NHS Innovation Accelerator (NIA)
The NHS Innovation Accelerator, or NIA, supports uptake and spread of proven, impactful innovations across England’s NHS, benefitting patients, populations and NHS staff.

Ideas (Wealth creation)

Innovation 'Elevator Pitch':
WaitLess is an app for patients, combining A&E & MIU real-time waiting times, numbers waiting, traffic & routing helping patients make better decisions about where to go for minor emergencies. In east Kent, it reduced minor A&E attenders by 11%.
Overview of Innovation:
WaitLess is an innovative new app for patients. This reduces A&E attendances during busiy times by showing patients the quickest place to be seen, simply. It proves patients can be treated faster and closer to home by highlighting alternative services, driving activity away from busy A&Es. It's free for patients to download and was designed by patients for patients, funded by CCGs and STPs. Our charging model is 25,000 per CCG, or 3p per person based on population.

It's priced delibarately low to make WaitLess accessable to all, and can be deployed in less than two weeks. WaitLess was independently evaluated by the University of Greenwich and the Behavioural Insights Team and found to achieve an 11% reduction in minor attendances. 

Various studies undertaken since 2009 have found A&E attendance reduction schemes to be difficult to achieve. This is thought to be due to a number of factors incuding that patients find urgent care pathways confusing and hard to navigate. Various studies have identified that patients make a relatively quick decision about where to access treatment minor injuries. Once patients have arrived in A&E, evidence shows that they are committed to waiting to be seen and often reluctant to move. WaitLess applies an effective three second nudge to patients, by showing the quickest place to go and using real time routing options to help avoid traffic and overcrowding busy units during peak times. 

A reiew undertaken by encompass MCP found the following observations, which were confirmed as statistically significiant by the behavioural insights team and the University of Greenwich:
  1. Improved patient experience as patients are signposted to units with the lowest wiaiting times
  2. Reduction in A&E minors attendances by 11%
  3. An overall reduction of 5% in attendances across A&E and minors as more patients choose primary care.
  4. Quick and responsive, nudging patientstowards facilities with lowest waiting times.
  5. Takes pressure away from A&E and flattens activity
  6. Quick to deploy
Business cases for WaitLess are currently being considered across a broad range of regions, inclduing the South West, Greater Manchester, Yorkshire and the Humber, Surrey and Sussex. Given the benefits to the NHS, we are seeking to significantly accelerate this rollout across the NHS and to explore alternative uses for WaitLess (such as Primary Care). As a proven autonomous decision aid, WaitLess is a key pillar to any urgent care strategy.
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: 
Wealth creation / Digital health / Innovation and adoption / Person centred care
Benefit to NHS:
WaitLess has been independently evaluated by the University of Greenwich and the Behavioural Insights Team and found to deliver reduced activity, waiting times and save money for the NHS. The headline benefits are:
  1. Reduced minor injury attendance profile across the whole health economy. The total number ofcases (including A&E and MIU) shows a significant decrease (5% less, p=0.024).
  2. The total number of A&E cases shows a significant decrease (11% decrease, p<0.001).
  3. The proportion of cases (MIU out of (MIU+A&E) shows a significant decrease (the effect size varies by day of the week, but is approximately 3-4%, p<0.001)
  4. Reduction in A&E minors attendances by 11% within six months against an end of year target of 5%.
On days where there is significiant pressure on majors, it is  common for waiting times in minors to increase. As waiting times increase in one facility, patients choose alternative locations where waiting times are improved.  This has the net effect of spreading activity across A&E and UTC settings much more effectively.

As patients choose A&E because they are unaware of level 3 & 4  A&E units (UTC), nationally Hospitals are facing an increase of circa 5% year on year in A&E attendances. Peak attendances are predictable, occuring in the early evening and at weekends. WaitLess acts as an autonomous patient decision aid, helping to reduce pressure without impacting on surrounding UTCs. In addition to the benefits to patients, operational and performance benefits, WaitLess also saves money for Commissioners.

It is common for Urgent Care Centres to have much ower waiting times than A&E departments. By using real time data, WaitLess influences patients to choose the facility that willsee them fastest, giving improved overallexperiencefor patients and encouraging more competition among providers of urgent treatment services.

With many UTCs commissioned on block arrangements, overheads are already paid for. In these scenarios, each A&E attendance saved is equivalent to 85.00 per episode saved. Where UTCs are commissioned on PbR, the standard tariff is 65.00 per episode. in thesecases, WaitLess saves 20.00 per episode. The PbR savings alone equate to 100,000.00 per CCG. 
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
Activity analysis has highlighted over the years that A&E is seen as a  trust brand by patients. Commissioning of alternative facilities with different names, such as MIU / UTC / Minor Injury Cinic / MIIU has created a significant confusion among patients about which services are  available and what they offer. A number of self help apps have been developed to support patients, however these have nationally had a limited impact on emergency attendances to A&E. Since 2004, the UK has seen A&E attendances grow by 5% year on year. A&E Departments are now widely reported to suffer from overcrowding, leading to sub-optimal conditions both for clinicians and patients. The majority of A&E attendances are from patients who choose to self present to Hospital, most with Ambulatory and more minor conditions. As an ex Urgent Care Commisisoner and General Manager for A&E and Acute Medicine, I knew prior to the build of an app that patients make a quick decision about where to access urgent care services, which was recognised by the behavioural insights team in 2015. In many other parts of healthcare planning, autonomous patient decision aids have been found to be highly effective in terms of both influencing behaviour and flattening demand. This can be seen in the NHS rightcare guides. WaitLess provides this for Urgent Care services. It helps the local population in the following ways:
  1. Encouraging people to access care services closer to home
  2. Reducing avoidable A&E attendances
  3. Improving the patient experience
  4. Empowering patients to mae a better decision about where to go to be seen
  5. Reducing pressure on overstretched A&E departments
  6. Savng money for the local health economy to re-invest in pathway changes that are sorely needed to improve urgent care flow.
Current and planned activity: 
We are currently enagaged in discussions around WaitLess with Nene and Corby CCGs, Yorkshire and the Humber and Greater Manachester. As part of the National Innovation Accelerator, we have ensured WaitLess is built on a platform that is simply scaled. Patient feedback has highlighted a need to provide WaitLess at scaleas patients commute for work and leisure and come to rely on the information. Our diffusion plan is outlined in a 12 week programme per CCG which can run in parralel with up to 26 CCGs per cycle. As WaitLess technology is bespoke, it has been built with scaling in mind. Our 12 week programme can be accelerated to 2 weeks, depending on each health economies informtion capabilities and appetite.
What is the intellectual property status of your innovation?:
As a developed and deployed product, we have IP rights  to our innovation
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Simple
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Alistair 07/03/2018 - 02:41 Publish 1 comment
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Innovation 'Elevator Pitch':
RespiraSense demonstrated a potential for 6-12 hours earlier detection of patient deterioration when compared to the standard of care. Putting that into context, for every 30-minute delay in treating Sepsis, increases the risk of mortality by 7%
Overview of Innovation:
RespiraSense is the world's only continuous respiratory rate monitor. Respiratory rate is the earliest and single most sensitive indicator of patient deterioration, more so than heart rate if systolic blood pressure. In fact, 26 breaths per minute are considered the earliest point of divergence between Spo2 and respiratory rate. Giving rise to 12+hours of false security is accurate RR is not measured. 

The standard of care remains the manual counting of breaths per minute, which has been shown to be biased and prone to error. With evidence showing no change in the quality of measurements for over 170 years (1846SirHutchenson) (2017Badawy). 

RespiraSense gives medical teams the advantage of being able to intervene early, thus reducing time to intervention and improving outcomes. Outcomes such as Average Length of Stay, Average Unit Cost of Care, and Patient Safety targets can be achieved. 

RespiraSense is a simple, wireless, and discrete wearable monitor, placed on at admission and worn/measuring continuously for up to 7 days. Each patient receives a new sensor and a reusable electronic device or Lobe. See how the system works @ https://www.youtube.com/watch?v=u6KB1hBPQbM  
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 / Wealth creation / Digital health / Innovation and adoption / Patient and medicines safety / Person centred care
Benefit to NHS:
Each year, there are approximately 500,000 admissions of Sepsis and Pneumonia with an average unit cost of £4,600 per admission. These two conditions are increasing in incidence and often lead to an escalation of care due to the risk of undetected deterioration. It's shown that a 5% reduction in the escalation of care of these two pathways alone, through the use of continuous Respiratory Rate monitoring triggering decreased time to interventions (Fluids, Oxygen, Antibiotics, Steroids), can reduce the average unit cost by £300 and the average length of stay by 0.5 days. This translates into a total Net cash saving of £115m and 250K bed days. Popular opinion suggests that as high as 20% reduction is achievable - Evidence pending. 

Each event prevented, having an average cost of £25,000, will pay for a whole year's supply of sensors for one year.
Initial Review Rating
5.00 (2 ratings)
Benefit to WM population:
West Midlands Trusts are driving the awareness of Sepsis through their ambulance services, patient awareness campaigns, and in-hospital initiatives. With 44,000 lives lost each year attributed to Sepsis, it is important to Prevent, Diagnosis Early, and Effectively Treat the condition. RespiraSense focused on the area of Diagnosis Early. Research suggests that NEWS2 is a more sensitive indicator of deterioration due to Sepsis than QSOFA. Both of which have Respiratory Rate as a critical parameter to measure. There is clinical and economical value in monitoring this essential vital sign accurately and clear additional benefit to having it monitored continuously. RespiraSense achieves both with low impact of False alarm due to its innovative design, boasting advanced motion-tolerance. 
Current and planned activity: 
PMD Solutions is working with Nursing Times to launch an educational campaign on the clinical science and importance of respiratory rate monitoring in acute care clinical practice. 

In addition, PMD Solutions is looking for Respiratory and Emergency teams to partner with and create a culture of Peer Leadership in the development of best practice for respiratory rate monitoring. 
What is the intellectual property status of your innovation?:
RespiraSense is positioned to be the new industry standard in respiratory rate monitoring. It is patented in Europe, United States, China, Hong Kong, and Japan. 
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Simple
Regulatory Approvals:
Please describe any current regulatory approvals you have achieved and how they were met/ in progress/planned.
Commercial information:
Please describe how the product/service is being developed commercially, whether in development, trials, pilot or full commercial delivery. Include the results you have from any market/demand surveys and forecasts . Please include any research you have on the broader commercial opportunity for the innovation both within the health sector nationally and internationally.
Investment activity:
Please describe what stage of investment you have reached and whether you are seeking additional rounds of investment. Please include cash investment as well as investment of soft assets such as access to specialist equipment, knowledge, trial base etc. and indicate the types/sources of your investment such as grants etc.
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?
Investment sought:
What investment are you looking for in order to support wider adoption of this innovation and what have you managed to secure to date? Please provide a breakdown of these costs if possible.
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Myles Murray 02/03/2018 - 21:21 Publish Login or Register to post comments
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Innovation 'Elevator Pitch':
ORCHA is the world’s largest Health App library ORCHA has been designed to offer local targeted app stores to engage populations and to support professionals to recommend the best apps to their patients.

Overview of Innovation:
ORCHA, the Organisation for the Review of Care and Health Applications, is an SME specialising in the rapidly developing world of health and care mobile applications and related digital health services. The medical and wellbeing app market is growing fast, offering the prospect for clinicians and patients to better monitor, report and manage multiple health challenges. Apps exist and are in development for a wide array of users, ranging from solutions that remind and assist people with essential activities, to approaches that monitor key physiological parameters to improve management of multi-morbid long term conditions and to improve quality of life through enabling social interaction.


 
There is growing evidence that apps can improve outcomes for populations and patients, however, there is currently little independent review to ensure their effectiveness, safety or value to users and professionals. This limits user and professional confidence, the growth of app businesses, and also constrains the opportunity for the UK population to take advantage of apps to address major health demographic issues while potentially reducing load on public resources. The sheer scale of emerging apps in health and care also actively inhibits the use of these services, as patients, carers and their health and care professionals struggle to find the right solutions. Finding a clear and trusted pathway through these congested waters is a critical enabler of any wider digital health strategy.  ORCHA provides the solution. It delivers a clear and robust approach to the review, validation and dissemination of these services and through this core capability creates an attractive powerful and multifaceted digital health hub that patients, carers, health and care professionals and developers themselves are all able to utilise to drive this critical agenda.
 
The ORCHA platform has been designed to consist of multiple ‘white labelled’ variants, which are all driven by a common repository of review information and associated data. Through this approach it is possible to create solutions targeted for particular geographies, conditions or cohorts, enabling the key ORCHA components to be seamlessly integrated into existing public facing and professional facing solutions.
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: 
Mental Health: recovery, crisis and prevention / Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Wealth creation / Digital health / Person centred care
Benefit to NHS:
The key benefit of the ORCHA solution is to individual patients & citizens in supporting them to find solutions they can trust to improve their health & wellbeing & in also supporting clinical professional groups across health & care providers, who wish to recommend, prescribe & clinically implement apps.  We have hundreds of GPs, clinicians & carers who are using this feature to prescribe apps to their patients & clients. For example, we are working with in primary care where local practices are using the system to recommend the best smoking cessation app to their patient lists known to smoke. We are also working with care assistants who prescribe apps as a part of health checks & we are working with Mental health services, where patients are provided with an app at their GP appointment & along the IAPT or CAHMs pathway. Here apps have been seen to reduce patients need for therapy, drugs & have also been used to achieve better outcome measures across the whole pathway.
 
The ORCHA tool is the first scalable assessment of health-apps, enabling clinicians to recommend & end-users to benefit from apps of guaranteed quality & safety. Through research-oriented design, ORCHA enables clinicians & commissioners to provide solutions in areas of unmet need, gauge the opinions/experiences of users & evaluate impact of services against patient-level outcomes. By making evidence central to activities, ORCHA is slowly transforming mHealth, from a largely uncertain prospect, to a valued tool in the armoury of clinicians & patients alike; mitigating risks & improving the likelihood of TECS embedding themselves as valued components of clinical pathways.
 
ORCHA are:
  • Increasing the availability of evidence-based services to those otherwise unable to fully benefit from face-to-face services, enabling care from home & helping the NHS maintain ‘equal access for equal need’
  • Increasing trust among those using & commissioning app-based services, by informing users of the risks & benefits of over 3,500 health-apps to date
  • Working with East Lancashire, West Lancashire, Bolton & Salford health economies to ensure those quitting smoking, still receive adequate support following the reduction or withdrawal of funding for smoking cessation support
Initial Review Rating
3.40 (1 ratings)
Benefit to WM population:
The key benefit of the ORCHA solution is to individual patients and citizens in supporting them to find solutions they can trust to improve their health and wellbeing and in also supporting clinical professional groups across health and care providers, who wish to recommend, prescribe and clinically implement apps.  We have a growing number of GPs, clinicians and carers who are using this feature to prescribe apps to their patients, and clients.
 
We work at regional and local level to activate populations to access a local library of health apps to support their health or health needs, activate patients through their trusted professional and upskill the professionals communities with a wide range of apps and the ability to prescribe these solutions to create a digital health offering which is reportable, managed and governed.
 
We also support health and care app developers. ORCHA not only provides these individuals and organisations with a ‘route to market’ outside the very crowded and commercially challenging confines of the various major app stores, but it also provides an environment for solution improvement, collaboration and the creation of critical interfaces that not only drive greater interoperability between complimentary solutions, but also starts to enable the creation of shared standards and common protocols around key issues such as data privacy and control.

ORCHA are:
  • Highlighting that working in schools is a viable & sustainable approach to activating young people & their families to use health-apps for health promotion; with the average child registering with ORCHA subsequently recommending 6.4 apps to others, 61% resulting in a download
  • Supporting KS4 students in raising awareness of taboo subjects including sexual/mental health through the use of apps. Students are now using ORCHA to extend their advice to include additional apps (not just period trackers) to attendees of the shool based clinic
  • Enabling North West London CCG to identify barriers to implementing TECS, promote efficiency & extend the effective reach of existing care; gaining user feedback to overcome these barriers & realise the benefits of TECS across North West London
  • Demonstrating, through our academic research published in BMJ:Evidence-based mental health, that contrary to popular belief, app quality is not correlated with both prior download figures & user-review scores, providing prospective app-users with useful information to minimise blind faith in popular apps[3].

 
Current and planned activity: 
Health app activation is a real challenge for health care systems. The ORCHA Solution enables customisable App Libraries that can help you to promote reviewed Apps to a specific population. These tailored App Libraries, “ORCHA Microsites” have been designed to enable them to be configured to meet your specific requirements. ORCHA Pro-Account works with the Microsites & is in essence a prescribing solution for health/care professionals. The service supports organisations that have commissioned App Licenses (an increasing trend) to manage the distribution of licenses by their staff & the ProAccount provides the core infrastructure for managing & monitoring Health App prescribing more broadly. The act of recommending an App via the Pro-Account feature is a key tool where individuals are 10 times more likely to respond positively to a prompt from healthcare professionals than if they arrived on the site via a direct search. Engaging clinical communities is a core feature of our solution.
 
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
2
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Liz Ashall-Payne 27/02/2018 - 13:54 Publish Login or Register to post comments
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