A clinical management service for stroke prevention

UCL research has developed international standards for electronic health records (EHRs), enabling patient records to move with them to different health providers and clinicians in different settings to collaborate more effectively. The work has been successfully commercialised as a stroke prevention service through spinout company Helicon Health.

The standard, ISO EN 13606, is the only internationally published standard for communicating EHRs between diverse healthcare systems. It is mandatory in all EU countries and has been publicly adopted in the UK (NHS England), Sweden, Spain, Brazil, Iran. Countries considering its adoption include Norway, Ireland, Japan, Korea, Malaysia, Rwanda and Australia.

UCL researchers have placed the standards based EHR at the heart of a unique package of stroke prevention services that helps the management of patients with atrial fibrillation (AF) who need anticoagulation. The service went into full clinical use at the Whittington Hospital, London, in August 2008. It was spun out, with funding from UCL Business, to form Helicon Health in 2012. The resulting package of services is now called HeliconHeart.

What needs does the stroke prevention service meet?

The NHS's shared care agenda requires strong collaboration between the patient and his/her clinical team, which may comprise a GP, practice nurse, hospital clinician and pharmacist. Access to a real-time electronic health record is therefore crucial.

In addition, the risks associated with anticoagulation need to be carefully managed. Each anticoagulated patient has a narrow and unique safe dosage window, which changes over time and can be influenced by lifestyle changes, other medications and certain foods; it therefore requires regular blood test monitoring (every few weeks) and careful dose adjustments. Either too high or too low a level of anticoagulation can lead to serious or fatal haemorrhages, or stroke.

What does the package of services include?

Compliant with National Institute for Health and Care Excellence (NICE) guidelines on atrial fibrillation and self monitoring, and cited as a learning exemplar in NICE's guidelines for anticoagulation, the HeliconHeart package uniquely includes:

• a web and standards based electronic health record (EHR)
• anticoagulation and stroke prevention anticoagulation advisory functions
• remote blood pressure monitoring
• digital INR monitoring
• real-time audit across multiple sites
• blended learning (for clinicians and patients)
• clinical governance
• professional services to help establish the service.

HeliconHeart is now being used by five NHS Clinical Commissioning Groups (CCG) across north London and Hertfordshire, covering two hospital trusts, 30 general practice delivery sites and three community pharmacies (including Boots). It underpins care for 7,000 at-risk patients. This patient cohort is growing at an average rate of 5% per month.

In financial terms, every prevented stroke saves the NHS £16,000 a year; the estimated saving to each CCG is approximately £500,000 a year, to which the HeliconHeart service makes a significant contribution.

By facilitating care between community staff and hospital specialists, the system has enabled the Whittington Hospital to transfer more than 600 patients over the last few years from the more inconvenient and expensive hospital service to a local GP or community pharmacy service, while still being able to remotely monitor their quality of care. This has released capacity in the hospital for the referral of new and often more complicated patients. The service was commended in a NHS Customer Service Excellence award made to the Whittington Cardiovascular Department in 2009.

Helicon Health now employs 9 full-time and part-time staff.

Related links

• Helicon Health
• Whittington Health
• Helicon Health cited as exemplar in the shared learning database that accompanies NICE guidelines on atrial fibrillation
• UCL Institute of Epidemiology and Health Care case studies
• UCL Computer Science case studies