Clinical Evidence

Effective outcomes as evidenced by 20 peer-reviewed journal articles and over 100 independent clinical studies

Flo is proven to help clinicians work smarter and have more fulfilling patient encounters

You can rely on Florence to deliver safe and effective outcomes as evidenced by 20 peer-reviewed journal articles and over 100 independent clinical studies. From the very beginning of Florence, patient safety and clinical efficacy has been our top priority.

By working with academic institutions and clinical researchers, we have robust clinical evidence not only from the UK but also from successful trails and implementations in the United States (for the Veterans Administration) and in Australia.


Clinical studies

Journals & Guidance – Florence

Publication/Reference Title
PLOS Medicine, 2020,, Vicky Hammersley, Richard Parker, Mary Paterson, Janet Hanley, Hilary Pinnock, Paul Padfield, Andrew Stoddart, Hyeon Gyeong Park, Aziz Sheikh, Brian McKinstry Telemonitoring at scale for hypertension in primary care: An implementation study
Journal of the American Medical Informatics Association, 2020, ocaa122,, Jason J Saleem, Jacob M Read, Boyd M Loehr, Kathleen L Frisbee, Nancy R Wilck, John J Murphy, Brian M Vetter, Jennifer Herout Veterans’ Response to an Automated Text Messaging Protocol During the COVID-19 Pandemic
British Journal of Clinical Psychology 2020, Sam Malins, Sanchia Biswas, Shireen Patel, Jo Levene, Nima Moghaddam, Richard Morriss Preventing relapse with personalized smart‐messaging after cognitive behavioural therapy: A proof‐of‐concept evaluation
Journal of Psycho-Oncology 2019, Chloe Wells, Sam Malins, Simon Clarke, Iwona Skorodzien, Sanchia Biswas, Tim Sweeney, Nima Moghaddam, Jo Levene Using smart‐messaging to enhance mindfulness‐based cognitive therapy for cancer patients: A mixed methods proof of concept evaluation
British Journal of General Practice 2019; 69 (suppl 1): bjgp19X703529. Brian McKinstry, Vicky Hammersley, Richard Parker, Hilary Pinnock, Paul Padfield, Janet Hanley, Andrew Stoddart and Adam Steventon Evaluating a large-scale roll out of blood pressure telemonitoring using routinely acquired data
US National Library of Medicine National Institutes of Health 2019 Aug; 36(Suppl 5): S54–S57, PMCID: PMC6719802, Connie Jaenicke, FNP-BC, BMTCN, corresponding author Dan Greenwood, MS, RD, LD, CNSC, Kathleen Nelson, MS, CNS, ONS, Mark Klein, MD, Bev Foss, RN, Lara Carson, RN, BAN, Kim Smith, MS, PA-C, and Evan Mariash, MD Use of Mobile Messaging System for Self-Management of Chemotherapy Symptoms in Patients with Advanced Cancer
Primary Health Care 2018 Chambers R, McKinney R, Schmid M et al (2018) Digital by choice: becoming part of a digitally ready general practice team. Primary Health Care. doi: 10.7748/phc.2018.e1502 Digital by choice: becoming part of a digitally ready general practice team
Journal of Nursing & Healthcare, 2016 Vol. 1 Issue 2; Parijat De , Susan Irwin, Jagjit Kaur, Karen Moore Use of an Innovative Technology Enabled Care Service (Tecs) “Florence” To Empower Patients and Enhance Adherence to Treatments in Diabetes
(RCNi) Primary Health Care, 2016, 26(7):24-30 Caroline Poole, Janice Maslen, Lisa Joanne Taylor Enabling Supported Self-Management of Wound Care in the Community Setting to Increase Quality and Efficiency of Service Delivery Primary Health Care
Innovative Practice in Higher Education; Vol. 2 (3) Elizabeth Boath, Richard Machin, Martin Dixon, Nigel Thomas, Phil O’Connell, Lisa Taylor Stop with the FLO: using text messaging to improve retention rates in University Students
British Journal of Healthcare Management 10.12968/bjhc.2016.22.1.23 Lisa Taylor, Jane Birch-Jones Implementing a technology enabled care service
BMC Family Practice 2015, 16:83 doi:10.1186/s12875-015-0301-2, Elizabeth Cottrell, Tracey Cox, Phil O’Connell, Ruth Chambers Implementation of simple telehealth to manage hypertension in general practice: a service evaluation
Gastrointestinal Nursing – 10.12968/gasn.2014.12.Sup1 Mark Holmes, Sian Clark TECHNOLOGY-ENABLED CARE SERVICES: NOVEL METHOD OF MANAGING LIVER DISEASE 
BMJ Open – 2015;5:e007270 Elizabeth Cottrell, Tracey Cox, Phil O’Connell, Ruth Chambers Patient and professional user experiences of simple telehealth for hypertension, medication reminders and smoking cessation: a service evaluation
Dove Press – 10.2147/NRR.S72791 Audrey Cund, Jayne L Birch-Jones, Martin Kay, Patricia Connolly Self-management: keeping it simple with “Flo”
Public Health England – Blood Pressure System Leadership Board Tackling high blood pressure From evidence into action
BMJ 2013; 346 doi: Brian McKinstry, professor of primary care ehealth, Janet Hanley, principal research fellow, Sarah Wild, professor of epidemiology, Claudia Pagliari, senior lecturer, Mary Paterson, research fellow, Steff Lewis, statistician, Aziz Sheikh, professor of primary care research, Ashma Krishan, statistician, Andrew Stoddart, health economist, Paul Padfield, professor of hypertension Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial
BMJ Open 2013;3:e002671. doi: 10.1136/bmjopen-2013-002671 Janet Hanley, Jenny Ure, Claudia Pagliari, Aziz Sheikh, Brian McKinstry Author affiliations Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study
BMJ Open 2012;2:e001392 Elizabeth Cottrell, Kate McMillan, Ruth Chambers A cross-sectional survey and service evaluation of simple telehealth in primary care: what do patients think?
NICE – Hypertension (CG127) Interactive simple telehealth for the management of blood pressure
BMJ Open – 2012;2:e001391 Elizabeth Cottrell, Ruth Chambers, Phil O’Connell Using simple telehealth in primary care to reduce blood pressure: a service evaluation

Journals – Others of Interest

Publication/Reference Title
US National Library of Medicine National Institutes of Health 2015 April; PMCID: PMC4406229, Amanda K. Hall, Heather Cole-Lewis, and Jay M. Bernhardt Mobile Text Messaging for Health: A Systematic Review of Reviews
Digital Health 2019, Volume 5: 1–21, Cigdem Sahin , Karen L Courtney, PJ Naylor and Ryan E Rhodes Tailored mobile text messaging interventions targeting type 2 diabetes self-management: A systematic review and a meta-analysis
BMJ 2018;361:k1959 Rosie Dobson, Robyn Whittaker, Yannan Jiang, Ralph Maddison, Matthew Shepherd, Catherine McNamara, Richard Cutfield, Manish Khanolkar, Rinki Murphy Effectiveness of text message based, diabetes self management support programme (SMS4BG): two arm, parallel randomised controlled trial
BMJ 2017;358:j3203 Iona Heath, former general practitioner Commentary- Information without Wisdom
BMJ 2016; 6(7): e010853. doi: 10.1136/bmjopen-2015-010853Claire Reidy, Anne Kennedy, Catherine Pope, Claire Ballinger, Ivo Vassilev, and Anne Rogers Commissioning of self-management support for people with long-term conditions: an exploration of commissioning aspirations and processes
JAMA Intern Med.doi:10.1001/ jamainternmed.2015.7667, Jay Thakkar; Rahul Kurup; Tracey-Lea Laba; Karla Santo; Aravinda Thiagalingam; Anthony Rodgers; Mark Woodward; Julie Redfern; Clara K. Chow Mobile Telephone Text Messaging for Medication Adherence in Chronic Disease A Meta-analysis
Fam Pract Manag. 2000 Mar 7(3):47-51. Martha M. Funnell, MS, RN Helping Patients Take Charge of Their Chronic Illnesses – The best thing you can do for your patients with chronic diseases is to let them run with the ball.
BMC Family Practice 2015, 16:80 doi:10.1186/s12875-015-0289-7, Natalie Leon, Rebecca Surender, Kirsty Bobrow, Jocelyn Muller, Andrew Farmer Improving treatment adherence for blood pressure lowering via mobile phone SMS-messages in South Africa: a qualitative evaluation of the SMS-text Adherence SuppoRt (StAR) trial
NICE Medicines Evidence Commentary UK study finds evidence for the effectiveness of text messaging on adherence to cardiovascular preventative treatment
PubMed; J Med Internet Res. 2014 Oct 17;16(10):e222. doi: 10.2196/jmir.3442; Kannisto KA, Koivunen MH, Välimäki MA Use of mobile phone text message reminders in health care services: a narrative literature review.
PubMed; Worldviews Evid Based Nurs. 2014 Apr;11(2):81-8. doi: 10.1111/wvn.12030. Epub 2014 Mar 5; Jones KR, Lekhak N, Kaewluang N Using mobile phones and short message service to deliver self-management interventions for chronic conditions: a meta-review.
BMJ 2013;347:f6070 Hilary Pinnock, Janet Hanley, Lucy McCloughan, Allison Todd, Ashma Krishan, Stephanie Lewis, , Andrew Stoddart, Marjon van der Pol, , William MacNee, Aziz Sheikh, Claudia Pagliari, Brian McKinstry ** Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease: researcher blind, multicentre, randomised controlled trial
Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No. CD006611. DOI: 10.1002/ Whittaker R, McRobbie H, Bullen C, Borland R, Rodgers A, Gu Y. Mobile phone-based interventions for smoking cessation.
Journal of Hypertension:doi: 10.1097/01.hjh.0000379198.08164.51, Wizner, B; Gaciong, Z; Narkiewicz, K; Szykula, D; Grodzicki, T HIGH RISK PATIENTS BENEFIT MOST FROM THE SMS-BASED INTERVENTION: PP.20.272

Clinical – Florence

Publication/Reference Title
Neurology Text Message Reminders and Intensive Education Improves Positive Airway Pressure Compliance and Cognition in Veterans with Traumatic Brain Injury and Obstructive Sleep Apnea: ANNIE Pilot Study (P1.097)
The Lancet 2018; Volume 391, No. 10124; Prof Richard J McManus, PhD et al Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial
Oxford University – Dr Katherine Tucker Self Monitoring of Blood Pressure during Pregnancy
Public Health England – High blood pressure: data, guidance and health service planning and Long term health conditions Case study – Telehealth helps patients manage their own conditions
Practice Nursing 2014; Vol 25, No 8; Collis L, Whitmore M, Chambers R Telehealth in primary Care: what’s in it for me?
theguardian – Dr Ruth Chambers OBE How can telehealth help patients take responsibility for their health
GP – Professor Ruth Chambers OBE Adopting remote monitoring via telehealth in your CCG’s practices – part 2: inhaler reminders
GP – Professor Ruth Chambers OBE Adopting remote monitoring via telehealth in your CCG’s practices – part 1: hypertension
NHS Health Check Search: multiple case studies

About Florence

Publication/Reference Title
The Health Foundation How Flo is making a difference
The King’s Fund Florence: telehealth for long-term conditions
U.S. Department of Veterans Affairs Mobile app empowers Veterans to be full partners in their own care
The Health Foundation Flo: telehealth with a human touch
U.S. Department of Veterans Affairs More about Annie
Inside Commissioning – Dr Ruth Chambers OBE Tackling Telehealth (2014)
Inside Commissioning – Dr Ruth Chambers OBE Tackling Telehealth2 (2015)
U.S. Department of Veterans Affairs VA & NHS – Simple Telehealth conference June 2014
U.S. Department of Veterans Affairs Annie briefing
Inside Commissioning – Jayne Birch-Jones How a patient champion can help spread telehealth innovation Hundreds of patients sign up to taking their own health readings (Bucks County Council)
The Health Foundation Shine: Improving the value of local healthcare services


Publication/Reference Title
Home and Mobile Health Monitoring Towards Scaling Up Home and Mobile Health Monitoring in Lanarkshire
The Health Foundation Reducing emergency admissions: unlocking the potential of people to better manage their long-term conditions
British Journal of General Practice; Br J Gen Pract 2018; 68 (668): 108-109. DOI: Making technology-enabled health care work in general practice
NHS England Challenging Health Inequality
Nuffield Trust The digital patient: transforming primary care?
Scottish Government National Action Plan for Technology Enabled Care, “Supporting & Empowering Scotland’s Citizens”
House of Lords Long Term Sustainability of the NHS
Care Quality Commission CQC cite Flo as ‘Outstanding’ in General Practice
Dr Ruth Chambers OBE, Marc Schmid, Jayne Birch-Jones Digital Healthcare: The essential guide
Scottish Government NHS Scotland Annual Report 14/15 (GRAHAM)
The Health Foundation The Power of People
Care Quality Commission CQC award ‘Outstanding’ rating for General Practice and Flo
Dr Phil Hammond Staying Alive – How to Get the Best from the NHS
Care Quality Commission Outstanding Practice – Florence in Maternity Services
NHS England-News Realising the greatest asset the NHS has – Dr Martin McShane
theguardian – Richard Vize Why technology is no longer a barrier in the NHS
theguardian – Dick Vinegar (Patient from Hell) Telehealth: small scale initiatives can reduce costs and help patients
HSJ Telehealth + PHILIPS – Claire Read (Page 3) Long-Term Thinking (supportive partnerships is crucial)

Others of Interest

Publication/Reference Title
The Lancet 2018; Prof Richard J McManus,PhD, Prof Jonathan Mant, MD, Marloes Franssen, PhD, Alecia Nickless, MSc, Claire Schwartz, PhD, James Hodgkinson, PhD, et al. Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial
New York Times; Aaron E. Carroll Wearable Fitness Devices Don’t Seem to Make You Fitter
Dept of Veterans Affairs; Neil C. Evans, MD Guiding principles of delivering health care in the digital age
NHS England News Service Spec; using social media, texts and Skype to keep young people engaged in treatment for their diabetes
The Health Foundation; Chris Perry, Krishna Chhatralia, Dom Damesick, Sylvie Hobden, Leanora Volpe Behavioural insights in health care; Nudging to reduce inefficiency and waste
Oxford University – Professor Richard McManus What will blood pressure management be like in 2020; C. Varon, J. Minter, M. Stapleton, S. Thomson, S. Jaecques, S. Sanders-van Wijk, H. P. Brunner-La Rocca, S. Van Huffel Telehealth for patients with heart failure: A comparison between telehealth systems