Chris Wright (founder) developed the first beetroot product – RheMOS or Rheumatology MOnitoring System as it was affectionally known in 1995 in his garden shed. A friend (and clinician) approached him with a dilemma. He was spending too much time at the end of the day checking paper blood test results for patients taking the potentially toxic drugs he had prescribed them. It was a worry for him – an adverse reaction to the drug could lead to hospitalisation, or worse. He thought it was possible to get electronic copies of blood tests from the hospital laboratory.

And as he knew Chris was a programmer perhaps he could ‘knock up’ a programme to collect the electronic results and check them for him? As Chris was always up for an interesting challenge and only three young children and a mortgage to pay left him plenty of ‘free time’, he thought … why not?

Every solution needs a problem

Time to stop tech-tinkering and look at the problem. Nothing worse than a solution looking for a problem. There were three things that the clinician wanted to identify: blood values that were out of range, deteriorating trends in blood values, and people who didn’t attend for testing when expected (DNAs). It was true (and still is) that the laboratory flagged up abnormal results, but their ranges were too crude (male/female), and more granularity was needed. So there was a requirement to identify results specifically for the patients he wanted to monitor. And then configure rules in the database that would check for abnormals, trends, and DNAs. Oh, and that rule setting had to be flexible – clinician wanted to be able to set up his own drugs and monitoring profiles. And add patients and so on. No black box technology that required expensive ‘programmer’ support.

Inconvenient for patients

So the requirements were reasonably clear, and the results were available. But there was another problem. The patients that the clinician was interested in had to come to the hospital for their bloods to be taken, otherwise the laboratory didn’t know which results to send out. And sending all patient results out, every day, was complete overkill (until some years later, when it became the norm). Besides, it was time-consuming and inconvenient for the patients and the hospital to have them come in just for a blood test. A more community-based approach was required.

A bit more investigation and engagement with GP-based phlebotomy services and a novel solution was found. A special code (RheMOS) was added to every physical blood sample form taken by the community-based phlebotomy service. That code was entered into the lab system on receipt of the physical sample and the electronic result found its way to the RheMOS system by virtue of the code. And the best bit for patients? No more visits to the hospital for blood testing – just pop into their local surgery.

DMARD monitoring is born!

So… the right blood tests for the right patients were identified and available. The database was set up and populated with drug profiles and rules to identify any alerts. And that included a rule to identify when a blood test for a patient wasn’t received when expected (the DNA). Amusingly (although perfectly normal at the time), the flat file of results couldn’t be delivered via the hospital network so the clinician had to dial up using a modem (remember those?) over a telephone line to collect the results. In fact the first installs of RheMOS all used that method.

But the important bit was that alerts were being generated and problems in blood tests identified. The automated monitoring had started.

And now?

Things have moved on in 20 years. RheMOS became TAMONITOR, a cloud-based Microsoft ASP.NET service. THERAPYAUDIT won a SMART innovation award to develop the platform. Sites came and went, but those remaining were all upgraded by 2008. As HL7 took over from ASTMS we developed a configurable HL7 interface engine that enables us to receive all test results from a laboratory and filter for just the ones our customers are interested in. TAMONITOR is now morphing into beetroot dmard. And we extended the platform to provide a non-clinical data collection and audit tool for the London Sexual Health Programme which is now used to provide sexual health advice for the majority of London Boroughs, Bristol, Cambridge, Suffolk and Hertfordshire. In all we now support 35+ NHS and Public Health clients.

And the future?

We evolve by listening to our customers and meeting the needs of patients. Both  are telling us it’s time to involve patients more in their monitoring and self-care. The increasing prevalence of smartphone technology empowers people in health as in so many other aspects of their lives. Developing beetroot patient will bring us closer to patients and their needs. And adopting beetroot as a brand will make the experience for them less technical and intimidating. But we’re concerned about the ‘stickability’ of apps. There’s a lot of bad press about medical apps being of limited value and popularity with people. That’s why we’re investing in psychology and artificial intelligence to provide a better pre-assessment of patients (to see if they’ll use an app and if so what it should like for them). And also to provide a more intelligent ‘drip-feed’ of education and coaching materials. All with the intention of empowering patients to self-care.

‘Go West (or east) Young Man!’

And we’re looking for new markets for our tried and tested services. In 2017 we will start a couple of trials of beetroot in China, following two years of research and development specifically for that market. One of our trials will be in the National Demonstrator centre for assisted living in Guiyang in the south of China. We hope to run parallel trials in Guiyang and Tyneside. Are people across the world that different? Not really. Healthcare problems are very similar the world over. And the solutions surprisingly similar as well.

Meet the Team

We’re a small team with the main players shown here. What we may lack in size we make up for in creativity, agility and productivity. So there you go. Size doesn’t matter after all.