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Idea Description
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Innovation 'Elevator Pitch':
The PCAF service is a nationally recognised, peer reviewed, multi-award winning service that is provided within GP practices to support the identification, diagnosis and treatment for patients with AF with the aim of preventing AF-related strokes.  
Overview of Innovation:
The PCAF service is an innovative consultant-led service that provides dedicated expert resource to GP practices to: 
  • Identify additional 'unknown' AF patients within the clinical system; 
  • Qualify the accuracy of the AF register(s), referring patients for diagnostics to secure a diagnosis where required;
  • Assess the risk of stroke within the AF population by using a robust risk assessment tool (i.e. CHA2DS2- VASc);
  • Undertake comprehensive case note reviews of all patients who have been assessed as being at high risk of stroke with the aim of identifying those who would benefit from receiving an expert review;
  • Provide ‘in-house’ consultant-led AF clinics, ensuring that all patients at high risk of stroke receive access to an expert review and patient education;
  • Optimise the treatment and management of patients with AF, supporting quality outcomes and an increase in health related quality of life;
  • Provide one-to-one and group clinical education, thus ensuring a ‘legacy’ is left amongst clinical teams within primary care;
  • Enable access to an AF Stroke Prevention RCGP and CPD accredited eLearning package, enabling clinicians to increase their knowledge and skills on the current evidence base;
Primarily, the service will optimise the treatment and management for patients with AF (whilst being fully compliant with NICE Guidelines, local guidelines/pathways and the local medicines management formularies), ensuring a reduction of AF related stroke incidence within GP practices.

The service comprises of the following four phases, all of which are provided by Inspira Health:
  • Phase 1 - PRIMIS audits are run on the practice clinical system (including GRASP-AF).
  • Phase 2 - 5 clinical audits are completed and involve comprehensive patient case note reviews.  Each audit will identify patients at high risk of stroke who would benefit from an expert review;
  • Phase 3 - Patients are systematically invited to an expert review and are provided with education;
  • Phase 4 - Patients are reviewed by an independent local specialist (e.g. Consultant Cardiologist) within their GP practice and their management is optimised.
All clinicians within the practice are provided with an opportunity for one-to-one education during Phases 2 and 4.  In addition, all clinical staff are offered the opportunity to undertake an RCGP and CPD approved AF Stroke Prevention on-line eLearning package which consists of 5 modules and a competency assessment through patient case scenarios. 
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:
This Programme will support primary care to reduce the burden of AF-related Stroke in our population through achieving the following clinical aims: Where appropriate, to increase rates of anticoagulation use in AF patients identified as high risk of AF-related stroke not currently receiving appropriate anticoagulation; Optimise anticoagulation of AF patients unstable on Warfarin through transfer to NOACs where appropriate.  The programme is funded through a joint working project between Bayer HealthCare and West of England AHSN.
Challenge identified and actions taken :
The UK sees 150,000 strokes per year of which 20% are attributable to AF (Ball 2013) giving a figure of 30,000 AF-related strokes. Extrapolating the results from phase one may result in approximately 15% fewer strokes in high risk patients across the UK.
  • Quality Improvement: Create an approach that will enable clinicians to re-evaluate how identification, diagnosis and treatment occurs and consider NOACs alongside traditional anticoagulants
  • Strategic: Create an approach that will enable a CCG to sustainably drive implementation of the above (including appreciation of risks (financial and otherwise) of implementation).
Impacts / outcomes: 
Phase One: Across eleven partner practices in phase one, 2,688 patients with AF were identified. Of these, 335 patients were rated as being at ‘high risk’ (i.e. had a CHA2DS2Vasc score of greater than one); over a three-month period, 131 patients were reviewed with regard to optimising their management.

As a consequence, it has been estimated that between five and six strokes were prevented over this period.

Investigations into the potential financial implications of a stroke have suggested an associated cost of £23,315 per stroke (National Audit Office, 2010).  Applying this principle to the findings of the innovator phase could suggest costs between £116,575 and £139,890 may have been avoided.
Which local or national clinical or policy priorities does this innovation address:
Enhancing quality of life for people with long-term conditions
Supporting quote for the innovation from key stakeholders:
The programme is funded through a joint working project between Bayer HealthCare and West of England AHSN.
Plans for the future:
 It is anticipated that accredited online training resources will be available by Q1 16/17.
Tips for adoption:
Project management resource; CCG Leads (clinical; managerial; pharmacist); Other CCG support (comms; finance; project sponsor; primary care team); Resource to deliver training (clinical updates and quality improvement); quality improvement mentoring and coaching; caseload audit resource; availability of practice support pharmacists to work with practices; informatics (to enable quantitative evaluation of impact). Online tools to support patients and practices in shared decision-making, implementing a quality improvement project are already available.
  • Clinical Champions (both at strategic and project level)
  • Modelling of Health Economic impact of adoption
  • Building a community of practice (with regard to both clinical case for change, as well as creating a shared language and experience underpinning the quality improvement element)
  • CCG also included this clinical area in their primary care offer.
It is critical that the health economic impact of the project and associated changes in prescribing costs should be explored with each CCG during initiation. We have a local health economic modelling tool that could be adapted to suit local needs.
Contact for further information:
Anna Burhouse, Director of Quality (anna.burhouse@weahsn.net) Stephen Ray, Programme Manager (stephen.ray@weahsn.net).

www.dontwaittoanticoagulate.com; Phase one evaluation (full version and executive summary) available; Health economic modelling tool.
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Innovation 'Elevator Pitch':
An expert-lead education platform for medical and dental professionals, providing crowd-sourced digital verifiable CPD and revalidation capabilities to improve patient care and administration for healthcare professionals and hospital trusts.
Overview of Innovation:
Medical professionals face a burden on managing their continuing education. To date, the methods of gaining CPD are largely book-based, rudimentary, expensive, fragmented and inconvenient. According to our market research, over 80% of dentists and medics surveyed wished to have a cheaper and simpler way to gain their CPD. Further to this, hospital trusts face great difficulties with CPD administration including revalidation, which is currently a largely manual based task in NHS trusts.
 
With over 95% of doctors and nurses owning a smartphone, there is an overwhelming need for a disruptive force to digitalise and advance this vastly under developed sector of professional education within one technological umbrella.
 
To solve these problems, we have been working with a large team consisting of 40 expert content writers, 5 experienced developers and several leading figures in NHS innovations to facilitate implementation within the wider healthcare environment.
 
With this great team, we have created the world's first innovative, simple and high-quality CPD education mobile app for medical professionals that crowdsources the way that expert-level content can be consumed and centralises all paperwork for the individual and HR trust.
 
An individual can gain all their CPD needs, directly accessing the expert knowledge pool of fellow medical professionals via our app, whilst enjoying the cheapest and easiest solution to do so from our market research*. An individual can save up to £130 each year on their required CPD hours from the MedicaliQ service, and hospital trusts will save an average of £10,000 annually. By creating an open platform for experts to contribute content, this will create a paradigm shift in the way that knowledge is gained and shared.

Further to this, we have created a breakthrough and simplified administration system for healthcare trusts to intelligently manage workforce-related issues such as revalidation and mandatory training, which is currently being piloted with the Manchester Hospital Trusts. 
Stage of Development:
Close to market - Prototype near completion and final form may require additional validation/evaluation and all CE marking and regulatory requirements are in place
WMAHSN priorities and themes addressed: 
Education, training and future workforce / Digital health / Innovation and adoption
Benefit to NHS:
Directly supports NHS workforce development

By crowdsourcing expert knowledge via CPD we aim to reduce the current CPD spend in terms of both administration time and in providing externally accredited courses (HR spend per staff on providing externally-accredited courses are estimated at £800/staff per module. This can greatly be reduced with our centralized pool of experts.  
 
Opportunity to deliver mandatory staff training through the education platform, encouraging greater autonomy in learning styles – can carry out training and revision both online and offline. All articles have an audio assist option with a variety of accessibility options to appeal to the wider learning taskforce.
 
We are piloting a breakthrough service with the University of Central Lancashire whereby the CPD courses offered within the app will also be academically certified as a qualification (PGCert, PGDip or Masters level), the first service of its kind in the UK.
 
The MedicaliQ platform can tie in with existing third-party educational resources and CPD providers to partner and add value to their educational offerings, allowing individuals to test and certify their knowledge in a unique collaborative environment.
 
Regular board meetings with advisory panel with divisional leads to direct key educational strategies

Content produced by senior practising clinicians and healthcare professionals within the NHS and private sector, ensuring a bank of expert-level knowledge disseminated for other clinicians
 
Management of workforce issues via our Revalidation program will help support individuals and trusts to streamline their administration requirements with the provision of approved and certified educational materials.

This dynamic educational resource will be available 24/7 and offline, and thus facilitates training in a cost-effective and immediate manner ensuring up-to-date knowledge for a better-informed workforce to improve patient outcomes and care. 
Initial Review Rating
4.60 (1 ratings)
Benefit to WM population:
MedicaliQ will have a NHS-wide and global reach.

An improvement in skills and knowledge of clinicians to offer enhanced patient care to citizens of the West Midlands region.

Unique opportunity for the local industry to gain feedback in current medical practices from leading consultants and professors, via in-app feedback, for crowdsourced knowledge pooling.

More simple, affordable and efficient access to high quality education for clinicians in the region and across England.

Engagement with higher educational institutions in the West Midlands to supplement and deliver their medical educational courses via more innovative platform (via in-app integration – currently being trialed with UCLan).

A specialist advisory board will be set up in the Medical and Dental sectors with meetings held in the West Midlands 4 times per year.

Devolves development and delivery of medical-related educational programs and CPD from hospitals to individuals in conjunction with the current expert pool via regional organizations and professional bodies such as the Royal Colleges and regulatory authorities.

Potential to utilize the crowd-sourced nature of the platform to develop the services to devolve and facilitate individual clinicians to partake in primary care research across the West Midlands area.

Reduces the administrative burden on staff for CPD whilst opening access to high-quality continuing education to ensure up-to-date knowledge and optimised patient care.

Ability to convert your CPD earned in the app into a real-life qualification via our academic partners UCLan.

Affiliations with national conferences held at the NEC Birmingham to administrate their CPD.

MedicaliQ will immediately create new jobs in the local area to support production with an opportunity for the team to grow as the services develops.

Looking to develop a global training focus on e-education in the West Midlands.
Current and planned activity: 
The current concept of mobile-based education is proven with our world-leading student app, and signing up over 5,000 dentists onto our dental CPD app.
 
MedicaliQ has been accepted onto the Digital Health.London 2016 accelerator, a pioneering NHS accelerator program that works to bring new innovations into the healthcare ecosystem.
 
Our pilot with the Manchester Trust will help inform our plans to create a product that can scale to the standard administration protocols of a large NHS Healthcare provider.
 
In scaling the mobile product, we will create a third party system for existing CPD providers to provide content. General CPD material will first be provided for the average medical professional with a view to engage specialist interests, in partnership with our advisory board. We are then looking to integrate the product to offer CPD solutions to the wider allied healthcare professionals, such as paramedics and health care assistants.
 
NOTE: Please see attached business summary
What is the intellectual property status of your innovation?:
MedicaliQ Ltd owns all IP involved in the innovation. The brand names, ‘DentaliQ’ and ‘MedicaliQ’ have been trademarked as both image and text (see attached). 
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
1 year
Ease of scalability: 
Simple
Regional Scalability:
Once developed, MedicaliQ can be scaled and adopted across hospitals and primary care providers in the West Midlands area for both individual based CPD and revalidation needs. Our pilot with the Manchester Hospitals trust will demonstrate how we may integrate such a solution from the HR personnel perspective, creating a streamlined system that can be scaled to any other hospital setting including the West Midlands. Our solution benefits both the individual clinician and the administration backend of hospitals, ensuring a two-pronged strategy. Distributing the platform via local GP surgeries to provide a similar service, via EMIS, will further provide scalability options in the region. There is a large focus towards a digital transition to care as part of Digital Birmingham’s agenda, so it would be concordant to roll the product out to other providers in the region. Hospital universities in the region will also benefit from the whitelabelled CPD package for their postgraduate students.
Measures:
There are three main outcome areas that impact is being measured against: individual clinicians, hospital trusts and contributing authors.
 
Individual clinicians: improving access and convenience to expert-lead education to enhance continuing education and promote self-learning. This ultimately leads to having more up-to-date knowledge and providing better patient care.
 
Hospitals: enhancing, digitalizing and streamlining the workforce administration methods for continuing education and revalidation to save clinical time and prioritise patient care.
 
Contributing authors: to provide authors with an opportunity to curate and disseminate their expert knowledge within a crowd-sourced environment to provide an independent income stream.
 
To support the above impact areas, we will be applying the following measures to gauge success of the innovation across both quantitative and qualitative aspects:
  • Number of monthly downloads
  • Monthly revenue
  • Profit margins
  • Number of purchased articles and repeat
  • Number of customers (and thus the market share)
  • The number of articles in our bank
  • User rating
  • User reviews
  • Time spent on app
  • Number of successful revalidation applications
  • Number of post-graduate student signups via University courses
Other measures across the broader aspects include:
 
Quality
Customer: number of purchased articles, repeat customers, user feedback/rating, time spent on app
Technology: reliability, accessibility, downtime
 
Safety
Customer: accurate educational content (verified by expert panel)
Technology: meets information governance standards, appropriate 2-step authentication procedures, back-up content
 
Cost
Customer: customer acquisition costs, amount paid per customer, amount earned by author’s per article
Technology: operational costs
 
People
Authors: quantity, engagement and submission rates; experience/qualifications
Adoption target:
The conservative business model assumes a national registered member accounting for 10,000 Year 1, 50,000 Year 2 and 100-200,000 Year 2. Our original DentaliQ product had 10,000 users register in the first month of launch in 2016. Assuming a 10% uptake by registered users for a paid-for CPD service, MedicaliQ will be viable by Q2 of Year 2.
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Innovation 'Elevator Pitch':
DLS Supported Self Management puts patients in control of their own health; connecting lifestyle goals to health benefits, sharing data with health professionals and making virtual clinics a reality. 
Overview of Innovation:
DLS Supported Self Management consists of two modules which are both available through the web, android and iOS apps.
 
The first, prescribed by health professionals or through self-referral, is a lifestyle plan, which will help patients, and their health professionals map out important lifestyle goals related to specific conditions and pathways.
 
The lifestyle plan will connect existing monitoring devices and lifestyle apps, and allow this data to be shared with care teams and health professionals, giving them the visibility to provide professional support, encouragement and advice to the patient when it is needed most.  Once set up, it will become the coach needed to help the patient stick to their plan offering reminders, encouragement, advice and feedback based on progress, as well as access to a range of prescribed self-care courses and condition focused support groups.
 
The second module will bridge the gap between the patient and clinical worlds, integrating directly into Primary care clinical systems and providing a seamless workflow. This includes:
  • visibility on each patients lifestyle plan, patient collated data and comments made by the patients care team (including non-medical data).
  • A virtual clinic with a dashboard of patients within that specific clinic (e.g) diabetes and a RAG view of the patient data within each record.
  • Easy access to communications tools such as video calls and the phone, the ability to prescribe self-care content and the facility to send, receive and record patient messages.
Both modules will sit on a platform that will provide secure identity management, deliver robust management of patient consent and through a developer platform, will allow third parties to build against the system, enable access for open and paid API’s and deliver bespoke websites to be delivered against it. 
Stage of Development:
Trial stage - Trial stage to prove that the idea actually works as intended
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Digital health / Person centred care
Benefit to NHS:
The systems have not yet been built, or trialed, that is in progress as we speak. Therefore the hard evidence, figures and statistics behind these assumptions are yet to be quantified.
 
The lifestyle plan module is designed to promote patient self-management, leading to less dependency on the health system as a result of pro-actively improving lifestyle factors that reduce the re-occurrence of acute episodes for patients with a long-term condition. This promotes improved health outcomes for the patient and decreased cost to the health system as a whole. 
 
Healthcare professionals have a clearer, more informed view of the patient between consultations, leading to more informed consultations at more appropriate times (via the RAG and alert system). This increases efficiencies as patients can be monitored remotely with consultations as and when they are required, rather than at regular intervals.
 
Healthcare professionals will be able to set-up alerts based on the data patients shared, supporting proactive healthcare and decision making.
 
Virtual Clinics mean that when a consultation is required, it can be conducted quickly and efficiently for both the patient and clinician, remotely via video consultation, telephone or message, with face-to-face consultations only when they are required. Patient measurements are submitted in advance via the lifestyle app. This will likely show a favorable improvement in the efficiency of clinician time as well as providing a more convenient, modern service for the patient
Online Discussion Rating
5.00 (3 ratings)
Initial Review Rating
3.00 (1 ratings)
Benefit to WM population:
The innovation will drive positive outcomes for the West Midlands health economies by impacting patient demand.
 
In promoting self-management in this way, we are asking patients to become more responsible personally for their health and less reliant on the health system to keep them within the healthy parameters of their conditions. By supporting patients to be involved in managing their own care, we help to improve Patient Activation Measures (PAM).
 
In doing this, we expect to see:
  • a reduction in patient demand for primary and urgent care services;
  • efficiency savings from managing the patients that are seen in a more timely manner;
  • Improved clinical capacity;
  • better patient outcomes;
  • fewer missed appointments
Current and planned activity: 
We’re working with primary care partners and CCG payers to define the product scope and will involve patients/clinical users to better understand specific functionality and usability.
We have spoken to
  • Diabetes UK to ensure we’re contributing to Diabetes prevention and treatment strategies and to user test our products.
  • GPSoC framework providers to find the most efficient way to integrate our professional tools directly into the primary care clinical systems.
  • Health Exchange in Birmingham to balance our digital provision against face-to-face options so we can reach more patients, particularly those most in need of help.
  • Commercial technology providers to leverage the best the market has to offer, instead of reinventing the wheel. This, for example, will provide a simply way to harvest data from 3rd party devices and apps, allowing us to focus on the patient experience and engagement. 
The product will be trialed with a co-hort of diabetes patients through Aylesbury Vale CCG.
What is the intellectual property status of your innovation?:
The IP is owned by Digital Life Sciences and is in the process of being trademarked. 
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
1 year
Ease of scalability: 
3
Co-Authors:
Regional Scalability:
Supported Self Care is designed to be delivered at scale to Primary Care populations. The product sits on the DLS patient platform, which is already supporting 70,000 patients in the West Midlands, 82,000 in Worcester and is about to bring on an additional 200,000 patients in Aylesbury Vale CCG area and 300,000 in Chiltern over the next year.
 
When it is launched, the innovation will be available commercially to any organization, in the West Midlands, or other regions, who wishes to purchase it. 
Measures:
The success of the supported self-care product will be measured by;
  • The sales revenue generated
  • The clinical patient outcomes (yet to be confirmed)
  • The reduction in patient demand for primary and urgent care services;
  • Efficiency savings from managing the patients that are seen in a more timely manner;
  • Improved clinical capacity;
  • Better patient outcomes;
  • Fewer missed appointments.
 
Prior to implementation of the first pilot, we will undertake a benchmarking exercise which will define the exact outcomes we want to measure and reporting will be put in place to track improvements.
 
This will include a patient / user survey of existing services to gauge satisfaction levels, which will be repeated towards the end of the project.
 
As part of each deployment register we put a risk register in place, which will highlight any project risks encountered along the way in terms of quality, safety, cost and people. In addition our clients have their own clinical recording methods to keep abreast of any patient safety and or quality issues. 
Adoption target:
Yr 1 SSC deployments include the technology/ product license fee and the business change and transformation required to embed the product sufficiently to deliver a return on benefits.
Rates of adoption are: 
 2018  4 projects, £50,000 licence revenues
2019  8 projects, £70,000 licence revenues
2020  9 projects, £100,000 licence revenues
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