Technology in Care Andrew Marsden Medical Advisor, National Procurement

2. Technology in CareAndrew MarsdenMedical Advisor, National Procurement

3. Technology in Care

4. Product Development Health Service Provider Pure Science Applied Science Biomedical Technologies Horizon Scanning & Procurement Patient Unmet Need Medical &Surgical Practice Safety, Efficacy / Value Guidance

5. Product Development Targeted / Wider Indications Pharmaceuticals – Large Molecule / MABS / RNAi IV Diagnostics - Lab on a Chip Imaging –Molecular Diagnistic Contrast, Dual Subtraction Procedures – MIS , Screening Biomedical Devices – Convergence IT & Communications – WIRELESS, DICOM & EPR Higher Expectation Breakthroughs Biology- Genetics /Proteomics Chemistry – Molecular / Combinatorial Chemistry Physics – Biomaterials / Nano-Technologies Mathematics & Computational Increase Leads & Targets Medicine / Biomedical Research Molecular Engineering Bioengineering Biomechanical / Mechanical Engineering Bio photonics Bioinformatics Electronic,/ Electrical Engineering IT / Computational Engineering Software Engineering Etc etc + Convergence & Complexity Health Service Provider Pure Science Applied Science Patient Unmet Need Medical &Surgical Practice Safety, Efficacy / Value Guidance Wave of Innovation…

6. Product Development Targeted / Wider Indications Pharmaceuticals – Large Molecule / MABS / RNAi IV Diagnostics - Lab on a Chip Imaging –Molecular Diagnostic Contrast, Dual Subtraction Procedures – MIS , Screening Biomedical Devices – Convergence IT & Communications – WIRELESS, DICOM & EPR Higher Expectation Breakthroughs Biology- Genetics /Proteomics Chemistry – Molecular / Combinatorial Chemistry Physics – Biomaterials / Nano-Technologies Mathematics & Computational Increase Leads & Targets Medicine / Biomedical Research Molecular Engineering Bioengineering Biomechanical / Mechanical Engineering Bio photonics Bioinformatics Electronic,/ Electrical Engineering IT / Computational Engineering Software Engineering Etc etc + Convergence & Complexity Health Service Provider Pure Science Applied Science • COLLABORATE • Trial/ In-Line Evidence Development • Clinical Outcome Registries • Risk Sharing Deals • Strategic / Aligned procurement ANTICIPATE Horizon Scanning Centre APPRAISING/ REGULATING Health Technology Assessment (HTA) NICE (1999) / SMC (2002) TRANSLATIONAL RESEARCH Patient Unmet Need Medical &Surgical Practice Safety, Efficacy / Value Guidance COLLABORATION / INNOVATION

7. SGHD Patients and Quality Division NHSQIS Board Chief Executives Board Finance Directors Board Medical Directors Directors Public Health Regional Planning Group Medicines Management Consultant Lay Representative The Scottish Health Technologies Group

8. Remit of SHTG • To identify existing and new technologies, including devices, which are likely to have significant implications for patient care in the NHS in Scotland, and areas where there may be evidence to support disinvestment • To ensure that assessment and appraisal of the effectiveness of technologies is carried out as needed, taking account of assessment and appraisal work being carried out elsewhere, for example, by NICE, by the Centre for Evidence-based Purchasing, and by other Technology Assessment groups • To facilitate the implementation by the NHS in Scotland of evidence-based recommendations on technologies including NHS QIS Health Technology Assessments and NICE Technology Appraisals The group is advisory and has no directorial control over Health Boards

9. Business of SHTG • Scottish Health Technologies Group (SHTG) • Horizon Scanning • Appraisal of key topics, to include disinvestment of older technologies • Supporting Implementation of Recommendations that are a material change to current practice • Monitoring the take up of such initiatives • Quality Improvement Scotland (QIS) will… • Prepare and circulate a quarterly horizon scanning report • Maintain a register of all topics • Record all decisions and actions • Prepare and circulate systematic reviews and evidence notes of the clinical and cost effectiveness evidence for topics requested • Prepare and issue to NHS Scotland implementation advice as requested

10. Sources of Horizon Scanning • Non drug Technology Briefings issued by the National Horizon Scanning Centre University of Birmingham • New HTAs that have entered the NHS QIS work programme since last horizon scanning Report • Non drug HTAs published by i) NHS QIS ii) the National Coordinating Centre for Health Technology Assessment (includes all undertaken for NICE) and iii) those published by other international agencies • SIGN Guidelines that have been consulted on since last horizon scanning report • NICE: Interventional Procedures • Evidence Notes • Topic proposals by Group members • Topic proposals by National Procurement on new technologies and divestment

11. Market Tracking Actual vs committed Publish Quantitive Market Data / Commercial Research Market Status Update / Product Scoring & Ranking Company Pipelines Targeted / Informed Priorities Customer Alignment Horizon Scanning Health Technology Assessment Strategic Collaboration Monitor Uptake/ Assess Impact Role of Procurement ? Strategic Procurement Tactical Procurement Research Supply Market P2P (Purchase to Pay Define Requirement Tender / Product Scoring Supplier Selection Contract / Implement Manage Supplier / Monitor Uptake

12. CARDIOLOGY ( VASCULAR) • Current • Drug Eluting Stents • Bare Metal Stents • Catheters & Ballons • Hydrophilic / Hydrophobic Guidaewires • IVUS Imaging • Emerging • Bioactive stents • Bifurcation Stents • PFO Closure Device • Carotid Artery/ Full Body Stenting • Future • Bioresorbable Stents • Vulnerable Plaque • MS CT Angiography • C Reactive Protein Screening Procurement Scanning opportunity? • Incremental vs. Disruptive ? • Changes / Additions to Indications ? • Rate of Change & momentum ? • Financial Impact / Commercial Context ?

13. Areas of NP Involvement • Input from commodity leads on market research in their areas of special interest • Information from major suppliers and trade organisations on technology road-mapping • Proposals for specific Health Technology Assessments on emerging areas • Contribution on the take-up of new technologies (and the disinvestment of old) through the monitoring of the implementation of new national contracts • Information on clinical outcomes following the introduction of a new technology • Events & Reporting

14. "The NP Horizon Scan Report" • Brief Description of the Technology • Likely Patient Group/s • Current Treatment Alternatives • Level and amount of research evidence currently available (if known) • Prediction of clinical and strategic relevance

15. "The NP Implementation Report" • Identify the value added of a strategically sourced contract OR manage the supplier-to-customer processes • Provide information to inform business cases and track implementation activity • to monitor take up rates for new technology OR • displacement rates for disinvested products

16. Outputs from NHSQIS • Evidence-based Assessment Report • Supervision of Work Programme • Publication on website

17. Current Examples • Blood Glucose Monitoring • Insulin Pumps • CPAP for Obstructive Sleep Apnoea • Flexible Endoscopy technologies including nasal intubation and double balloon colonoscopy • Interventional cardiology technologies including coronary stents and percutaneous valve insertion • Blood Scavenging • Digital mammography in breast screening • Dual Energy Subtraction Radiology • Tissue Viability Products e.g. Topical Negative Pressure; active micro-stimulation mattresses • Haemostatic Agents