Healthy.io will be testing smartphone-based home urine testing for antenatal care in 100 women in the Royal United Hospitals Bath NHS Foundation Trust. We aim to assess how smartphone-enabled home urinalysis, combined with home blood pressure measurement, improves patient safety through proteinuria earlier detection, reducing demand on health services by avoiding face-to-face visits and improving patient experience in a cost-effective and scalable way. Using computer vision and user-centric design, Healthy.io's is the first company to turn the smartphone camera into a clinical-grade medical device. Our urinalysis product (Dip.io) is the first CE accredited and FDA cleared smartphone-enabled automated urinalysis device. Built around the 10 parameter dipstick, a self-testing kit and a smartphone application, the device enables lay users to self-test for protein and other analytes in their urine, in the comfort of their home, with no quality compromise. Our proprietary algorithm and cloud-based service allow for interoperability and integration with any clinical system. Results are immediately available to clinicians for follow-up. Blood pressure monitoring and urinalysis are part of routine antenatal care. Our 'maternity care box' combines our urinalysis test kit and a blood pressure monitor enabling women to self-test before and if needed, between visits and reliably share results with their midwife. The study will last 12 months starting July 2019. A maternity care box will be offered to 70 women with uncomplicated pregnancies and 30 women with hypertensive pregnancies. They'll be instructed to conduct the urine test and BP measure before attending their antenatal appointment. Women with hypertensive pregnancies will receive additional Dip.io test kits to increase testing frequency between appointments. Shifting routine testing to the home has the potential to: Improve women's experience and involvement in their health Reduce appointment time spent on routine testing to enable midwives to focus on clinical and patient-facing activity. Mitigate against risks in at-risk pregnancies through more frequent home testing to early detect complications (e.g. preeclampsia). reduce up to 60% of Day Assessment Unit visits needed for at-risk pregnancies during the third trimester (if normal results). Embed electronic results directly into clinical record. This model has been implemented in non-NHS healthcare settings and has received positive feedback from both patients and clinicians. This study will evaluate the feasibility and acceptability of the model in an NHS setting, to generate evidence to help scale the innovation, make product improvements and test the Budget Impact Model designed by Kent Surrey & Sussex AHSN.

"_""**Long term conditions** are now a central task of the NHS'_Five Year Forward View **_Lack of staff_** _is ""the biggest priority that we have now... in the NHS""_ Jeremy Hunt We propose to tackle these challenges together. Some in East London can expect thirty years of poor health, compared with just twelve elsewhere. Our mission is improving outcomes and experiences for older adults with long-term conditions, while reducing costs, across the 2 million people of East London. The diagnostics, smartphone applications and management tools in our proposal are already making dramatic contributions to people with long-term conditions. They are Test Bed-ready, and are already being used by senior clinicians and savvy patients. However, there are a range of barriers to their wider use. We think of this in terms of varying types of **_digital exclusion_** faced by: * Patients * Staff * Organisations and systems We will look at the power of junior members of the workforce to overcome those barriers, in partnership with patients: Expert carers -- domiciliary carers using digital diagnostics and data to spot deterioration and better manage medication, using: * Whzan Telehealth - digital measurement of vital signs * Healthy.io - digital urine analysis * Echo - digital pharmacy Digital prescribers -- Healthcare assistants in primary care prescribing digital applications -- and supporting people to benefit from them - to prevent deterioration of long-term conditions, using: * Our Mobile Health - the platform for digital prescribing, integrated into EMIS * Sleepio - proven digital medicine for sleeplessness * Liva - a digital platform connecting patients and health professionals to drive behaviour change Administrator patient supporters within acute care - administrators using digital pathway tools to support patients to change their lives, using: * DrDoctor - digital appointment and pathway management * Tickerfit - digital programmes of education and exercise for heart failure Through innovations within these three roles, we will seek to: * Improve patients' confidence, health outcomes and ability to self-manage * Increase skills and work force productivity * Remodel areas of the workforce and service pathways across East London * Scale these models, backed by training, investment and dedicated adoption partnerships Care City is an innovation centre for healthy ageing, based in Barking. We will lead the delivery of this programme, with our eight innovators and supported by the following partners: * Nuffield Trust - evaluation * Innovation Unit - service design * Good Things Foundation - digital exclusion and co-design * UCLPartners - system change"