after 6 months and 12 months.
 
The X-PERT reporting processes include other metrics including cholesterol and blood pressure. We’d welcome this being reported too.
 
The metrics for the Diabetes Prevention Programme are being developed by Public Health England. A substantial data set is already in place for the face to face programme. The digital dataset is yet to be determined. 
Adoption target:
433,000 people with Type 2 in WM. NICE/NHSE/DUK all advocate education and support with parliament stating that CCGs should plan for radical expansion and improved access.  The unmet need is substantial. As a digital and telephone service we can operate at scale. Capacity is likely to be set by the funding available.
 
Min level is 250 people per CCG
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