DXS International plc

ExpertCare – Simplifying complex medicines prescription

The EU funded report Polypharmacy Management by 2030: a patient safety challenge published by SIMPATHY (Stimulating Innovation Management of Polypharmacy and Adherence in The Elderly stated that:-

“Inappropriate polypharmacy and medicines adherence in the elderly is one of the most significant public health challenges of the current age. This burden is set to increase as the population ages and more people suffer from multiple long-term conditions. There remains a lack of evidence-based solutions, as both medical research and healthcare delivery models have focused on single disease interventions. This challenge, and the limited range of solutions, have significant implications for how healthcare resource is used to address inappropriate polypharmacy. However, with up to 11% of unplanned hospital admissions being attributable to harm from medicines, and over 70% of these being due to elderly patients on multiple medicines there are significant opportunities to reduce this burden by timely and effective interventions.

The Institute of Medicine report, Responsible use of Medicines demonstrates that 0.3% of the global health budget could be saved by managing polypharmacy appropriately. The report identifies key areas of focus which include using risk stratification to identify vulnerable patients and a more collaborative role for pharmacists, physicians and patients. Facing the challenge of reducing patient harm, the European Union (EU) issued a public health call to identify, develop and implement innovative solutions that can be implemented at scale to address key problems. Stimulating Innovation Management of Polypharmacy and Adherence in the Elderly (SIMPATHY) is one of the funded projects to deliver tools to implement polypharmacy management programmes throughout the EU in the context of quality, economic and political factors.”

ExpertCare  is a novel solution, that uses artificial intelligence to support health professionals in quickly, accurately and consistently implementing best evidence medicine optimisation guidelines using contextualised information based on the patient’s clinical and therapeutic status, including comorbidities. It implements the NICE (or similar) guidelines to provide dosage recommendations and warning of potential interactions, suggesting which medication should be stopped, replaced, continued or adjusted. It also indicates whether a medication is required for the treatment of a comorbidity.

Regulatory status: ExpertCare is MHRA registered and CE-marked under MDR (EU) 2017/745 rule 12 as a Software-as-a-Medical Device (SaMD) product Class 1 low-risk product. Registrations will be transitioned to UKCA by 2023 and updated continuously as the product is developed. DXS are an accredited NHS General Practioner IT Futures (GPITF) Catalogue Solution supplier – Medicines Optimisation Capability and BSI Certified for ISO 20000; 27001; 22301.

ExpertCare will include the chronic conditions of diabetes, chronic kidney disease, atrial fibrillation, cholesterol and hypertension in their multiborbidity medication compliance solution.

After an extensive survey of current products we are not aware of any product that can provide the unique features of ExpertCare.

We believe we could be a valuable contributor to the CareMatrix PCP programme and the prime objectives of tackling multimorbidity and saving time. The EC solution:

• reports a 40% impact on medication compliance and blood pressure control, which in turn is the major contributor for coronary artery disease, stroke, heart failure, atrial fibrillation and chronic kidney disease.
• eliminates variation in care and considers medication prescribed by all specialists for an individual patient’s comorbidities.
• saves substantial health care professional consultation time. Remote consultations remove the necessity of face-to-face consultations.
• addresses three CareMatrix Building Blocks.

1. Early and comprehensive assessment with a preventive approach

“Early and comprehensive assessment with a preventive approach: Persons at risk of multimorbidity or multimorbid patients at risk of further health deterioration are often not identified early enough by the care sector and therefore not provided with the preventive care which could avoid, delay or slow down the deterioration of their health status.”

– The ExpertCare risk stratification tool will be unique in using risk stratification algorithms and machine-learning approaches to help prioritise caseloads and identify ethnic and socio-economic gaps and needs.

2. Interdisciplinary collaboration/Interdisciplinary team

“PMM are often treated by different specialists who, under a disease management approach, try to optimize the treatment of the single condition they are responsible for, without taking proper consideration of the possible interactions and conflicts between treatments for the different conditions that converge in a same patient” and

3. Individualized and patient centered care

“At the same time, it is difficult to follow standard protocols, guidelines or care pathways in the case of PMM, since there are many co-existing conditions and circumstances in each case and treatments set up for different chronic conditions, including medication and health recommendations, can interact or be conflicting, and this is specially recurring in care for PMM. This complexity requires prioritization between different therapeutic objectives, treatments and medications, including considering de-prescription of certain medicines.”

ExpertCare consistently implements best evidence medicine optimisation guidelines using contextualised information based on the patient’s clinical and therapeutic status, including comorbidities and eliminates problematic polypharmacy.

The CareMatrix Business Case objectives are also addressed by ExpertCare (EC):

• “reduction in time spent for visits to care facilities” – EC saves 70% of meds consultation time and can be conducted remotely, making face to face consultations un-necessary.
• “improvement from baseline in aspects of care” – EC trial sites show substantial improvement in medication compliance and blood pressure control.
• “reduction in the number of clinical errors” – EC is clinically assured and eliminates prescribing errors.

Other added value:

DXS/ExpertCare was a phase 1 contract award winner for Horizon 2020 Health Status Monitor innovative ICT-enabled monitoring to improve health status and optimise hypertension care (Call identifier: SC1-DTH-10-2019-2020. Ended May 2021). The subsequent phase II engagement gave us insight into the requirements of integrating into the consultation workflows and clinical coding in the various EU countries participating in the PCP (Turkey, Croatia, Sweden ed Italy). Our bid included territorial partnering and a joint venture strategy proposal to exploit established networks and market knowledge in Europe.