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Innovation 'Elevator Pitch':
​​​This innovation empowers chemotherapy patients to undertake leucocyte monitoring in their own home. A small-scale trial has been completed showing positive feedback from patients, clinicians and carers potentially saving time, lives and money.
Overview of Innovation:
Dignio helps Health Providers (Hospitals, Clinics, Home Nursing etc) to achieve better outcomes for their patients and reduce the need for traditional face to face consultations and admissions via an integrated Telehealth, Remote Patient Monitoring, eCBT and ePROMs platform.
The side effects of chemotherapy seriously impact cancer patients’ daily lives. Managing them effectively is a long-time concern for doctors and clinicians.
Dignio Prevent is a secure, off-the-shelf, cloud based, device agnostic, Remote Patient Monitoring and Telehealth Solution. Dignio can be deployed very quickly with no input from, or impact on, current IT structures, software or licensing services. For chemotherapy patients Dignio can provide a complete remote patient vital signs monitoring solution which included an innovative, Bluetooth enabled, home based, white blood cell monitoring device.
By combining daily Remote Patient Monitoring of vital signs with CBT and frequent home based white blood cell measurement, healthcare providers can follow the patient in real-time and quickly catch any deterioration in the patient’s health and decrease the number of outpatient visits and reduce chance of hospital re-admission.
Patients and their carers prefer to be at home, they feel more secure, more in control and less stressed. They begin to learn about and understand how they are responding to chemotherapy and begin to modify their behaviour and manage themselves.
This solution can be delivered on a "per patient per month" subscription basis.
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)
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Overview summary:
Working in collaboration with TeleHealth platform developer Dignio, Sykehuset Østfold Hospital in Norway began the pilot project in January 2017.
 
This ground-breaking cancer care pilot project has produced significant results. This is the first trial in the world where patients were empowered to measure their own white blood cells in the comfort of their own home. A small-scale trial has been completed which has shown positive feedback from patients, clinicians and carers. And now the hospital is funding a larger scale clinical trial.
Challenge identified and actions taken :
The side effects of chemotherapy seriously impact cancer patients’ daily lives. Managing them effectively is a long-time concern for doctors and clinicians.
 
The project was initiated and managed by Sykehuset Østfold Hospital’s cancer specialists Elisabet Nilsen Holm and Andreas Stensvold. Working in collaboration with Norway based TeleHealth platform provider Dignio A/S, Sykehuset Østfold Hospital began the project in January 2017.
 
Dignio Prevent is a secure, off-the-shelf, cloud based device agnostic Remote Patient Monitoring and Telehealth Solution. Dignio can be deployed very quickly with no input from, or impact on, current IT structures, software or licensing services. For the project with Sykehuset Østfold Hospital Dignio provided a complete remote patient vital signs monitoring solution which included an innovative, Bluetooth enabled, home based, white blood cell monitoring device.
 
By combining daily Remote Patient Monitoring of vital signs with CBT and frequent home based white blood cell measurement, healthcare providers can follow the patient in real-time and quickly catch any deterioration in the patient’s health and decrease the chance of hospital re-admission. Analysis of the data improves patient outcomes, reduces treatment costs and decreases re-admissions.
Impacts / outcomes: 
“It’s clear from the pilot project that patients are happy to be monitored and managed in this way. They prefer to be at home, they feed more secure, more in control and less stressed. They begin to learn about and understand how they are responding to chemotherapy and begin to manage themselves.”
Elisabet Nilsen Holm, Cancer Specialist, Sykehuset Østfold Hospital
 
“I hadn’t used a tablet before, I don’t even have a smartphone, but the software is very easy to learn and use. When I was asked to join the trial I didn’t have to think twice. It’s interesting and exciting and has reassured me throughout the entire post chemotherapy period.”
Betty Helen Kristiansen, Cancer Patient
 
Combining Remote Patient Monitoring with CBT and home based white blood cell analysis improves patient outcomes, reduces treatment costs and decreases hospital re-admissions.

Our results which have been independently validated by the City of Oslo.
There is an English language version of their report into the effectiveness of Dignio at:
https://www.dignio.com/s/Telehealth-in-Norway-March-2017.pdf
 
As you will see in the report the outcome of using Dignio was:
32% Less hospital admissions
42% Less outpatient consultations
39% Less hospital bed days
59% Less home nursing
Which local or national clinical or policy priorities does this innovation address:
Cancer - increasing diagnostic capacity
Supporting quote for the innovation from key stakeholders:
“The side effects of chemotherapy seriously impact cancer patients’ daily lives. Managing them effectively is a long-time concern for doctors and clinicians.
 
By combining daily remote monitoring of vital signs combined with frequent white blood cell measurement we can follow the patient almost in real-time and quickly catch any deterioration in the patients’ health and decrease the chance of hospital re-admission.”
 
Elisabet Nilsen Holm, Cancer Specialist, Sykehuset Østfold Hospital
Plans for the future:
Sykehuset Østfold Hospital is currently funding a larger scale clinical trial of Dignio Prevent for home based white blood cell monitoring for patients undergoing chemotherapy.
 
This chemotherapy remote patient monitoring solution is now available in the UK via the UK subsidiary Dignio Ltd.
 
Dignio Ltd are actively looking for opportunities to replicate, in the UK, the successful pilot project that has been completed in Norway.
Tips for adoption:
The minimum pilot size to produce meaningful results is 20 patients. The patients have to be trained (it takes about 1 hour) and the nurses have also to be trained on how to care for patients remotely and how to interpret the results. This normally takes around 1 day with ongoing support from our team in Norway (they all speak perfect English). The trial in Norway comprised of patients with the most aggressive cancers where any contra-indication or exascerbation needed very speedy detection and diagnosis.
Contact for further information:
Ken Garner
Director of Business Development
Dignio Ltd
0203 371 9358
Ken.garner@dignio.com
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Innovation 'Elevator Pitch':
The Silhouette® solution enables integrated care ,closer to home, for patients with diabetic foot ulcers, using digital wound imaging and objective wound healing data available remotely in real time, to improve patient care and reduce system costs.
Overview of Innovation:
Digital Silhouette® solution for diabetes foot management improves clinical objectivity and patient experience 
 
Diabetes is a major health challenge in the UK with a rapidly increasing number of people affected. Active disease of the foot is a crisis situation for a patient with diabetes and requires timely referral and management. A proven solution for reliable and remote monitoring of diabetes foot ulcers, Silhouette, is available to support integrated care, releasing capacity in acute out-patient clinics and supporting safe care in community settings. 

An EMAHSN-supported demonstrator established with Derby Teaching Hospitals NHS Foundation Trust and Derbyshire Community Healthcare Services Trust has led to improvements in clinical management and patient experience:

Clinical Lead, Professor Fran Game, Consultant Diabetologist, Clinical Director R&D, Derby Teaching Hospitals NHS Foundation Trust:
“As a result of implementing the Silhouette system, we have been able to safely transfer an increasing portion of patients for treatment in community clinics and have improved waiting times in our out-patient clinic. Importantly, patients are happy with the new model of care. In a survey following introduction of digital ulcer assessment, 71% of patients reported a greater confidence in the care they had received.”
 
Service User, Patient Experience:
Patient A.S. from Kilburn said; “We only live just down the road from the clinic and it saves so much time for us, it is much closer to home than the hospital is, which means we are not spending so much time getting to and from appointments.”

Innovation Solution Deployed:
  • Silhouette® digital wound imaging & information system deployed as a telehealth solution, to build community capability for on-going treatment.
  • 3D measurement technology accurately maps ulcer size, enabling clinicians to assess wound progress & response to treatment with objective data
  • Enables reliable & remote monitoring of patients with active DFU & chronic complex wounds
Impacts to date:
  • EMAHSN independent qualitative and quantitative evaluation
    –Over-whelming improvement in patient experience
    –Positive feedback from clinicians
    –Reduction in acute Out-Patient over-crowding
     
    First year 462 (7.4%) appointments moved to community
    First year 5 camera, total investment £66k, first year savings £35k
    Business case based upon reduction in treatment/tariff costs

SilhouetteStar Camera


Dr Bruce Davey - CEO ARANZ Medical with SilhouetteStar Camera

 

 
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 / Wealth creation / Digital health / Innovation and adoption / Patient and medicines safety / Person centred care
Benefit to NHS:
The Silhouette digital solution for diabetes foot management has been successfully deployed in an EMAHSN-supported Demonstrator. The deployment of Silhouette is enabling an integrated diabetes foot pathway in Southern Derbyshire , linking care across acute and community.
A Business Case is available on request from EMAHSN, please email Dara.Coppel@nottingham.ac.uk 
The reported benefits to date include:
Patient outcomes: Greater convenience for patients, through treatment in community, less time waiting, less travel, with remote oversight by specialists to provide joined up care
Efficiency gains: health care professionals can access the secure Silhouette digital data quickly and in real time allowing escalation and de-escalation from community to hospital based on objective clinical data on ulcer status and risk. Adminstration reduced with automated reporting of patient's ulcer treatment and progress to GPs, reducing admin time and cost of letters to GPs.
Cost-effectiveness: A shift of hospital treatment appointments to community, trending at 8% has yielded savings on tariff costs across whole system. Cost reduction on adminstration involved with reporting to GPs.  
Online Discussion Rating
5.00 (1 ratings)
Initial Review Rating
4.80 (2 ratings)
Benefit to WM population:
Health: Using objective clinical data on ulcer healing to building efficiency in acute out-patients, building community capability for care closer to home to support improvements in patient safety, experience and outcomes.
Wealth: Better use of NHS funds to enable staff to manage patients with a focus on outcomes rather than activity 
Growth of a UK SME to create jobs and new solutions for the NHS.
Current and planned activity: 
Current activity: 
Entec Health and ARANZ Medical are actively engaging with expansion of Silhouette deployment across Derbyshire county as part of the Derbyshire NHSE Diabetes Transformation programme. In addition, a number of other NHS Diabetes Foot Services are working with us to develop and deploy a Silhoeutte-enabled MDFT in Nottinghamshire and Cambridgeshire & Peterborough. These initiatives involve CCG /STP stakeholders to support sustainability plans for the innovation and transformation work for long-term gain for patients and the NHS.
Planned activity
We are seeking to work with CCGs/STPs and NHS Providers who have a vision for deploying Silhouette in diabetes foot ulcer management and chronic wound management to drive forward a patient-centred, outcomes-led, service. 
What is the intellectual property status of your innovation?:
Silhouette digital wound assessment and information management system is developed and manufactured by ARANZ Medical Limited, based in New Zealand, with ARANZ Medical Limited having ownership of IP for Silhouette brand and Silhouette technology.

 
Return on Investment (£ Value): 
medium
Return on Investment (Timescale): 
2 years
Ease of scalability: 
Simple
Regional Scalability:
Please describe how the innovation could be scaled across the WM region. Have you implemented at scale in any other regions?
Measures:
What outcomes are you hoping to achieve and what are the measures that you will use to gauge the success of the innovation and how will these assessments be made? Please ensure that you have quality, safety, cost and people measures.
Adoption target:
What are the targets for adoption across the WM and what are the minimum viability levels?
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Innovation 'Elevator Pitch':
Digital Transfer bag for essential clinical patient information such as medical, falls and frailty information, diet/nutrition/hydration etc. To improve patient safety and provide important information to HCP's for patients conveyed.
Overview of Innovation:
Creation of a Digital Transfer bag for essential clinical patient information such as medical information, falls and frailty information, diet/nutrition/hydration etc. To improve patient safety and provide important information to Health Care Professionals for patients conveyed to Emergency Departments, hospital appointments or occupational therapy services. The app can also incorporate additional elements that will help to tailor their care such as an electronic falls risk assessment (eFRAT), simple initial questionnaires i.e. recent coughs and colds, general health, mental health, stability checks. Integration of Point of Care testing such as UTI testing for symptomatic patients. Results can be emailed to GP/ night nursing services for treatment prescription if required. Quick identification and treatment can improve patient experience and reduce falls risk associated with UTIs.
Stage of Development:
Ideas stage - Early concept and ideas stage
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Digital health / Innovation and adoption / Patient and medicines safety / Person centred care
Benefit to NHS:
Frail older people living in care homes are amongst the most vulnerable in our society.  Often simple referrals for outpatient clinics are aborted due to lack of sufficient information available and availability of knowledgable staff to accompany the patient.  Calls to paramedics result in conveyances for the same reason.
Within a care home when someone is conveyed to hospital they must be accompanied by a member of staff, this could be any one who is available, and they may not have a lot, if any, medical knowledge or knowledge of the persons previous health. Using an app would mean anyone would be able to travel to hospital with the patient as they would have all the information they would require on admission.
Currently personal and clinical information and standardised paperwork is being sent along with the patient in the ambulance. This opens up the possibility of sensitive data being lost, or not passed on to the care team who need it. The app would store encrypted data within the N3 network. Could utilise DM+D (Dictionary of medicines and devices) to reduce input error for medication information.
Ideally this could be operated in a phased approach with basic services initially and others added on in a second phase.
Care homes provide a vital service within the national health and care system, however due to insurance requirements many have become increasingly risk-adverse, insisting that the slightest stumble, confusion or change in a patient be medically reviewed.  With falls alone this results in calls to ambulance services that often result in unnecessary conveyance because the information is not routinely available.  Clinical, paramedic and patient time is wasted due to repeated appointments and attends due to insufficient information available at the point of incident.
 
Benefit to WM population:
Improved, faster treatment for illnesses, remote monitoring by qualified staff reducing need for appointments and long waiting times.  Nominated professionals and individuals can hold virtual consultations using shared information.
Current and planned activity: 
Early engagement and development has been discussed as part of an existing AHSN project in the East Midlands, but this area of work is not part of that project, and has been identified as an area of innovation and improvement.
A digital platform is already available and can quickly be tailored to deliver many of the requirements here, and this constitutes the current Phase of the work.
Next steps would be to engage with selected homes of both residential and nursing home categories and varying sizes to test performance, with the aim to roll out within a twelve month period.  
The following developments would be to work with other innovation partners to integrate with others digital technology platforms to support care homes in managing their patients, it would also be further developed to enable roll out in assisted living, sheltered housing and residential properties.
What is the intellectual property status of your innovation?:
This product is in development, and this is the first time we have shared it as we are now at the point of needing further advice and assistance.  WMAHSN have been approached to support us on protecting the IPR for this innovation.
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
2 years
Ease of scalability: 
3
Regional Scalability:
Please describe how the innovation could be scaled across the WM region. Have you implemented at scale in any other regions?
Measures:
What outcomes are you hoping to achieve and what are the measures that you will use to gauge the success of the innovation and how will these assessments be made? Please ensure that you have quality, safety, cost and people measures.
Adoption target:
What are the targets for adoption across the WM and what are the minimum viability levels?
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