Title: Using digital health to transform the management of long-term conditions in the NHS: Assessing real-world patient experience and empowerment and improvements to productivity and capacity
Funder: Department of Health and Social Care

Abstract: Background: Healthcare systems face increasing demands for monitoring and treatment of long-term conditions. Remote digital monitoring avoiding hospital visits offers many advantages. During the Covid-19 pandemic safety from transmission has become a major benefit. Itecho has developed the AscelusTM platform, which enables patients to send information through a 'symptom checker' to their clinical team, which reviews this, and the patient s blood tests. Patients then receive encrypted clinical advice, results of blood and other monitoring sent directly to their smart phone/device (Figure 1). Patients deemed at risk are called for face-to-face appointments. Aims and objectives: To assess, in the real-world setting, how AscelusTM impacts long-term condition management, hospital capacity/productivity and patient experience/empowerment to then support procurement, commercialisation and scale up. Methods and timelines: We will assess real-world implementation of AscelusTM in 7 haematological conditions across a comprehensive series of domains in eleven interlinked work packages, encompassing: Co-design of new digital haematological care pathways, underpinning bespoke platform amendment/integration into hospital IT systems. Patient validation and safety cohort observational studies, drawn from cohort of 4,560 patients in 3 London and 1 Sheffield site(s). Evaluation of patient experience and empowerment using focus groups, Ux laboratories, discrete choice experiments and PAM-13 scores. Economic modelling and cost/benefit analysis. Mixed methods qualitative study of clinician motivators/barriers to adoption Feasibility of future AI development for MGUS monitoring. A new (post-stage 1) work package to assess the enablers and barriers around digital inclusion. Impact and dissemination: The project will allow patients more convenience and control; hospitals/clinicians to have additional capacity for complex cases; the NHS to save resources. It will also facilitate environmental benefits (less driving/car parking). Our highly skilled, multi-disciplinary team with academic, commercial, PPI and clinical backgrounds and national leadership roles provides a great opportunity to spearhead digital transformation in haematology across the UK.

Lay abstract: Plain English Summary In 2018, out of 96.4 million NHS outpatient appointments, 64% were for long-term conditions. Supporting these patients uses 70% of the NHS/Social care budget; this cost keeps growing and funding cannot keep up with demand. The NHS Long-Term Plan recommends the use of technology to reduce outpatients appointments, reserving face-to-face consultations for patients with more complex needs. Additionally, Covid-19 now makes it less safe for vulnerable patients to attend hospital, so many routine face-to-face appointments are cancelled, increasing the need for remote monitoring. Itecho Health has developed a Digital Health platform called AscelusTM, integratable with hospital IT systems, which allows face-to-face outpatient appointments to be replaced by convenient mobile interactions. Patients send information through a 'symptom checker' to their existing clinical team, which is reviewed alongside the patient s blood tests. Patients then receive clinical advice, results of blood and other monitoring (often from GP input) and information on medication and appointments directly to their smart phone/device. Similar technology, but limited to stable HIV, has proved successful in 11,000 patients across five European hospitals, through a &euro;5.4 million EU-funded project (EmERGE). Our team of industry professionals, patients, charity leaders, doctors, nurses, and academics jointly developed this proposal, which received strong PPI input from patients and four charities (Myeloma UK, CLL Support, Sickle Cell Society, Leukaemia Care). In this first research of its kind under real world conditions, the project aims to evaluate AscelusTM in management of seven long-term blood disorders affecting over a million people in the UK (chronic lymphocytic leukaemia, myelodysplasia, Monoclonal Gammopathy of Undetermined Significance (MGUS), smouldering (asymptomatic) myeloma, hemochromatosis, iron-deficient anaemia and sickle cell disease). For example, over 500,000 NHS patients have MGUS and up to 20% progress to develop blood cancers, requiring twice-yearly lifetime monitoring. Patients will benefit through a faster, safer and more convenient way of managing their condition. The NHS will benefit from freeing-up of consultant time to focus on more complex cases, as well as financially (estimates suggest that if only 25% of NHS MGUS patients used AscelusTM, annual savings of &pound;16 million would be achieved). AscelusTM is already being piloted in MGUS and prostate cancer. The research will comprise 11 work packages designed to integrate the already-developed AscelusTM platform with hospital IT services at three London sites and one Sheffield site (4,560 patients), followed by its validation in a patient study, health-economic analysis and assessment of patient self-management, with an Inclusion-based sub-study. We will share results with patient groups, professionals and NHS procurement teams and explore the scope for adapting AscelusTM in other long-term conditions. Besides benefitting patients and the NHS, we hope the project, with its evidence base, will enhance the growth of Itecho Health in this important market.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE