1. Messaging Enabled Care Services
Washington D.C. Conference 2014
Paul Marriott MA FCIM, TECH Eng. IME
NHS England Northern Senate
Lead Consultant and Advisor of Technology Enhanced Care Services (TECS) to NHS England
Lead professional and advisor in the development and implementation of TECS in the
North of England and Clinical Advocate for TECS UK and International NHS England
NHS England TECS - Clinical Advocate 2014 Winner
Marriott.p1@sky.com@VallumPaulM

2. In performing my role
• I lead Telehealth Programmes TECS (Technology Enhanced Care Services) for the
NHS in the North of England
• I work Nationally and Internationally for NHS England promoting and advising on
TECS implementation clinically and strategically
• I am a key innovator, leader and problem solver for new innovations within TECS
• I am an author and the inventor of the Multi Matrix Telehealth or (TECS) Model

3. About us
• NHS England Northern Senate
is the largest health region in
England
• The area covers boarders with
Scotland in the North and
Yorkshire and Lancashire in the
South
• The region is hugely diverse
and is an extreme mixture of
industrial, rural, agricultural
and cities. The region covers 2
National Parks within the UK
NHS England Northern Senate

4. 4
• Life is in three parts. It begins with a trauma (birth) and ends with trauma
(death) and in between we face life and wellbeing challenges in multiple
ways and of multiple magnitudes.
• Nothing is universal to us all except the beginning and the end of life,
therefore the middle section of life has to be met by a diverse Multi
Matrix Approach to supporting health and wellbeing.
• The Multi Matrix Model of Technology Enabled Care Services is a concept
developed by me in 2011 that seeks to match technology with the whole
life perspective of patients.
• It links prevention and lifestyle change to disease development and
progression through its stages to end of life and in the most cost and
patient effective way.
Multi Matrix Model
of Messaging Enabled Care Services

5. Prevention is Easier than a Cure
I recently met 8 teams of Oncologists and Radiographers and asked them:
How can NHS England help reduce the number of Tumour and Cancer sufferers you
encounter?
The answer was simple and universal REDUCE SMOKING!

6. Optimum Health
Robust Health
Good Health
Average Health
Signs of Illness
Chronic Illness
Irreversible Illness
Premature
Death
WholeLifePerspective
Conception
Death
The Multi Matrix Telehealth Model Seeks to Cross the Whole Life
Perspective by Proportionally Matching Telehealth Systems with the
Patients Needs, Lifestyles and the Clinicians Medicine.

7. NHS Florence SMS Simple Telehealth System
SMS
Prompts and
adviceGP Practices
Specialist Clinicians
Community and Specialist
Nursing
Public Health Smoking Pathway

8. A Useful Tool That We Have Used SOTW is Quality Function Deployment
We Now Call it “Health Function Deployment”
The Customer
Needs or Wants
are Listed on the
Left
Needs/Wants
are Ranked
Numerically in
Order of
Importance to
Customer
How these Needs/Wants
can be Delivered are
Listed
Scores are Totalled Needs Plus
How's and a Ranked Set of Needs
and How to Fulfil them Emerges

9. Condition Clinical Lead
 Heart Failure, Angina etc. FT, GP
 COPD and Respiratory etc. FT, GP
 Hypertension GP
 Diabetes FT, GP
 Gestational Diabetes FT
 Pre Pregnancy HbA1c Family Planning FT
 Parkinson’s FT
 Rapid Discharge FT
 Deprivation Medicine and Social Prescribing GP and 3rd Sector
 Acquired Head Injury and Stroke FT, GP
 Primary Care Step Up Step Down GP
 Care and Nursing Home GP
 Weight Management FT, GP, LA & PH
 Smoking Cessation LA & PH
 Remote Wound Dressing Monitoring FT
 Community Matron Case Load FT
 Alcohol Induced Morbidity FT
FT = Foundation Trust GP = General Practitioner LA & PH = Local Authority & Public Health
Some of the Current Florence Pathways in the
Northern Senate (there are now over 80)

10. Messaging Enabled Care Services are the Most
Adaptable, Usable Form of Telehealth Care
Provision I know
LET ME SHOW YOU SOME EXAMPLES OF WHAT WE HAVE DONE
SO FAR

11. Remote Wound Management Over Wide Geographical
Areas

12. As an Example Addiction Medicine Pathway
GP
Recovering Substance User
3rd Sector Volunteer
Patient Buddy
NHS
Florence System
None Medical Control Centre

13. Carer Pathway Local Authority Social Care and
Primary Care
GP
SMS Telehealth
Patient and Carer
HQ 9 or Questionnaire
Telecare Control Room
Social Care/Housing

14. The Application of a Message Enabled Care Monitoring and
Support Service in Pain Management (Example Pain Diary)

15. Typical Pain Management Diary
Date After
Block
Good Relief of
Leg Pain
Partial and
Satisfactory Relief of
Leg Pain
Partial but
Unsatisfactory
Relief of Leg Pain
No Relief of Leg
Pain
Same Day √
Day 1 √
Day 2 √
Day 3 √
Day 4 √
Day 5 √
Day 6 √
1 2 3 4
Intervention

16. The outcomes for those patients referred for Telehealth in South
Tyneside have demonstrated significant reductions in access to
health care in the three months following the use of Telehealth.
The Key Outcomes are as follows:
53% reduction in attendance at A&E
55% reduction in Emergency Medical Admissions
14% reduction in access to Urgent Care Service
No patient having more than one hospital admission
71% reduction in costs associated with A&E attendance and
Emergency Medical Admissions.
Telehealth Reported Outcomes South Tyneside
Hospital COPD and Heart Failure Patients

17. Patient Case Studies
• Heart Failure patient is admitted for the fitting of an assist device. Operation has to be postponed as the
patient fluid levels are too high. Because Telehealth is on the ward and the patient can use it he is discharged
from acute HF bed at a saving of £2,000 per day. The patient is then monitored from home by Cardiology
Team whilst medicating with diuretics. Six days in an acute bed are avoided.
• COPD patient “Flo has made my life easier. if I have a very poor day when I cannot manage to mobilise, I can
take my readings from my bedroom unlike other systems I have used. Also on better days I can take Flo with
me. It’s a nurse in my pocket.”
• TB Medication Reminder. TB sufferers have to take medication regularly and clinical staff have to verify that
patients have complied with the drug regime for a 6 month period. An enclave of TB patients with whom it is
difficult to engage have been given Flo to manage their medication reminders. The patients have largely
chaotic lifestyles and mostly don’t respond to clinicians who attempt to contact them. The Flo system has
proved successful in that patients willingly comply with the SMS reminders and valuable clinical time has
been saved along with a robust audit trail of drug compliance.

18. 18
Key Points
NHS England Northern Senate
• Messaging Enabled Care Services is the most adaptable, usable form of
Telehealth Care Provision I have encountered. Even disparate patients respond
to SMS contact.
• When used in a Multi Matrix way Messaging Enabled Care Services can work
across the whole life perspective from Conception to End of Life and from
prevention of illness to chronic disease management.
• We in NHS England Northern Senate have developed over 80 pathways and this
is only scratching the surface of what this technology can do we believe.
• Our Work So Far in the Community has Shown Telehealth Can Produce
53% reduction in attendance at A&E
55% reduction in Emergency Medical Admissions
14% reduction in access to Urgent Care Service
No patient having more than 1 hospital admission
71% reduction in costs associated with A&E attendance and Medical Admissions