DXS International (AQUIS:DXSP) — Investor Presentation

0:01 Performance. Company's results. The The We

0:20 call is open. Open. These will is be available via the investor me company, dashboard on the website. I'd also like to remind you this presentation is being recorded. Before we begin, we'd like to submit the following poll. I'd now like to hand you over to David Immelman, CEO, and Steven Bauer, COO of DXS INTERNATIONAL PLC. Good morning. Hi, Paul. Good morning to you. Good morning, Paul. The floor is now yours, gentlemen. Thank you. Great. Well, thanks. Thanks very much. Well, firstly, I'd like to just thank everyone attending this presentation.

1:08 Thanks for making the time and the effort. We're excited to share our business with you. And of course, for those of you that already know quite a bit about the business, I I have included some information here for for the benefit of people who may not know as much as you do about the business. So, it may may seem to be a bit repetitive, but bear with me because I think overall it's going to be exciting and interesting. I'm going to approach this with a very short overview of the actual business. I'm then gonna get into telling you what it is we do, more about it, how we do it, and then I'm going to be talking about the new areas into which we we're moving and why we are and what opportunities that those are presenting for us as a company and for for shareholders.

2:03 So without any further ado, let me, I'm gonna put this video off. It's gonna make it easier to present. And, yeah, let me start. Thank you. Right. So as a business, we provide clinical decision support to approximately 20% of GP practices throughout The UK and I'm going to tell you more about clinical decision support in a few moments. Clinicians use our proprietary clinical decision support solutions and that's an acronym we'll be using throughout the presentation CDS, which are deployed at clinical sites such as GP practices and importantly these systems are interfaced with the various patient electronic healthcare record systems.

3:03 Obviously, the reason for that is because we need to be able to be analyzing each patient's data to provide tailored information to the person, the clinician who's in the patient encounter and about to treat that patient. We currently have an annual turnover of 3,400,000 and have ambitious plans on how we're going to grow that revenue going forward. Currently, we have invested over £4,000,000 into the development of what we call our new expert clinical decision support solutions, And that's what I'm going to be talking about later on in the presentation. Clinical decision support, what is it?

3:48 For clinicians, we provide treatment decisions in the form of guidance, alerts and reminders in their workflow and during the patient encounter. And as I said earlier, what it boils down to is a busy clinician and while we all know these people are incredibly bright, they have so much information that they have to deal with with so many different patients on a daily basis that we try to help to distill information for them in meaningful way. The other side of the coin is communicating with patients, and we do this via SMS messaging or an app, and we send reminders and requests for medicines, measurements, medicine information, blood pressure readings.

4:39 We provide lifestyle advice. And I think you you will have heard many of you, and and I'm sure you'll agree, that it's becoming more and more important for patients to start taking certain levels of responsibility for their care. And so this is a way setting up these channels of communication with patients and I think this has become a lot more evident during the past year with many and many of the consultations being conducted online. One example. What are the benefits of clinical decision support? Well, we we, as a business, we we don't make these incredibly complex clinical decisions about how you should treat a patient. We leave that to the experts.

5:30 And gold standard treatment advice exists. It's there. And if implemented according to the existing guidelines, the outcome is that this will result in the best possible outcomes for the patients, clinicians and healthcare payers. And what we mean by that is that if you look at the I use three organizations at the bottom, the first block is an organization called NICE, UK organization called the National Institute for Health and Care Excellence. This is an organization that is highly regarded not only in The UK but around the world and they will create treatment guidelines and pathways and if we pick something, for example, like a diabetes or COPD or asthma, if you picture like a a pathway, it's almost as one of our GPs said, imagine it to be like a GPS, and you're driving in your car, you're trying to get to a destination.

6:38 And you could turn right, turn left, go straight, etcetera, etcetera, because these are all points of different decisions that need to be made based on certain information about that particular patient, such as their medicines they're on, their clinical parameters that they present with, their age, their demographics, and so on, you can just picture in your mind how incredibly complicated this becomes. So these organizations, they've created all this information. It exists. In the in The US, the organization that handles and is the is the gold standard for treating heart disease is American Heart Association, and the same in Europe.

7:25 But with clinical decision support comes a challenge. You know, this information is complicated. And if we use the NICE guidelines as an example, they are particularly if you look at guidelines for long term conditions, and I'm going to talk about that in more detail, Let's take a hypertension guideline. If you look at the guidelines for hypertension and their related comorbidities, you're looking at 300 plus pages of information. It's staggering. If you look at the guidelines for diabetes, two seventy eight pages. Now, again, I said you've got incredibly dedicated and busy, overloaded clinicians.

8:13 And so the challenge that we have is to take this gold standard information and to present it in summarized, bite sized chunks in the workflow and during the patient encounter. This challenge is exacerbated at the moment by an increasing shortage of doctors, of GPs, and this is not only in in in in The UK. This this is applicable globally. Let's just look at a few facts. In The UK every year, you you have about 330,000,000 consultations. It's a staggering number. And a 150,000,000 of those consultations, 50%, were for people with long term conditions, also known as chronic conditions, things like hypertension, asthma, etcetera.

9:11 These are diseases that are difficult and complex to treat, and again, I'm going to go into that in more detail a little later. When you think that the time per consultation in The UK according to the National Health Service is about ten minutes, you start to imagine the quantum of time that is spent on long term conditions in these consultations. Add to that a current shortage or estimated shortage of about 6,000 GPs in The UK, and recent information is that forty nine this is a survey that was conducted. Forty nine percent of GPs plan to reduce their clinical hours, eleven percent are planning to retire within three years, and fifteen percent are planning a career change.

10:07 You know, this this is this is serious. It's staggering, and it impacts on on a lot of people like you and I who depend and rely on these amazing amazing clinicians to to manage our health care.

10:26 So how do we as a business contribute towards solving this problem? I said earlier, step one, if you look at the first box, we take these complicated treatment guidelines, and then we have teams of of a combination of clinical people, software development people, and others, And we build this information into our clinical decision support solutions. And these are in three basic formats. One is what we call guidelines, more like document formats. The second is more sophisticated templates and tool sets supported that then has data through out of which you can extract reporting that is important.

11:17 And finally, the area which we are incredibly excited about and we're going to be also talking more about is into our new expert solutions, which are using smart rules based algorithmic systems. We take these systems, our clinical decision support solutions, and then we connect these to the patient's electronic health record. What that enables us to do is to extract the data from the record and to then personalize the treatment advice for each of us. Again, I mentioned earlier that that uses data such as your demographic data, your clinical data, your medication data, and other information that is available.

12:09 And using that information, it now instantly presents these busy clinicians with summarized, concise device in the workflow and during the patient encounter. And I said previously, patients too are receiving their personalized advice in their app or via their text messaging in an effort to get a better patient engagement.

12:42 I want us to just have a look at how our clinical decision support has evolved, and we really here are pursuing excellence. It's something we're proud of. We started out, if you look at the bottom of this curve, with what we called passive technology and that was really more about presenting guidelines and documents, in the workflow of the clinician. From there, we've moved to more interactive workflow tools and templates, and this is where we we found ourselves in 2020, and currently, we continue with that. And we have teams with clinicians, developers and so on who build more sophisticated templates and tool sets that enable a clinician or a nurse to work through a particular patient's problem in a very systematic kind of way. But it is still time consuming. It does require that time which we which we've we've said is is such a problem and an increasing problem or the lack of time.

13:54 Where we are in 2021? I said earlier, we've invested over £4,000,000 into our expert rules based clinical algorithms. What is the difference? The difference is that we can take that 300 plus page hypertension review, And we've built our own intellectual property with these amazing teams we have, as I say, that consist of doctors, pharmacists, mathematicians, software developers, and many others. They extract all of that data into our IP, into the system, into this expert rules based system that we built so that when that system accesses a patient's record, it instantly auto analyzes all of that patient's data against our rules based engine.

15:04 And it pops out three or four simple recommendations on what should be done about that patient. And if I use hypertension as an example, it was the the the suggestions or the recommendations, which, by the way, are then in line with the gold standard that has been presented by those experts, it it might say, we recommend that you stop this drug and this is the reason why. You add this drug and this is the reason why. You you increase the dosage on this drug and this is the reason why. And if you do that, that patient will not only be now treated in what they call compliance with the gold standard recommendations, but we know that once patients are being treated in compliance, then a lot of the other outcomes will improve. Their blood pressure should improve. So if their blood pressure wasn't controlled at the time, if they treated in compliance,

16:17 controlled blood pressure should become an automatic result of compliance. And this is what we are so unbelievably excited about, and we're gonna talk about that in more detail. And then where are we heading? We've all heard about artificial intelligence. It's bandied about daily at the moment and case based reasoning. I have to say that while it is unbelievably exciting and there's a huge amount of effort and work that's being done in this area, at the moment, as far as health care goes, AI is still rife with problems. It's not a panacea yet, but the it but unquestionably, it is the direction of travel. And we are making sure that we are going to be collaborating with the experts in this regard so that we can marry up what we do, what they have, and ultimately come up with even more incredible solutions and outcomes which will result in better management of health care.

17:24 If we have a look at our current solution suite, we've adopted a modular approach. And I've talked about the the where we are, where we started, and where we are. And that those two products are DXS Point of Care, which is our life solution and and current revenue earner. Complete Care is the more clinical tools and template based solution, which helps to navigate complex consultations. We have bundled that together now with point of care. And so it takes point of care to another level, and we're in the process of marketing and selling that solution in The UK.

18:09 The two systems at the bottom, Xpert Care and My Vital Care, those are the two solutions that form part of our new Xpert algorithm based type solutions. And for every, pathway or long term condition, that is recommended by the experts, you can kind of divide that guidance into two parts. The one part is with the clinician facing part, which largely deals with medicines, and and that sort of thing. And the other part is the the the part that deals with the patient, and that's my vital care. So the expert care part is currently in the pilot phase, and we started that last year.

19:00 I will not pretend that during this time of COVID, it has been very difficult, understandably understandably, with the precious clinicians have been under. And it's been but trying to get the traction and get it going has been pretty tough. And but we have we have had good pilots. We've had feedback. We have enthusiasm, and I'll give you some more info on our pilot shortly. The My Vital Care solution, which we had informed our investors we would be piloting last year, we we've pushed that out, and we hope to be getting those pilots, in May this year or thereabouts.

19:45 It we may find. It could be later. We don't know how soon things will begin to normalize. Now I've talked about the the general management of providing clinical decision support for diseases generally. But with our new intellectual property algorithmic solutions that we've developed, we have made a conscious policy decision to focus and become experts at the management of long term conditions.

20:28 And here, I'm just trying to show you. These are 10 common chronic conditions, and I think some of you will be shocked at the percentage of us that have got some of these conditions. Hypertension, fifty per eight percent of us 65 have got diagnosed hypertension, and that puts aside the millions that are wandering around undiagnosed. High cholesterol, forty seven percent. Arthritis, thirty one. And you can look through this. It's just diabetes, 27. It's just amazing. And when we consider these long term conditions, that thirty percent of there's a I I want to say, actually, the thing with rising with with long term conditions, it's a rising threat.

21:23 That's what the World Health Organization regards this as because it's not getting better, because it's all sorts of problems, you know, lifestyle, obesity, and all sorts of things contributing towards the increasing numbers of people with long term conditions. So when you think that thirty percent of the global population have long term conditions, Just do the arithmetic. And here comes the really scary part. Seventy percent of those people, of those thirty percent, 70% of the health care spend is used by the thirty percent of people with long term conditions. So let's just break that down into money.

22:13 The health care budget annually in The UK is a £120,000,000,000 plus. So 70 percent of that, which is almost £80,000,000,000, is being used by 30% of the population who have long term conditions, and that's the fact. This is made worse by the fact that there's a increasing aging population, and 20% of The UK population will be 65 by 2,030 or over. Long term conditions are the biggest financial challenge for health care funders such as the National Health Service. They constantly they acknowledge that if the the guidance is there. If we can improve the way we treat them in in in adherence with our guidelines in this best evidence medicine, we will cut costs by keeping people out of hospital for by averting events such as heart attacks and strokes and things.

23:21 All of this problem is made even worse and more complicated when you think that people with a long term condition have more than one. Sixty percent of people with a long term condition have one or more long term conditions. So if a person had hypothetically hypertension, there's a good chance they might have diabetes as well and so on. The World Health Organization estimates that by 2030, there will be a 10,000,000 global shortage of doctors and nurses. And I said earlier that there's a 6,000 shortage in the in The UK of GPs only. So we in our, road map to deal with long term conditions, we picked one to start with, and we decided on hypertension.

24:17 This wasn't left to guys like me who are nonclinical. This was given to clinical experts to make loads of research to make these decisions. Hypertension, fifteen percent of the global population, not just adult population, global population, are diagnosed with hypertension, which is ten million throughout The UK. Hypertension is the major cause of heart attacks and strokes and currently costs the National Health Service £2,000,000,000 per annum. The consultations that hypertension requires, just hypertension, is four million GP man hours per annum in The UK, which is the equivalent of 2,700 full time GPs.

25:16 The reason is that yes, there are competent prescribing nurses and competent prescribing pharmacists out there who can manage medicine reviews, complex medicine reviews with hypertensive patients, but at the moment they are not in the majority, they are in the minority and therefore the complex hypertension reviews require GP input, and it's using up huge amounts of time because it's so complicated to treat. Of course, this provides an opportunity to us as a business. If we look at the hypertension opportunity, if we had a 30% market penetration of our new expert care hypertension solution that we have been developing for a number of years and are now piloting, and to give you a sense of what that means, throughout The UK, England, Ireland, Scotland, and Wales, there's about 9,000 practices.

26:28 These are reducing, amalgamating, and so on. So if we had approximately 3,000 of those practices, which we believe we we can access not instantly, but over a period, the implications is that that could potentially avert five thousand strokes and three thousand heart attacks per annum. It could save one million GP man hours per annum. That in turn, of course, significantly can improve a practice's profitability, and let us not forget that practices ultimately are businesses. They generally are owned by a couple of partners or maybe by a company in some instances, and they have to make a profit. They have a contract with the NHS but they do need to be profitable.

27:23 And so anything that they can do that helps with their profitability is important to them as a business. And last but not least, by managing hypertension in line with best evidence medicine, ultimately can result in savings according to the NHS of at least £30,000,000 per annum on a 30% market penetration of our system. Our our system, our hypertension pilot system, it it's checking the right boxes. These are this is the feedback that we're getting from the pilots that we're running at the moment and have been, last year.

28:16 When when we when we extract a patient's record or a number of patients' records and across these pilots, what we're finding is that only fifty percent of those hypertension pilot hypertensive pilot patients, sorry, are compliant with the current treatment guidelines. We would love it to be a hundred percent because you're gonna get the best outcomes. Remember, we're gonna reduce strokes and so on and so on. But the fact remains is that only fifty percent are currently compliant with the best evidence treatment guidelines. What's really exciting is that during these pilots, after the use of expert care for the first time, compliance went up from fifty percent to seventy four percent, a 48% improvement in compliance after using the our Expert Care solution once.

29:17 Because to remind you, the Expert Care solution is this clever algorithmic rules based engine that sucks in patient hypertensive patients' data, analyzes it, processes it through a very complicated pathway, and comes up with a few recommendations that says, if you do this, this patient will become compliant. The other information that has emerged from these pilots, And this is something that we are emphasizing and working hard towards because this product has been designed to be able to empower nurses and pharmacists, non GPs, to conduct hypertension reviews with minimal GP input.

30:16 And that's how we can save significant GP time. And and that is in line with the National Health Services, plan at the moment. They are encouraging these primary care organizations, primary care networks to hire prescribing pharmacists to conduct medicine reviews and even sponsoring part of their salaries because they recognize that they need to delegate part of the work to these pharmacists and nurses to free up these qualified doctors to be able to focus on what's really important. Not that this isn't important, but for them to be able to do that, them being the nurses and the pharmacists, they've got to have the right tools, and that's what we're providing.

31:09 Our pilots have also shown that on the feedback that more than 90% of the clinicians who have used this Expert Care product are enthusiastic about it. The feedback has been really good, beyond what we expected. If you look at our ExpertCare Hypertension solution and the benefits that it can provide is we've worked out an average 9,000 patient GP practice can be saving about three hundred and twenty eight GP man hours per annum. And after removing some costs relating to recruiting a pharmacist, that represents a £25,000 annual saving on the bottom line of that practice, which is significant when you consider that the investment that the practice would need to make for our solution, they would be getting a 10 times return on investment here.

32:18 The saving to the National Health Service for that average size practice would would be around £14,000, and that's by reducing heart attacks and strokes. And, of course, let us not forget, the outcome and have we will be having healthier, happier patients, which, of course, is the end goal of all of this. Now we are aggressively planning to grow our business. And, yes, we had hoped this would start last year, but we had some unexpected interruption. So we what we're doing is we will continue selling our existing DXS point of care and complete care solutions, which I went through earlier.

33:10 And following these successful pilots that I've been talking about, we will launch our new clinician facing patient facing hypertension expert solutions. And we hope that that that those launches are going to be happening, I I like to think maybe May, June, July, somewhere around there, if all things being equal and vaccinations go as well as they are, etcetera. And then let us not forget that in the future, our engine, our IP that we have developed, although we have picked hypertension as the first point of entry, we will we have a road map to add new long term conditions into that engine.

34:04 And we've had we have clinicians asking us about that and and what are we gonna do next? And and then we ask them, well, what would you like next? And, you know, you get varying answers. And some of them are such as diabetes, and others to this engine. So that will be exciting for us as a business because it will provide the ability to then upsell on top of our hypertension solution for new for additional products. And I can I have a vision, and I can see eventually how, these highly competent GPs in a practice will have been able to delegate a lot of this type of work, this review work to competent pharmacists and competent nurses that are adequately trained?

35:04 Then I wanna talk about the international market. I said earlier that this hypertension problem is is a global problem. It's not limited to to The UK by any means. And last year, we were we we, being my my colleagues and myself, came across a tender that was put out by a consortium between Turkey, Croatia, Italy, and Sweden. And these four countries that have a population of 90 odd million people and thirty million hypertensive patients according to them. They formed this initiative, and they conducted huge amounts of research into hypertension, and and they decided that they needed to tackle hypertension.

36:04 And, of course, when we read this, considering that we'd been beating this drum for years and years and years, And when we started reading through this tender, we thought, my goodness me. This is as if someone has read our minds and knows what we're planning, and and they want to do exactly the same. And we decided to have a have a go at tendering, for this this tender. Now the tender, is divided into three phases. Phase one, which is three months, was to be able to produce your your architectural drawing, for the want of a better word, to them to say, this is how we're gonna build this solution for you.

36:56 And if you and for that, if you if you won phase one, you will you paid for phase one. And then if you succeed, you move through to phase two. So there were seven people, that that were selected for phase one, seven organizations, and we were one of them. We're pretty excited and proud to say that we're a small business up against some heavy hitters there and excuse me. Yeah. We're excited that we we we were granted this this this phase one award. So we we've got our work cut out for us, as you can imagine, started on the March 1 this week, and it ends at the end of May. And we we're gonna have to work flat out to hopefully produce an amazing tender that will then see us moving through to phase two.

37:51 Of the seven, three or four move through to phase two, and they will then have eight months in which they need to develop the actual, products that they have presented in phase one and for which each of us that get through will be paid. And then at the end of phase two, they will whittle that down to two companies who will take what they've built, and they will pilot it over a twelve month period and for which they will be paid. And at the end of that twelve month period, they will be expected to then take what they've built and to try to commercialize it.

38:40 So if we can get through with this, it'll be an amazing funded way of getting a product built for a particular territory because even though we've already got a lot of the technology, there will be a lot of localization and languages and stuff like that. But it would be a fantastic opportunity for us to end up after twenty four months with a sound solution that could be applied throughout the European Union and give us an opportunity to go in to try and market it and sell it commercially. I I mentioned that there are ninety million hypertensives in those count people in those countries. But throughout the whole of the EU, a matter of interest, there are ninety million people with hypertension.

39:32 And so that shows us the sort of opportunity if we can get through. But, you know, even if we don't get through to phase two or phase three, we already will have the architectural drawing. We'll have much of the solutions already built and functioning. And and as The U EU was always one of our intentions to to target, it would it would be a great springboard for us into that market. So we're very excited about that. The USA. I know it's a big market, and I know many companies who have come away with their tail between their legs and so on and so forth.

40:21 And so we we have a a very, I'm I'm going to say, careful approach here. We've and and how we're doing that is we started out by doing a huge amount of research into hypertension in The US. Again, it is a huge problem accepted and identified by all the powers that be there. We have we have demonstrated our U our UK product to US cardiologists and family physicians, and there's a clear endorsement for the need for hypertension for an expert solution such as ours. And so we are, at the moment, in the process of localizing our UK version into a US version.

41:15 What that actually means is, you know, here we have UK drugs, there we have US drugs. Here we have UK clinical codes, and so we we need to we've got people matching these up at the moment. Here, we have the nice pathway for hypertension. There, we have a path a different pathway. And so we'll have a clinician who will take the data and put it into our IP because it's built it's designed to be able to do this. And once that's completed, then we will secure we will get a couple of those pilots going. And we have to have some pilots going towards the end of this, calendar year. And following some successful pilots, we hope that we we could start to try to identify some value added resellers.

42:11 We call them VARs. And these are companies that were already operating in the markets where where where our products can be used. And so the idea is that we will share revenue with them, and and they they will if, you know, if if we're selling at £1, they might get 70% or 60% of the pound, and we may take 30 or 40% of the pound, and each of us will have our responsibilities. And that way, we will hopefully avoid having to try to go and replicate what we do here and set up offices and people and and try to leverage off organizations that already are in those, market sectors.

42:59 The UK has a hundred and eight million hypertensive patients, and we reckon if over three, four, five years, we can target maybe 10 of them, you can start to imagine the the the the kinds of revenue streams that we could potentially earn through, those countries. We we have spent a lot of time and effort and money building something amazing. If we do not be brave, sensibly brave, and get out there and make the most, aggressively market these solutions, and, of course, we may, and I had I did say this a year ago that we would require, to at some stage to source additional funding for that.

43:54 But we need to get out there smartly and capitalize on what we believe we the edge is that we have at the moment with what we've developed. And and and and this is what's going to give us the exciting revenue curve, and it's gonna help us finally to grow this business. And we've been planning this for a long time. Just a little bit about our company and some of our endorsements that we're proud of. We are an NHS accredited company in The UK, and and in particular for DXS point of care, it means that it does receive central funding for prospective clients to buy, of course, that they have budget available and and they haven't used up all their budgets on other things.

44:52 Our ExpertCare hypertension solution is regarded as a medical device, And we spent the last probably eighteen months, working on accreditation, which we're happy to say we now have. So we are a c it is a CE accredited solution. We also, as a company, are ISO accredited, ensuring, our investors that the company is run within the ISO rules and regulations, and therefore, that we do implement proper, governance and all sorts of things that is required from us as a business. And down at the bottom there, I talk about our partnerships.

45:38 Now to to operate in this environment and to operate in the environment in which we do operate, I said earlier that you have to have access to patient records. And so currently we have individual partnership agreements with EMIS, SystemOne and Vision, which give us secure access to 95% of The UK patient records. EMIS is the largest of the clinical system providers. They have about 55% of the market. System one probably has about 35% of the market. Vision has probably got six or 7%, and then the rest goes to a much smaller company.

46:30 And the London Procurement Partnership is an organization that enabled us via a tender process to to become an accredited supplier to that procurement partnership. They represent members, And currently, they have 30 members that are a combination of NHS trusts, hospital trusts, and clinical commissioning groups by and those CCGs are in primary care, and each of them represent 40 or 50 GP practices. And that's another method through which they they will put out tenders by their members.

47:17 But then these they short circumvented in their mini tenders that we can then respond to as as an accredited supplier to them. Of course, we never lose sight of our customers because, quite frankly, if the customers do not love and like what we do, we're dead in the water. We can we can be talking to all the other organizations, But if the doctors, the nurses, the pharmacists, admin people do not love what we have, we are dead. And we make a concerted effort to try to respond and deliver the best possible service and, of course, solutions.

48:05 Have we made mistakes in the past? Yes. We have. And we try to learn from those mistakes and move ahead and prove and show to the our customers that we are the right people they should be working with because we are willing to respond. Just a short quick snapshot of last year's turnover. For the year ended April 2020, we turned over £3,200,000. We are a small business, but we're around, and we're still there. And and and we now are going places with what we have and what we've developed. Our turnover for the half year in October 2020 was £1,700,000, and we showed a profit for the period of 2020 of $428,000 and for the half year of £224,000.

49:05 I just pulled out of the balance sheet what I thought might be some salient points. By October last year, our investment, I've said, into new IP was over £4,000,000. We had cash in the bank of 1.2, some revenue that we receive in advance, and those were our shareholder funds. So to summarize the opportunities that I of which I've been talking about for the last half an hour is we certainly plan to grow The UK market, and that is through a combination of existing systems.

49:53 And on top of that, our new, expert solutions that we've been working on because we truly believe that is what's going to take us into the next serious level of revenue in The UK. And, of course, need not needless to say that one of the ways we're gonna do that is by leveraging off our 2,000 existing GP practice markets. But we have already, last year, started a marketing exercise where we are targeting, key people at a number of different levels, and this goes from ICSs down to CCGs down to their primary care networks down to practices, and to the people within the practices, doctors, partners, you know, clinical leads, people with a special interest in hypertension, practice managers, pharmacists, and so on.

50:59 And it's it's all about communicating with these individuals and trying to share with them using the the power of, LinkedIn and email and and and other whatever other medium we have at our disposal, working with the organizations to whom they may subscribe such as the the practice manager association, the pharmacy association, and so on and so on. So we we're trying to come in at a multipronged approach. We want to we're going to do our damndest to try and win phases two and three of this tender. We know what we're up against. We're not complacent, but we're gonna give it our absolute best shot. And I hope when I speak to you again, I'll be able to be smiling and saying, well, we got through to phase two. So but it's not a given. We know what we are up against.

52:07 We're working to establish a US pilot. It's work in progress at the moment, Localize the product, get the pilot, and hopefully, it's gonna be a successful pilot and then start to and and like I said, we will need to be raising some funds. And then, of course, I mentioned we will add new long term conditions to our expert engines, which will then start to give us the upsell opportunity. And, of course, not you know, let's not forget the huge benefit to the people that have to manage these conditions. And then our our longer term vision is, I said it earlier, is we'll continue working with experts in the field of artificial intelligence and and also DNA and personalized health.

52:59 And, you know, this is nothing new, and this sometimes, I think, for some people, this seems like a million miles away. It's not. It's happening. The NHS has an initiative that's been going on for a long time. And if you can picture how this can work, here we have a hypertensive patient and we can now follow that hypertension patient's journey, juxtapose their demographics, they were male or female, their age, their conditions, and they were being treated according to certain medicines and and and and and look at the outcomes that happened. And now imagine, on top of that layering your that person's DNA, and, eventually, an amazing picture begins to emerge of the effectiveness of of treatment against the DNA. And I think you can all see just how powerful that could be going forward in the future.

54:09 And that brings me to the end of what I hoped was an informative presentation, and I hope you can see that we have a plan and we're excited about where we're going. So thank you again for your attendance, for your interest, and we hope in maybe six months time we will provide you with another presentation, something similar, and at least been able to tell you how we have progressed against some of the plans we've presented here today. Thanks very much. David, thank very much for the presentation. And ladies and gentlemen, please do continue to submit your questions using the Q and A tab situated on the top right hand corner of your screen. Just while the company take a few moments to review those investor questions submitted already, I'd like to remind you that a recording of this presentation, along with a copy of slides and the published Q and A, can be accessed via your investor dashboard on the Investor Me company platform.

55:07 I'd also like to remind you that your feedback is important to the company. And immediately after the presentation has ended, you will be redirected for the opportunity to provide your feedback in order that the company can better understand your views and expectations. David, Steven, just kind of conscious of time, but we've had a number of presubmitted questions from investors, perhaps I could just start the q and a session off with these, if I may. The first one, I think, if I could address that to you, Steven, if that's okay. Who would you say are your main competitors, in your space, and what sets you apart from them? Thank you, Paul, and, thanks for this question. Well, in the healthcare sector where we operate and as you can see from the presentation that David has taken you through, there are significant needs in this market and yeah, challenges to be overcome.

55:58 And that, of course, presents great opportunity. And and that stimulates competition, of course. And whilst, you know, generally, we view competition as as good and healthy. Yeah. It means that we need to be on our toes. And, you know, one thing in our favor is that there are significant barriers to entry to these markets and and that, you know, that places us very well for the future. And with those barriers, it's only really the the the the companies that are very focused and committed to excellent service that can stay that distance. So but it is a challenging market, of course.

56:47 And one of our very strong advantages is that we are integrated with all all the major medical record providers in The UK like EMIS and SystemOne as David mentioned. And this means that we are able to provide solutions that go across those disparate systems. And and that's really important because it it levels the playing field. It standardizes the care that gets offered. And we also see that clinicians are wanting to practice flexibly, work in a way that supports their their kind of lifestyle and so on. And and that was happening before the pandemic and we've seen that really accelerate through the pandemic. So, you with our platforms that go across the disparate EMR providers, it allows those clinicians to move to different practices to operate in different care settings and still have the familiarity of of our products, which is a really good advantage.

57:57 And with our expert care solution, we also see that we've got a a currently a a first mover advantage there. And as David said, we've we've got to be aggressive with our sales and marketing approach both in The UK and internationally to to really capitalize on that first mover position. So we're very conscious of that. So, yeah, I'll hand back to you, Paul. That's fantastic. Thank you very much. And, David, perhaps I could pass the next one on to you. I think you have touched on this during the presentation, but how large is the market opportunity for DXS, and how do you look to scale the business? Yeah. Well, I mean, as I said and I'm going to be talking here about our hypertension expert solution because I emphasize that that is where I believe greatest growth opportunity lies.

58:56 I mentioned to you that when you consider and let's take the countries that we have are now focusing on. I said to you that The EU have ninety million hypertensive patients. The The US has over a hundred million hypertensive patients. In The UK at the moment, we have ten million hypertensive patients, just to put it into some sort of context. Now if you look at our our business model, unless for any reason the model has to change in a particular country for whatever reason, the current models that have been presented are presented on a per patient, registered patient basis.

59:55 What I mean by that is that if a practice has got 10,000 registered patients, We know that fifteen percent generally across the board will be diagnosed with hypertension, so fifteen hundred of those people will have hypertension. So if you take the the collective numbers for The UK, for The US, for The EU, we're talking about a total of about 200,000,000 people. That's just people with hypertension. That's not representing their population as a whole, but that that will represent about fifteen percent of their overall population.

1:00:43 We will will be charging a fee, a recurring annual fee per registered patient. So if, for example, we could access 10%, and I'm not saying this is the number, it'll vary on territory by territory, but for the sake of simplicity, if we could access the market that represents ten percent of the two hundred million hypertensive patients, that means we would have about, twenty million hypertensive patients. And that that in turn would probably be representing, you know, if if you want to work it back to the population size, it it's it's quite significant.

1:01:39 You know, if you if you say fifteen percent, is is the twenty million, then you're looking at about a 100 plus million population to get to that number. And so we generally charge on a fee per registered patient. So you can do the numbers, and you can just picture that if you had 20,000,000 or 30,000,000 or more patients for which you were being paid a fee per annum, and then adding to that, you had people with diabetes being added on and COPD being added on. It's a it's a it's a SaaS model, isn't it? Software as a service model. And so that so you can see how that market can considerably grow.

1:02:29 It it is huge, and it is up to us to see how aggressively we can get in there. And it and there's a there's a model here. Have a good product. Prove it. Have it endorsed through the right organizations. Make sure it produces unbelievably incredible reporting because reporting is crucial and it does. Showing all the returns on investments for people that are paying the costs. If you have those key ingredients taken care of, we can go into these markets and that will determine how much of those markets we can access. But you can see, even with a 10% access of these markets, it it becomes an amazingly viable business. And one of the great things about this model, by the way, is we do not have it is not heavy on admin requests that are required.

1:03:27 It does not need huge infrastructure. It's something that can be managed remotely, hosted remotely. It's web based. It's it's it's got all the right it ticks all the right boxes for good margins, for scalability, and so on and so on. So yes, I can just say to you, of course, like I did earlier, if we access 30% of The UK market, then that will mean this and that. But you need to see the bigger picture here. And I think that's how the market was the question was asked. That's fantastic, David. Thank you. David, Stephen, I am kind of conscious of time. We have just run over the hour. And having said that, we have got a further number of questions that have been submitted from investors.

1:04:15 I don't know perhaps if you could just have a little scan through the questions that have come through during the event and if there are couple you could perhaps pick out before we direct investors to give you some feedback perhaps. Well, there's a question here. It says, what is the budget for the initial US pilot? If you go onto the HS Monitor website, all that information is readily available for you there. And and and it and and you can rather than me take up a lot of time now, it's very, very clearly shown. And I would suggest you you go to that website.

1:05:07 Did lockdowns in South Africa impact slow development programming? Well, no. Fortunately, we were able to to move all our staff to work from home. And for those of you who don't know, we we have a back end operation in Cape Town. And like we did in The UK, every single one of our staff were moved to work from home and were able to do so effectively. The other companies participating and this is another question, who are the other six companies to Phase II of EU trial? Again, they're on the website.

1:05:52 If you go and have a look, they're clearly set out there. How is our software deployed? Is it cloud based? The this especially, all our news news stuff is cloud based, and even our existing stuff is as is in the process of moving heavily away from practice based, which it used to be, to cloud based solutions. What is the budget for the initial US pilot? Well, maybe you'd like to talk to us and we can discuss that. I think we've run out of time though, you know, Paul. Yes. I'm conscious of everybody's time. Yes. What what what I will say, obviously, to all the attendees today is that the company will review all questions submitted today and we'll publish those responses where appropriate to do so. And we'll also publish the link to the website of, HS Monitor so you can have all that information as David's, alluded to.

1:06:56 David Sieben, look. Thank you very much for addressing those questions. David, perhaps before I just redirect investors to to give you some feedback, just a a final couple of closing words would be fantastic, please. Yes. I think I'll even put on my, my video. Yeah. I I really just wanna say thank you. We we really appreciate your participation, and I I hope and I I actually would appreciate if if you guys gave us some feedback on this presentation and whether you found it useful and helpful, whether you do that by sending us an email or through this website. Paul, how can that be done? Literally, as soon as you finish wrapping up, all the investors would be re redirected to give feedback, so you'll get it straight through the platform. Yes. Yes. And any any improvements that you think we can make and anything you think we could do to make a a session like this much more meaningful for yourselves, please let us know.

1:08:00 And, and as you as you know, you know, if any of you feel the need to have a one on one conversation, or Steven, we we are available. We make ourselves available, and that can can be arranged. So, once again, thanks for everything. Thanks, Steven. Thanks, Paul. Everyone else concerned, and I look forward to the next presentation and to the traction that we're going to get. That's fantastic. David, Steven, thank you very much for updating investors today. Steven's asked if he'd love your feedback. Could I ask investors not to close the sessions? You will be automatically redirected to give your feedback. If you've accessed the meeting via our website, the feedback page will appear in front of you. If you've accessed the meeting via the link in the email, just simply have to log in. It takes a couple of seconds to give your feedback and be greatly appreciated.

1:08:55 On behalf of DXS INTERNATIONAL, we'd like to thank you for attending today's presentation.