Dignio Ltd – Written evidence (INQ0060)

Submitted by: Dr Ewa G Truchanowicz, Managing Director, on behalf of Dignio Ltd (UK branch of Dignio AS, Norway)

1. Question 5: Technologies facilitating treatments for ageing and age related diseases

Norwegian Minister of Health Bent Høie interviewed in October 2016 about the research findings from applying the Dignio system: ‘One is almost shocked by the great effects

– not least about the long-term effects. We have probably found the main solution to the challenges we face in this area (seniors with serious chronic conditions).’

1.1.                      The purpose of deploying technologies should be a dignity continuum where any services interacting with the individual perform to the same standard of quality. The technologies need to be selected for interoperability and to promote cohesion in approaches to treatment and prevention of illness in the ageing population. The technologies needed for the growing segment of the older members of the society will include:

1.1.1.  Recording and acting upon well-defined Patient Reported Outcomes, including reliable means and solutions encouraging individuals to report the defined outcomes

1.1.2.  Wearable devices monitoring the physiological status

1.1.3.  User-friendly, home-based diagnostic devices

1.1.4.  Medical devices measuring parameters of interest specific to each individual and defined by their healthcare professional

1.1.5.  AI algorithms predicting exacerbation of the condition under treatment

1.1.6.  Medication compliance supporting devices

1.1.7.  Platforms supporting two way communication between healthcare professionals, carers and patients

1.1.8.  Pathways integrating information from multiple sources into one, longitudinal patient record, accessible to any healthcare professional dealing with the patient

1.1.9.  Novel treatments, e.g. personalised medicine, require far more intensive monitoring of the patients to assess the effectiveness and cost effectiveness of the treatment

1.2.                      Whilst technologies listed above are all available, there are multiple barriers to adopting these solutions within the healthcare, social care and more broadly across organisations that ought to promote illness prevention and encourage lifestyles supporting well-being. Dignio provide all the technologies above, apart from the AI algorithms, and we are currently developing a solution to provide cost-effective and robust long-term monitoring of patients receiving novel treatments.

1.3.                      Our current solution for connected care is presented below:

1.4.                      The use of our technology has been assessed in Norway as part of an independent review commissioned by the Oslo City Council in 2016 [VIS – Velferdsteknologi i Sentrum: The Introduction of Personal Connected Health and Care in the Central Districts of Oslo: A survey of outcomes. Revised version of interim report 2 of 2. October 2016]. The results of the review indicated reduced number of consultations, reduction in hospital stay duration and frequency and reduction in the use of home support services. These substantial reductions in service provision did not result in impaired patient outcomes and perceptions of quality of service.

• Reductions after 1-3 months: Outpatient consultations 26.9%; Number of admissions 5.1%; Bed-days 27.0%
• Reductions after 4-6 months: Outpatient consultations 41.8%; Number of admissions 32.3% ; Bed-days 39.1%
• Improved experience for the patients (93% feel that with Dignio Connected Care some is ‘more or significantly more’ understanding their health situation; 66% reported improved self-management of their condition; 58% feel a stronger sense of safety and security with Dignio Connected Care).
• Efficiencies to healthcare providers (32% reduction in cost per patient per year; 59% less time used by home care nurses; 34% fewer hospital admissions).

1.4.1.  Qualitative research assessing benefits of the system listed these findings:

• 01  Reliable equipment for the user requires robust systems at the local authority end
• 02 What worked before may not necessarily work now
• 03  Coaching in recognising the body’s signals and managing own health
• 04  Personal connected health and care provides a sense of safety through perceived presence
• 05  Not a problem to be solved, but everyday life to be lived
• 06  From casual chatting about illness to informed dialogue
• 07  It’s not personal connected health and care that gets you out of the house
• 08  End user mapping is an open (and uncharted) landscape

2. Question 6: Technologies supporting living independently for longer

2.1.                      Technologies monitoring individuals and environments will need to work in tandem

2.2.                      There are multiple solutions available for monitoring and triggering response based on both individual and environmental data – Dignio provides the individual level monitoring

2.3.                      There are no common standards accepted for e.g. environmental monitoring technologies

2.4.                      Individual monitoring technologies vary from wellness apps to medical device grade solutions- Dignio solution uses medical grade devices only

2.5.                      Individual consumers often do not understand the difference and its impact on the effectiveness of the device or service

2.6.                      Living independently requires support in various domains, one of which is medication compliance (Dignio solution includes remote medication compliance support and monitoring), and others may be performing specific tasks e.g. blood pressure measurement or blood glucose monitoring (Dignio solution includes notifications for patients to remind them to complete the tasks, alerts to the healthcare professionals if tasks not carried out and alerts to healthcare professionals if patient’s test results breach their individual values pre-set by their healthcare professional).

2.7.                      Fragmented introduction of technology is likely to be ineffective e.g. with effective individual monitoring, but no pathways to respond to the data. Thus integration of response pathways aligned with technology available to support independent living is necessary, with no gaps in the provision, as e.g. in the current status of discharge from hospital for elderly individuals requiring social support. Rich data streams may be rendered useless if there is no pathway to integrate, store and interact with the data. As one of the participants in the 2016 review in Oslo reported ‘It’s not personal connected health and care that gets you out of the house’, and support pathways are needed that utilise, but cannot be replaced by technology.

2.8.                      Independent living needs to be supported by adequate physical and technological infrastructure, including adequate connectivity to enable the devices supporting independent living to communicate with each other and their central platforms

3. Question 7: Technologies to improve mental health and reduce loneliness for older people

3.1.                      There is a multitude of communication technologies, but communication alone is not enough

3.2.                      Technologies allowing an active intervention and support from healthcare professionals exist but are not widely used in the UK: Dignio Connected Care is designed to support behavioural change and support interventions to improve mental health outcomes (e.g. access to healthcare provider’s online resources)

3.3.                      Mental health and physical health are intricately connected and each cannot be treated in isolation from the other- solutions encouraging physical well being promote the type of behavioural change that benefits the mental well-being too

3.4.                      Loneliness has multiple detrimental effects manifested physically, emotionally and cognitively

3.5.                      Technology alone can be quite effective, but it is not the full answer, technological solutions need systems, pathways and staff to make them fully effective.

3.6.                      To date there is no technological solution beyond facilitation of human interaction, that can replace all aspects of the interpersonal interaction and thus reduce loneliness

3.7.                      Encouraging the older members of the society to remain well, physical and mentally, is the best route to reducing loneliness.

3.8.                      For individuals suffering from severe, chronic or co-morbid illnesses, technology can support and facilitate the staff based intervention and allow the healthcare professionals to manage their workload more effectively

4. Question 8: What are the barriers to the uptake of the technology

4.1.                      What is needed to help overcome these barriers?

4.1.1.  Culture and economic model shift within the healthcare and social care system- whereby illness prevention and well-being promotion are rewarded

4.1.2.  Economic incentives, but also proper technology scrutiny methodologies to avoid financial losses, to encourage triage and adoption of innovation

4.1.3.  Reduction of the current fragmentation and removal of the diffusion of responsibility across multiple providers

4.2.                      To what extent do socio-economic factors affect access to, and acceptance of, scientific advice and use of technology by older people and those who care for them?

4.2.1.  Older people have no difficulty interacting with technology when proper training is provided and the technology is designed to accommodate the specific needs of this population: the oldest user of Dignio is 90+ and the majority of our patient users are frail, elderly people with co-morbid, chronic illesses

4.2.2.  Scientific advice can be presented in a variety of ways and one way communication of facts is not optimal: the use of Dignio platform led to patients having a better understanding of their health situation, this was through collaborative two-way communication with healthcare professionals

4.2.3.  Clear communication of the value placed on the data provided by the patient encourages them to interact with the healthcare/support care provider and feel empowered: the data reported by the patients within Dignio system is acted upon by their healthcare professionals and patients know their reports are viewed promptly

4.2.4.  Socio-economic disadvantage does not have to be a barrier to technology uptake if the technology is made available to the target individual free of charge and no hidden costs

4.2.5.  Unless extreme isolation is the case, most individuals are surrounded by a network of other individuals, who exert various influences, and their support for the technological or any other solution needs to be secured to ensure ongoing support for the target individual utilising the technological support and scientific advice willingly and effectively.

20 September 2019