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Idea Description
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Innovation 'Elevator Pitch':
Dip.io, a CE approved product turns the smartphone into a clinical grade device enabling lay-users to test urine in their own home, with clinical accuracy and share results electronically with their clinician.
Overview of Innovation:
42m urine tests a year are undertaken in the NHS to screen for a wide range of conditions. Currently patients collect a sample at home and bring it to the clinic or provide a sample in the clinic where it is either tested on site or sent to a laboratory. This is inefficient, inconvenient for the patient and presents opportunity for improvement in patient experience, clinical quality and cost efficiency.
Healthy.io is the first company to turn the smartphone into a regulatory-approved clinical device. Its first product, Dip.io, uses computer vision and user centric design to turn the smartphone into a urinalysis device. Built around existing semi-quantitative urinalysis dipsticks, Dip.io complements established clinical efforts by empowering patients to test themselves at home with no quality compromise, and securely share results with a clinician.
Healthy.io is empowering patients to take urine testing into their own hands, opening up an immense opportunity to improve preventive efforts and enable early interventions. Key pathways in which digital urinalysis has strong potential to improve patients’ lives and reduce cost to the NHS:
  • Antenatal care: women with hypertension or diabetes in pregnancy have a higher risk of developing pre-eclampsia, a leading cause of maternity morbidity. Dip.io has proven through a usability study at Johns Hopkins to improve women’s experience and could reduce outpatient appointments amongst high risk pregnant women.
  • Chronic Kidney Disease (CKD): Home-based screening of albumin:creatinine (ACR) for people with diabetes or high blood pressure, to increase adherence to NICE CG 182 and diabetes care process beyond the current level of 50%.
  • Urinary tract infections (UTI): opportunity to improve self-management for patients at risk of admission from UTI (e.g. MS), reduce the 5m GP attendances for UTI in primary care and create digital pathways for pre-op assessment through using digital urine testing, within existing clinical guidelines.
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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Innovation 'Elevator Pitch':
Dip.io, a CE approved product turns the smartphone into a clinical grade device enabling lay-users to test urine in their own home, with clinical accuracy and share results electronically with their clinician. 
Overview of Innovation:
42m urine tests a year are undertaken in the NHS to screen for a wide range of conditions. Currently patients collect a sample at home and bring it to the clinic or provide a sample in the clinic where it is either tested on site or sent to a laboratory. This is inefficient, inconvenient for the patient and presents opportunity for improvement in patient experience, clinical quality and cost efficiency.
 
Healthy.io is the first company to turn the smartphone into a regulatory-approved clinical device. Its first product, Dip.io, uses computer vision and user centric design to turn the smartphone into a urinalysis device. Built around existing semi-quantitative urinalysis dipsticks, Dip.io complements established clinical efforts by empowering patients to test themselves at home with no quality compromise, and securely share results with a clinician.
 
Healthy.io is empowering patients to take urine testing into their own hands, opening up an immense opportunity to improve preventive efforts, enable early interventions and increase optimisation in the outpatient setting. Key pathways in which digital urinalysis has strong potential to improve patients’ lives and reduce cost to the NHS:
  • Antenatal care: women with hypertension or diabetes in pregnancy have a higher risk of developing pre-eclampsia, a leading cause of maternity morbidity. Dip.io has proven through a usability study at Johns Hopkins to improve women’s experience and could reduce outpatient appointments amongst high risk pregnant women. 
  • Chronic Kidney Disease (CKD): Home-based screening of albumin:creatinine (ACR) for people with diabetes or high blood pressure, to increase adherence to NICE CG 182 and diabetes care process beyond the current level of 50%.
  • Urinary tract infections (UTI): opportunity to improve self-management for patients at risk of admission from UTI (e.g. MS), reduce the 5m GP attendances for UTI in primary care and create digital pathways for pre-op assessment  through using digital urine testing, within existing clinical guidelines.
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 / Digital health / Person centred care
Benefit to NHS:
Benefits to NHS in line with FYFV:
  • Primary Care (Diabetes and CKD screening): Smartphone enabled self-testing offers a critical complement to existing population health efforts by shifting testing from primary care to the home. Providing alternatives to face-to-face contact frees up GP resources and nursing time. NICE recommends that every person at increased risk of CKD (people with diabetes or hypertension) needs to annually get their urine tested. However only 50% of people with diabetes and 30% of people with hypertension have a regular urine test reported. Over 1 million cases of CKD remain undetected. Diffusing Dip.io to every at risk patient (8.3m) could improve adherence with no additional overhead, reducing CKD cost by up to £1bn.
  •  
  • Maternity Safety (Proteinuria screening): The Maternity Transformation Programme (Better Births) prioritises improvement in maternity safety and provision of consistent quality. This includes halving the rates of stillbirths, neonatal and maternal deaths by 2025. Around 15% of women with hypertension or diabetes in pregnancy have a higher risk of developing pre-eclampsia, a leading cause of maternity morbidity. Automated home-screening for proteinuria in at-risk pregnancies has the potential to early identify pre-eclampsia, save £1,500 for each avoided false negative, save up to £75m by reducing 60% of outpatient appointments (3rd trimester) and reduce antenatal consultation time by 25%.
  •  
  • Urgent and Emergency Care (Urinary Tract Infection): Conducting common diagnostic tests at the patient's home supports "improving the ability of patients to self-care for minor illnesses" (UECR).  This includes the need to anticipate recurring conditions such as UTIs. 1-3% of GP visits are UTI related and UTIs accounted for 14% of emergency hospital admissions in MS patients costing the NHS over £43 million. Dip.io offers the opportunity to improve self-management for patients at risk of admission from UTI, reduce the 5m GP attendances for UTI in primary care and create digital pathways for preop assessment within existing clinical guidelines.
  • Harnessing technology and innovation: Our solution leverages existing technology to transform care delivery and supports the drive to digital adoption. We easily integrate into other technologies (integrated with PKB and Allscripts) and make sure interoperability is built in. We are replicating this model for our next product to bring innovation to woundcare management.
Online Discussion Rating
5.50 (2 ratings)
Initial Review Rating
4.20 (1 ratings)
Benefit to WM population:
Our smartphone-enabled digital urinalysis service aims to improve quality and efficiency of existing pathways, driving better patient outcomes and experience.

Main benefits:

Maternity safety: women with hypertension or diabetes in pregnancy have a higher risk of developing pre-eclampsia, a leading cause of maternity morbidity. NICE CG62 recommends dipstick urinalysis during each prenatal visit to screen for proteinuria, an indicator of pre-eclampsia. Increasing testing in between regular pre-natal visits could reduce Pre-eclampsia complications. Women with at-risk pregnancies receive 7-10 Dip.io kits. Following a defined frequency, the women conducts the test at home. The clinician automatically receives the results and is alerted if results are abnormal for immediate follow-up care. This model of care is being rolled out across mayor HMOs in Israel and received more than 90% preference in a Johns Hopkins usability study. Dip.io has proven to improve women’s experience and could reduce outpatient appointments amongst high risk pregnant women.

Diabetes and CKD screening: NICE clinical guidelines recommend people with diabetes/hypertension need to get their urine tested annually but adherence is low e.g. only 51% of people with type 1 diabetes tested. Digital testing could improve adherence and reduce costs. Patients with no recorded albumin reading receive our smartphone urinalysis home-test. Results are immediately available to the clinician and those with abnormal results are invited to a follow-up extensive checkup. This model makes it possible to reach people at risk, who have not received appropriate testing, thus increasing adherence to CKD screening.

Urinary Tract Infection (UTI): opportunity to improve self-management for patients at risk of admission from UTI (e.g.MS), reduce the 5m GP attendances for UTI in primary care and create digital pathways for preop assessment through using digital urine testing, within existing clinical guidelines.
Current and planned activity: 
NHS:
  • Salford NHS Trust rollout for renal patient management
  • Care UK rollout for uncomplicated UTI management
  • North East and North Cumbria AHSN with South Tees NHS Trust to test renal clinic at home (Northern Counties Kidney Foundation)
  • Modality and Yorkshire and Humber AHSN to test diabetes/CKD screening model
  • Applying to Test beds for at risk pregnancy (Cheshire & Merseyside) and CKD screening (Care City).
  • NeuroResponse social enterprise based at UCL on Multiple Sclerosis pathway
 

International:
  • Usability study in pregnant women at Johns Hopkins with 92% favourability (soon to be published)
  • US National Kidney Federation and Geisinger Health to improve care for people with hypertension- successful increase in adherence (soon to be published)
  • Dutch Kidney Foundation and Dutch Health to test population screening for ACR in at risk population compared to other method
  • Roll out in two HMOs in Israel for at-risk pregnancy model
Return on Investment (£ Value): 
N/A
Return on Investment (Timescale): 
N/A
Ease of scalability: 
Simple
Regional Scalability:
Our plan is to scale regionally and nationally through a B2B2C business model. We offer several commercial packages that differ in terms of scale, level of integration, agreement timeline and distribution/shipment method. This allows us to partner with different players within the NHS to provide them full digital capabilities through customised, white label kits, a localised application and access to our algorithm in an end-to-end service proposition. Our vision is to serve as the backbone for smartphone enabled, image based medical diagnostics and enable partners to bring our innovation to their existing user base.
Measures:
Healthy.io and the Dip.io solution work together with healthcare organizations to improve efficiency, value and outcomes by digitizing existing pathways. Measure include:
  • Save outpatient appointment and reduce consultation time to reduce resource pressures.
  • Increase clinical guideline adherence, improving patient safety
  • Improve patient experience (e.g. minimise absence from work and avoid travel expenses)
Adoption target:
Start with a phased roll out to try, test and scale the innovation in a regional NHS organisation. We anticipate that success from this roll out will lead to spreading the implementation of the technology to other specialties within the organisation, other hospitals/GPs within the group and to other providers and partners within the WM area.
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Innovation 'Elevator Pitch':
65m urine specimens analysed annually in the UK breaks down to 250,000 every working day, of which 45,000 will be unreliable. This means 45,000 patients daily who will not be treated for urine-based infections. Peezy Midstream means they can.
Overview of Innovation:
Peezy Midstream can save the NHS £30m in reduced retesting of the most common diagnostic procedure.

It is a simple but innovative device that automatically captures clean-catch urine from men, women and children (from toddler age). It is especially valuable for the elderly and pregnant women for whom accurate urine screening is essential.

The average national mixed growth rate reaches from 0.38% to over 70%; the average is 18% - that's nearly 1 in 5 patients who will not receive accurate right-first-time treatment from their urine specimen.

Peezy Midstream reduces mixed growth rates to 1.5%, which means many more patients will be treated right-first-time, saving the NHS as a whole over £30m in direct retest costs and over £1bn indirectly through saving repeat staff and resource time.

Peezy Midstream captures urine specimens hygienically - it prevents spills and splashing, improving infection control in healthcare settings. It can be held by the tube if help needs to be given - the assistant does not risk becoming soiled either.

Dignity is implicit; easy Peezy is comfortable, quick and removes the need to start-stop-start when giving a midstream urine specimen.

There is no down-side to using Peezy Midstream. It saves lives, saves time and money and reduces unnecessary broad spectrum anitbiotic prescribing. Peezy is poised to make novel cancer urine tests more efficient too.

Each Peezy kit costs just 87p on the NHSSC; use ten for every retest. Available on the NHS Supply Chain and on the UK Drug Tariff - growing in popularity with midwives and care givers to the elderly.
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: 
Advanced diagnostics, genomics and precision medicine / Wellness and prevention of illness / Clinical trials and evidence / Innovation and adoption / Patient and medicines safety / Person centred care
Benefit to NHS:
Peezy Midstream delivers huge cost and efficiency savings plus clinical benefits:

(See attached WM mixed growth data and separate cost savings model)
  • Reduction of average West Midlands mixed growth rate of 17.5% to 1.5%
  • West Midlands direct savings of £307,798
  • West Midlands indirect savings of £12,339,337 (see attached WM cost savings model)
  • reduced urine specimen mixed growth from West Midlands average  to 1.5%
  • right-first-time urine analysis, diagnosis and treatment - don't see the same patient twice for the same problem
  • delivers specimen into 10ml tube that fits most automated laboratory urine analysers (no decanting in lab)
  • no soiling, dry tube, clean toilets: more hygienic for healthcare professionals
  • targeted prescribing, reducing need for broad spectrum antibiotics
  • improved infection control: no spills or splashing of urine
  • works equally for men, women and children (from toddler age)
  • excellent for pregnant women where antenatal screening must be super-accurate; they don't have to see the funnel is in place - they can feel it
  • antenatal screening accuracy for maternal diabetes, pre-eclampsia
  • excellent for the elderly prone to UTI, which can affect both wellbeing and behaviour
Initial Review Rating
4.20 (1 ratings)
Benefit to WM population:
  • West Midland Patient Savings of £90 (please see attached WM cost savings model, Patient Savings tab)
  • Accurate urine specimens mean prompt, accurate diagnoses
  • Patients will no longer need to visit their GP more than once for urine-related illnesses
  • They will receive the correct, targeted antibiotic, helping the fight against anitmicrobial resistance, encouraged by over prescribing of broad spectrums
Current and planned activity: 
  • Peezy Midstream is on the NHS Supply Chain at 87p (Peezy, tube, genital wipe)
  • It is approved by NHS Prescription Services and on the Drug Tariff for prescribing
  • Quality Improvement Audit at Barts (London) shows reduction in mixed growth from 17.5% to 1.5%
  • Quantative clinical study results pending from Stanford Medical School
  • Peezy currently part of MS Rapid Diagnostics Pilot, London
  • Prescribing growing amongst antenatal population
  • In use within some NHS departments: urology, outpatients, pre-admission, antenatal, A&E, Ambulance Services
What is the intellectual property status of your innovation?:
Patent and trademark granted:
  • UK
  • USA
  • Europe
  • China
  • Australisa
  • Asia
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
Simple
Regional Scalability:
Easy; Peezy is available through the NHS Supply Chain
Forte Medical is happy to attend your location and brief staff on usage and instructions if necessary
Measures:
Reduced mixed growth
Reduced retesting
Reduced repeat appointments
Cost and efficiency savings
Adoption target:
6 months
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Innovation 'Elevator Pitch':
We have successfully designed, implemented and evaluated a standardised triage system for use within maternity care.  It is currently used in eight maternity units, with more planned.
Overview of Innovation:
Triage systems are designed to ensure the patient receives the level and quality of care appropriate to their clinical needs and resources available. Triage involves establishing the presenting problem, undertaking a standardised physiological assessment including vital signs and results in a score being assigned based on predictors of urgency which determines the priority of on-going care.
The physiological changes associated with pregnancy mean the standard triage tools may not be applicable. In addition, the underlying good health of the maternity population, which may mask the severity of maternal illness, and no assessment of the condition of the unborn baby reinforce the need for a specific maternity tool. While some informal triaging takes place within maternity care, a national survey showed that women currently wait to be seen in the order in which they arrive and that current prioritisation systems do not use clinical determinants.
 
Birmingham Symptom specific Obstetric Triage System (BSOTS)
The system was co-produced by clinicians and researchers in Birmingham to prioritise care for women presenting with pregnancy related complications or concerns.  
The BSOTS bundle includes:
  • Completion of a standard clinical triage assessment by a midwife within 15 minutes of the woman’s attendance.  This includes taking a brief maternal history, completion of baseline maternal observations, assessment of pain levels, abdominal palpation and auscultation of the fetal heart rate .
  • This assessment is used to define a category of clinical urgency using a 4-category scale, which guides timing of subsequent assessment and immediate care (by an obstetrician if required) using algorithms.
 
  • Standardised symptom-specific algorithms are used for allocation of clinical priority and the immediate care and further investigations of the eight commonest reasons for attendance (abdominal pain, antenatal bleeding, hypertension, suspected labour, ruptured membranes, reduced foetal movements, unwell/other, and postnatal concerns). 
 
  • Documentation is provided to support and standardise completion of the clinical tasks required.
 
Implementation of BSOTS requires multidisciplinary training of clinicians which takes approximately three hours. The BSOTS training has also been developed and elevated by the team
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: 
Innovation and adoption
Benefit to NHS:
The benefits to the NHS of a dedicated maternity triage system are centred on improving safety for women and their babies by reducing the interval from their attendance to their initial review by a midwife and prioritising urgent care. BSOTS is supported by Royal College of Obstetrics and Gynaecology and Royal College of Midwives for national implementation.
Implementation of BSOTS as the system improves management of the triage department by enabling staff to:
  • See how many women are waiting who have not yet had their initial triage assessment to determine level of clinical urgency
  • See how many women who have had the initial assessment and the level of clinical urgency is known for each women
  • Know when further assessments are due for women in the Department
  • In circumstances where women attend who require urgent treatment it allows women with less clinical urgency to be safely moved out to the waiting area and escalation to occur
  • Facilitate easy handover of the department between shifts using SBAR
  • Use a shared language between clinicians to communicate clinical priority
BSOTS  provides a standardised process to manage emergency attendances and reduces staff safety concerns in maternity triage whilst increasing their resilience and improving handover and communication.
 
Initial evaluation at BWCNFT demonstrated  that the use of BSOTS increased the numbers of women seen within 15minutes of attendance from 39% to 54% [Relative risk (RR) 1.4 (1.2, 1.7 (95% confidence interval (CI)] and reduced the time to medical review for those who require it. Thus providing a robust pathway for rapid assessment and urgent medical care if required, improving outcomes for mothers and their babies.
Good reliability and validity of the BSOTS bundle were found on the basis of the numbers of women who re-attended and investigation of predefined maternal and neonatal morbidities.  All the midwives reported that BSOTS training had improved their knowledge and confidence and that implementation of the system improved safety for mothers and babies and reduced stress amongst the clinicians.
Intra-rator reliability was excellent both at BWCNFT initially with an Intracluster Correlation Coefficient (ICC) of 0.961 (95% CI 0.91-0.99), and in the additional maternity units where the ICC was 0.971 (0.915-0.996). There was no apparent difference between midwifery band level and amount of triage experience. Showing that the BSOTS tools are reliable and consistent for use amongst varied midwifery staff.
Initial Review Rating
4.60 (2 ratings)
Benefit to WM population:
The West Midlands remains a national outlier for poor rates of perinatal and infant mortality and is committed to the national ambition to halve the number of stillbirths, neonatal and maternal deaths and brain injuries by 2025.
 
In line with the National Maternity Review (published in February 2016) which set out a clear vision for maternity services across England to become safer and to promote good practice for safer care; the Birmingham Symptom specific Obstetric Triage System (BSOTs) improves the process and clinical prioritisation of care for women presenting with pregnancy related complications or concerns. BSOTs has also been shown to prioritise urgent care for those women who are most unwell or requiring more rapid access to obstetric intervention and emergency treatment.
 
With increasing use of the Birmingham Symptom specific Obstetric Triage System (BSOTs) across the maternity units within the West Midlands region, women can expect continuity of process and care when they present to units with urgent concerns and that care is standardised across the region. Standardisation of the maternity triage pathway also provides an opportunity to ensure that the midwifery and medical workforce in maternity are able to be trained with the right skills to implement appropriately timed and clinically relevant prioritised of care within all maternity triage departments in which they may work.
Current and planned activity: 
The Birmingham Symptom specific Obstetric Triage System (BSOTs) is currently used in seven units nationally; including half of all maternity units within West Midlands.
A further twelve maternity units have received training for their implementation teams and are due to launch the BSOTs programme in the next six months.
Bespoke training courses for maternity teams are held in Birmingham every two months. This training includes specific training the trainers materials, the BSOTS© maternity algorithms, Triage Assessment Cards and Patient information posters and tips for implementation from other units.

Further development of the Birmingham Symptom specific Obstetric Triage System (BSOTs) with Clevemed systems to transfer the paper based system into an electronic tool with contemporaneous patient record is on-going; due to complete by May 2019. This will enable maternity units currently using the Badgernet Maternity electronic system to use BSOTs digitally and further improve availability.
What is the intellectual property status of your innovation?:
Use is currently protected by signing a Licensing agreement provided by UoB and MidTech.
 
The schedule within the licensing agreement includes the Birmingham Symptom specific Obstetric Triage System (BSOTs) package for Training and Implementation and is intended to ensure the package is used as intended and that training has been given before implementation
The package is intended to support local training, implementation and on-going use of the (BSOTs) system, in the maternity unit assessing women who attend with unscheduled pregnancy related concerns. This package is set out during the face to face training course, it includes specific training the trainers materials, local training materials, the BSOTS© maternity algorithms, BSOTS© Triage Assessment Cards and BSOTS© Patient information posters. The components of the triage system should be adopted in its entirety, rather than separately.
Return on Investment (£ Value): 
N/A
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Simple
Co-Authors:
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