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HSJ: Healthcare’s Future Transformed by Technology

October 10, 2014 | Sotera Wireless

Hospital Transformation    

In Association with At the click of a button: Healthcare’s future transformed by technology

10 October, 2014 | By Matthew Shelley

The way technology is successfully being used to drive healthcare delivery shows the potential of using innovative systems in the UK. Matthew Shelley considers avatars, eHealth platforms and wireless monitoring.

Early this year a group of European health leaders went on a study tour of America to find examples of how technology was being used there to drive and support the transformation of healthcare delivery.

While the group saw many examples of remote technology, automation of processes and monitoring equipment, they identified three technologies with potential to bring about transformational change in the UK. Here we profile these.

Remote care

Sense.ly is an avatar based system developed to provide remote care with a human face. Already in use in the US, discussions are underway to bring this virtual clinical assistant to the UK.

The technology uses voice recognition technology and an avatar to give and request information and provide instant feedback. The avatar is available in different characters – the most popular being ‘Nurse Molly’ – and in different languages, including English, French and Spanish.

The avatar ‘nurse Molly’ uses voice recognition technology to give and request information and provides instant feedback

It can be used on mobile devices, TV monitors, phones, home computers or in kiosks to carry out functions including appointment booking, patient monitoring and some triage.

‘A virtual clinician uses voice recognition technology to provide instant feedback’

Halesowen GP Jonathan Darby, who was on the study trip, is attracted by the technology’s sophistication and ease of use. is seeking funding from Dudley Clinical Commissioning Group, where he is a board member and leads on systems and processes, to trial Sens.ly in  a small number of local practices.

Navigating primary care

Initially, Dr Darby hopes to use it for home monitoring of patients with chronic conditions such as heart disease and diabetes. He also believes it has immediate potential for helping patients navigate the area’s primary healthcare services. But that is just for starters.

‘Clinically, the only limit to its potential is your imagination’

He says: “I think it will slot into our [electronic health records] system quite easily which would be absolutely huge for us. Clinically, the only limit to its potential is your imagination.”

A family doctor is getting more difficult to afford, says Ivana Schnur

Possible gains include avoiding unnecessary hospital admissions and engaging with people, like younger diabetes patients, who GPs often have difficulty pulling into the healthcare system, making them vulnerable to major problems in later life.

The system is used in US medical centres where patients can pop into a kiosk, give their details and have their vital signs checked automatically.

Ivana Schnur, company co-founder and chief medical officer, says this can save 20 minutes per patient – some 15 per cent of nurse time. It can also save time on follow up calls and delivering results, as well as eliminating human error from some tasks.

While the voice recognition is very good, Dr Schnur says it is not perfect. However, the percentage of people who complete their interaction with the avatar is in the high 80s.

At the press of a button

Most clinical decisions are made by pressing a button rather than relying on speech. Also, the avatar’s words can be shown on screen and it can be paused.

Home calls can be made several times a day, with the system linked to medical devices such as blood pressure monitors and alerts to book appointments or organise an immediate phone call or visit from a nurse or doctor if there is a problem.

‘The use of avatars maintains a sense of personal care’

Data can be analysed over time building up a more comprehensive picture than any that relied on intermittent home visits – allowing trends to be spotted early.

Yet, one of the most interesting features of Sense.ly is more intangible – the readiness of patients to trust a computer programme which presents in the human form. And according to Dr Schnur, the use of avatars maintains a sense of personal care.

“In Europe there is very much the tradition of the family doctor who knows all about you and your background and makes homes visits when they are needed,” she says.

“This is getting more difficult to afford these days. But with Molly as your ambassador you can have a trusted presence in people’s homes. This improves services and offers peace of mind.”

Leveraging specialist skills

The potential for technology to leverage specialist skills is something that is already being realised in the US  and could hold attraction for the UK

The ClickMedix eHealth platform is a mobile technology that allows doctors and healthcare teams to review large volumes of patient data and images.

It also facilitates the transfer of preliminary diagnostic work to community staff through protocol-based systems.   This minimises the need for staff training and encourages workflow efficiencies.

‘Specialists were able to review data and images from up to 20,000 patients a week’

Currently used in 15 countries and in a diverse range of work environments, from the US to Columbia, the system promises to boost the number of patients a specialist can serve by between four and 10 times.

In India,where hearing loss due to infection is widespread, ClickMedix partnered with medical device company Medtronic to deliver a programme where nine minimally literate healthcare workers used mobile phones with otoscopes to gather data and conduct initial diagnoses.

Ear, nose and throat specialists then reviewed the data and images from up to 20,000 patients a week. The approach doubled the number of patients whose hearing was saved and cut ear, nose and throat care costs by 93 per cent per patient..

Potential for chronic and complex conditions

For the NHS there are extensive possibilities in areas such as care and treatment of patients with chronic and complex conditions including diabetes, or for alerting clinicians to possible signs of early stage dementia.

“Nurses or healthcare workers visiting someone’s home can be prompted to ask a series of questions and gather information on everything from symptoms to diet, exercise and medication,” according to company chief executive and founder, Ting Shih.

‘ClickMedix has dramatically reduced repeated hospital visits and physician costs by 50 per cent’

This capacity to check what medication a patient is on and whether they are taking it, as well as being able to find out what foods they actually eat, rather than rely on what someone says or remembers when they visit a specialist can be invaluable, she adds.

ClickMedix can also be used to let patients carry out cognition quizzes and allows visiting care workers to assess their memory and explore other possible early signs of dementia.

For patients with more advanced dementia, plus other chronic conditions, ClickMedix has dramatically reduced the need for repeated hospital visits and has achieved 50 per cent reductions in physician costs.

Patient data can be saved in PDF form so it can readily be saved into a records system or shared between providers. The company also puts a keen emphasis on affordability as it works hard to maximise adoption, claiming to be “a fraction” of the cost of other systems.

But in UK terms, Ms Shih believes it is the ability to rapidly increase specialist care capacity through task shifting and to plan workflow that will kick start its adoption by the NHS.

Automation

ViSi Mobile – a wearable, lightweight device that constantly monitors electrocardiogram, heart and pulse rate, peripheral capillary oxygen saturation, blood pressure, respiration rate and skin temperature – impressed the European visitors as the technology most likely to transform healthcare.

Their enthusiasm is shared by Ben Kanter, chief medical information officer of Palomar Health, which has been carrying out trials involving around 12 patients per shift since 2013.

ViSi Mobile is a lightweight device that constantly monitors various factors such as heart and pulse rate

ViSi Mobile is a lightweight device that constantly monitors various factors such as heart and pulse rate

Patients recovering from surgery at the Palomar Medical Center have been fitted with the device to provide early warning of changes in their condition and to try to avoid unexpected deteriorations which could result in the need for transfers to intensive care or even lead to sudden deaths.

Dr Kanter, a critical care physician, sees it as putting “a safety belt around the patient”. Within a fortnight of the trial starting, ViSi Mobile identified a series of problems with patients and had achieved its first “significant save”.

By replacing four-hourly spot checks with an uninterrupted flow of data, appropriate clinicians can be alerted the moment something changes.

‘ViSi Mobile identified a series of problems with patients and achieved a “significant save”‘

It has also facilitated changes in the hospital’s nursing model. Time previously spent wheeling spot check monitors around, setting them up and manually recording the data can now be used for more high level patient care.

Palomar Health plans to roll ViSi Mobile out across all its 240 non-ICU beds.

Dr Kanter says: “These days if you are sick enough to be in hospital then you have to be pretty darn sick, so monitoring every four hours may not be enough.

“I think the day will come when we all think that for patients to be properly safe in hospital they have to be monitored with this kind of technology.

“We need to have better eyes on the patient, and this allows us to do that. Our interest is not just what it does at present, but in all the additional sensors that could be included later on.”

UK pioneers

The equipment costs around $5,000, and just $30 for the disposable version of the device which its makers, Sotera Wireless, say represents a highly attractive investment, especially beside the cost of conventional alternatives.

‘The system uses a hospital’s own wifi so there’s no need for expensive infrastructure’

Gary Manning, vice president of sales at Sotera Wireless, says up to 20 US hospitals will be using ViSi Mobile by the end of the year, and he is heading for the UK to talk to six hospitals about establishing pioneer sites.

He believes that part of its attraction is simplicity: it uses a hospital’s own wifi network and meshes readily with electronic record systems, so there is no need for expensive infrastructure..

Data from the device can be fed to monitors anywhere and can be routed through to a nurse or doctor’s bleep

Data from the device can be fed to monitors anywhere and can be routed through to a nurse or doctor’s bleep

The move may well be of particular interest in the UK where innovations like intentional or care rounding have been gaining traction, showing there is an appetite for more frequent checking.

Mr Manning adds that this technology makes the best use of staff skills. He says: “We don’t need degree trained nurses to take blood pressure. We can give people all the data they need so their role is to act on it.”