While most GP practices have switched to telephone consultations to keep in line with social-distancing rules amid the COVID-19 pandemic, an NHS Trust in Birmingham is going one step further and delivering specialist consultations at a distance, complete with digital stethoscopes, remote ultrasound scans, and even ECGs.
The University Hospitals Birmingham NHS Foundation Trust (UHB) is using a 4G/5G network provided by BT that lets clinicians use diagnostic devices remotely to treat patients at a distance.
The technology is being trialed in a purpose-build station called Norman Power, which provides intermediate care for patients who are preparing to return home. BT has set up a workstation in Norman Power, which connects to another workstation in the Older People's Assessment and Liaison (OPAL) department, located over two miles away, in Queen Elizabeth Hospital Birmingham.
If a member of the team working at the Norman Power station raises doubts or concerns about a patient, they can be directly linked via video to the OPAL team, so that a gereatrician can discuss the case, diagnose the patient in real time and provide advice on the treatment plan.
For example, if a nurse notices shortness of breath in a patient, an OPAL gereatrician could remotely carry out a clinical examination by using a digital stethoscope to hear the patient's breathing. Andrew McKirgan, who has been leading the remote station work at UHB, told ZDNet: "There are scenarios where the team at Norman Power feel like they need advice or a clinical opinion. Now, if they are feeling concerned, they can open up a video link and there will be a gereatrician.
"We can offer that specialist support thanks to the information feeding back to the specialist team. This provides much more support to staff and a better outcome for the patient."
Over the past few months, as the COVID-19 pandemic gathered pace, BT pulled together the workstations, as well as portable devices that nurses can use to liaise with experts directly from patients' beds, such as wearable high-definition cameras.
McKirgan explained that the concept is still being tested to refine some key elements of the process. At the moment, remote experts can use a stethoscope, as well as carry out ECGs and ultrasounds in order to examine the patient; but the team is still determining which diagnostic devices should be added to the clinicians' palette.
"We are figuring out whether these three are the right three," says McKirgan. "We can see the stethoscope and the ECG are used a lot, and the ultrasound a bit less. So we are still deciding which diagnostic devices we should have as core devices in our portfolio."
The Norman Power station was built two years ago as an intermediate care facility to ease the pressure on care capacity in hospitals in Birmingham. In the past few months, therefore, the station has had a critical role in freeing up beds in the city's hospitals, as the COVID-19 pandemic placed an extra strain on the NHS.
Although the project was timely, given the scope of the crisis, McKirgan said that it was by no means limited to the pandemic. "We have been collaborating with BT for about a year," he says, "in order to find ways to connect different parts of what historically have been disparate sections of the system."
BT and UHB have been working to connect paramedics in ambulances responding to a 999 call, for example, to a GP that can determine whether the patient needs to be treated in hospital.
In this case, the ambulance was fitted with a 180-degree camera, and the vehicle could link to live measurements of clinical data such as the patient's heart rate, or their medical records.
Central to the connected ambulance's success was that it operated via BT's 5G network, which was deployed to Birmingham last May. The UHB's most recent efforts to perform remote diagnosis in the Norman Power station are also intended to make use of 5G, although not immediately.
"We can use it with 4G, and we haven't had any issues with latency," said McKirgan. "But our aspiration is to use 5G, because the type of diagnostics we will want to do will work better with 5G. The more you do with connected teams, the more speed will become important."
Looking forward, McKirgan intends to trial the technology in other health service sectors. Remote experts could come in particularly handy for mobile community teams that go into patients' homes, for example in the form of a device that could be attached to a rucksack.
The UHB lead said that discussions were on-going with local community trusts, with the ultimate goal of linking up all intermediate care across Birmingham.
"Paramedics or community nurses could go into patients' homes, and if they are concerned about a patient, they would have the ability to contact a specialist team, send them information via diagnostic devices, to add value to their assessment," said McKirgan.
This could also help care home workers or home-care providers access different types of medical input and deliver healthcare in a more integrated way, he added.
It remains that the biggest obstacle to the technology's deployment might be resistance from the patients themselves. Remote diagnosis, indeed, is likely to generate vast quantities of extra data, of the kind that some might be uncomfortable sharing.
The idea of having a medical consultation saved in a video file somewhere might not sit well with every patient. To this end, extra care will have to be taken to protect patient privacy, and to make sure that the technology is prepared against technical glitches and privacy leaks.