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Innovation 'Elevator Pitch':
Virtual Clinic is an innovative mobile app which securely sends real time patient data to the hospital database.  A web interface allows the consultant to review a patient’s condition online and give feedback to the patient.
Overview of Innovation:
Virtual Clinic enables patients to manage their conditions more effectively by communicating information about their condition on a daily basis, reducing the need to attend a clinic unless it’s absolutely necessary.

A collaboration between Imobisoft and Birmingham Children’s Hospital, the Virtual Clinic app enables patients to securely communicate information about their condition directly to a clinician while simultaneously updating the Trust’s electronic patient record system.

Currently, patients with long term conditions or requiring post-operative care regularly attend outpatient clinics. The majority of these appointments require no clinical intervention and may require several hours’ travel for what might be a very brief questionnaire-based session with a clinician.
 
If a patient’s condition changes between routine appointments, the app automatically alerts the clinician who can respond immediately and effectively, having been provided with details about the change. An intervention can be made earlier, potentially decreasing the risk of morbidity or the need for more complex interventions or hospital admission.
 
Providing patients with immediate feedback on how their lifestyle or treatment impacts on their symptoms provides immediate personalised education to help them manage their condition.
 
Virtual Clinic is a free app. Users download it onto their phone and enter their unique code to create their profile. Symptoms are recorded via slider bars and radio buttons and sent in real time to the server. Clinicians view the data received, either via an alert when abnormal data is received or by logging onto the web interface to see all data for a particular patient over a period of time. Clinicians can send a message via the web interface to the patient’s phone and run reports on patients, symptoms, etc. from the database.
 
The functionality of the app can be applied to the majority of long term conditions currently managed by regular Outpatient appointments.
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':
Virtual Clinic is an innovative mobile app which securely sends real time patient data to the hospital database.  A web interface allows the consultant to review a patient’s condition online and give feedback to the patient.
Overview of Innovation:
Virtual Clinic enables patients to manage their conditions more effectively by communicating information about their condition on a daily basis, reducing the need to attend a clinic unless it’s absolutely necessary.



A collaboration between Imobisoft and Birmingham Children’s Hospital, the Virtual Clinic app enables patients to securely communicate information about their condition directly to a clinician while simultaneously updating the Trust’s electronic patient record system.

Currently, patients with long term conditions or requiring post-operative care regularly attend outpatient clinics. The majority of these appointments require no clinical intervention and may require several hours’ travel for what might be a very brief questionnaire-based session with a clinician.
 
If a patient’s condition changes between routine appointments, the app automatically alerts the clinician who can respond immediately and effectively, having been provided with details about the change. An intervention can be made earlier, potentially decreasing the risk of morbidity or the need for more complex interventions or hospital admission.
 
Providing patients with immediate feedback on how their lifestyle or treatment impacts on their symptoms provides immediate personalised education to help them manage their condition.
 
Virtual Clinic is a free app. Users download it onto their phone and enter their unique code to create their profile. Symptoms are recorded via slider bars and radio buttons and sent in real time to the server. Clinicians view the data received, either via an alert when abnormal data is received or by logging onto the web interface to see all data for a particular patient over a period of time. Clinicians can send a message via the web interface to the patient’s phone and run reports on patients, symptoms, etc. from the database.
 
The functionality of the app can be applied to the majority of long term conditions currently managed by regular Outpatient appointments.
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
Benefit to NHS:
Successful implementation of the Virtual Clinic app will support the health care community vision and aims by:
 
1. Adding to the communication channels between patient and consultant at the time that their chronic condition has worsened
2. Improving efficiency in clinical workflows via automatic two-way messaging between the patient’s app and the clinician
3. Providing real time clinical intelligence on a patient’s symptoms to highlight any clinical issues via alerts
4. Patients using Virtual Clinic will not have to attend regular Outpatient appointments if the condition has abated, thereby freeing up Outpatient appointment slots
5. Providing prospective data on patient outcomes, informing future patient management decisions and advances in practice.
 
The implementation of Virtual Clinic is expected to realise improvements in a number of areas:
 
• Redesigned processes associated with monitoring of chronic conditions
• Real-time monitoring when a patient’s condition worsens
• Ability to interact with a patient when their condition initially worsens, rather than at an outpatient appointment when the condition has continued to deteriorate
• Decreased Outpatient appointments
• Decreased A&E attendances and admissions with disease complications
• Improvements in information for reporting purposes via the collection of data regarding a patient’s condition
• Collection of validated prospective health status data
• Improved outcome data for audit and research
• Improved patient satisfaction.

Virtual Clinic can be customised for various metrics monitored via Outpatient appointments (e.g. incontinence, asthma, diabetes, etc.). Currently, Virtual Clinic is used for patients at Birmingham Children’s Hospital with anorectic malformations and chronic constipation.

“Virtual Clinic allows the clinician to communicate via the app with the patient and give feedback. It also allows the clinician to tailor the treatment of the patient more precisely based on his daily symptom recording and therefore adjust his follow-up in clinic according his clinical needs. By allowing the clinician to monitor a patient's condition in real time, the Virtual Clinic app has huge potential to improve patient care. I believe it will reduce the number of unnecessary Outpatient appointments, deliver significant cost savings, free up capacity and inform future advances in practice."    Mr Ingo Jester, Consultant Paediatric Surgeon, Birmingham Children’s Hospital
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
1. Imobisoft Ltd is a West Midlands based SME and adoption of the Virtual Clinic app within the region would allow the company to grow and take on additional specialist staff
2. Reduction in unnecessary Outpatient appointments
3. Improved health and wellbeing from the enablement of early intervention, potentially decreasing morbidity and preventing the need for more complex interventions or a hospital admission
4. Reduction in travel for patients (reduces pressure on the region’s transport infrastructure)
5. Reduction in the need for parents and/or carers to take time off work to escort the patient to and from hospital.
Current and planned activity: 
A pilot study is currently in progress at Birmingham Children's Hospital NHS Foundation Trust. The ROI will be available when this completed.

Other NHS engagements include:

University Hospitals of North Midlands NHS Trust
Heart of England NHS Foundation Trust
South London and Maudsley NHS Foundation Trust
What is the intellectual property status of your innovation?:
The intellectual property in the Virtual Clinic app is owned by Imobisoft Ltd.
Return on Investment (£ Value): 
N/A
Return on Investment (Timescale): 
N/A
Ease of scalability: 
4
Regulatory Approvals:
Not applicable.
Investment sought:
Not applicable.
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Innovation 'Elevator Pitch':
Medopad's remote monitoring platform provides clinicians with insight into patient progress in between clinic appointments. This can prevent unncessary outpatient appointments or bring forward appointments for patients who are not progressing well. 
Overview of Innovation:
The Medopad app is a health ecosystem with a patient view and a clinician view. It is very intuitive and user-friendly, having been designed with Apple in their Cupertino, California labs. 

Patient app
Patients interact with Medopad through a single smartphone app or via connected devices and sensors. Instead of multiple apps for each disease, patients have a single, centralised point of access via the Medopad platform. The Medopad app is composed of different modules and divided into four user-friendly and intuitive sections: patient profile, data collection, patient dashboard, and learning & education. Medopad provides 100+ data collection modules ranging in functionality: medication and symptom trackers, photo and video capture, tele-consultation, and questionnaires. We also provide activity-based modules for specific disease indications including the 6-minute walk test, used by cardiovascular patient cohorts to avoid travel into clinic. We can also integrate devices and sensors, i.e. glucometers and spirometry. To enable self-management, we can provide in-app videos and digital leaflets for patient education. Equally important, patients have access to their dashboard, providing a visually engaging view of trends in their own health and wellbeing data.

Clinician dashboard
The Medopad platform is built specifically for each clinician and their patient cohort via a custom integration. Clinicians monitor and manage their patient cohort through a web-based dashboard, where they can view trends in patient data that otherwise were not available to them before. Empowered with increased information, stakeholders can create customised alerts to identify patients who are progressing poorly. By extension, data availability allows clinicians to provide a high level of personalisation in between clinic appointments by sending patients customised notifications to support self-management.

 
 
 
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 / Education, training and future workforce / Wealth creation / Digital health / Innovation and adoption / Patient and medicines safety / Person centred care
Benefit to NHS:
Medopad's solution enables clinicians to spot health deterioration sooner, preventing costly complications.  To name a few, we are working the Royal Free NHS Teaching Hospital, Guy's and St. Thomas's, Royal Salford, and Chelsea and Westminster.

At Guys' and St. Thomas' hospital, we are working with both community nurses and hospital vascular consultants to monitor venuous leg ulcer healing. While there are no estimates for the total cost burden of venous leg ulcers specifically, the total cost of acute and chronic wounds to the UK NHS is estimated to range from £4.5 to £5.1 billion, with 78% of costs falling on community NHS services for chronic wounds (Guest et al 2015). This pilot is currently underway. Patient's leg ulcers are photographed by themselves or the community nurse during wound dressing changes. Patients' acitivity is also tracked, as increasing mobility is a sign of a healing leg ulcer. This pilot is being used by vascular consultants to identify deteriorating wounds earlier, which may necessitate a move from a community-based management to hospital-based interventions. 

At the Royal Salford, we are working with consultants to monitor patients with renal disease. In this pilot, patients are completing tasks at home that would normally be done by the nurse. Specifically, patients are monitoring weight, blood pressure, and completing a urine test at home using Healthy IO's urine dip stick test. This saves the nures time when the patient does travel into clinic, where the nurse needs only complete the remaing blood test. Apart from saving nurses time during clinic, renal consultants are able to monitor patient progress in between appointments. If patients' blood pressure and weight are not deteriorating, the consultant may postpone the appointment, and equally, if indicators seem to be worsening, the consultant can provide timely care by bringing the patient in sooner. Renal disease is a costly condition; the NHS in England spent an estimated £1.45 billion on CKD in 2009–10. By monitoring patient progress, there is potential to reduce some of these costs by reducing disease progression and complications. 
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
The Medopad platform provides clinicians with insight into patient progress in between clinic appointments, this has the potential to provide patients with preventative and timely care by spotting problems sooner (as described in the previous section). For the patient, prevention of further deterioration means improved quality of life. Additionally, the platform has the potential to reduce unnecessary clinic appointments for patients.

At the Royal Free, patients with peripheral arterial hypertension (PAH - a rare disease) are using the Medopad smartphone to avoid travelling into clinic for appointments. Instead, patients complete a six-minute walk test (a measure of disease progression) at home. Since it can be done from home, patients can do this more frequently, on a weekly basis, which provides clinicians with richer data on which to assess patient progress. Due to the nature of the condition, PAH patients suffer from symptoms like breathlessness that are made worse with activity. By avoiding long distance travelling to one of seven specialist PAH centres, patients' health is improved and they have a better experience of care. 

At the Harley Street Clinic, we have worked with children that have a rare form of brain cancer (DIPG). Parents recorded videos of their child performing certain tasks and recorded additional health data. The clinician was able to more frequently monitor the children's progress without putting additional undue strain on both parent and child. Using the platform in this way was particularly improtant for vulnerable patients, such as these children, not to mention reducing the burden on parents.  
Current and planned activity: 
As mentioned in the previous sections, our solution and deployments have been co-developed with clinical experts and innovators across several top UK NHS teaching hospitals. 

We are currently looking for partners in the West Midlands, such as the AHSN, clinicians, and nurses, to engage in several pilot projects across a range of disease areas. Medopad is offering pilot projects free of charge for 12 months as a way to gather evidence of effectiveness and cost-effectiveness for our solution. As a part of the project, we include implementation and ongoing support.

In the longer term, we are looking to provide a transformative experience of care by providing intelligent and AI-powered clinical support systems to move the needle from reactive to preventative care. In that vein, we are looking for motivated and committed health care professionals to work with us in this journey. 
What is the intellectual property status of your innovation?:
Medopad's IP is related to its smartphone app and clinician web-portal. 
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Simple
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Innovation 'Elevator Pitch':
Liver transplant patients often travel long distances for outpatient appointments. A randomised study is being conducted to evaluate the impact of outpatient consultations administered through a video call on the myhealth@QEHB patient records portal
Overview of Innovation:

Virtual clinics, where patients can have a hospital appointment with their clinician from home, are emerging in practice, but their effectiveness is unclear. This study will evaluate whether a virtual clinic developed by University Hospitals Birmingham NHS Foundation Trust (UHB) called myVirtualClinic improves patient satisfaction compared to standard face-to-face appointments for liver transplant patients.
 
A parallel, two-arm, statistician-blinded, randomised evaluation is being undertaken to evaluate myVirtualClinic. Clinically stable liver patients 1 to 5 years post-transplant (n=180) will be randomised in equal numbers to virtual clinic appointments (intervention) or standard face-to-face appointments (control). The intervention group will have outpatient appointments from home via secure video link accessed through the UHB patient portal. All patients will complete baseline questionnaires before randomisation and electronic follow-up questionnaires after each appointment over 12 months. The primary outcome is the difference in scores between groups for three areas of satisfaction (modified Visit-Specific Satisfaction Instrument, VSQ-9). Secondary outcomes include quality of life (EQ-5D-5L), costs, clinical contacts and user experiences (patient, carer and health professional).
 
The study has been approved by the NHS Health Research Authority (HRA) and received a favourable ethical opinion from the West Midlands Solihull Research Ethics Committee on 24.10.17. Research governance approval was obtained from University Hospitals Birmingham NHS Foundation Trust in February 2018. The study is sponsored by University of Birmingham and is registered on ISRCTN (Ref: 14093266)

The study is a collaboration between NIHR CLAHRC West Midlands Chronic Disease Theme based at the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust.  The study principle investigator and clinical lead Dr James Ferguson (Consultant Hepatologist) developed the myVirtualClinic intervention with the University Hospitals Birmingham Informatics and myHealth@QEHB team. The lead University of Birmingham Research Fellow evaluating the intervention is Elaine O’Connell Francischetto and other members of the myVirtualClinic randomised evaluation steering group are Gill Combes, Sarah Damery, Eric Deeson, Janet Jones, Foyzal Miah, Pamela Nayyar, Aziz Sheikh and Katie Squire.
Stage of Development:
Evaluation stage - Representative model or prototype system developed and can be effectively evaluated
WMAHSN priorities and themes addressed: 
Digital health
Benefit to NHS:
Findings from this research could be applicable to a wide range of settings that could use virtual clinics. MyVirtualClinic has the potential to reduce the cost base for the NHS and an ecomonic analysis is being undertaken. These findings will allow a more in depth understanding of how the virtual clinic was beneficial or how it could be improved for future practice within the NHS.
Initial Review Rating
4.20 (1 ratings)
Benefit to WM population:
The myVirtualClinic study is patient-centred and has been designed with input from patients, clinicians, researchers and IT staff. It is anticipated that myVirtualClinic will utilise technology to improve patient satisfaction with their care. In addition, myVirtualClinic could provide a cost and time saving for patients, removing the need to travel long distances for outpatient appointments.
Current and planned activity: 
University Hospitals Birmingham have completed the development and pilot testing of myVirtualClinic software. The randomised evaluation started recruitment on 12.03.18. As of 17.05.18, a total of 24 patients have been recruited and randomised. The study is due to recruit and randomise 180 liver transplant patients across four liver clinics at University Hospitals Birmingham.
 

 
What is the intellectual property status of your innovation?:
The myVirtualClinic intervention is the intellectual property of Health Informatics team at the University Hospitals Birmingham NHS Foundation Trust.
Return on Investment (£ Value): 
medium
Return on Investment (Timescale): 
3 years +
Ease of scalability: 
3
Co-Authors:
Regional Scalability:
Findings from this research could be applicable to a wide range of settings that could use virtual clinics.
Measures:
The primary outcome is the difference in scores between groups for three areas of satisfaction (modified Visit-Specific Satisfaction Instrument, VSQ-9). Secondary outcomes include quality of life (EQ-5D-5L), costs, clinical contacts and user experience. Statistical analysis will be descriptive and on an intention to treat basis. The primary outcome will be analysed using baseline, 3, 6, 9 and 12 months questionnaires (according to patient appointment frequency) and comparisons made between study arms. A within-trial cost consequences analysis (CCA) will be undertaken on the economic data.  Interviews about the experience of virtual clinics will be undertaken with patients, carers/family members and health professionals.
 
Adoption target:
150 clinically stable liver patients 1 to 5 years post-transplant will be randomised in equal numbers to virtual clinic appointments (intervention) or standard face-to-face appointments (control).
Rejection Reason:
Not currently in a position to spread to other organisations
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