Ref: MJG161006 Confidential and copyright 2016

How remote monitoring of patient recovery can transforming patient outcomes and reduce costs

for the NHS

There has long been a need to deliver moreinformation on the fitness of a joint both in terms ofscreening to reduce injury and then to monitor andimprove recovery.

In early 2000 motion analysis was initially developedas a way to provide screening of athletes, inparticular football players but only 2-3 times a year

How to detect potential injuries before they occur?

Injuries can occur for a number of reasons, buttypically are a result of joints and muscleperformance gradually decreasing over time.

The only way this decrease can be effectivelydetected is through daily screening so that trenddata can be obtained. To do this a portable systemwas needed so that the players could screenthemselves when away from the training ground.

But how to do this remotely and cost effectively?

BPMpathway was born.

How to increase PROM’s, reduce costs and deliver a patient centric recovery solution post

orthopaedic trauma?

In the world of orthopaedics, there has long be a need to try to reduce costs by:

• Releasing patients as soon to save on over night bed costs and to free up beds• Applying support services such as physio’s where they are needed, ie a personalised care package• Reduction of wasted appointments where ‘everything is fine, thanks for coming in’.• To increase PROM’s so that the hospitals/trust’s can become more efficient

The challenge was:

How to develop a reliable way to measure the recovery performance of a patient, after they have been discharged, in a manner that was easy for them to use, motivated them and highlighted potential issues such as infection as soon as possible?

Finally, how could this reduce costs for the NHS?

There has also been a need to increase the motivation of thepatients so that they persist and finish there course of recoverytreatment so that they can return to a productive life quicker andnot become ‘bounce back’s’ due to the condition never quite goingaway.

By teaming upwith B.Braun weare able to accessand support all ofthe UK trusts.

BBC video on Golden Jubilee pilot

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Typical patient recovery results

Month one of recoveryEasy standard position, patient sat on the floor or their bed, clean UI.

Alarms are set for sending automated alerts back to the hospital.

Initially low and slow ROM 22deg but rose to over 90deg but still slow. QoM okPain score showing pain under control but still there

Patient UI

Professional UI

Patient recovery results

Month two of recoveryMore advanced position, patient lying on their front

Any indication of infection would show up as a reduction in ROM and increased pain score result.

Now the patient had faster movements and lower pain scores and so did not return at ANY time back to the physio’s or surgeons.

'BPMpathway will revolutionise how we

collect movement data in orthopaedics'Consultant Orthopaedic Surgeon Jamie Buchanan, East Sussex

Healthcare NHS Trust

'As orthopaedic surgeons, we often struggle to

accurately capture and record our patients’ range

of movement, particularly around complex joints

such as the shoulder.

BPMpro is a non-invasive novel technology that

uses wireless motion sensors to measure

movement in three planes and presents the data as

easy-to-understand, animated graphics.

BPMpathway is remarkably easy to use with

intuitive software.

Never before has such a simple device collected so

much genuinely useful data so easily.'

Other pilot results

Hospitals around the world have been running pilots usingBPMpathway over the past 24months but in the UK, hospitals suchas Castle Hill (Hull) are now doing Total Knee Replacement Surgeryas day cases as a result of being able to remotely monitor andassess the patients during their recovery phase.

This results in significant reduction in costs while patientengagement is high.

The global market for post-operative assessment is huge. Every year, more than 1.1mpeople in the US have hip or knee replacement surgery. 85% of all hip and kneereplacements are carried out because of osteoarthritis, the most common type of arthritisor degenerative joint disease, which affects 9.6% of men and 18% of women aged 60 yearsor older.

Some 150m people worldwide, including 40m Europeans, suffer from the disease. Withlengthening life expectancies and ageing populations, osteoarthritis is set to become thefourth leading cause of global disability by 2020.

Furthermore, it is estimated that there will be a 174% increase in demand for hips and a674% increase in demand for knees through 2030.

What is the scale of the potential?

UK potential and cost savings to the NHS

EU Country Population (m)Likely number of orthopaedic and spinal cases P.A

Germany 81 236,763

UK 65 189,995 France 65 189,995 Italy 61 178,303 Spain 46 134,458 Poland 38 111,074 Romania 20 58,460 Netherlands 16 46,768 Belgium 11 32,153 Greece 11 32,153

Czech Republic 11 32,153 Portugal 10 29,230 Sweden 10 29,230 Hungary 10 29,230 Austria 9 26,307

Other EU 100 292,300

Switzerland 8 23,384 Norway 5 14,615

Average length of stay on an orthopaedic ward is 3.5nights, so a reduction of just 1 stay saves £350/night.Just 1 reduced physio session £50/session.Reduced ‘bounce backs’, patients who are not fullyrecovered and come back, average £2500.Reduction in wasted follow ups, ie everything was ok£100 per saved visit/

Potential cost saving:

1 night saving: 190,000 x £350 = £66 million(£200m if 3 nights are saved)

1 physio session 190,000 x £50 = £9.5 millionBounce backs 10,000 x £2500 = £25 millionReduced follow up 50,000 x £100 = £5 million

Total potential saving

£100 -£200 million per year

Ref: MJG161006 Confidential and copyright 2016