A smart ambulance service that would allow people to be treated by consultants via video link before they reached hospital is to be rolled out across the UK, after a trial with NHS East of England showed it could dramatically improve results for patients.
The service was particularly impressive in the case of strokes, where time is crucial in preventing damage to the brain. Millions of brain cells die each minute as a clot or a bleed cuts off blood supply.
“Every 15 minutes a stroke is untreated takes three years off someone’s life,” said Alan Lowe, cofounder and chief executive of Visionable, the UK video collaboration platform that has designed the smart ambulance system. “Imagine the difference it would make if you could start treatment in the ambulance.”
Treating a stroke is not simple. Staff need to be sure which type of stroke it is — an ischemic stroke caused by a clot, or a haemorrhagic stroke caused by a ruptured blood vessel. The treatment for one type kills patients with the other, which is why medical practitioners need to review a CT scan of the internal organs before they begin administering drugs.
In the East of England trial, paramedics in an ambulance were connected via video link to stroke specialists to help make more accurate treatment decisions during the journey. In another part of the trial, once patients reached hospital, images from connected CT scanners were beamed through to specialist consultants instantly, making treatment decisions quicker.
As a result, the number of patients receiving the clot-busting treatment they needed within the critical first three hours went from just 5 per cent to 41 per cent.
It not only saved lives, it also saved the NHS East of England trust an estimated £19m. Treating strokes costs the NHS £7bn a year — £3bn of that is for hospital treatment, £4bn is for rehabilitation. Cut the time needed for rehabilitation and you make big savings.
Visionable raised £6m from private investors in June and has just received a £500,000 grant from Innovate UK, the innovation agency, to help roll out the smart ambulances across the country. The company also has plans to develop specialist wearable devices for paramedics and electrocardiogram (ECG) monitors that could stream patient data straight from the ambulance.
The goal was to have portable CT scanners in the ambulances themselves to provide diagnosis even faster, said Mr Lowe. Scanners are decreasing in size to the point where this is becoming feasible. At the same time, the rollout of 5G mobile networks will make it possible to transmit huge volumes of patient data while on the move.
“5G will really enable mobile medicine, you need 5G if you are going to stream patient data back to specialists from the ambulance. At the moment, a lot of areas do not have good 4G coverage, so you are really limited in where you can deploy services,” said Mr Lowe.
The twin trends of wearable technology and improved mobile networks are combining to change the way medicine is practised. The Covid-19 pandemic has already pushed patients into a rapid adoption of remote medical consultations. The next step, however, will be adding in remote diagnostic tools and wearables that can continuously monitor patient health.
“Telehealth is developing at the rate of knots as health services try to keep vulnerable patients away from hospitals, but a video consultation is not enough,” said Paul Landau, the founder of Careology. “You need additional context about the patient, how they were yesterday, how they were two weeks ago.”
Careology is a UK healthcare platform that allows patients to monitor biometrics such as temperature and blood oxygen levels at home, sharing a dashboard with their doctor, so that any problems can be spotted faster.
Mr Landau originally developed the system to help his wife, who was suffering from Hodgkin lymphoma cancer, track her symptoms between visits to her specialist. Now Careology has added a system to track symptoms of Covid-19, which is being used by private doctors’ practices in London to monitor patients remotely.
An increasing number of wearables are being drafted in.
Oura rings, health trackers worn on a user’s finger, are starting to be used as a Covid early-warning signal. The devices, which record body temperature, heart rate and movement, were shown to have a 90 per cent accuracy rate in detecting cases of Covid-19 before the onset of symptoms in a study by the West Virginia University Rockefeller Neuroscience Institute in the US. Organisations including a US hotel operator and the US National Basketball Association, have issued rings to players and staff to help spot Covid-19 signs early.
Beyond fighting coronavirus, wearables could make healthcare more personalised, said Michael Niddam, co-founder and managing director of Kamet Ventures, a healthtech investor.
“The truth is that no doctor has a 360-degree view of patients any more. There is not enough time in consultations. But these technologies can help get back to that,” said Mr Niddam.
One of Kamet’s investments is in Berlin-based Medloop, which has developed an app that allows a more direct connection between patient and doctor. Patients can book appointments and view results through the app, while doctors can use the system to see the overall health of each patient, quickly identifying those who are at greater risk and need to be called in for a consultation.
In UK pilots, Medloop identified patients who were overdue for clinical care, allowing doctors to help them before they reached crisis point. The company believed it had prevented a number of emergency hospital admissions as a result.
A fully preventive healthcare approach — where the machines and your doctor know you are ill before you realise it yourself — was still in the “blue sky thinking” stage, said Visionable’s Mr Lowe. But healthcare should at least aspire to offer the speed and convenience that people have grown used to with online shopping.
“We are designing a platform that can give patients a completely friction-free, Amazon-style experience,” Mr Lowe said.
This article was amended to correct the figure the NHS trust saved during the Visionable trial, from £90m to £19m
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