NHS Western Isles is getting excellent results from its recently introduced 'Florence' programme for home health monitoring.

This system uses text messaging to keep in touch with patients who have conditions that need regular monitoring. The patients – diabetic or cardiac, for example – are sent regular texts asking them for information such as blood glucose, blood pressure or weight. They then test themselves and send in the results.

The text messages are generated by a computer programme but look like messages from a real person. All the results are collated on a web interface which can be viewed by clinicians, in real time, provided they have internet access.

Crucially, if the readings fall outwith certain parameters, such as those agreed in their patient management plan, an alert will be sent to the patient’s clinician to allow for early intervention to hopefully reduce the need for a visit to the GP or hospital. A text will also be sent back to the patient advising them that, for example, their blood glucose is a bit high and what to do next.

NHS Western launched the system, named after Florence Nightingale, for diabetes and cardiac patients in October – making the health board one of the earliest adopters of the system in Scotland (Lothian and Lanarkshire are others). Its system is now also live in smoking cessation, dietetics and GP blood pressure monitoring.

This is quick work, given that NHS WI only started looking at its options for technology-enabled home health (telehealth) monitoring last July (2015), when it received its initial £50,000 project funding from the Scottish Government.

The first patients to be tried on the system were those with diabetes and heart failure and already staff have seen transformations in patient care.

One young patient in particular – Erin Graham, 16, from Stornoway – has transformed her diabetes management with the help of Flo. Erin, who was diagnosed with diabetes when she was 12, was admitted to hospital last September because her blood glucose was so high (an HbA1c reading of 112mmol, putting her at a very high risk of complications).

Three months after starting to use the Flo system on her mobile phone, Erin has managed to reduce her blood glucose to 75mmol – reducing her risk of complications by a massive 80 per cent.

Erin’s story has been so remarkable, in fact, that the Western Isles Flo project is now being cited around the world, by the inventor of the system, as a great example of what is possible in telehealth. It has been discussed at conferences in Queensland, Australia, and Maine and Washington DC in the US, as well as Qatar.

Iain Trayner, Diabetes Service Co-ordinator and Home Health Monitoring Programme Manager at NHS Western Isles, said: “We’ve been quite successful. Although the numbers are fairly small, the impact is quite high in terms of their quality of life and their prognosis.

“We have worked hard to get where we are with Flo in the Western isles. We have witnessed some excellent results so far and we are looking forward to helping more people improve their self management and confidence when living with a long term condition.”

NHS Western Isles did consider other technology options for home health monitoring, including a system using tablets and Bluetooth-enabled equipment such as scales. But, as Iain said: “We initially felt the simple way to go was the best way.

“Using the Florence system, all they need is a mobile phone and most people have a mobile phone. If they don’t we can give them one. The system itself is very cheap. It costs about £15,000 a year which is peanuts. It is 8p a text message and it doesn’t cost the patient anything.”

The system is tailored to each patient by clinicians who adjust the settings, define when messages should be sent, what information they are asking for and how the system should respond. It enables much more detailed and regular monitoring of a patient than routine appointments do.

Later this month (February), Iain Trayner will be flying to the US to talk to the Veterans Health Administration (VHA) about the success of Flo in the islands. He was invited to take part in the annual exchange programme between the NHS and the VHA after Flo’s inventor, Phil O’ Connell of NHS Simple, spoke about how impressed he was by NHS Western Isles.

Phil, a previous winner of NHS Inventor of the Year and NHS Inspirational Leader of the Year, said: “I was so inspired by how the Western Isles had just picked it up and run with it and I was communicating that with teams in the USA – we’re helping the Veteran’s Health Administration over there on something very similar.

“I was telling them stories of what Stornoway has been doing with the system and the impacts. They were very excited by the stories and the results they were getting in Stornoway.

“They took the learning and know-how that we’ve got and accelerated the implementation of that at a level we’ve not seen anywhere else. The first patient on the system was on the system before I even came up to get the team started – they were so proactive.”

He added: “Florence seems to have hit the mark. It motivates, energises and encourages patients to take a more active part with their clinicians in managing their healthcare. When they do that, they get better and better outcomes. Patients know Flo is a computer but it doesn’t feel like a computer – it’s a warm, friendly, non-judgemental persona.”

Iain is the only representative from Scotland taking part in this year’s NHS and US Veterans Health Administration Partnership Exchange Programme, from February 29 to March 3 at the VHA’s headquarters in Minneapolis, where best practice and ideas are shared. Although he will be speaking about Flo, Iain is also hoping to get some ideas about the successful introduction of video conferencing, where clinicians hold ‘virtual’ consultations with patients so they no longer need to travel to appointments.

Iain said the invitation to America was “brilliant” and “a huge opportunity to gain knowledge and experience from people who’ve done it”.

NHS Western Isles chief executive Gordon Jamieson said: “We set ourselves a challenge to be a world leader in the application of telehealth and telecare, as we recognise that technology is a key ingredient of our ability to deliver person-centred, sustainable and effective care. I am very pleased and encouraged by this evolving area and thank those involved in taking this forward.”

More information on the system is available at www.getflorence.co.uk and www.simple.uk.net.

Erin Graham