Advice

The technology

The technology

Lenus COPD Support Service (Storm ID) is a remote management service for people with high-risk chronic obstructive pulmonary disease (COPD). COPD is a chronic inflammatory lung disease that causes difficulty breathing. The digital health technology allows people with high-risk COPD to share their health data with healthcare professionals. It integrates 3 components:

  • A web app for people with COPD to record patient-reported outcomes. This allows 2‑way messaging between healthcare professionals and patients, access to self-management plans, and links to information on pulmonary rehabilitation.

  • Patient-acquired data from Fitbit and home non-invasive ventilation (NIV) devices.

  • Cloud-based healthcare professional dashboard, including 2‑way integration with electronic health record data.

Lenus COPD Support Service needs a smartphone, tablet, or computer with internet access for use. People with high-risk COPD complete regular patient-reported outcomes in the app including a symptom diary, COPD Assessment Test, Medical Research Council Dyspnoea Scale, healthcare episode questionnaire, and EQ‑5D‑5L. The app shows visualisations and trends in the data, which can be used to support self-management. Health data is also collected from connected Fitbit and home NIV devices.

All data is exported to the cloud-based healthcare professional dashboard and integrated with the person's clinical summary and electronic health record. Healthcare professionals are presented with visualisations of these data outputs. The company claims this data can be used to understand the likelihood of an exacerbation and to provide treatment when needed. Lenus COPD Support Service also allows asynchronous messaging between patients and healthcare professionals and sharing of care plans.

The service also generates longitudinal datasets that can be used to build artificial intelligence models to predict patient events.

Innovations

The company claims that Lenus COPD Support Service is the only technology for COPD on the market that combines data from patient-reported outcomes, medical and wearable devices, and clinical records. It claims that the device is more effective in reducing exacerbation events than other apps for COPD.

Current care pathway

People with COPD should be offered treatment and support to stop smoking, pneumococcal and influenza vaccinations, pulmonary rehabilitation if indicated, optimised treatment for comorbidities and a personalised self-management plan. Inhaled therapies may be prescribed if needed to relieve breathlessness and exercise limitation.

Self-management plans should include education and an individualised exacerbation action plan for people at risk of exacerbations. Treatments and plans should be revisited at every review. People with COPD should be on the primary care COPD register and should attend a follow-up review at least once a year and more often if needed. Follow up is typically done in primary care and includes a clinical assessment of smoking status and motivation to quit, symptom control, need for pulmonary rehabilitation, medication effects, inhaler technique, and need for referral to specialist services. The healthcare professional will also measure:

  • forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) with a spirometer

  • body mass index (BMI)

  • Medical Research Council dyspnoea score

  • oxygen saturation of arterial blood in severe cases of COPD.

People with very severe COPD may have reviews at least twice a year in primary care. For most people with stable severe COPD, regular hospital review is not needed but quick access to hospital assessment should be provided as needed. People with COPD who need interventions such as long-term NIV should attend regular review with a specialist. Hospital follow ups should also be available for people with frequent exacerbations, home ventilation, and lung volume reduction.

NICE's guideline on COPD does not recommend the routine use of telehealth monitoring of physiological status as part of the management of stable COPD.

The following publications have been identified as relevant to this care pathway:

Population, setting and intended user

Lenus COPD Support Service is intended for people with high-risk COPD, defined as Global Initiative for Chronic Obstructive Lung Disease (GOLD) group C or D. There are about 1.2 million people with diagnosed COPD in the UK. About 20% of people with COPD may have symptoms and exacerbations in line with GOLD 2017 group C or D (for example, Sansbury et al. 2021). People with high-risk COPD may be offered Lenus COPD Support Service in addition to standard care as part of their individualised care plan.

Costs

Technology costs

The technology costs (excluding VAT) are:

  • initial setup, including information governance: £10,000

  • a fixed licence fee to use the platform: £30,000 per year

  • user fee: £10 per patient per month, with a 20% discount for over 1,000 patients.

Initial setup costs include integration costs for NHS settings with existing systems (including patient management systems and electronic medical records) that already have integrations with Lenus COPD Support Service. The company said integration costs would be agreed with NHS settings that have new systems which do not have existing integration within its catalogue. Costs do not include the Fitbit or NIV devices.

Costs of standard care

Lenus COPD Support Service would be offered in addition to standard care. The company claims it may result in earlier community intervention in cases of a likely exacerbation and may prevent unnecessary hospital admissions. These costs, based on the 2019/20 National Schedule of NHS costs, may include:

  • community specialist asthma and respiratory nursing for adults: £48.03 for non-face-to-face care and £95.15 face-to-face care, per unit

  • non-elective short stay for COPD or bronchitis with or without single or multiple interventions (DZ65A to DZ65K): average £488 to £4,319 per unit

  • non-elective long stay for COPD or bronchitis with or without single or multiple interventions (DZ65A to DZ65K): average £704 to £5,578 per unit.

Resource consequences

Lenus COPD Support Service is currently used in the NHS. The company claims the technology provides multiple data sources, which help healthcare professionals determine when a person may be at risk of an exacerbation of their COPD. This may result in earlier community intervention and prevent clinical deterioration and more costly hospital admissions. There is some evidence that Lenus COPD Support Service may result in fewer admissions, occupied bed days, and community reviews (Taylor et al. 2022, Taylor et al. 2021a).