From Flo to Annie How Flo is being used in the USA

Annie is a mobile messaging system based on Flo. It’s now being used as part of the health care programme for veterans in the USA. We look at how Flo’s daughter Annie was born and is now transforming lives across the pond.

Annie was named after Lt. Annie G Fox, the first woman to receive the Purple Heart for combat in the USA. Like the Florence Simple Telehealth system (Flo for short), Annie is a text messaging system that supports patients to take more control over their own care and helps them to improve their health.

How Flo’s American daughter was born

Annie was inspired by and adapted from Flo as part of an innovative partnership between NHS England and the Veterans Health Administration (VHA) in the USA. Health care isn’t universally free in the USA, however the VHA provides free or significantly discounted care to 8.76 million veterans each year, making it the largest health care system in America.

Phil O’Connell, who developed Flo in the UK, tells us how the partnership came about.

‘A colleague called Jo Harding, who’d done a lot to help us develop Flo, introduced me to a team from the VHA’s mobile health care programme at a big NHS event a few years ago. Jo was involved with an exchange programme the NHS was running with the VHA, which was looking at how we can encourage the use of new digital health technologies.

‘I spent a few hours being grilled by some of the VHA’s top clinicians and then suggested that they go and have a look at Flo in action on Sunderland Primary Care Trust’s exhibition stand at the event.’ 

Dr Wyatt Smith was one of the visitors from the USA who spoke to Phil that day. He is Chief Executive of Ablevets, an organisation helping the VHA to introduce new ways of using technology to improve health care. A veteran himself, (Wyatt was previously Deputy Chief Information Officer for the US Military Health System), he says he could instantly see how Flo had potential for use with veterans in the USA.

‘We know that only a little over half of veterans can receive emails on their phones, whereas over 95% of mobiles in the USA can send and receive text messages,’ he explains. ‘So the simplicity of using text messages appealed to us.’

Developing Annie

Phil went out to Washington DC and talked in more detail about how the NHS and VHA could collaborate.

However, it wasn’t as simple as just using Flo in the USA. Phil needed to find a technical partner who could provide text message services in America. There were also cultural differences and specific USA regulations which meant Flo needed to be adapted, as Wyatt explains:

‘Standardising the text message terms took some extensive collaboration between the USA and UK partnership team’ says Wyatt. ‘Another challenge was working through the USA’s privacy regulations, since text messaging is not secure. We had to create methods to comply with our privacy protection laws’.

This development process allowed the team to create some new functions for Annie. Like Flo, Annie offers a text messaging service that can be set up by a doctor or nurse to help patients manage their own health. However Annie has also been developed to offer secure messaging between health  professionals, plus options for contacting people in groups. So patients can sign up to group information messages (anything from public health messages about healthy eating to appointment reminders).

‘We look at Annie as the next version of Flo,’ says Wyatt. ‘Flo is Annie’s wonderful mother.’

How Annie is making a difference

Annie was piloted in 2014 and focused on supporting veterans with heart failure, diabetes, hypertension and weight loss concerns. This was very successful and the VHA is now introducing Annie across the US, with continued support from the NHS.

‘The potential for collaboration between different communities of clinicians is very powerful,’ says Phil. What we learn from using Annie in the USA will be fed back into the community of health professionals using Flo in the UK.

Wyatt is equally enthusiastic. ‘Annie and Flo are the future of medicine,’ he says. ‘They are a simple, automated way to assist patients make changes in their lives to achieve better health.’