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					                Notes from the 1st SAPHE Steering Committee Meeting
                                             15th September 2006

            Meeting attendees

            Steering Committee: Richard Foggie (DTI), Bill Maton-Howarth (Dept. Health), Mike
            Clarke (in place of Jeremy Porteus for the first meeting), Alan Clark (Strategic
            Commissioning Partnership), Hans-Aloys Wischmann (Philips Medical), Joe O’Brien (in
            place of John Harries for the first meeting)

            SAPHE Project staff: Guang-Zhong Yang (Principal Investigator, Imperial College), Oliver
            Wells (Imperial College), Nigel Barnes (BT), David Walker (Philips), Hannah Wells

            Apologies: Jeremy Porteus (Dept. Health), John Harries (BT), James Barlow (Imperial

            1st SAPHE Steering Committee Meeting Agenda
                Introductions                                                           All
                SAPHE Vision and Project Plan (15 mins)                                 Guang-Zhong
                SAPHE Top Level Requirement Specifications
                    Summary of the SAPHE System Top Level Requirements (15             Nigel Barnes
                    Discussion of content and implications.                            All
                       SAPHE populations – defining the target system users
13:30 – 15:30

                       SAPHE service provision
                       SAPHE architecture and components
                Discussion ‘From Telecare, towards Pervasive Healthcare’
                    Presentation on Telecare policy development (15 mins)              Oliver Wells
                    Facilitated discussion on delivery and business model scenarios
                       Lessons learnt from existing models of Telecare                 All
                       Defining the concept of Pervasive Healthcare and defining the
                         parameters of what SAPHE should deliver as a preventative
                         mode of health monitoring
                       Developing a business model for SAPHE
                General Comments and Feedback from Steering Committee                   All

            0116448b-b0d7-4257-b194-cc2eb2e0604a.doc                                                   1
Concept points identified prior to the meeting for Steering
Committee feedback:
1. Is the project/system focused on the right users?
2. Broadband or dial-up phone-line? Do we need to have a permanent connection? Is
   broadband reliable enough? Does mobile/3G offer a feasible alternative?
3. Can we build the conceptual SAPHE system without being based on a response/alarm?
4. How can we keep the system in-line with requirements of primary health care providers?
5. How do we work towards service provision for the particular conditions that have been

Introduction to SAPHE Project - Guang-Zhong Yang
(see Introductory Presentation

The meeting is intended to address two broad topics of discussion:
   Top Level Requirements
   Business Models for SAPHE and where it fits in with the market niche

Initial questions raised by Steering Committee:
Are there more scenarios available in order for readers to contextualise the system for all of
the identified conditions? (CHF, COPD, Dementia, Diabetes, Care of the elderly, etc.)
BT is looking at identifying a range of additional scenarios. They are looking at including
scenarios that will describe how patients enter the PCT acute care cycle (dependent on their
The project needs to look at the clinical areas of how SAPHE can help in preventative care.
The Dept. of Health (DH) is building on interest in anticipatory management – BMH can help
the project on sharing information and feedback from that research.

Overview of the SAPHE Top-Level Requirements - Nigel Barnes
(see Requirements Analysis presentation

What is SAPHE trying to achieve?
There are some difficulties in measuring the efficiency of the proposed SAPHE system, and
its ability to add value based on a limited trial as in the specification.
The trial needs to be based on a model, rather than solely on the results of randomized
control-group based trials.
PCT commissioners would be very interested in looking at the savings that they can make in
utilising the service of a SAPHE system (because hospital admission costs to the PCT are
around £2-3K per ‘hit’)

0116448b-b0d7-4257-b194-cc2eb2e0604a.doc                                                         2
Care Pyramid
The central aim of the SAPHE system is in trying to prevent the second level of people with
long-term conditions, moving into the ‘frequent flyer’ acute care patients top level of the
pyramid. The patients at the top level of the pyramid often have the most complex cases
(housing, co-morbidities, a range of social issues)
SAPHE needs to look at a risk stratification, based on admission data including diagnostics
and then the social care aspect in order to address this ‘fit’ within the care pyramid.

Data Analysis
How will the system generate context-awareness data apart from using sensors?
The project needs to establish ground truth somewhere along the line – this is usually
achieved by a supported by questionnaire and daily phone contact with the trial subjects.
An alternative, e.g.: Cypac (Swedish company - ) use printed systems
for data capture.

Data Fusion
Data fusion is the core research activity within SAPHE. For example: the earpiece sensor that
eliminates the need for multiple sensors by using accelerometers to produce an activity index,
or the fusion of data from ambient sensors for behavioural/activity monitoring.

SAPHE needs to consider:
   Multi-modal
   Appropriate to individual (needs based)
   Customisable by individual
   Authentication

Prof. Antony Furniss (working in Warwick) has conducted previous research on relevant
RFID technologies and may have solutions to some of the problems associated with multiple
household monitoring.
Connecting for Health contacts: George McGuinness (main project lead) and Mike
Bainbridge. Connecting for Health is also planning to contribute input towards the Continua
Alliance standards. The project recognises its need to be aware of the approaches to Telecare
implementation being considered by Connecting for Health.
Plans for SAPHE to engage with the Continua Alliance, especially in the area of standards
development? Philips view is that it will be 2-3 years until the Continua Alliance device
standards will be available. This will be an opportunity to bring more pervasive technology to
the alliance which is healthcare focused, but not always with such advanced technology.
Consideration should also be given to the problem of SAPHE technology revealing un-
noticed healthcare needs, e.g. rolling out a SAPHE system on a large scale – the population
of undiagnosed ‘ill’ people will increase and there may not be the healthcare resources to
treat them.
The consortium’s perceived purpose of SAPHE is as a management tool and not a diagnostic
tool. If it moves towards consumer market, SAPHE systems may go more towards

0116448b-b0d7-4257-b194-cc2eb2e0604a.doc                                                      3
Avoidance of hospital admission could work as a driver for the commissioning of a SAPHE
system. However, there is still a concern that NHS consultants will fill the spaces freed - it
may not have much effect on the acute admissions.
Changes in commissioning may result in better alignment of needs for such a system.

General Feedback from Philips Medical (Hans Aloys-Wischmann) on the
SAPHE Requirements Analysis (D02)
Good document, very thorough and 90% in agreement with the project’s Requirements
Analysis, could do with some polishing. Have some disagreements:
 There is an assumption that the system will reduce the amount of treatment that people
  require – however – those conditions that would have gone undetected are now identified
  and need to be treated. The SAPHE project should analyse more closely economical
  benefit. There are too many unknown parameters
 20 patients in the trial – this is not enough to get a trend – go for understanding, analysis
  over a long period of time.
 Emergency response cannot be excluded from the trial1.
 Need to look closer at the nurse and informal carer requirements – look at the efficiency
  and the input required
 Advice is to look again at the target users as Elderly Care with the Chronic Disease areas
  on top. They all have very different cost requirements.
 Need to be clearer of the project objectives: are we keeping people out of hospital, are we
  improving care?
 Ambitious project

From Telecare towards Pervasive Healthcare - Oliver Wells
(see SAPHE Policy & Uptake presentation

Business and Economic models
There are factions in the Dept Health who can support work in this area. The system
hypothesis should primarily be improved effectiveness – SAPHE should not be hypothecated
on ‘cost saving’ and ‘efficiency’.

SAPHE Potential market
Frost and Sullivan put the worldwide market way below £40bn.
‘Blob’ sensors would probably end up being marketed by games people
Philips research indicates a firm price cap of £100 per month paid by (well-off) families for
services. Individuals would pay a maximum of £20 per month. .
Heart failure patients cost about £3000 per year. The additional costs added by the SAPHE
system (@ £1000 per year) are a significant cost increase to the Health System.

  We need to explain that we expect an established emergency system to be running in parallel to minimize the
risks for the trial subjects and avoid unnecessary development costs.

0116448b-b0d7-4257-b194-cc2eb2e0604a.doc                                                                        4
The SAPHE project needs to be able to demonstrate that it is better than something that can
be supplied by a mobile phone.
National framework, sales of Health Buddy from Wal-Mart in the US for private customers
are $99 per unit plus $49 for connection to the service.
The Public vs. Private business model is becoming more blurred. The service provision is
being devolved to the patient in the form of a cash sum. The public sector currently acts as a
broker, and is poorly placed for that.
It is hard to determine the costs of domiciliary care. SAPHE needs to cater for a home-care
Negative drivers - in the US there is a litigation potential, as in the US – if a clinician does
not act on an alert or information, they can face action
A domiciliary monitoring system offers the opportunity for patients to be more empowered in
their interactions with the doctors
There is a great deal of detailed modelling required of the motivations and financial interests
of all stakeholders in the deployment of such systems.

Summary of Action Points
What                                                               Who                      By
Make contact with Dept. Health for background support with         IC BEIC Team             Nov
data to help in developing telecare business models                                         06
Contact Prof. Antony Furniss                                       IC DoC Team              Dec 06
Contact George McGuiness and Mike Bainbridge.                      All (OW to               Dec 06
Consider overall feedback on Requirements analysis, and            SAPHE                    Oct 06
begin to develop Exploitation Plan with comments from              Management Group
Steering Committee
Investigate Cypac’s use of printed circuits for capture of         Philips (as part of      Dec 06
general context-aware data                                         Common node)
Further the development of the SAPHE scenarios for all             Nigel Barnes & BT?       Nov
chronic conditions identified                                                               06
Consider having the next steering committee earlier than           All (HW to               Oct 06
April 2007                                                         organise)
Discuss the trial hypothesis to focus more on proving the          Nigel Barnes,            Oct 06
system and the ability to add value through continuous             supported by
monitoring and contextual awareness - rather than looking          Andrew Sixsmith
primarily at efficiencies within the PCT.
Set up accounts on SAPHE website for all (permanent)               HW                       Done
Steering Committee members for access to restricted content
Send out reminder for Pervasive Healthcare Horizons event,         HW                       Done
taking place at IBE (Imperial) with all SAPHE staff
involved, 17-10-06

0116448b-b0d7-4257-b194-cc2eb2e0604a.doc                                                           5

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