TIDMAVIA
Avia Health Informatics plc
(formerly Avia Investments plc)
Admission to trading on AIM
Placing to raise GBP1.18million at60p per share
Acquisition of The Plain Software Company Limited
Avia Health Informatics plc (AIM: AVIA) (`Avia' or `the Company'), the
developer and provider of clinical decision support systems worldwide,
announces that it has completed the acquisition of The Plain Software Company
Limited (`Plain'), and that dealings on AIM have commenced.
HIGHLIGHTS
* Cancellation from trading on PLUS, reverse takeover and admission to AIM
* Placing to raise GBP1.18 million before expenses at a placing price of 60p
per share
* Acquisition of The Plain Software Company Limited completed. Plain develops
and delivers clinical decision support systems for primary and emergency
healthcare markets in the UK and internationally
* Plain Odyssey software suite supports triage, assessment and advice for
first line patient contacts, including out-of-hours services, GP practices,
emergency medical services, walk-in centres, prisons and insurance
companies
* Over 60 per cent of Primary Care Trusts commissioned out-of hours services
in England use Odyssey, covering around 30 million people
* Plain has in excess of 60 contracts with customers for installation,
licences and support - more than 20 per cent of these customers have been
with the company for over five years
* Extensive, proprietary, clinical database developed over the past 15 years
by teams of doctors, nurses and academics. Software is wholly owned by the
Company and its design draws on Bayes' theorem of conditional and marginal
probability
* New .NET version of Odyssey developed; service-orientated architecture and
web-deployed version is under development.
Chairman, Barry Giddings, commented:
"Plain has significant growth potential and by investing in product
development, we are confident of being able to accelerate its growth. It is
also an operational platform on which Avia can build, through organic growth
and via acquisition. These will be complementary and will enhance market
penetration, providing access to new markets as well as improving product
usability and function.
"Health informatics is a fast-moving, growing market with a large number of
small, underfunded businesses, many with excellent products and intellectual
property but without the commercial support to realise their potential.
"Our aim is to build a global healthcare informatics business in an expanding
market."
16 November 2009
Enquiries:
Avia Health Informatics plc
Barry Giddings, Chairman 07770 747 818
Nigel Leavy, Finance Director 07966 013 421
Merchant John East Securities Limited (Nominated Adviser and Broker)
Simon Clements/Bidhi Bhoma 020 7628 2200
Lothbury Financial (Financial PR)
Gary Middleton/Michael Padley 020 7011 9411
Introduction
Avia Investments plc announced on 27 February 2009 that it had entered into a
conditional agreement to acquire the entire issued share capital of Plain, a
company which operates in the healthcare technology sector. The consideration
for the Acquisition was approximately GBP1.6 million satisfied by the issue of
2,501,662 Consideration Shares at the Placing Price and the payment by the
Company of GBP105,000 in cash.
Background
Avia was admitted to trading on PLUS on 25 March 2008 with the objective of
making equity investments in the healthcare technology sector. On 27 February
2009, the Company announced that it had made a secured loan of GBP100,000 to
Plain in order to provide the company with additional working capital and allow
it to expand its current activities, prior to the Acquisition. Avia also
announced on 27 February 2009 that it had signed a conditional agreement to
acquire Plain and trading of the Company's shares was temporarily suspended
from trading on PLUS pending the publication of this document.
The Directors have significant experience in the medical, healthcare, software
and technology sectors and intend to grow the Enlarged Group through both the
expansion of existing trade and by further acquisitions.
Background information on Plain
Plain develops and delivers clinical decision support systems for primary and
emergency healthcare markets in the UK and internationally. Its Odyssey
software suite supports triage, assessment and advice for first line patient
contacts, including out-of-hours services, GP practices, emergency medical
services, walk-in- centres, prisons and insurance companies.
Plain was founded in February 1995 by Prof. Jeremy Dale, Robert Crouch and
Michael Bennett, to develop and market clinical decision support software for
primary care workers.
Prof. Jeremy Dale is Plain's Clinical Director and a non-executive director of
Avia.
Plain's initial product was a telephone triage clinical decision support
system, (known as "TAS"), which recorded its first sale in November 1995. TAS
was selected as one of three systems for the then new NHS Direct. In 1998, an
independently-led randomised control trial research study into the safety and
effectiveness of nurse telephone consultation using TAS in out-of-hours primary
care, the SWOOP study, showed cost savings and efficiency gains that could be
achieved as a result of an improved clinical assessment using TAS.
The study found that nurses using the product were at least as effective as GPs
in out-of-hours telephone consultations. This in turn reduced demands on
doctors' time while allowing for savings in staffing costs.
TAS was initially selected by nine of the 17 NHS Direct pilot sites and was
also supplied to GP out-of-hours and walk-in-centres in the UK. However, in
2000, the NHS Direct tender was awarded to the AXA group using an American
decision support system which had not been one of three original systems
trialled. As a result, Plain lost its NHS Direct contracts, forcing a major
retrenchment of the business. Subsequently, the management team refocused their
efforts on markets not addressed by NHS Direct, targeting out-of-hours and face
to face care. TAS was re-designed and re-launched as `TAS Odyssey' in 2002.
In 2003, MedicInfo B.V. ("MedicInfo") in Holland acquired 10 per cent. of
Plain's issued capital, becoming a strategic partner and distributor of Odyssey
in Holland. Due to further share issues in 2003 and 2005 the shareholding of
MedicInfo was diluted to 9.6 per cent. of the company. Plain currently receives
fees for the provision of six Odyssey contracts in Holland.
The tender process for out-of-hours decision support was relaxed in 2003 by
allowing competitive tenders to NHS Direct. In 2005, Plain supplied 32 per cent
of PCT commissioned out-of hours services in England using Odyssey. In 2008,
this had grown to over 60 per cent Currently, around 30 million people in the
UK are covered by out-of-hours services using Odyssey products.
In 2007, Barry Giddings was brought in as a consultant to help develop the
Plain business. He was subsequently appointed as Chairman and Managing Director
of the company. The Board and management team were restructured with additional
focus placed on the sales and marketing function, product design and technical
development expertise to complement the existing clinical and academic
expertise.
In 2009, Plain, with the assistance of a secured loan from Avia, commenced the
development of a new .NET version of Odyssey.
Clinical database
Plain's products, further details of which are provided below, are based on an
extensive, proprietary, clinical database developed over the past 15 years by
teams of doctors, nurses and academics. The Odyssey clinical database currently
comprises age/sex specific interlinked symptom-based question sets, each of
which includes questions and potential answers together with self-care advice,
immediate care advice, differential diagnosis, examination and care plan
guidance and prompts and education text. Every question has multiple potential
answers, each of which carries a weighting, and it is the cumulative analysis
of the weighted responses that determines the advice that the patient receives.
The database has over 50,000 questions and answers with 13,000 potential
examination findings covering sets of symptoms specifically relating to adults,
children and the elderly. A team of clinicians led by Dr. Mark Vorster is
responsible for reviewing and updating the entire clinical content on an
on-going basis.
All clinical content is encrypted to prevent copyright infringement.
The decision support software
The proprietary software is wholly owned by the Company. Its design draws on
Bayes' theorem of conditional and marginal probability to evaluate and analyse
clinical information input by the user against decision support criteria which
are stored in the clinical database. This differs from algorithmic approaches,
as adopted by Plain's primary competitors, since typically such systems lead
the user through rigidly structured "yes/no" based questions and without the
ability to alter previous answers without restarting the data entry. The
Directors believe that Plain's system has the advantage of imitating natural
consultation and decision making processes, so allowing the clinician to
respond flexibly to a patient's description of symptoms.
The National Programme for IT requires industry standard communication
protocols, the most recent being HL7 Version 3 which is essentially an
XML-based mark-up standard intended to specify the encoding, structure and
semantics of clinical documents for exchange. XML makes it possible to define
the content of a document separately from its formatting, making it easy to
reuse that content in other applications or for other presentation
environments. This is especially important for systems that share structured
data, particularly across the Internet, and for adaptable applications that are
either translated into different world languages or which are frequently
updated.
All Odyssey systems currently use XML for communication and Odyssey is capable
of being embedded into third party systems which provide the requisite link to
the National Spine.
Applications
All products are marketed under its `Odyssey' brand. Odyssey comprises a suite
of applications, which between them allow both non-clinically trained staff and
clinicians to assess and process patients efficiently and safely. The products
are designed for easy inter-operability and cross-platform integration and are
embedded into the patient administration system used by the majority of the
UK's out-of-hours GP services. The products can also be integrated with other
national and international patient administration systems and ambulance
management systems.
The products are available either via annual subscription, quarterly
subscription (if 10 or more licences are purchased) or on a consumption basis,
in the case of Odyssey Pay As You Go. Customer support, education and
consultancy advice is an integral part of the product offering. Regular and ad
hoc updates of clinical content are included in subscription fees.
The products have been translated into German, French, Italian and Dutch and
are already in use in these languages.
The current product suite comprises four stand-alone decision support front-end
applications and an integrated set of three of the applications:
Odyssey TeleAssess
Plain's first application, originally known as `TAS', was launched in 1995 and
subsequently rebranded. Odyssey TeleAssess supports clinician-led telephone
triage and provides up to date clinical advice for patient assessment. In the
UK, it is used primarily by both out-of-hours services and by GP surgeries
in-hours to efficiently manage patient care.
Internationally, Odyssey TeleAssess is currently used in the Netherlands and
the Republic of Ireland for out-of-hours services, by health insurance
companies in Switzerland and the Netherlands and by an attendance management
company in the United States.
Odyssey FaceToFace
Odyssey FaceToFace was launched in 2005, targeted at Walk-in Centres and
similar nurse-led clinics. It supports nurses who carry out direct patient
consultation providing assessment and examination decision support,
documentation and care management plans. In addition to providing access to the
clinical database and assessment system, Odyssey FaceToFace also has the
capability to capture and annotate digital photographs and x-rays which are
stored in the patient's records.
It is currently in use in the UK by NHS walk-in-centres and primary care
centres staffed by varying grades of nurses and, more recently, it is also
being used by the prison service.
Odyssey Reception
Odyssey Reception was developed in 2006 to support non-clinician decision
making with respect to the prioritisation of patient queues and the
identification of potential emergencies.
The product is aimed primarily at call handlers and receptionists throughout
primary care services. It has been designed to allow easy operation without
prior medical knowledge. Odyssey Reception presents short sets of age and
gender specific questions, based on the patient's symptoms, and subsequently
allocates the patient to the most appropriate grade of available medical staff
to deal with the severity or complexity of the matter.
Odyssey Gold
Odyssey Gold is a combination product which comprises Odyssey TeleAssess,
Odyssey FaceToFace and Odyssey Reception combined into one suite. This allows
for simple integration and information sharing across the product range, from
initial call through to a face to face consultation.
Odyssey Pay As You Go
Applications can also be made available to lower volume users who are charged
on a per patient encounter basis.
Odyssey SelfAssess
Odyssey SelfAssess was developed for pilot site use from February 2009 and is
an on-line self assessment decision support system, created by Plain for
individuals wanting to assess their symptoms and acute healthcare needs, and
gain access to healthcare advice and/or the need and urgency of contacting a
healthcare provider. It supports patients to characterise their problem through
answering questions connected to the symptoms they are presenting, in just the
same way as a doctor or nurse might explore their history.
Odyssey eCover
Odyssey eCover was launched to enable telephone triage of patients during a
public health crisis. It is the first of Plain's web-delivered products and is
currently being marketed to help primary care trusts manage the pandemic swine
flu outbreak.
Odyssey FirstAssess
Odyssey FirstAssess is to replace the versions of Odyssey FaceToFace and
Odyssey Reception now being used to improve healthcare within prisons,
supporting high levels of achievement against many of the Offender Health
Prison Health Performance and Quality Indicators and offering leading clinical
decision support.
Odyssey FirstAssess is currently in development to offer enhanced functionality
designed for use in the HM Prison environment.
Odyssey ParaMedic
Odyssey ParaMedic is currently in development for pilot use in the `SAFER'
trials with Swansea University and three ambulance services. Embedded into a
mobile system on board ambulances it is designed to empower paramedics to make
decisions regarding the safety of taking patients home rather than to hospital,
thereby saving the health economy significant resources. Initial trials are
being planned and focus on elderly patients suffering falls.
Odyssey TAS
Odyssey TAS is a Dutch-market specific version of Odyssey TeleAssess.
Additional services
Plain offers a range of additional fee earning services that support the
Odyssey products including implementation, technical support, training and
consultancy. These services are self-contained and can be purchased on an ad
hoc basis by existing customers or by non-customers.
Migration to .NET
Plain has developed a new .NET version of Odyssey, which is currently being
evaluated by a customer. In order to dramatically open up new market
opportunities, the current product requires an updated delivery mechanism which
reduces the significant intervention requirements associated with installation,
training and support on client-server networks. By redesigning the software
delivery of the clinical content, Avia will be able to service existing Odyssey
clients more efficiently via the SaaS model, especially with regard to
technical and clinical upgrades, while also enabling the opening of significant
new markets for global expansion.
Specifically these new markets include; GP Surgeries, Care Homes, Ambulance
Services, Prisons and crucially the distribution of Odyssey products by sales
channel partners.
In order to migrate the products onto a new technology platform, Plain is
developing a service orientated architecture ("SOA"). This will allow the
development of products that can be; deployed locally on a device (PC/tablet PC
/mobile phone in the future); embedded in 3rd party applications and hosted in
a SaaS solution held in secure data centres in regional and national locations.
Development of software that is web deployed (i.e. click on a link and it will
install on a local machine) and web enabled (access it directly through a web
browser either hosted on a local network or central server) has been commenced.
The following stages have been taking place over the past six months and will
continue into the first quarter of 2010. These represent the key stages of the
development lifecycle of Odyssey.NET SOA.
* Initial Exploration: including an `intellectual property harvest' of the
current product range.
* Prioritisation: of the results of the IP harvest to define the scope of
planned development.
* Design: performed mainly by the .NET Solution Architect and working closely
with both internal and external customers to identify requirements.
* Training: a significant amount of effort is being applied to training of
existing staff, through structured training events, weekly development
training sessions and peer programming.
* Development: the development process involves a series of 2-6 week
iterations, known as sprints, intended to focus on a prioritised set of
objectives, or storyboards.
* Building: framework services (demographics, security, clinical etc).
Delivering: at the same time delivering saleable products for the business - to
this aim, the Odyssey eCover application is the first .NET product to market.
Testing: this is crucial to delivering high-quality product to the marketplace
- the philosophy of the Odyssey.NET SOA is to test early and test often.
It is envisaged that although the final delivery of the .NET SOA will not be
until Q2 2010, Plain has released certain products and applications already. A
refined version of Odyssey eCover is expected in Q4 2009 and will provide
additional opportunities in the global markets. This initial release will
contribute to the release of the full Odyssey.NET TeleAssess product, to be
undertaken in 2010. To assist the roll out of these products Plain will rely on
close cooperation with its partners and discussions are progressing well with
all major suppliers to the group's existing markets.
Plain is cooperating with key third party suppliers for the Clinical Content
service for TeleAssess to allow close integration of these tools within their
own product development which is expected to lead to additional revenues.
The Directors believe that the .NET architecture offers significantly enhanced
ease of use and flexibility and will enable Avia to target both a wider patient
base and a wider geographical coverage.
Within all of the Odyssey applications is a comprehensive and secure audit
trail, documenting details such as times, dates, symptoms and advice given.
Financial summary of Plain
The table below contains information extracted from the audited financial
information for Plain for the three financial periods ended 31 March 2009 and
research and development expenditure for those three years.
Audited Audited Audited
12 months to 12 months to 13 months to
28 February 29 February 31 March
2007 2008 2009
GBP'000 GBP'000 GBP'000
Revenue 1,615 1,547 1,878
Profit/(Loss) before tax 71 112 (217)
R&D Expenditure charged against 173 245 136
profits
For the period up to 31 December 2008, Plain's research and development
expenditure has been fully written off in the year in which it was incurred.
From 1 January 2009, development expenditure is capitalised when it meets the
criteria set out for recognition in International Accounting Standard 18 and
amortised over its useful economic life. In the financial statements for the 13
months ended 31 March 2009, GBP31,141 was capitalised.
Plain has incurred trading losses in the 13 months ended 31 March 2009 as a
result of the recruitment of 18 employees in order to further expand and
develop its operations.
Market background
Clinical decision support technology has grown in response to the needs of
governments and healthcare providers to improve the safety, efficiency and
effectiveness of healthcare services in the face of increased expectations,
demands and costs. A key area for cost savings comes from the more effective
use of skilled nursing staff, allied health professionals and healthcare
assistants who, to help relieve the pressure on doctors' time, can assume
greater responsibility for certain roles and patient assessments which have
historically been undertaken by doctors. This not only increases doctors'
access to patients with more complex or urgent needs, therefore improving
waiting times and care levels, but can also reduce overheads. Clinical decision
support software can support clinical processes from patient self assessment to
telephone and face to face nurse or receptionist assessment in areas as diverse
as pharmacies, prisons, ambulances and insurance. It can also provide rigorous
documentation and audit trails in the event of insurance and litigation.
The UK healthcare market has changed in recent years. The consolidation of
Strategic Health Authorities and the reduction in number of Primary Care Trusts
from 309 to 152 in 2006 and English Ambulance Trusts from 31 to 13 attempted to
standardise services and to centralise budgets and purchasing decisions. On the
other hand, there has been a move towards greater competition in the delivery
of services; for example, increasing use of the private sector for the
provision of services such as out-of hours, GP-led health centres
(`polyclinics'), emergency medicine and an increasingly important role for high
street pharmacists. The increase in alternative primary care services such as
walk-in- centres and polyclinics coupled with acknowledged gaps in clinical
assessment skills, opens the market for effective clinical decision support
technology.
The out-of hours market accounts for over 60 per cent. of Plain's current
turnover. Plain has a dominant position in this market with almost two thirds
of PCTs using the Odyssey support services or related products in which Odyssey
is incorporated.
Revenue model
Plain sells a range of services to the primary care sector, primarily derived
from interrogation of its clinical database.
Customers pay an annual subscription fee based on the chosen software
application. Subscription fees also include charges for maintenance and updates
of the clinical data. Training and enhanced training courses are offered for an
additional fee.
It is the intention of the Enlarged Group to supplement the current range of
front-end applications for the database with additional products covering areas
such as emergency departments, long term condition management, the Ministry of
Defence and ambulance services, as well as health insurers, via self diagnosis
systems, care homes, pharmacies and health advice lines. It is envisaged that
the revenue model will remain the same with subscription charges being levied
on a per user basis.
Customers
Plain has in excess of 60 contracts with customers for installation, licences
and support. More than 20 per cent of these customers have been with the
company for more than five years. These clients are primarily UK based, with
six customers currently coordinated via the strategic alliance with MedicInfo
B.V. Plain also has customers in the USA, Switzerland and Ireland.
At present, approximately 60 per cent. of revenue is derived from the sale of
services to out-of-hours services providers with a further 23 per cent.
directly to walk-in centres.
Competitors
Competitors range from large multinational operators to smaller single sector
businesses and compete directly with UK based algorithmic systems providers. It
also competes indirectly with doctor-led services where there is a less
accepted need for clinical decision support packages. Clinical Solutions (CAS)
is currently the largest competitor of the business with software used by NHS
Direct, other health advice lines and walk-in centres. Additional competitors
in the UK include Nightingale Guidelines and NHS Pathways. International
competitors include McKesson, a US market leader in the insurance sector,
Fonemed and PSIAM, a product from Priority Solutions Inc. which offers a fully
automated clinical content product integrated with ambulance services.
Product Development
Plain intends to further invest in software and market development to access
new markets, which include emergency departments, long term conditions,
sickness and absence management, care homes, and increase penetration of
existing markets such as ambulance, insurance, prison sectors, and the armed
forces. Future development will focus on:
* developing a service orientated architecture that will provide discrete
services such as security, demographics or clinical assessment to third
party systems. This will facilitate integration of clinical content and
improve user experience;
* providing a flexible workflow model that allows healthcare services to
adapt the system to their practice;
* enhancing security services to improve protection of patient
confidentiality; and
* creating flexible user interfaces to enable products to operate on a wide
range of devices including touch screens, mobile devices and tablet PCs.
Future strategy for the Enlarged Group
The Directors intend to develop and grow the Enlarged Group both organically
and through a "buy and build" strategy. The Company will target complementary
businesses with strong management teams which will operate alongside Plain,
enhancing market penetration and providing access to new markets as well as
improving product usability and function.
Current trading and prospects of the Enlarged Group
Current trading is in line with Plain's historical performance for the period
ended 31 March 2009 and with management's expectations. These expectations are
based on Plain's long term strategy to recruit new personnel and train and
enhance the skills of existing personnel as required to develop and deliver
`.Net' products and services from the fourth quarter 2009. The strategy also
includes the further deployment of web enabled products and services for
delivery in 2010 and its classic product range for delivery to a wider customer
base in existing markets in late 2009.
Development in .NET has progressed throughout the second and third quarter 2009
with product delivery for both research and commercial release. The research
and development release of the Odyssey SelfAssess.NET product has been
successfully web deployed and has been well received by both GPs and the
patients that have used the system.
The Directors are pleased with the progress that has been made over the past
few months and anticipate the proceeds of Placing having a significant effect
on the outlook for 2010.
Share capital statistics
Placing Price 60p
Number of Placing Shares to be issued 1,975,100
Number of Consideration Shares to be issued 2,501,662
Number of Ordinary Shares to be issued to providers of services in lieu of fees
160,980
Number of Ordinary Shares in issue following Admission 4,950,249
Placing Shares as a percentage of the Enlarged Issued Share Capital 39.90 per
cent
Consideration Shares as a percentage of the Enlarged Issued Share Capital 50.54
per cent
Market capitalisation of the Company at the Placing Price on Admission GBP2.97
million
Gross proceeds of the Placing GBP1.185 million
Cash consideration for the Acquisition GBP105,000
Net proceeds of the Placing GBP1.02 million
Terms defined in the admission document dated 20 October 2009 have the same
meaning in this announcement.
END
Cientifica (LSE:CTFA)
Historical Stock Chart
Von Jun 2024 bis Jul 2024
Cientifica (LSE:CTFA)
Historical Stock Chart
Von Jul 2023 bis Jul 2024
