Overview of the Florence Simple Telehealth text messaging system

Flo is a text messaging system that sends patients reminders and health tips tailored to their individual needs. As our Flo: telehealth with a human touch film shows, Flo has had a huge impact on people’s lives, revolutionising the way patients manage their own health. Since 2010 it has been used by more than 30,000 people in over 70 health and social care organisations in the UK. Here we explain how Flo works and why it was developed.

What is Flo?

The Florence Simple Telehealth text messaging system, or ‘Flo’ for short, was named after Florence Nightingale, the founder of modern nursing. It is a text messaging system with a human touch, and has helped to transform the lives of thousands of patients since it was first introduced by a team at NHS Stoke on Trent in 2010.

How does Flo work?

The technology behind Flo is fairly straightforward. Clinicians (doctors or other health professionals such as nurses or community matrons) can adjust the settings on Flo for each patient, defining when messages should be sent, what information they are asking for and how the system should respond. Flo then sends regular text messages to patients helping them to monitor their health, sharing any information sent back by the patient with the person managing their care.

For example, a patient with hypertension could be asked to check their own blood pressure each morning and then to text the results back to Flo. If the results are outside agreed limits, Flo will pass this information on to their clinician, while also suggesting that the patient makes an appointment or speak to someone on the phone.

It enables much more detailed and regular monitoring of a person’s health condition than is possible if a patient just attends regular appointments. Clinicians are also able to view real time information about their patients at any time via a simple web interface.

Developing Flo

The system was developed by a team at NHS Stoke on Trent (now Stoke Clinical Commissioning Group) to encourage patients to stick to their treatment plans, particularly for long-term conditions such as diabetes or hypertension. The team worked closely with telecommunications partner Mediaburst Ltd to develop a simple system.

An early clinical trial showed the impact using Flo had for patients with hypertension and chronic kidney disease. The trial showed better and faster clinical results in managing people’s blood pressure compared to a group of patients who didn’t use Flo. The patients who used Flo also had high levels of patient satisfaction. Results went on to be published in the BMJ and interest in Flo has grown ever since.

Rolling out Flo

Encouraging more areas of the NHS to use the Flo system is now the responsibility of nhssimple, a social enterprise. nhssimple supports health professionals to use Flo and is helping to build a community of people working in health and social care who can share knowledge and learning about the many different ways Flo can be used.

nhssimple and NHS Stoke-on-Trent CCG have now rolled Flo out to more than 70 health and social care organisations across the UK. It is being used to support an ever growing list of conditions, including asthma, heart failure, chronic obstructive pulmonary disease (COPD), and stress incontinence. It’s also being used to make sure patients take their medicines, to aid recovery after surgery, and to support people who want to stop smoking or lose weight.

An adapted version of Flo, named Annie, is also now being used to support veterans in the US.

Flo received funding from The Health Foundation in 2011.