DigitalHealth.London is celebrating the news that myCOPD is one of six innovations which is pioneering the new Innovation and Technology Tariff, (ITT) introduced by NHS England, to support the uptake of technology across the NHS. In parallel, but separately from the ITT, NHS England is also centrally funding a second National Innovation Accelerator (NIA) project, AliveCor Kardia, through a 7th theme within the digital health sector, ’Identification and measurement of atrial fibrillation through mobile ECG technology’.
A new approach to funding technology
At the recent ITT Showcase attended by DH.L, which was hosted by UCLPartners for London, Rob Chesters, Senior Innovation and Research Manager, NHS England, set the scene for what the tariff will offer providers in the short term, as well as hopes for the future.
The ITT represents a new approach, using a number of mechanisms to fund innovations which meet identified theme specifications. Four of the themes are funded under a simple zero cost model, through which providers order the innovations directly from the supplier at no cost and NHS England reimburses the supplier directly. One further digital innovation will be reimbursed based on use, and a sixth will be refunded under the National Tariff.
One of the main aims of the ITT is to resolve some of the limitations in the types of innovation that can be incentivised through national pricing. The theme under which myCOPD qualifies is, ‘web-based applications for the self-management of chronic obstructive pulmonary disease’ and represents an initial step in testing methods which will work for digital health.
Several series of technical standards criteria had to be met before submissions were tested against clinical criteria with input sought from leading medical experts. Following due diligence on the innovation theme submissions, the shortlist was evaluated by a Selection Panel on 13th October 2016.
Managing Chronic Obstructive Pulmonary Disease (COPD) costs the NHS more than £1bn each year. However, treatment is complex, and compliance is often extremely low, leading to poor outcomes and potentially wasted prescribing. For this reason, improving self-management for patients with COPD is a key priority for the NHS.
Evidence indicates that disease-specific self-management improves health status and reduces hospital admissions for patients with COPD. myCOPD is an integrated online education, self-management, symptom reporting and pulmonary rehabilitation (PR) system, which helps patients to manage their condition more effectively with a plan and inhaler diary, a COPD Assessment Test, a pulmonary rehabilitation program, online education tutorials, weather and pollution forecasts, and symptom reporting. The platform interfaces with a clinician-facing dashboard to allow remote monitoring and management of patients at individual and population level. Local healthcare providers and CCGs can use the platform to monitor exacerbation burdens in real time, and review potential inequalities in health care to more effectively plan support services.
myCOPD is currently the only NHS approved app on the recently released NHS App Store. It is being used across England with CCGs, hospitals, community teams, pulmonary rehab providers and primary care, and is being delivered to patients who are newly diagnosed with COPD, patients being discharged from hospital, and patients at their annual review, It is also being offered to patients who find it difficult or unable to attend class-based Pulmonary Rehabilitation, and in areas where there are long waiting lists for class-based PR.
myCOPD has proven to correct 98% of patient inhaler errors without clinical involvement, has been proven to reduce time in delivering the annual review by 50% and has doubled the rate of recovery from acute exacerbations. It provides the same outcomes as class-based Pulmonary Rehabilitation classes. Therefore, a CCG with an average COPD population of 5,000 patients would expect to make savings in the first year alone of over £200,000 if deployed to 60-80% of their COPD population. myCOPDs PR service costs £20 for the life time of a patient, versus current NHS costs of £400-£800 per six-week course
NHS England has identified MyCOPD as the only self-management software solution which currently meets the required ITT specification, although a number of web-based and iOS applications which help patients manage their condition more effectively are also available.
The ITT payment arrangement for this innovation is based on software licenses. NHS England will fund myCOPD licenses for patients with a diagnosis of severe or very severe COPD, up to a maximum of 20% of the total COPD patient population per CCG. New and existing COPD patients managed by community or secondary care are eligible.
According to the National Cardiovascular Health Intelligence Network (NCVIN, 2016) co-ordinated by Public Health England, the estimated prevalence gap for people aged 64/+ with atrial fibrillation (AF) not yet diagnosed is 420,498. Left undetected and untreated, this presents a risk of over 12,600 AF-related strokes per year in England, yet 90% of strokes can be prevented when symptoms are caught early enough to take proactive measures. Early detection and monitoring can pave the way for better treatment, and help avoid the illness, disability and premature death associated with AF-related strokes, leading to major healthcare savings.
AliveCor’s Kardia Mobile Electrocardiogram (ECG) device is a mobile heart monitor that allows individuals to detect, monitor, and manage heart arrhythmias with automatic analysis. AliveCor’s Kardia captures ECG recordings of the heart using FDA-cleared machine algorithms in just 30 seconds, anytime and anywhere, providing instant feedback.
From a ‘strip’ attached to, for instance, a mobile phone, the device captures an ECG recording and detects atrial fibrillation simply by pressing two fingers from each hand on the device. The app-based service also allows its user to share the data with their doctor for analysis and diagnosis. The strip is then produced as a PDF for diagnosis, sharing and storage into the electronic health record.
In addition, the device can be used to capture shortness of breath, heart palpitations, dietary habits, sleep and exercise patterns. Based on published, peer-reviewed clinical studies using Kardia Mobile, it’s currently the most clinically-validated mobile ECG available.
Selected for the NIA in July 2015, Kardia mobile is currently being used in over 38 NHS organisations including GP practices and acute trusts across all 15 Academic Health Science Networks, enabling the recording of two million ECGs across the UK.
A further 45 CCGs have already expressed interest in adopting myCOPD in 2017/18 as it becomes available via the ITT.
NHS England is undertaking further work to develop its approach to the ITT with plans to expand it to new areas of innovation in 2018 /19. Any supplier of a product/innovation within the ITT who is not listed in this document but considers that they are, or may be able to provide that innovation in accordance with the specifications in the ITT, may contact NHS England to obtain information about review of the list and the process for future inclusion in the ITT, at email@example.com
Access the full document, ‘The NHS England Innovation and Technology Tariff 2017 to 2019 Technical Notes’ here: https://www.england.nhs.uk/wp-content/uploads/2017/05/innovation-tech-tariff-technical-notes.pdf