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Graphnet Health Limited

Docobo Remote Monitoring

Graphnet's Docobo solution is a proven cloud based Remote Patient Monitoring Virtual Care and Virtual Ward telehealth platform which allows clinical teams to remotely monitor and manage complex, chronic and episodic patients in their places of residence for proactive prevention. Patient interaction options include our CAREPORTAL, docoboAPP, docoboSCREEN and docoboWEB.

Features

  • Disease specific and patient specific customizable question sets
  • Multi-parameter threshold event detection and alert generation
  • Multiple patient interaction options – phone/tablet/web – Equality of access
  • Approved Medical Device with ECG and respiration measurement capability
  • Text, audio, photo and video messaging + video calls
  • Interoperable with GP, Population Health and Shared Care Record systems
  • Located within NHS HSCN network
  • Scheduled assessments to periodically record clinical, PROM’s and PREM’s
  • 24/7 availability

Benefits

  • Releases capacity, reducing GP face to face appointments by 30%
  • LTC monitoring reduces hospital admissions by 40%
  • Case management and structured response to patient deterioration
  • Meets medical/legal requirements needed
  • Secure Data Storage within NHS information governance regulatory framework
  • Meets the technical/cognitive needs and ability of patient cohorts
  • Enables services to track and evaluate performance and service levels
  • Early discharge reduces acute hospital bed stays, shortening stay lengths.
  • Monitoring reassures patients, improves well-being, reduces appointments need and requests

Pricing

£1 a unit

  • Free trial available

Service documents

Request an accessible format
If you use assistive technology (such as a screen reader) and need versions of these documents in a more accessible format, email the supplier at salesandbids@graphnethealth.com. Tell them what format you need. It will help if you say what assistive technology you use.

Framework

G-Cloud 14

Service ID

9 1 5 9 4 3 1 6 9 6 7 9 5 3 9

Contact

Graphnet Health Limited Lisa Haslam
Telephone: 03330771988
Email: salesandbids@graphnethealth.com

Service scope

Software add-on or extension
Yes, but can also be used as a standalone service
What software services is the service an extension to
Graphnet Shared Care Record and Population Health solutions
Cloud deployment model
  • Public cloud
  • Private cloud
Service constraints
The service is based upon a very 'open' software stack and deployment model. Specifically though; - Browser access must be based on the approved list below - Mobile device access must be based on supported mobile operating systems (IOS, Android as primary platforms) - Mobile device management is not included - just the clinical applications - The local deployment model 'may' by constrained by local IG and security policies regarding presentation of secure information via N3 or public networks.
System requirements
  • Microsoft Edge (Chromium)
  • Google Chrome
  • Firefox

User support

Email or online ticketing support
Email or online ticketing
Support response times
Support is available on commencement of the project and we offer a variety of support packages. Each support package includes full details of call priority rankings and the corresponding response times agreed with the customer. Typically though, we respond on the same day to all questions.
User can manage status and priority of support tickets
No
Phone support
Yes
Phone support availability
9 to 5 (UK time), Monday to Friday
Web chat support
No
Onsite support
Yes, at extra cost
Support levels
Options to suit customer's need. Typically 9 - 5.30pm, 24/7 or other daily times possible subject to agreed SLA and commercials. Costings depend on the number of product and user licences required. Support engineers are supplied as part of the Service Desk provision as specified under the Service Level T&Cs for each customer.
Support available to third parties
Yes

Onboarding and offboarding

Getting started
When onboarding a user, Graphnet distinguishes between -

1. The ‘Organisations’ providing Health and Social Care Services.
2. The individual users employed by the Health and Social Care organisations.
3. Patients using the Docobo remote monitoring solution.

Helping ‘Organisations’ involves;-

•Supporting organisations to set up their question sets, their monitoring equipment and it’s interface to the Docobo platform, and their alerts.
•Supporting ‘In Context Single Sign-On (SSO) from the organisation’s Electronic Patient Record (EPR) into the Docobo product.
•Information Governance – we help the customer attain the necessary DPIAs and with any public consultation etc.
•Project Management – including the supply of fully populated Prince artefacts such as Project Initiation Documentation, project plans, risk logs etc.

Supporting the individual users involves;-

•Training - Graphnet provides a tailored Train the Trainer programme and specialist training for end users (including both clinicians and specialist users such as system administrators). We have clinicians who support this.
Supporting the patient’s involves –
•On line videos and eLearning packages.
•Individual set up and training where required.
Service documentation
Yes
Documentation formats
PDF
End-of-contract data extraction
In each agreement Graphnet provides a Project Initiation Document (PID), a component of which is an agreed exit plan detailing how data would be provided back to the customer should the contract end. The documentation always includes details of Graphnet’s obligations to transfer data and will detail an agreed format.

The exit plan details the various aspects of the shared record, specifically data supplied by the citizen and data supplied by clinicians and NHS staff.

Users can then extract their data at the end of the contract through a process facilitated by Graphnet. This involves accessing a designated data extraction tool. Users can select the data they wish to export, specifying the format and destination for the extracted data. Graphnet also commit to provide additional support to ensure a smooth transition and compliance with data protection regulations. Clear communication and documentation will be provided to support users throughout the extraction process adhering to industry best practices and regulatory requirements.
End-of-contract process
6 to 12 months prior to the contract expiry, Graphnet will work with the customers senior leadership, finance and contract management teams to discuss what options are available. Options to discuss would include.

Non-Renewal: Clearly we hope that all contracts are renewed, but in some rare cases contracts do expire. In such cases where appropriate provisions are made such that any information entered into theDocobo solution is returned in a format agreed with the customer and that here is a managed transition to a new system.

Renewal: Contract is renewed. Contracted components and/or participant organisations may alter.

Should the contract actually no longer be required Graphnet will offer the provision of other reasonable termination assistance at the Authority’s request at the Supplier’s standard rates (e.g. to assist with data migration to the replacement contractor’s system). In addition, if necessary, a “read only licence” for historic data is offered.

Using the service

Web browser interface
Yes
Supported browsers
  • Microsoft Edge
  • Firefox
  • Chrome
  • Safari
Application to install
Yes
Compatible operating systems
  • Android
  • IOS
Designed for use on mobile devices
Yes
Differences between the mobile and desktop service
None - the solution re-sizes based on the resolution of phone.
Service interface
Yes
User support accessibility
WCAG 2.1 AA or EN 301 549
Description of service interface
Docobo Remote Monitoring has a clean, modern and intuitive user interface, designed in collaboration with a wide-range of our users. The system uses native operating systems, with screens designed for each device to achieve the best user experience. Secure access to information is rapid, with meaningful landing page views, pre-configured to meet the requirements of specific groups of users. Consistent screen layouts and unambiguous, familiar navigation tools simplify use and engage users. Landing page summary tiles display key information, with further details a click away.
Accessibility standards
WCAG 2.1 AA or EN 301 549
Accessibility testing
We test with common screen readers that work with supported browsers and we do this testing in conjunction with our customers and their users.
API
Yes
What users can and can't do using the API
B2B API allowing 3rd parties to render our patient views within their own system. We also support single sign, also known as in context patient launch from within core clinical systems.
API documentation
Yes
API documentation formats
PDF
API sandbox or test environment
Yes
Customisation available
Yes
Description of customisation
Users can customise access through full RBAC of patient lists, access to data, etc.

Users can select what data columns they wish to view, and which patient cohorts.

Patient question sets and care packages can be customised and within our customer base there is a multitude of these for different conditions and pathways.

Alert thresholds and policies are fully customisable.

Scaling

Independence of resources
We use Microsoft Azure as our platform which has limitless scaling capability and we configure our solutions to access this resource on demand. Availability / Capacity is a key consideration in our comprehensive approach which covers the hardware platform, software design and associated processes which cover Support and Maintenance, Business Continuity and Disaster Recovery. For a cloud hosted solution we provide an auto-scalable compute layer along with dedicated storage that has been sized appropriately for current and agreed future expansion requirements, with redundancy built in.

Analytics

Service usage metrics
Yes
Metrics types
Too many to cover in 100 words as there are a range of reports on usage and performance. Indicators include;-

Usage
Unique users accessing the system–showing growth
Patient records accessed–showing growth
Patient usage –showing growth
Number of organisations accessing the system–showing growth
Number of API calls and response times–showing growth
Number of patients with care plans –showing growth
Number of Remote Monitoring alerts

Performance
Availability
Calls closed within and out of SLA
Screen/transaction response performance at Azure
Reporting types
  • Real-time dashboards
  • Reports on request

Resellers

Supplier type
Not a reseller

Staff security

Staff security clearance
Conforms to BS7858:2019
Government security clearance
Up to Baseline Personnel Security Standard (BPSS)

Asset protection

Knowledge of data storage and processing locations
Yes
Data storage and processing locations
United Kingdom
User control over data storage and processing locations
No
Datacentre security standards
Complies with a recognised standard (for example CSA CCM version 3.0)
Penetration testing frequency
At least once a year
Penetration testing approach
‘IT Health Check’ performed by a Tigerscheme qualified provider or a CREST-approved service provider
Protecting data at rest
Physical access control, complying with CSA CCM v3.0
Data sanitisation process
No
Equipment disposal approach
A third-party destruction service

Data importing and exporting

Data export approach
Users export their data through a user-friendly interface provided by Graphnet. Upon accessing the designated export feature, users can select the specific datasets they wish to export, choosing from various formats such as CSV, Excel, or PDF. The software offers options to customize the export settings, allowing users to tailor the output to their requirements.
These extracts can be ad-hoc or scheduled. Bespoke extracts can also be setup using Microsoft Azure functionality into any supported system, and this service is further enhanced by our population health module that has riche features for data analysis and extraction.
Data export formats
CSV
Data import formats
CSV

Data-in-transit protection

Data protection between buyer and supplier networks
TLS (version 1.2 or above)
Data protection within supplier network
TLS (version 1.2 or above)

Availability and resilience

Guaranteed availability
99.9% excluding agreed maintenance windows out of hours.

Graphnet recognise that each solution provided are all critical solutions for the provision of safe and effective care. To that end Graphnet have multiple systems and procedures to ensure the solution(s) are available.

When deployment issues are logged they are immediately triaged to determine the extent to which the availability has been affected. The levels of severity and the associated resolution time are detailed below.

P1 (Critical) Entire system unavailable/unusable. Resolution: within four hours
P2 (High) Significant loss of the service but the impacted business function is not halted. Resolution: within eight Hours.
P3 (Medium) Significant loss of the service but the impacted business function is not halted. Resolution: Resolved within one hundred and twenty Hours.
P4 (Low) defined as Intermittent or partial faults resulting in loss of non-critical functionality where the software is still useable or there is a suitable alternative. Resolution: within twenty days

The recovery time objective (RTO) is four hours and the recovery point objective (RPO) is 0.5 hours from the initial incident.
Approach to resilience
Graphnet recognise that remote monitoring is now fundamentally relied upon for the provision of safe patient care.

Graphnet's hosted Azure service is robust, secure and highly available hosting service. Microsoft Azure meets a broad set of international and industry-specific compliance standards, such as ISO 27001, HIPAA, FedRAMP, SOC 1 and SOC 2, as well as country-specific standards.

Graphnet maintain numerous Operational standards which are designed to further ensure the provision of a resilient service. These include:

Business Continuity Process: Mitigation against, fire, bombing, flooding and area wide outage etc.
Quality & Security Processes: Ensure quality solutions are deployed safely and securely.
Risk Assessment Processes: Continually reviewing recognised risks and mitigation processes.
Access Controls: Ensure only approved staff have access to customer environments.
Penetration Testing: To mitigate against malicious attacks.

In the rare case of a system outage, Graphnet will declare a “Priority 1” incident whereby support services are as a norm extended to 24/7 with a target resolution of 4 hours.
Outage reporting
All outages are recorded as part of the incident management process and should a problem be detected then the service desk will inform the customer by phone, email, and via the automated Jira alerting system that also gives a link to a dashboard. There are alerts configured for the application that trigger an automated ticket creation in Jira (service desk) and these are automatically sent to the customer. Thus the customers are alerted in 3 separate ways, telephone, email and Jira alert.

Identity and authentication

User authentication needed
Yes
User authentication
  • 2-factor authentication
  • Username or password
Access restrictions in management interfaces and support channels
RBAC manages restriction of access - which is all managed by our NHS clients.
Access restriction testing frequency
At least once a year
Management access authentication
  • 2-factor authentication
  • Username or password

Audit information for users

Access to user activity audit information
Users have access to real-time audit information
How long user audit data is stored for
At least 12 months
Access to supplier activity audit information
Users have access to real-time audit information
How long supplier audit data is stored for
At least 12 months
How long system logs are stored for
At least 12 months

Standards and certifications

ISO/IEC 27001 certification
Yes
Who accredited the ISO/IEC 27001
British Assessment Bureau
ISO/IEC 27001 accreditation date
28/06/2021
What the ISO/IEC 27001 doesn’t cover
Our 27001 covers the full business operation without exclusions. Graphnet holds Certification number IS 614375 and operates Information Management Systems which comply with the requirements of ISO/IEC 27001:2013
ISO 28000:2007 certification
No
CSA STAR certification
No
PCI certification
No
Cyber essentials
Yes
Cyber essentials plus
Yes
Other security certifications
Yes
Any other security certifications
DSPToolKit

Security governance

Named board-level person responsible for service security
Yes
Security governance certified
Yes
Security governance standards
ISO/IEC 27001
Information security policies and processes
We have ISO 27001 and Cyber Essentials Plus certification a range of policies to ensure we adhere to IG and Information Security arrangements. These include:

-Access Control
-Information Governance
-Project and Security Coding
-Clean Screen and Clear Desk
-PID
-Secure Software
-Solution Development Procedure
-Data Transfer (Encryption)
-Secure Disposal
-Acceptable Use
-Network Control.

We have other specific guidance and polices available to provide assurance with our Data Processor and internal responsibilities.

We have a Governance Board which our CFO and SIRO, Director of Information Governance, Cyber and Compliance (Data Protection Officer), Information Security Manager, ISO Compliance Manager, all sit on. Through these key roles we ensure policies are reviewed and amended in light of any issues arising, audit reviews and process changes etc.

Policies are available to all staff via our employee hub system which requires staff to read all required policies.
We incorporate the Crown Commercial Service’s Generic Standard GDPR clauses in all our contracts where we process personal data; we process in compliance with Article 32. Where services use the “cloud” this processing adheres to the fourteen National Cyber Security Centre cloud service security principles as applicable to UK OFFICIAL and the cloud host complies with ISO27018.

Operational security

Configuration and change management standard
Supplier-defined controls
Configuration and change management approach
All changes implemented under our EN13485 Medical Device QMS and our ISO27001
To ensure the security and reliability of Graphnet's solutions, Graphnet follow a 5 phase configuration and change management process.
• Development and QA and internal only proof of concept (POC) activities
• Customer facing POC work.
• Build of all pre-production systems that may go on to hold customer or Graphnet data (deployment phase work)
• BAU customer systems provided by Graphnet including all UAT, Sandpit, Training, Testing, Production or Live systems.
• Exit planning defines all data management activities
Vulnerability management type
Conforms to a recognised standard, for example CSA CCM v3.0 or SSAE-16 / ISAE 3402
Vulnerability management approach
We use a combination of internal vulnerability scanners, system monitoring and industry sources to monitor for possible threats, applying patches within 14 days of their release. Additionally, we use NHS CARE-cert, US-Cert and industry publications to assess threats weekly and respond accordingly. Out Of Band patch releases are investigated and installed immediately if appropriate.
Protective monitoring type
Supplier-defined controls
Protective monitoring approach
The application is monitored 24/7 by a third party Security Operation Centre (SOC) using Microsoft’s Sentinel, Defender for Cloud and Azure policies, with alerts raised for anomalies found, including suspicious or potentially malicious activity. Audit logs are retained for all Azure, web application and SQL server activities for 1 year. The application keeps its logs indefinitely.
Incident management type
Supplier-defined controls
Incident management approach
Incidents are formally managed through Graphnet's Support Desk, using an ITIL focused call logging application to record, track and manage issues through all stages of the incident lifecycle. The Service Desk is also briefed on the service responses agreed through the customer contracts and use the incident logging application to monitor incidents’ service level response times. Problems are identified through incident reviews and managed through diagnosis, resolution and planned changes. These reviews of issues attempt to identify trends/recurrent issues; when identified, these undergo a root cause analysis and recommendations are made for changes to the product based on the analysis.

Secure development

Approach to secure software development best practice
Independent review of processes (for example CESG CPA Build Standard, ISO/IEC 27034, ISO/IEC 27001 or CSA CCM v3.0)

Public sector networks

Connection to public sector networks
Yes
Connected networks
Health and Social Care Network (HSCN)

Social Value

Social Value

Social Value

  • Fighting climate change
  • Covid-19 recovery
  • Tackling economic inequality
  • Equal opportunity
  • Wellbeing

Fighting climate change

Helping to tackle climate change is a key objective for Graphnet. Our deployments are delivered remotely and we are striving to achieve Net Zero Carbon emissions before 2050.

Our procurement team prioritise suppliers with sustainable practices and environmentally friendly materials and equipment.

We conduct an environmental assessment at the outset of any project, identifying specific targets and areas for improvement.

Our Standards and Compliance team collaborate with stakeholders to integrate environmental considerations, such as energy-efficient technologies, waste reduction measures, and carbon mitigation strategies.

Monitoring systems track progress and measure the effectiveness of our commitments. For example, assessing whether travel was necessary and conducted in the most environmentally friendly way practical.

Audits provide an independent assessment to validate our environmental performance and following project completion, a comprehensive evaluation assesses the success of our initiatives, incorporating lessons learned for future projects.

Measurement and reporting utilises quantitative and qualitative metrics, tracking energy consumption, waste diversion rates, carbon emissions, and employee engagement in sustainability initiatives.

This approach ensures that our efforts go beyond our core service offering, integrating environmental best practices into each project to make substantial contributions to carbon reduction, sustainable waste management, and energy efficiency.

Our solutions are designed to help customers become paper-free or paper-lite. This enables customers to minimise the need for medical records libraries, reducing their need to store and dispose of paper-based records. Our mobile capability reduces carbon footprints by eliminating the need to travel, and our Docobo Remote Monitoring provides a trusted and highly effective remote patient monitoring solution that allows patients to be monitored and supported within their home. This reduces or even removes the need for patients to regularly visit the hospital for monitoring and removes the environmental impact of having to travel to and from the hospital.

Covid-19 recovery

Graphnet has a strong track record in supporting COVID-19 recovery. We delivered the original and successful NHS Vaccination system and supported 12 ICBS with their Covid monitoring work whilst the pandemic was in its first 18 months. We have continued to help these customers fight Covid in various ways including the following examples:

Graphnet’s Care@Home solutions enable individuals with COVID-19 to be remotely managed at home by Virtual Ward Care Teams.

Our Covid-19 dashboards enable community teams to view and be alerted to changes to patients’ status including Covid-19 Infection status and exposure. We support alerts for vulnerable or shielded patients and offer care planning functionality including a PRSB accredited RESPECT form.

Covid-19 highlighted the significant health inequalities that exist in maternity and neonatal care and Graphnet developed an interactive pregnancy dashboard. This has allowed customers to see a clear picture of women’s vaccination status, which stage at gestation they were in, ethnicity, any long-term conditions and socioeconomic factors. This enabled targeted intervention where it was needed most. It also enabled direct engagement with pregnant women shielding from Covid though a patient app.

During and since the pandemic there is concern that there has been an increase in the number of patients with COPD that have yet to be properly diagnosed. Our at scale identification of these patients, based on a set of clinical criteria, enables cohorts to be referred to an appropriate service, for example a Community COPD Hub for a differential diagnosis and where necessary onward referral for specialist MDT assessment, diagnostics and treatment. These people are vulnerable to Covid and this work is seen as early Covid protection by our customers who use this facility from us.

Graphnet’s population health, shared care records and remote monitoring have played a key role for our customers in fighting Covid.

Tackling economic inequality

Graphnet commit to 100% of staff being paid above the relevant Real Living Wage as specified by the Living Wage Foundation. This is monitored by Graphnet’s Programme Director for this framework and across the company and reported up to Graphnet’s Compliance Board. We also report to the customer programme board for each contract.

Our solutions target health inequalities and this can be seen on our web site. Examples of these are:

•Core 20 +5 directly supporting this NHS approach to health inequalities via a series of subject specific use cases including an overarching summary dashboard.

•Working with multiple customers Graphnet developed a fuel poverty dashboard linking UPRN data with Energy Performance Certificate information and drawing health and care information from all parts of the care system. For example, people with respiratory conditions who are also in lower quality housing are at risk of harm from fuel poverty.

Our work aided customers to identify cohorts of citizens most at risk of health complications and hospital admissions to establish an evidence base for an initiative to prescribe heat for those most in need.

We also enable customers to drill further into the fuel poverty dashboard with a focus on those who have a 50% or higher risk of emergency admission in the next 12 months, are not in a care home, and are living in the most deprived and fuel poor geographies. This allows a future focus on citizens where it is possible to improve outcomes, and then learn from that to develop other pathways.

Another similar initiative is our work to identify multigenerational households where data shows there is a high prevalence of health inequalities. Customers have used this data to visit these houses and facilitate vaccine take up, better management of conditions such as diabetes, asthma, and CVD.

Equal opportunity

Our solutions support diverse workforces and help encourage more disabled people into work, especially through our ability to identify cohorts of people who need targeted assistance and then to provide a multi agency care co-ordination platform for them.

As well as the benefits of our solutions for disabled people we seek to have 5% of full time equivalent disabled employees (FTE) hired or retained on the contract.

Our solutions are designed to be usable by people with disabilities. The accessibility of our web offering is underpinned by the VEUTIFY framework, the A11Y project and NHSE guidance. We also meet the Web Content Accessibility Guidelines (WCAG) for the public facing aspects of our application.

Staff and users with visual impairments can adjust font sizes and colours to help them read and process information. Controls are designed to support users with colour-blindness. The solution can be used with screen readers and we work to optimise this.

For staff with physical disabilities, working from a desktop may not be appropriate. So, we have designed our solutions to work from handheld devices or mobiles. This means staff choose the best device for them rather than trying to accommodate a device that doesn’t take their disability into account.

Our Docobo Remote Monitoring solution provides the means for disabled people to be monitored and supported in their own home. Expectant mothers with a disability can benefit from community midwifery care at home because of our My Maternity App. In both examples, our solutions empower disabled people rather than expect them to accommodate the traditional care model of visiting a physical location – which in itself can be challenging.

Within the company, Employees with a disability can be home-based and special arrangements are made to include them in physical events such as meetings or staff socials.

Wellbeing

Graphnet work with customers to co-design solutions to support wellbeing initiatives. For example:
•Improving health outcomes: Ensuring professionals have the information needed. Feedback from a diabetes consultant who helped design our shared care record -“Access to the Care Record is helping me ensure that diabetes patients are on the correct medical regime for them, which is vitally important for this group of patients whose wellbeing depends on their medication”.

•Achieving better outcomes: Frimley ICB worked in close partnership with Graphnet to develop analytics that a) identified cohorts of patients who would benefit from remote monitoring, and b) monitored their results. This evidenced a 40% reduction in hospital admissions for the treated cohort and a 30% reduction in GP face to face consultations.

•Reducing inequalities: Our Fuel Poverty and Health Inequalities with Cheshire and Mersey ICB are two examples of co-design that have supported communities.

Dianne Green COPD service manager -

“Through the fuel poverty dashboard, we’ve been able to target patients in a completely different way. At the click of a button we now have all the information that we need. We can see whether they’ve been immunized, whether they’re still smokers, whether they’re on the best treatment, and what quintile of poverty they are living in. That has helped us to prioritise people that are most in need.”

“It is hard not to cry when speaking about the importance of this work. It is truly proactive.”

“I’ve been a nurse since 1986, and we’ve never transformed lives like this.”

•The Frailty module we built with customers analyses the over 65s to identify cohorts for early intervention, they are then given care plans.

Supporting independent living - Our remote monitoring solutions are currently helping 40,000 people to stay connected to their healthcare professionals and live independently in their own homes.

Pricing

Price
£1 a unit
Discount for educational organisations
No
Free trial available
Yes
Description of free trial
This would be a test system with dummy data in it. We would allow access to this for the purposes of trialling the product.
Link to free trial
We don't have a generic link as each customer's requirements are slightly different. We make test systems available on request with them configured as per the customer's requirements.

Service documents

Request an accessible format
If you use assistive technology (such as a screen reader) and need versions of these documents in a more accessible format, email the supplier at salesandbids@graphnethealth.com. Tell them what format you need. It will help if you say what assistive technology you use.