The document outlines the development and implementation of the doc@home digital care platform, which aims to improve patient management and outcomes in community healthcare settings. Funded through various EU projects, it includes phases for design, validation, and expansion of services for chronic disease management and telehealth. Initial results from trials have shown significant reductions in patient admissions and high levels of satisfaction among patients and caregivers alike.

1. doc@HOME
Digital Care Platform
- Improving outcomes and
efficiencies of managing patients
in the community
An EU Success story - From
an RTD Project to a delivered
service
Adrian Flowerday
MD Docobo Ltd
28/04/2014
Copyright Docobo Limited
Not to be reproduced without
permission
1

2. Copyright © Docobo Limited Not to be reproduced without permission
doc@HOME – an FP5 RTD Project
Transpond – an embedded OEM product
provider
– Approached by Estonian Research group to
join a project – proof of concept already
developed
– €2m project – 50% funded
– 3 SME’s and 4 Clinical sites
– Technologists, clinicians and practitioners
Docobo Ltd - SME formed Sept 2001
– to commercialise the output – doc@HOME
– Self funded/project initiatives for
development and validation
UK developer/manufacturer
– EN13485 BSI approved Medical Devices
EU Success Story
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Phase 1 Projects to Build Assurance
RTD Framework 5 programme (initial development)
– Design of home monitor and service infrastructure
– Demonstration of service delivery
DTI SMART Award -
– Value added design to FP5 outcome – design adapted to market
– Focus on USP of Patient Self Care Empowerment and Motivation
Quality of Life Programme – REALITY - validation studies
– Determine and demonstrate Socio-economic impact
– Qualify ethical aspects of deploying home monitoring
– Trial service delivery impact - 200 patients monitored over 12
months – Multi disease - create start of evidence base

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Phase 2 to Establish Evidence
eTEN project – business case and market entry
– Validation study - virtual outpatient clinic for unstable diabetic
patients
– Business case development - Roll out of services
Southampton COPD (Interreg III)
– COPD management in the community
– One of UK’s first successful Telehealth projects
Framework 6 project - (ENABLE)
– New approaches – assistive living – applied services
– Integration of smart sensors / data fusion / control / communications
– Next generation fall detectors
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Key Objectives – use case design lasted
Single and Multi-patient use
Configurable for all chronic diseases
Capacity to handle co-morbidities
Key vital signs – ECG, Respiration Rate, HRV,
Aortic Pressure wave
Programmable alerts
Logs interventions
Messaging
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Phase 3 widen product range
TSB ALIP1 PEACE and ALIP2 PEACEAnywhere – New product
development
– Develop Android based Medical device
– Develop new Web 2.0 based server
– Develop new comms options
Framework 7 project – (I Don’t Fall)
– Falls prevention and rehab
– Interoperability between Telecare and doc@HOME
– Connectivity to external devices for secure data transfer
Framework 7 project - (eSMART)
– Cross Europe Smart phone based symptom management for patients with
cancer
– Multi Language product range
Commercial success
– Two major Tenders won in UK NHS – Yorkshire and Nottingham City - 1000
patients
– 10 other NHS customers moving to the new solutions
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Need-ability Index
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ArtemusICS™ - Intelligent Identification
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Secure
Data
Warehouse
SUS Data
Primary Care Data
Tier II Data
GPSI Data
Risk Stratification
Engine
Risk
Score
ArtemusICS
Processing
Engine
Community Data
Social Data
ArtemusICS
• Statistically agnostic
• Web Based LTC Dashboard
• Drill down to CCGs and GP practices
• Filter by disease group and/or Co-
Morbidities
• Commissioned by NHS Surrey
• Predicted costs, vs actual utilisation
• Indentify unknown costs
Identifies
NEED
Intelligent Management
• Medicine Optimisation
• Condition specific optimisation
• Intervention assignment
• Regular refresh
• track change
• benefits realisation
• Intervention tracking - data
entry

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ArtemusICS – single source of population
health diagnosis and treatments
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Understanding Utilisation In Time
1510

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Options to meet need and ability
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Patient & Care Giver
•Elderly
•Poorly
•Symptomatic
•IT Literate
•Mild LTC’s
Diabetes II
Asthma
Case Management Wellness
CarePortal™
Smartphones
DocoboAPP
Encrypted and secure data
Broadband, 3G, 4G
Tablet Browser
Telehealth: Access choice according to clinical need, nurse/patient
preference and cost
TV
Clinical
Database
doc@HOME®
Flexible question selection to enable management of all co-
morbidities and clinical pathways for each patient
DocoboWEB™ (Email/SMS with URL + 2NET)
Health and
Well being
APP’s
NHS N3
Intranet

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Clinicians View
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14. HVI and Rhythm Analysis

15. Sinus Rhythm
Electrical vs mechanical activity

16. Wenkebach + Ventricular Beats
P-R wave gets progressively longer until P drops the followed by shortened P-R
Blood flow follows all typical QRS but is absent following Ventricular beat

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doc@HOME supporting Care Homes in Sussex
Developed with Sussex Community
Health
Involves Community Matrons who are
assigned to a set of Care Homes
Multi-Patient Unit set up in each Care
Home
– Questions for UTI, Respiratory, Cardiac,
Diabetes
– Different questions for each patient
– Care Home staff take tablet to each
patient on Mon, Weds, Fri
– CM’s monitor remotely via doc@HOME
and pick up negative trends
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doc@HOME supporting Care Homes in Sussex
Initial results – 3 months in
– One Care Home that had one of the highest rates of admissions (22 in
2013) – now within the normal range (2 in last three months)
– Patients and their relatives are extremely satisfied
• Patients like the solution
• Patient’s families like the solution and asking for their parents to be put on the
service and those that are using it don’t want it to stop
• Help identify the need for end of life care so the patients died in the place of their
choice
– Care Home is over the moon!
• CQC visited a home using the solution and loved it. Ticks all the boxes from CQCs for
patient involvement.
• Care Home staff are motivated, engaged and more confident
• CM able to educate Care Home staff
– CMs love the solution as it enables them to work closely with the home
staff and patients
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19. AF Screening – Stroke Prevention
Clinical Assessment Centre
Attendance at Flu/other opportunistic event
– Patients over 65
– All patients have 20 second Vital Signs snap shot
• ECG lead I; Aortic arch blood flow; Respiration
• + Dependent variables
– All patients answer symptomatic data question set
– Patients have BP measurement if not recorded in
the last month
– All patients identify concerns about falling

20. AF Screening - Results
Clinical Assessment Presentation
Docobo Assessment
– 851 patients recorded vital signs over 4 weekend clinics
– 3 life threatening conditions were identified and corrective
action taken
– 23 patients with definitive Atrial Fibrillation identified
– 16 patients with borderline Atrial Fibrillation – 8 confirmed by
12 lead ECG
– 12 different arrhythmias identified
Post Study (6 months)
– All patients reviewed and now on appropriate therapy
– No incidence of Stroke reported so far
– No deaths reported so far
– 3 lives saved by prescription of pacemakers
– All high BP patients being reviewed for optimum medication

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GPRS, 3G
Broadband
Patient & Care Giver
•Elderly
•Poorly
•Symptomatic
•IT Literate
•Mild LTC’s
Diabetes II
Asthma
Case Management Wellness
GPRS, 3G
Broadband
PSTN
CarePortal™
GPRS, 3G
Broadband
Smartphones
DocoboAPP & DocoboWEB™ (Email/SMS with URL
Encrypted and secure data
TabletPCs & Macs Laptop
GPRS, 3G
Broadband
GPRS, 3G
WiFi/Broadband
Telehealth: Access choice
according to clinical need,
nurse/patient preference
and cost
TV
GPRS, 3G
Broadband
Clinical
Database
doc@HOME®
H2020 – what do we want to do
H2020 development: Data
analytics to detect short
and long term trends and
predict onset of
degradation in health
H2020 Development
Intelligent sensors