myCOPD Integrated Online System

NHS Innovation Accelerator Fellow: Simon Bourne

Overview

Chronic Obstructive Pulmonary Disease (COPD) is a lung disease that is characterised by airflow obstruction or limitation (NHS England, 2012).

COPD is the second most common cause of hospital admissions in the country, costing the NHS over £800m in direct healthcare costs. Studies show that up to 90% of people with COPD do not take their medication correctly due to a combination of poor compliance and poor inhaler technique (Bourbeau & Bartlett, 2008).

myCOPD is an online platform to help people with COPD to manage their condition more effectively. It is available on any device that can connect to the internet and delivers a personalised COPD management system by asking patients a few key questions about their condition.

For people with COPD, it facilitates:

  1. Education and inhaler training
  2. Self-management
  3. Pulmonary rehabilitation
  4. Lifestyle changes
  5. Symptom reporting

For clinicians, it provides:

  1. A dashboard and geographical population map view
  2. An education and patient management suite (to allow monitoring and management of patients remotely, for example, by analysing COPD exacerbations, remotely changing medications and tailoring treatments and support).

myCOPD was designed by Simon Bourne of mymhealth.

mymhealth also have a range of other platforms to help people to manage their conditions including ‘myasthma’ and ‘mydiabetes.’  Platforms for pain management and heart failure will be launched during 2017.

View the video here: https://www.youtube.com/watch?v=e2XclULqRJU

 “I have used myCOPD for 9 months, I use it every day. Last year, before using MyCOPD I had 12 exacerbations, this year I have had just 2. I now know when and how to take my medication, when to use my rescue pack and perform my rehab exercises most days.” (Patient testimonial)

Example of a patient’s profile viewed through the clinician dashboard

The Case for Change

COPD kills approximately 25,000 people every year in England and Wales. Recent figures showed that COPD accounted for 4.8% of all deaths in England between 2007 and 2009. It is the fifth biggest killer disease in the UK (NHS England, 2012).

An estimated 3 million people have COPD in the UK. About 900,000 have diagnosed COPD and an estimated 2 million people have COPD which remains undiagnosed (Healthcare Commission, 2006).

COPD is the second most common reason for emergency admission to hospital, accounting for one in eight non-elective admissions, resulting in significant cost to the NHS. COPD kills approximately 23,000 people a year in England alone. Patients who are hospitalised are at particular risk of mortality with one in six people dying during an emergency admission due to COPD, and one in twelve patients dying within three months (Public Health England, 2015).

In the next ten years, £235m could be saved by the NHS if self-management is implemented correctly (Department of Health, 2012). COPD is predicted to be the world’s third largest killer by 2030 (World Health Organisation, accessed online 22.8.17), and the NHS Five Year Forward View (NHS England, 2014) states that it is looking for an expanding set of NHS accredited health apps that patients will be able to use to organise and manage their own health.

The benefits of systematic symptom documentation, explicit care planning, improved inhaler technique, improved adherence and better access to pulmonary rehabilitation, can all be expected to yield improved disease control (https://meridian.wmahsn.org/subdomain/other-innovations/end/node/1804).

Progress to Date

Under the NHS Innovation Accelerator (NIA), there has been a focus on:

  • Refining myCOPD, along with a multi-morbidity platform to include diabetes and asthma (‘myasthma’ and ‘mydiabetes’).
  • Building the evidence base through a large randomised control trial and health economic case
  • Developing website and marketing materials, contacting key people in over 100 clinical commissioning groups, and attending key conferences
  • Building national and international partnerships to support distribution
  • Looking at interoperability with other clinical systems such as EMIS and SystemOne.

Impact / Outcomes

The platform claims to correct 98% of inhaler errors without any other clinical intervention and has been shown to deliver the same outcomes as access to a face to face rehabilitation class. In addition, 95% of patients improved their symptom score using myCOPD (North, 2015).

These results were obtained from a service development project that compared the efficacy of myCOPD with a standard face to face NHS service. This took place over a ten month period, with 36 patients having a confirmed diagnosis of COPD. Prior to the intervention, 98% of patients used their inhalers incorrectly. Results showed that 95% of the participants who used the system showed a mean decrease in COPD Assessment Test (CAT) score of 4.5 (P<0.001) and an improvement in inhaler technique. The patient cohort who did not use the system had a mean increase in their CAT score of 2.4 points. By the end of the study, 98% of patients who used the system were using their inhalers correctly, translating as a 95% improvement in CAT scores with no other clinical intervention.

One study has shown that myCOPD is as good as class based pulmonary rehabilitation in a randomised controlled trial (Wilkinson et al, 2017). Further studies have demonstrated that myCOPD improves adherence to medication by 70% (estimated to previously be as low as 8% in many studies) and doubles the rate of recovery of patients hospitalised with COPD exacerbations (Green, 2016; unpublished, see protocol available at https://clinicaltrials.gov/ct2/show/NCT02706600).

Uptake Nationally and Locally

MyCOPD has now been implemented in Bradford CCG and South Coast CCG. Through the Innovation and Technology Tariff (ITT), myCOPD is being implemented across Mid and South Essex, Devon, and Ipswich and Suffolk Sustainability and Transformation Plans (STPs). It has also been taken up by GP Federations and the British Oxygen Company, to help deliver a hybrid pulmonary rehabilitation service.

The Medical Advisor of mymhealth attended the AHSN NENC Respiratory Network Meeting in July2017 and some NHS organisations in the North East and North Cumbria region are exploring the possibility of deployment within certain localities under the ITT scheme.

Which National Clinical or Policy Priorities does myCOPD Address?

The National Institute for Health and Care Excellence (NICE) recommends that patients with COPD are provided with a comprehensive self-management plan which includes high-quality information and educational material about the condition and its management, relevant to the stage of disease (Department of Health, 2010).

NICE (2010) also states that “pulmonary rehabilitation should be made available to all appropriate people with COPD including those who have had a recent hospitalisation for an acute exacerbation”.

Costs

License fee, per patient (lifetime access) – £20

Data management fee, per active patient (annually) – £5

Training – £400 (x2 days)

Project Management available (optional) – £200 per day

NHS ITT/ Reimbursement

NHS England have made myCOPD available at zero cost to CCGs and it can be ordered directly from the supplier subject to the eligibility criteria below.  Please note that the annual data management fee is also waived by mymhealth.

Eligibility Criteria:  Patients with a diagnosis of severe / very severe COPD up to a maximum of 20% of the total COPD patient population per CCG.

New COPD patients referred to an acute pathway managed by Community or Secondary care.

Existing COPD patients on the acute pathway managed by Community or Secondary care.

Ordering:   CCGs can order licences directly from the supplier at zero cost, up to the limit specified above. Enquiries to be forwarded to: ian.thompson@mymhealth.com

Reporting:  For each period of activity, providers must report back on a minimum data set.

For further information, see the ‘NHS England Innovation and Technology Tariff 2017 to 2019 Technical Notes’ https://www.england.nhs.uk/resources/pay-syst/development/tech-tariff-17-19-technical-notes/.

Further Resources

AHSN Atlas Case Study: http://atlas.ahsnnetwork.com/mycopd/

Website:              https://mymhealth.com/mymhealth/mycopd

YouTube:             https://www.youtube.com/watch?v=e2XclULqRJU

Twitter:                @mymhealthltd

NHS Digital Apps Library: https://apps.beta.nhs.uk/mycopd/

Media:

https://www.theguardian.com/society/2016/jun/17/nhs-to-offer-free-devices-and-apps-to-help-people-manage-illnesses

http://www.dailymail.co.uk/wires/pa/article-3645856/NHS-chief-agrees-new-budget-streamline-getting-medtech-patients.html

http://www.thetelegraphandargus.co.uk/news/15152256.Winner_of_Dragons__Den_style_health_technology_challenge_is_announced/

Contact for Help and Advice

mymhealth Medical Advisor / NHS England Clinical Entrepreneur Fellow: Harry Thirkettle (harry.thirkettle@mymhealth.com)

AHSN NENC: rachel.turnbull@ahsn-nenc.org.uk or carol.nicholson@ahsn-nenc.org.uk

Evidence Sources and References

Bourbeau J & Bartlett SJ. (2008) Patient adherence in COPD. Thorax, 63(9): 831-838 https://www.ncbi.nlm.nih.gov/pubmed/18728206?dopt=Abstract

Green, B (2016) Trial of E-Health Platform Supported Care vs Usual Care After Exacerbation of COPD (RESCUE) (completed 2016), unpublished, for protocol see https://clinicaltrials.gov/ct2/show/NCT02706600 (accessed 22.8.17)

Healthcare Commission (2006). Clearing the air: a national study of chronic obstructive pulmonary disease. London: Healthcare Commission; in https://www.nice.org.uk/guidance/cg101/chapter/Introduction

National Institute for Health and Care Excellence (2010) Chronic Obstructive Pulmonary Disease in over 16s: Diagnosis and management. https://www.nice.org.uk/guidance/cg101

NHS England (2012) An Outcomes Strategy for COPD and Asthma: NHS Companion Document – Impact Report, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216532/dh_134002.pdf

NHS England (2014) The NHS Five Year Forward View. London: NHS England. www.england.nhs.uk/ourwork/futurenhs

North, M. (2015) Improving outcomes with online COPD self-care. Nursing Times; 111: 30-31, 22-23. https://www.nursingtimes.net/clinical-archive/copd/improving-outcomes-with-online-copd-self-care/5088023.article

Public Health England (2015)  fingertips.phe.org.uk/documents/Atlas_2015%20Compendium.pdf

Wilkinson, T., Bourne, S., DeVos, R., North, M., Chauhan, A., Green, B., Brown, T. & Cornelius, V. (2017) Online Versus Face to Face Pulmonary Rehabilitation for Patients with COPD: A Randomised Controlled Trial, American Journal of Respiratory and Critical Care Medicine, 195:A4940, http://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2017.195.1_MeetingAbstracts.A4940

World Health Organization, Chronic respiratory diseases: Burden of COPD, http://www.who.int/respiratory/copd/burden/en/ (accessed 22.8.17)

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