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[ragnarr] 08/11/2021 12:59

SR: So, if all things go well, ok, because all of these huge opportunities are not going to happen (click fingers) like this, because we know that is not how it works. How do you envisage it scaling up, you know, so for, in other words, the NHS opportunity, your piloting this now, by the end of next year what, whats the situation. Are we talking about the first 40 wave happening or is it going to take longer than that, or…tell us a bit about that.

TO: Year so within the NHS, I think the first wave of 40 will start to come through any time between now and march of next year, it may roll slightly later than that, given the time delays often in the NHS…so lets say probably by the summer. And we would be positioning ourselves to be part of as many of those 40 sites as we possibly can, and…erm…I think the opportunity in India again the way to do this is to stand up a pilot in the real world, take that real world evidence, take that to a state level governments contract, because that’s where the funding is being held currently…erm in collaborating with our clinical partners, and then, actually that will become self- funding, certainly in India because we are generating that level of revenue within one state, that will fund then the expansion into a subsequent state and we can probably roll two or three states in parallel, given that level of revenue generation , so it becomes a bit like a rolling stone. Once we have started the momentum builds and builds and builds and that’s how we really drive the scale of this.

[ragnarr] 08/11/2021 12:58

SR: Ok …so how do you feel about your market now then based on these oppoprtunities

TO: Well...well I have for a long time erm… felt that Feedback has been very undervalued on the market, and largely because we have not been able to talk about these things that we have been doing. But now that we are, I…I…think that you are gonna see some significant shifts in that now, and I hope that everyone listening to this will understand the potential of =what we are about to do. And why it was necessary to go and raise the funds that we did, because now we are properly resourced to go and do this…ummm̷0;safe to say we are now a company that is firmly on the radar of some very exciting partners and we are really rip roaring to go and do this, and in fact (laugh) having just announced the fundi ng I spent the last four days travelling all around…ermR30; for various site visits within the UK to get the ..erm…. the ICS ..erm and CDC opportunities moving, but then also we have had numerous calls (laugh) back with India, to really get things operationalised, so we…we are on the verge of really…ermR30;kick-starting this now.

[ragnarr] 08/11/2021 12:58

SR: Tom you need to get a bit more excited about this because you are very err…very relaxed about it …its hundreds of millions of pounds

TO: Well actually the Carelocker opportunity is £8 Billion pound opportunity and annually for us… to give you an idea of the scale

SR: £8 Billion pounds or rupees

TO: Pounds !

[ragnarr] 08/11/2021 12:57

SR : Ok so I am going to ask you the same question again, I know you are a doctor and you don’t like numbers but how much money do you think is possible to come through this company with what you are doing.

TO: well we are addressing a total available market in excess of 10 Billion globally, I think that the CDC opportunity is a total addressable market of about 93 Million, here within UK, so a sizable figure, especially considering we are now live with the exemplar site right at the front runner of that, we are … very well positioned for it, and in India with the TB opportunity is enormous, so let me take you through that in a bit of detail, so ern, at the minute TB screening studies are typically charged at about 2000- 2500 rupees per screening episode, which is about 20-25 pounds , now we can provide our technology suite into that space for £2.00 at a 80 percent EBITDA margin, so 90 percent gross plus margin, and that will allow us to essentially to really scale that technology with our partners, clinical partners on the ground in India, and this is really how we scale and adopt this, so …the thing we didn’t mention earlier is that we spent the last eleven months with the dept of international trade working out who are the right partners on the ground are to this with in India ,and so we have announced we have the partnership with Qure.ai but we are also in discussions with Talco companies who can supply the cellular network coverage, and also the Bleepa box hardware as a managed service on the ground , and also large hospital chains we have been in India who are able to provide the radiologists and the clinical specialist who can provide the clinical endpoint to this TB screening pathway. And so what that means is that we will go in this TB screening with the right clinical partners whom will hold these state level government contracts, and we are leaving 90 percent of the potential TB screening contract on the table for those clinical partners. So we are really positioning ourselves as the technology solution in to this TB screening clinical service. It is also really important to think about it because as a UK company and a relatively small UK company we wont be able to stand this up on the ground unless we partner. So, we have to get the right clinical partners that can scale this. The Indian Government also wont contract the TB screening service to a UK provider. They want to use local clinical services …as they should…and so really we have to identify the right clinical partners who will own those state level contracts on the ground and then supply our service into them. Whenever the opportunity gets particularly exciting for us in India is the scale of that, so if you are going to screen the entire population within a five year period which for TB you have to really be doing about 20 percent a year, even if you hit 15 percent of the rural population of one state, lets take Rajasthan for example, that is 7.7 million patients every year who have to screen and a two pound a head that’s actually about £15 million pounds of revenue, and that really begins to stack, now there is a broader long term opportunity linked to this which is called the national digital health commission and its another one of Modis Government initiatives that bis basically saying actually they would like every Indian citizen to have a health ID and linked to that health ID a national digital care record. Now most of the population do not have health ID at the minute and so with the TB screening programme is the perfect opportunity to engage the population, so as they attend the TB screening, they can be given a national health ID. The TB episode that we store on Carelocker can become the first part of that digital care record. Which means that actually, Carelocker could become the clinical cloud store for the Indian health care record, and that is a much, much larger and much, much longer-term opportunity that we are that we are positioning for

[ragnarr] 08/11/2021 12:57

SR: It sounds to me very much like it’s a revamp, isn’t it, its something, an archaic system that as you say was done with old pagers and facsimiles is now, it need modernising, and this seems like the perfect solution to that.

TO: Absolutely, I mean we have to be realistic around it, Wea er all using our mobile phones for every aspect of our lives now, and it seems unreasonable to expect clinicians to continue to use, in many cases, paper erm (laugh) and even when they have gone digital to still rely on pagers, e-mail and faxes to communicate with each other. Its not secure to start with and its also not safe for patients, the delays cause huge harm there to patients and ..er…one of the great privileged that we had ion the last two year was to actually be able to use Bleepa during Covid 19 and we were able to support Pennine acute hospitals trust with their response to Covid 19, and the that we did that… was that actually a lot of senior clinicians have co-mobilities and had to shield, but you needed their expertise on the front line. But we were able to connect the junior doctors that remained on the front line with the senior stakeholders and therefore they were able to offer that advice and guidance to junior colleagues who remained. And in fact we had one …erm.. consultant who went back to India to shield with their family and was still able to run the entire care pathway from India with their junior colleagues who remained on the front line. Now that wouldn’t have been possible without Bleepa as a technology, and it was also being very interesting using Bleepa at Pennine over the last year to 18 months because they have done their own benefits analysis of the platform and we find on average that are saving 36.3 weeks of clinical time per year. That’s the equivalent of having another member or your clinical team, its like having another doctor on your team, erm, so this technology is not only safer, but it is also faster and if we are looking at how we drive efficiency in pathways, this is exactly how you do it. And its probably just worth me mentioning quickly there ate that junction the AI side of this, so a lot of AI companies are in existence now and they all have some amazing technologies, they are all extensively funded and they can be going at the health care market very aggressively. Now a lot of these tools are based around medical imaging, and a lot of those medical imaging tools are being sold at radiologists through packs work stations… now a lot of those tools I think hold limited benefits to the radiology community…ahh…that would diagnose a fracture, I should be clinically trained to be able to spot a fracture and if I have to deploy an AI tool every time I do a report on a patient , it is probably actually going to slow me down, but if you gave that same tool to a nurse or a junior doctor in A and E, suddenly you can get that diagnostic result much earlier in the patient pathway , long before a radiologist has ever got to see that study , and I think that’s the true power and the true potential for AI ..is to give it to frontline clinicians and put it right into their hands , and that’s where Bleepa is so uniquely positioned. So we hold that user relationship with on their network devise in the palm of their hands, we process all the data any way clinically that these tools need in order to operate, so we can share the medical imaging study with the AI provider in the background, have them process it and bring the report straight back in. So Bleepa can actually be a front-line deployment for AI. A point of care deployment tool for AI. And that I think is our, is a huge unique opportunity for us

[ragnarr] 08/11/2021 12:56

SR: From and escalation point of view, bringing err…peoples care out into the community which is basically what this is all about I thin in terms of out of the hospitals in to the community and we are talking about many, many different situation to go into, How big can this become in the UK her in terms of how many patients can you be looking after how many patients will be in the cloud, how many systems will be in place and I suppose the question as we are all investors is how much income is this company going to generate, if it happens the way you hope it is going to happen

TO: Yeah it’s a ..the key question right (laugh) so the thing with the community diagnostic centres are that it provides an opportunity for to take the technology not just to an individual sale to an individual hospital but to actually sell it to a region, and we are also again hitting this opportunity at exactly the right time, so this is now the focus of the Government, it is the focus of NHS England and it is the focus of every provider up and down the country. How do we address elective care backlog. The important thing is that funding has actually been brought in to do this, so the Government has already pledged 10 billion pound framework to initiate the CDC programme and the way that that works is that the money gets drawn down from treasury, it goes to HNS England and is then devolved down to something called the ICSs (Integrated care systems) and there are about 40 or so of those, and they responsible for procuring technology for a region , a regional population probably in the order of about 1.5 million patients each. And that gives us erm, sport of central decision makers for the first time that we can really have these conversations with. And that is going to be key to realising this opportunity.

And in terms of how the structure works for this, there are two components so there is the licencing of Bleepa to the clinical users within an area, so these are the GPs and the hospital clinicians that will be using Bleepa for the communication around that patient journey, but then there is also the storing of that data in the centralised Carelocker, and that is a separate charge. The slightly broader opportunity here is that we can also use the Community diagnostic hubs to recognise further growth of our core Bleepa sales into individual hospitals.

If a hospital was using Bleepa to communicate about a patient between primary and secondary care, it makes perfect sense that they then use it internally for their communication as well because the clinician are used to using the platform.

We will continue to selling Bleepa to individual NHS Trusts through the NHS X Clinical communication framework, so this is a central procurement frame work that originally had three million pounds of central funding alongside it, it was launched last summer, and it wont surprise anyone to know that 3 million pounds doesn’t stretch very far when you put this across the whole of the NHS, and so a lot of trusts approached this framework and got very interested to see what sort of tools were available to address their problems , but there wasn’t enough funding there to really incentivise them to do anything, so in recognition of that NHS X now bought on 125 million pounds of funding that should come on line later this year, and I think that will really be an opportunity for us to drive both adoption of Bleepa into individual NHS Trusts but then also at this regional level at the CDC programme

And in terms of how many people we can get on it…I would like to see everyone in the NHS using Bleepa…erm .. and I would like to see every patients record on Carelocker.. and I am sure a lot of people will say that is quite unrealistic, however I would say that we are so uniquely positioned to deliver this digital infrastructure at a regional level, and to provide that patient centric storage of data in their patients own Carelocker, that actually we can solve an number of the NHSs pain points through one procurement. And so, I think we stand a reasonable chance of doing it.

It is worth saying about Care locker, because we have not really discussed it, Carelocker is …an amazing piece of technology, so what Carelocker enabled us to do, because e we are centralising data around a patient through Bleepa as part of their clinical pathway, we can now actually store that data at a patient level rather than a system level, and what I mean by that is that in a traditional cloud model you put huge datasets up into the cloud, so put all of your electronic patient record data into one cloud silo and all of your packs data into one pack silo. What we are doing is taking information relating to an individual patient from each of those systems, centralising it, and storing it in the patients own cloud. And that has a number of clinical advantages. Firstly, around security which is always first a foremost in everyone’s mind. If you want to hack into a patients data in a Carelocker setting you have to hack into each individual patients records in order to access it. Now that means we can detect a security breach early, we can shut it down, but we also know immediately which patient is being compromised. Now if you compare that to a traditional cloud model where you hack once and gain access to a million patients worth of data you have no idea whose data has been compromised during that attack. The other big thing for us is around erm… cost efficiency, So again in a traditional cloud model you don’t know which patients are active or inactive in a care pathway, so you end up storing all of you data on very high cost low latency cloud, so its always accessible to the clinical setting. Now because of Bleepa and Carelocker we know exactly what are coming through a care system and which ones are not. And those patients that are not, we can actually store on something called Glacial cloud, which considerable cheaper. It takes a lot longer to draw the data pout of it, but it does actually much more affordable. And we can mover patients between those two cloud levels. So, if a patient gets discharged from their care setting, they get put on to Glacial, they get admitted onto a care pathway they get moved up to this slightly more accessible, but more expensive cloud.

And the last thing is around scalability, and this is where the opportunity really sits for the NHS, because the NHS is looking at cloud, its looking at how to make those cloud transitions, because it is the future, erm, cloud is actually more cost effective, its much more secure generally than traditional models of data storage. But the question has always been if we want to move a whole hospital, or a whole region into the cloud …that’s a huge undertaking…its a mass data migration its very very expensive, kits hugely resource intense, and its not particularly secure to do a mass movement of data . Now what we can do with Carelocker is we can transition an organisation to the cloud on a patient by patient basis as they come through a care pathway. So there isn’t a mass data migration. We are just extracting the data relating to that patient , centralising it and storing it every time they come through a care pathway. And over the course of a year, two years, five years all of the patients of a region will have come through that system and they will all have a Carelocker

[ragnarr] 08/11/2021 12:56

SR: And also because you we tied effectively to the NHS in the scheme obviously, you knew who to speak to as well

TO: Absolutely, and I think when you are designing technology as a clinician for clinicians it really makes sure that the product does what it needs to do, and it gives automatic credibility top what you are trying to do, and people don’t see you as a foreign company just trying to make money off the public, they see you as one of their own trying to solve a problem that they know they are all facing, and that’s exactly what we are doing

[ragnarr] 08/11/2021 12:55

SR: So, the interesting thing I am asking myself is how on earth did you get to this point yourself. How did it happen

TO: (laugh) My back story, er…so I trained as a radiologist in the NHS and …errr…I was getting increasingly frustrated with the technology that we were relying on , one of the big problems particularly for radiology that you have to share imaging between different hospital sites and it can take two and half hours to do this ,erm, for a digital portal called the image exchange portal, and fundamentally if that’s a patient that’s having a acute episode of something like a stroke , two and a half house is the difference between a patient surviving or ending up with disability, and (sigh) so it was almost faster and quicker for us to burn the imaging on to a CD and send it with the patient in the ambulance ,or even to sent the patient straight down the road and get them re-imaged at the hospital than it was to try and push these images digitally. And that just wasn’t acceptable to me so I decided that I was going to take a sabbatical from my clinical training and actually joined NHS England as a clinical entrepreneur fellow with NHS England. And what that allowed me to do for a period of about 4 year or so was really get into the central , erm, sort of streams of digital technology, work out what technologies were being looked at, what the actual digital problems were and more broadly in the system, and then also what sort of solutions were available for us to do something about it and it was at the time I came across feedback who had been operation as a medical imaging company for about 20 years and when I saw the company I looked at the technology and I just thought…wow230; underneath the hood was hidden away here are some incredible bits of technology that I think we can really do something with. So I decided to actually I am going to use this technology and going to build around it the right infrastructure to provide a broader communication package and then we are going to position this company into the medic (unclear) space, and that is exactly what we did and we took Bleepa from a concept to a full ]y certified medical devise, and in fact into our first NHS commercial sale within a two year period, which in the ..erm…medical world is really moving, I mean it takes on average about 5 years to typically get your first commercial sale ..erm…in the NHS, and that’s even longer if that’s a medical device, so to do that in 2 years was really shifting, and we could only have done it because we had that 20 year history and heritage of doing medical imaging, so we had a running start so to speak.

[ragnarr] 08/11/2021 12:55

SR: Moving away from human health, I believe there is also the veterinary space and also a deal announced with CBS.

TO: Yes absolutely, so The great thing about our technology is that it is applicable in all sorts of settings and we have always designed it in a way that , to keep that in mind really to make sure that it is useable across a broad suite and…the other thing is the NHS…as an organisation is typically quite slow in how it procures, how it makes decisions and so you never want to rely on that as your only commercial avenue, so in parallel with working with the NHS we did start looking at alternative market opportunities, and we were able to engineer an opportunity with the equine division of CBS, and so Bleepa is now used across 20 of the equine practices for vet communication and, but this is also where we developed the Bleepa box I mentioned earlier, because unlike in the human space , you tend not to image your animals in hospital you take the imaging to the horse, so a lot of their imaging is actually done in the field or in stables and so we needed that network ability to push the imaging to make it accessible.

[ragnarr] 08/11/2021 12:54

SR: WOW, so it I almost like, I guess to the AI side of things it looks for a set pattern of an infection or some, er, dark marks, spots or something and then it can determine whether or not that patient has actually got TB at that point. Right.

TO: Yeaah it’s a bit like pattern recognition and it is reflective of how we train as radiologist, so when I was graining I was probably trained on about 50,000 or so CT scanned…sort X-rays…now the CURE algorithm , to give you some sort of idea and perspective =is trained on millions of chest X-rays , and er its slightly , er, depressing how good it is (laughs) but er its definitely an amazing tool and one of the first tools to get FDA approval for the US as well so its really is one of the best examples of AI technology

[ragnarr] 08/11/2021 12:52

Ok here goes.i will post it question and answer at a time. I have added the err and a hesitations where its clear tom is thinking carefully about what he is saying. I wouldn't recommend reading its in the ADVFN App as I find it doesn't cope with spaces and punctuation very well.

THERE ARE NO POINT FOR FINDING SPELLING OR GRAMMATICAL ERRORS.



Sunday Roast: Do you want to talk to us a bit about what Feedback actually do.

Tom Oakley: Yeah absolutely, so as a company what we are really all about is making platforms and technology that allow clinicians to make better decisions faster about patients, from any location and really we do it three ways. We build clinical teams around individual patient journeys, so that you can communicate about your patient and fundamentally that means you can get the advice and guidance from more senior clinicians earlier in a patient pathway.

And the second thing that we then do is that we pull in information about a patient and centralise it into that patient journey, so we show you their medical imaging, we can pull in things like their blood results, histology reports and other types of structured data, so that all the data you need is all in one place, so that you can make those decisions on the go.

And the last area that we really focus on is allowing you to make better decisions off the data that we are presenting you with by working with AI tools, imaging learning tools through a number of our partners. So that’s really how we make those better decisions faster.

[lr2] 08/11/2021 12:45

The filter is your friend.

[yump] 08/11/2021 12:43

You can't help yourself can you ?

[jaforsadi] 08/11/2021 12:36

Placing willAllStart offloading soon

[yump] 08/11/2021 12:35

I'd like to know how the money is going to be spent and which parts of the technology are costing which lumps of the money.

Given that Bleepa started as an app.

[emigna2020] 08/11/2021 11:25

Odyn!!!!!!!!!!!!!!!

[ragnarr] 08/11/2021 10:08

LR2 - Ged I will post it later this morning when im at a computer - Il warn you its quite long but you are right, I missed lots just listening to it

[lr2] 08/11/2021 10:03

I also would like that Ragnarr. Too often things of importance get lost on the internet.

[ged5] 08/11/2021 09:58

Ragnarr, I was doing the same but my typing skills are so poor it takes about 5-10 times of listening so I for one would very much appreciate your effort.

[yump] 08/11/2021 09:52

There is a massive advantage in the hubs starting from scratch - hopefully practices can be brought right up to date without having all the budget and existing obstacles slowing it all down.

I wonder if we’ve still got spare buildings after the results of Blair starting the selling/off process.

Plenty of high street properties could be repurposed I guess.

[ragnarr] 08/11/2021 09:42

Point taken - i was being facetious :-)But Covid has completely altered the landscape on how the Govt view the NHS. There are now over 5 million people waiting hospital treatment and the NHS system as it is, is archaic and falling apart. What covid has done is focus the public on those failings and if the Govt. now know something has to be done.The interview, for me was quite enlightening. In all fairness Tom does tend to go on a bit and repeat himself so important things can get lost. I have transcribed it all if any one is interested i will post it.

[yump] 08/11/2021 09:16

Ragnarr

I was going to say apart from the vaccine, but didn’t because its not the norm.

Also the NHS just did the jabs and thats a simple rollout of a simple thing.