HEALTH TECH
MAGAZINE
TECHNOLOGY IN THE SPOTLIGHT
ROBOTICS IN HEALTHCARE February 2019
HIGHLIGHTS OF THE MONTH Plan To Remove Outdated IT Systems From GP Practices Launch Of The NHS App In England
Innovation Meets Neurorehabilitation eet EksoGT, the first exoskeleton for stroke and spinal cord injury rehabilitation.
NHS Sustainability: The Key Role Of Community Services Innovation Introduces RxCollect Robotic Prescription Collation Technology
NHS Launches Their Ten Year Plan Service Robotics lead the way with companion robot for the elderly The role of the Medicines and Healthcare products Regulatory Agency (MHRA) after Brexit Next-generation robot revealed to the world for the first time
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Launch Of The NHS App In England
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fter three months of testing from over 3,000 patients from 30 GP practices, NHS England has announced that they are now ready to roll the NHS app out across England. Feedback from both patients and staff during the private testing that was completed in December led to some changes and improvements to the app. However, now the NHS believes the app is ready for the public. What can the NHS app do? Once individual GP practices ensure their system settings are ready, the app will enable people to check their symptoms, book and manage their GP appointments. The app will also allow people to register as organ donors and order repeat prescriptions too. While these are just some of the benefits, the NHS Digital Executive Director of Product Development, Wendy Clarke claims that there is enormous potential for the app. NHS Digital will be welcoming feedback for the app to see what additional tools, resources and services that the app can offer.
NHS ENGLAND HAS ANNOUNCED THAT THEY ARE NOW READY TO ROLL THE NHS APP OUT ACROSS ENGLAND.
It is hoped that with the success and capability of the app, then it will attract more GPs to come on board and more innovations to be made. The app is available for download on both iOS and Android platforms, and later this year a browser version will be launched too. However, app users will not have full functionality of their app unless their GP practice goes live with the app. NHS England believes most GP practices will go live with the app between April and June this year. Improving NHS Digital Services The launch of the app comes with the announcement for the NHS ten-year-plan which has a primary focus on digital services. For the sustainability of the NHS, digital services can empower patients and individuals to have greater control over their own healthcare. With the app, people have access to trustworthy health information at the touch of a button allowing people to take control over their own symptoms and arrange a GP appointment if necessary.
NHS Launches Their Ten Year Plan
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he NHS has announced its Long Term Plan which covers the next ten years. The plan includes extensive measures including measures that will hopefully prevent 150,000 heart attacks, dementia cases and strokes. The initiative hopes to improve patient care and outcomes using the annual £20.5 billion budget that the government has issued for the next five years. What is the Long Term Plan? The NHS Long Term Plan has been developed alongside frontline staff, patients and families. Thanks to the extra £20.5 billion funding that the government is issuing every year, the plan hopes to ensure the health service can benefit millions of patients as well as the hard-working NHS staff. Matt Hancock, the Health and Social Care Secretary, says; “This government has given the NHS the multibillion-pound investment needed to nurture and safeguard our nation’s health service for generations to come.”
At the launch, the Prime Minister, Theresa May said; “The launch of the NHS Long Term Plan marks a historic step to secure its future and offers a vision for the service for the next ten years, with a focus on ensuring that every pound is spent in a way that will most benefit patients. This will help relieve pressure on the NHS while providing the basis to transform care with world-class treatments.” How will the Long Term Plan help the future of the NHS? The focus of the plan is to ensure the future of the NHS. Some of the goals mentioned in the Long Term Plan include; - Helping everyone to enjoy the best start in life - Ensuring people can age well - Promoting living well in communities - Increasing the workforce of the NHS - Mental health services to support 350,000 more children and young adults - Cutting waste to ensure taxpayers’ money is used efficiently - Improving outcomes for major for major diseases What measures are included in the Long Term Plan? There are many measures set out in the Long Term Plan including; - Improving digital health services - Ensuring every patient in England can access a digital GP - Providing more personalised care for older patients - Building stronger community care and primary care services - Improving out-of-hospital care - Supporting community health services and primary medical services - Helping children to get the best start in life through maternity ward improvements - Halving the number of stillbirths, maternal, neonatal deaths and serious brain injuries by 2025.
The role of the Medicines and Healthcare products Regulatory Agency (MHRA) after Brexit
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hile currently, the UK is a full and active member of the EU, after the withdrawal of the UK from the EU, the focus of the Medicines and Healthcare products Regulatory Agency (MHRA) remains in protecting and improving lives. Currently, the MHRA is working with the government to ensure that there will continue to be effective regulation for medicines and medical devices after Brexit.
and internationally with Competent Authorities to ensure market surveillance is upheld and direct action can be taken when needed. 3. Regulate devices
So, what will be the role of the MHRA after Brexit?
The MHRA will continue to oversee the work of the five UK Notified Bodies who all assess devices on the EU market. Furthermore, there will be the implementation on new Regulations for Medical Devices and IVDs, MHRA will continue to support this.
The Government Objective For MHRA After Brexit
MHRA Guidance For A No-Deal Brexit
A statement, published in the Financial Times, said there were three main principles they would like the MHRA to uphold after Brexit which are;
In the event that the UK leaves the EU without a deal in place, several technical notices were published which affect the work of the MHRA.
- No patient will be disadvantaged - The UK will play a leading role in the promotion of public health - Innovators will be able to access the UK market quickly.
These technical notices include;
MHRA Response To Brexit The European Council has expressed that the UK and EU retain a close partnership, with this in mind, the MHRA’s response to Brexit is one where there are still links and strong relationships across the EU. 1. Regulate medicines The MHRA will maintain a relationship with EU members as a new role as a reference member state. The MHRA plans to continue with current programmes that involve implementing EU legislation. Furthermore, the MHRA will continue with EU inspection duties. 2. Protect patients with market surveillance The role of the MHRA will be to continue conducting vigilant market surveillance that can help to protect patients and public health. After Brexit, MHRA will continue to coordinate responses across Europe
How medicines, medical devices and clinical trials would be regulated: Currently, medicines in the UK are regulated by the EU Medicines Regulatory Network (EMRN). A no-deal scenario would mean these functions would be taken on by the MHRA. The legislation surrounding medicine regulation will change slightly too. It is currently an offence to offer, sell or supply unauthorised medicine to a person in the European Economic Area. This will change the offence to the sale and supply to a person in the United Kingdom and the EU/EEA. The MHRA will also be responsible for assess post-authorisation safety studies and periodic safety update reports. Manufacturers will have to submit these directly to the MHRA. Batch testing medicines: The UK will no longer be a part of the EMA. However, the UK will accept batch testing of medicines if it is carried out in a country that is on the approved MHRA list. The list will include EU countries, EEA countries and countries outside of the EU which has an MRA. The will be no change to the current arrangements for batch testing Investigational Medicinal Products.
Regulatory information on medicinal products: After a no-deal Brexit, the UK will no longer be a member of the EU medicines and medical devices regulatory network. Instead of sharing information as previously conducted, the UK will have to create their own processes and systems for regulatory activities. For MHRA stakeholders, they would have to submit regulatory information directly to the MHRA who will create national portals so stakeholders can submit information such as paediatric investigation plans and device registration.
The MHRA strives to ensure that the public will be able to access new and innovative medicines and that the safety, quality and efficacy is checked and ensured. Contingency legislation in place At the moment, there is still no deal in place for the UK’s withdrawal from the EU on the 29th March 2019. As a result, the government has published contingency legislation that covers the regulations of medicines, medical devices and clinical trials, should a no-deal occur. The three pieces of contingency legislation that can ensure to continuing access and sale of medicines, devices and clinical trials are;
Advice For Marketing Authorisation Holders It has been recommended that Marketing Authorisation Holders may want to prepare for changes for marketing authorisation by following the advice from HMA and EMA. However, it is stressed that the MHRA will continue working at the same speed to process authorisations and that the MHRA will continue to collaborate so that public health is safeguarded and protection is uninterrupted.
- The Medicines for Human Use (Clinical Trials) (amendment) (EU exit) Regulations 2019 - The Medical Devices (amendment) (EU exit) Regulations 2019 - Human Medicines Regulations 2012, as amended by the Human Medicines (Amendment etc.) (EU Exit) Regulations 2019.
Plan To Remove Outdated IT Systems From GP Practices
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he Health and Social Care Secretary, Matt Hancock has launched a framework to remove frustrating, outdated IT systems with modern technology. The GP IT Futures framework plans to ensure that all IT systems in GP practices meet the minimum standards and ensure that they can communicate with each other. Furthermore, the framework hopes to encourage the best technology companies to invest in the NHS by creating an open, competitive market. Currently, the NHS IT market has two main providers which are considered to be slowing down innovation by creating long-term contracts which inhibit and trap GP practices from progressing. Many argue that GP practices and their current systems are not suitable for the digital age. How will the GP IT Futures framework help the NHS? - By 2024, all patients in England should be able to access GP services digitally - Practices will be able to offer online or video consultations - Framework changes should be able to reduce delays through seamless digitised information flows - Digitised information flows can also free up staff time, by connecting GP practices with social care providers and hospitals - Ensure that there are minimum IT standards in place which are secure, can communicate with others and are continuously upgradable. IT systems in GP practices that do not meet the minimum standards set forward by the GP IT Futures framework will need to be removed, and contracts with the providers ended. Contracts will only be in place with providers that understand the future plans of the NHS and the principles of the digitalisation and continual improvement for the health and care sector. Discussing the framework, Matt Hancock, the Health and Social Care Secretary, explains; “Too often the IT used by GPs in the NHS – like other NHS technology – is out of date. It frustrates staff and patients alike and doesn’t work well with other NHS systems. This must change.” Matt Hancock adds; “I want to empower the country’s best minds to develop new solutions to make things better for patients, make things better for staff, and make our NHS the very best it can be.”
DISCUSSING THE FRAMEWORK, MATT HANCOCK, THE HEALTH AND SOCIAL CARE SECRETARY, EXPLAINS; “TOO OFTEN THE IT USED BY GPS IN THE NHS – LIKE OTHER NHS TECHNOLOGY – IS OUT OF DATE. IT FRUSTRATES STAFF AND PATIENTS ALIKE AND DOESN’T WORK WELL WITH OTHER NHS SYSTEMS. THIS MUST CHANGE.”
NHS Sustainability: The Key Role Of Community Services
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he recently published NHS Long-Term Plan which focuses on the ongoing sustainability of the NHS has shown that a key focus for sustainability is by upgrading community care. The ten-year-plan commits £4.5 billion a year that will be spent on primary and community care. It is hoped that this funding will help to provide community care for over 370,000 with mental illnesses by 2023. To help with the Long-Term Plan, the NHS looks for support by organisations in the NHS Partners and NHS Confederation, such as The Community Network. The Community Network, chaired by Matthew Winn, have received the publication of the NHS Long Term Plan positively. Matthew Winn has spoken of the positivity surrounding the fact that community services will play a central role in the NHS. He said that this is something that the Community Network has argued for. He says; “A shift in focus towards prevention and community care will help ensure people can live healthier, longer lives, and receive care in or close to their homes, reducing admissions and demand on already over-stretched hospitals.” Support for frontline workers With regards to the additional £4.5 billion per year funding, Matthew Winn says the money will be a huge welcome. However, adds with the caution that the money must reach the frontline workers to ensure workforce challenges are addressed for the success of community services. With the funding and the focus, it is hoped that community services can deliver significant changes to the health and welfare of people. It can change the way people receive support from their community, especially vulnerable and frail patients. The role of The Community Network and other NHS Partners is to take the NHS LongTerm Plan and the funding and turn it into deliverable action so that the plan can achieve its ambition.
TECHNOLOGY IN THE SPOTLIGHT ROBOTICS IN HEALTHCARE Each month we cover healthcare technology that is revolutionising the healthcare sector. This month we focus on robotics leading the way with a companion robot for the elderly, a next-generation robot revealed to the world for the first time, the first exoskeleton for stroke and spinal cord injury rehabilitation and robotic prescription collation technology.
SERVICE ROBOTICS GenieConnect®
CMR SURGICAL
INNOVATION
Versius®
RxCollect™
EKSO BIONICS EksoGT
Service Robotics lead the way with companion robot for the elderly
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South-West startup, Service Robotics Ltd is launching a unique solution to older adult independent living later this year. The solution, the brainchild of co-founders Rob Parkes and Tim Morgan, is called GenieConnect® and combines a companion robot called Genie with a 24×7 video Care Centre and specialised software for personcentred engagement. Service Robotics is based in Bristol, on the same UWE campus as the Bristol Robotics Laboratory, and is currently raising funds on the crowd funding platform Crowdcube, on which they reached their funding target within the first 2 days of the 30 day campaign. “This is a huge endorsement of the idea and the people behind GenieConnect®, and I think we all know the market is there” said Rob Parkes. “GenieConnect® is an idea whose time has come, and we encourage anyone with an interest in independent living for older adults to look at our campaign.”
The funds from the current campaign will enable the Service Robotics team to deploy a pilot project in the UK, with up to 150 robots being issued to pre-qualified triallists, to verify and fine-tune the service ahead of a commercial launch later in 2019. There will be at least 3 pilot regions, including the West of England, East Anglia, Cornwall and one other yet to be determined. “Government grants have already been awarded from the European Regional Development Fund in 2 of these regions, and talks are at an advanced stage with a County Council in one of the other regions” said Parkes. Pilot partners include some of the largest affordable housing and care providers in the UK and respected research organisations. The pilot project will allow the GenieConnect® user to access a 24 x 7 Care Centre via video link on the face of the robot, using a simple voice command. The Service Robotics Care agent with chat with the user and provide information, assistance and referrals as necessary, to enable independent living for the user in their own home for longer.
As part of the solution that will be deployed in the pilot, Service Robotics are working with the UK’s leading developer of software for the personalised engagement of older adults. RemindMecare (aka ReMe, http:// www.remindmecare.com) is a unique app that delivers activities, support and therapy to improve person-centred care for the elderly and people with dementia.
health of the user and even predict health events before they happen. The circle of carers including family and friends can easily check on the user and be notified of any concerns according to the “mutual consent principle”. GenieConnect® is a realisation of the best of both technology and human care delivered in the form of a user friendly companion.
Service robotics will also partner with best-in-class security and privacy organisations to ensure that GenieConnect® users are safe from malicious hacks or privacy breaches.
For more information contact the team at: information@serviceroboticsltd.co.uk
But Parkes is even more excited about the future of the solution. “The pilot will be ground-breaking but we have much more to come from our technology roadmap later in the year. We expect to integrate the solution with smart home and smart health systems so we can ensure the
GenieConnect® is the brainchild of Rob Parkes and Tim Morgan – successful business owners, entrepreneurs and engineers with 50 years of experience between them. Both Rob and Tim have elderly parents who’ve found themselves living alone after losing their respective partners. Having seen first-hand how quickly a full and happy life can become lonely, Rob and Tim decided to use their innovation, skills and experience to create a solution – and GenieConnect® was born.
Next-generation robot revealed to the world for the first time
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MR Surgical unveils its small, portable and cost-effective surgical robotic system, as part of its mission to provide greater access to beneficial minimal access surgery. Designed to meet the complex requirements of minimal access surgery, Versius has been created and built by the CMR Surgical team in Cambridge, United Kingdom. Versius resets expectations of robotic surgery by providing a versatile system that is portable, transportable and affordable. This is made possible because of its small form factor, modular design and individually cart-mounted arms. Versius is easy to move between operating rooms and even hospitals, quick to set up and gives the surgical team easy access to the patient at all times. Biomimicking the human arm, Versius allows surgeons the freedom of port placement, but with the benefits of small fully-wristed instruments. With 3D HD vision, easyto adopt instrument control and a choice of ergonomic working positions, it is hoped the new open surgeon console will reduce stress and fatigue, offering the potential to extend the careers of surgeons.
CMR Surgical has more than doubled in size in twelve months. In only four years since incorporation, the company now employs over 220 people and recently announced a record breaking private fundraise of $100M. The company is currently undergoing validation studies for regulatory approval processes in Europe. The robotic system will be used in hospitals in the UK and continental Europe in the next year, with wider international expansion shortly afterwards. The unveiling has been accompanied by the release of never-before-seen images and a film that demonstrate the innovative design of the robot. About CMR Surgical CMR Surgical is a British private limited company developing the next-generation universal robotic system, Versius®, for minimal access surgery. The vision behind CMR Surgical is to make minimal access surgery universally accessible and affordable, transforming the existing market for surgical robotics while also addressing the six million people who still undergo open surgery each year.
With Versius, CMR Surgical wants to remove barriers that currently exist to robotic surgery. For patients and healthcare providers alike, the benefits of minimal access surgery are compelling. The promise of reduced trauma, faster recovery and improved clinical outcomes has been the driving force behind the development of surgical robotics for decades. However, despite these benefits, robotic surgery is not yet performing the majority of available surgical procedures due to current constraints, leaving millions of patients worldwide still undergoing open surgery.
Global annual revenues for robot-assisted minimal access surgery are presently approximately $4 billion and are anticipated to reach $20 billion by 2025.1
Martin Frost, Chief Executive Officer at CMR Surgical, said: “We believe Versius represents a paradigm shift in surgery. The ground-breaking design, coupled with genuine affordability, means that patients everywhere have the potential to benefit from the advantages of minimal access surgery. Versius is a great example of British innovation and its launch represents a pivotal moment in the next chapter of surgery and patient care.”
For further information, please visit: www.cmrsurgical.com
CMR Surgical, formed in 2014, has its headquarters in Cambridge, United Kingdom and is backed by an international shareholder base. The Company achieved the registration of its Quality Management System to ISO 13485:2003 by Underwriters Laboratories LLC® (‘UL’), and the status as a UL Registered Firm, in September 2015.
About Versius, the CMR Surgical robotic system Designed to meet the complex requirements of laparoscopic surgery, Versius’ compact size fits easily into the existing surgical workflow, while its ergonomic console design allows surgeons to work in a way that reduces physical and mental effort. Intended to be used across a range of surgical specialties, the versatility and portability of Versius, enabled by a unique and patented four-axis wrist joint, expands the potential for higher utilisation. The versatility of the system and compelling commercial model allows healthcare providers to offer the benefits of robotic-assisted procedures in a cost-effective way.
Innovation Meets Neurorehabilitation eet EksoGT, the first exoskeleton for stroke and spinal cord injury rehabilitation.
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he first exoskeleton FDA-cleared for stroke and spinal cord injury rehabilitation has been designed to help patients stand and walk during rehabilitation. EksoGT works with clinicians to promote correct movement patterns in all phases of recovery and challenges patients as they progress toward independent ambulation. EksoGT features a customised motor which supports strength for various impairment levels, from full assistance to patient-initiated movement. EksoGT also includes a suite of programs to help patients balance, weight shift, and step in place before walking. Sensors and software continuously monitor and regulate leg movement to minimize compensatory gait patterns. Clinicians can set training targets and modify assistance levels in real time for each leg independently based on session feedback. Session-specific walking time, distance, and speed, information is securely saved to the cloud for easier documentation. EksoGT also helps patients bear only their own weight with proper postural alignment so you can maximize treatment time. With more than 2,000 patients participating in 80 investigator-led clinical studies, EksoGT is the most widely-studied exoskeleton for stroke rehabilitation. EksoGT comes with two sets of rechargeable lithium ion batteries that allow for continuous use. Since 2012, Ekso Bionics, Inc. has sponsored or supported clinical research using the Ekso 1.1 and EksoGT exoskeletons. The vast majority of completed and ongoing studies are investigator-initiated. As of December 2018, over 2000 participants have been or are involved in 58 completed studies and 39 ongoing studies. Roughly half of the research is conducted within the U.S with the remainder within the EMEA. Because the first Ekso device was designed for those with spinal cord injury (SCI), most early research was conducted with SCI participants. With newer hardware and software accommodating more impairments, studies
in patients with stroke and other neurological diagnoses have been quickly increasing. As expected, many of the feasibility studies have led to larger studies (singlearm or comparative) where the investment of time and resources is considerable. Ekso Bionics, Inc. remains committed to demonstrating clinical benefit through research. The graph below shows how the areas of the current EksoGT research are now more diversified. Past research activity using the Ekso devices has culminated in over 55 conference presentations, chapters, and published articles including 12 review articles. Of the published articles, 33 describe results of Ekso use in individuals with spinal cord injury, seven report on research related to Ekso in stroke survivors, and one pertains to multiple sclerosis. In addition to gait function and balance, 2018 publications included changes in secondary complications, motor control, and neuroplasticity with EksoGT training. Visit www.eksobionics.com for more information.
Innovation Introduces RxCollect Robotic Prescription Collation Technology
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nnovation, makers of PharmASSIST® pharmacy automation solutions, announced the introduction of RxCollect™, a robotic prescription collation technology that automates the collection of patient-specific group and/or multi-vial orders in central fill and mail order pharmacies employing Single Piece Flow processing. “When it comes to increasing efficiency and reducing waste in high-volume prescription environments, Lean manufacturing’s single piece flow typically wins out over filling prescriptions in batch mode. With that in mind, we invented RxCollect as a downstream automated collation solution for high-volume pharmacies filling patient orders in a continuous, single piece flow mode of operation,” said Tom Boyer, COO, Innovation. “By filling and collating prescriptions individually, as they’re processed, you eliminate wasted idle time, increasing labor and machine utilization and allowing for greater throughput or shorter shifts.” The RxCollect technology comprises a FANUC® LR Mate 200iD/7L robot and 50 unique tubular collation queues, with each collation queue accommodating up to five 60-dram vials or bottles. If a patient’s order exceeds five vials/bottles, RxCollect assigns multiple collation queues for that patient order. During prescription fulfillment,
patient order collation occurs after each prescription has been filled. As each vial/bottle that comprises the order arrives via conveyor at the collation area, RxCollect scans the label prior to placing it into a pre-selected collation queue. When RxCollect receives and collates the last item in a patient order, the system releases the queue of vials/bottles into an awaiting carrier unit (e.g., a tote), and the tote is then released to its next destination. Each collation queue has an optical sensor to ensure that all items are released as expected. RxCollect has a modular, compact footprint that can be integrated into any new high-volume pharmacy design, or into any existing high-volume pharmacy system (Innovation or non-Innovation) with minimal disruption of operations. About INNOVATION Innovation is the leading provider of Pharmacy Intelligence and pharmacy automation to the retail, hospital, government, and mail order pharmacy markets. Our PharmASSIST family of pharmacy automation and process optimization solutions enable all types of pharmacies to increase operational efficiency, enhance patient safety, and provide a higher quality of patient care.
EVENTS COMING UP:
UKAuthority Digital Health & Social Care 2019 14th February 2019 London
Digital health and care congress
Digital Health Technology Show
22nd & 23rd May 2019
12th & 13th March 2019 London
London
Future Healthcare Exhibition & Conference 18th & 19th March 2019 London
Healthcare Partnership Network
Digital Health and Care Explained 7th March 2019 London
12th & 13th March 2019 Leeds
WIRED Health 26th March 2019 London
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What to look forward to in the next issue In the March issue we will cover the news highlights for the month of February. We will be covering more ground-breaking healthcare technology in our spotlight section with a focus on virtual & augmented reality in healthcare. The next issue will be coming out on Monday 4th March 2019.
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