UK healthcare: Saving lives with wireless tech
Philip Mason looks at some of the ways wireless communications are being used in the UK’s increasingly stretched public health sector
The most important thing is to make every second count, which in turn frees up staff to see more patients and respond to more emergencies
Like most organisations in the UK public sector the NHS is operating within a challenging financial landscape, due – at least in part – to the British government’s ongoing austerity measures.
According to health thinktank The King’s Fund, around 65 per cent of National Health Service Trusts are now in financial deficit. This problem could be exacerbated by the fact that public health funding is set to rise by a comparatively meagre £4.2 billion in real terms between now and 2021. This means organisations must find more efficient ‘smarter’ ways to work – including when it comes to their wireless communications systems.
As assurance manager for the NHS Ambulance radio programme Chris Lucas is uniquely placed to discuss how technology has become integral to easing the burden on medical professionals. The most important thing, according to him, is to help make every second count, which in turn frees up staff to see more patients and respond to more emergencies.
He gave an overview of how a typical NHS ambulance is kitted out. “The basic fit includes a fixed TETRA radio. The crew are also allocated two handheld devices, which have been procured across the service from Sepura,” he said. “There will also be a mobile data screen in the front of the vehicle, with the data in question driven predominantly by a mobile network operator who will differ depending on the Trust. Paramedics will be equipped with mobile smart devices.”
He continued: “Time is of the essence in an emergency and data transmission is quicker and more efficient via a mobile operator. But we still use Airwave’s ability to carry narrowband if there’s a failure or no coverage. It’s still the critical carrier for voice comms.”
Anyone up to speed with the UK emergency services’ communications will know that once the Emergency Services Network (ESN) gets up and running TETRA will be out of the picture. However, unlike the police and fire and rescue service, paramedics are already relying primarily on data because of the nature of the job.
Lucas says: “UK ambulance services are dispatched primarily using data not voice, with information about an incident from a control room coming through on the mobile screen or handheld terminals. Ambulance control room operators essentially work from an algorithm – utilising either NHS Pathways or the Advanced Medical Priority Dispatch System (AMPDS) – which gives a response code, depending on the incident.
“When we do use voice it’s different to the police or fire and rescue service because we’re usually one-to-one – the ambulance goes out and it’s their incident,” he continues. “However we will utilise the group talk function as our primary communications in major incidents and event management.”
The reason Sepura was chosen to provide Airwave devices was more to do with the usability of the units themselves than the systems architecture (which is still important). As with any critical responder the tasks paramedics carry out are extremely specific, which needs to be reflected in the design of their kit. Lucas says the Ambulance Service needed a timestamp function, specific functionality around swapping between talk groups, as well as some ergonomic features that no other manufacturer could provide to the same specification at the time.
The process of dispatching an ambulance and communicating with it while it’s on the scene is relatively straightforward. However, things become more complex once the paramedics and their passenger(s) arrive at hospital, where staff must be mobilised and the appropriate department alerted, often as a matter of urgency.
Guy’s and St Thomas’ NHS Foundation Trust runs two of the busiest hospitals in London and – like the Ambulance Service – is under immense pressure to deal with an ever-increasing workload. To cope the Trust has recently augmented its communications capability with a mobile data-based system designed to maximise deployment of its 1,100 workers.
Once an incident (say the arrival of a burns victim) is declared, the Everbridge platform sends out a notification to key staff either through text, email or its mobile app. If the message isn’t responded to within a set amount of time another communication is sent using an alternative delivery method; a process that continues until it’s acknowledged and acted upon.
The system is built on 19 globally-dispersed data centres, and service is delivered at the coal face by individual commercial mobile carriers or Wi-Fi. This is designed, according to Everbridge, to build in redundancy and resilience wherever the system is used.
As with the Ambulance Service’s increasing reliance on mobile data, platforms such as Everbridge succeed within the fast-moving health environment because of their flexibility. This was apparent during Unified Response, a 2016 emergency planning exercise (based on the scenario of a collapsing tower block in Waterloo) where notifications were sent out en masse to mission-critical staff.
“To me it’s not the method of communication itself that’s important so much as the automation behind it. That’s what allows you to be much more effective in reducing the time taken for people to get to an incident,” explains Everbridge’s managing director, EMEA Nick Hawkins.
He continues: “Historically a procedure document would have existed, which, when an incident occurred, would be consulted before any communication took place. By contrast, Guy’s and St Thomas’ now uses templated scripts, with information including who should be informed, when they should be informed, as well as the type of incident. Response occurs at the press of a button.
“As well as Guy’s we’ve also worked with South Western Ambulance Service to transform its communications, and the money saved through using the system equates to something like five crews of paramedics. We’re very proud of that.”
At the beginning of this year more than 20 hospitals in England declared a ‘black alert’, meaning that they couldn’t deliver comprehensive emergency care. Although overcrowding in A&E departments and other wards has been extreme, GPs are also under severe pressure as well.
Keith Grimes is an Eastbourne-based GP, as well as what he describes as a ‘digital healthcare practitioner’. His belief is that demand for local doctors can be alleviated through the innovative use of 4G and eventually 5G technology, something he is already incorporating into his practice with patient-orientated mobile phone apps and virtual reality.
“Many people working in healthcare are very stressed – burdened even – because of the number of people they’re expected to see,” he says. “However, there are immediately available digital products that can ease doctors’ workloads and make life better for patients.”
In his surgery this includes an Eko Core Bluetooth-connected digital stethoscope that attaches to a traditional version of the device to amplify patient heart sounds and store them via an app. The Cupris otoscope is a funnel-shaped smart device attachment that produces a digital rendering of the inside of a patient’s ear.
According to Grimes there are multiple benefits to using these devices, not least the ease with which the diagnosis can be communicated with both patients and other doctors. He says: “Both Eko and Cupris have platforms that allow you to share information securely with a colleague, which obviously makes it easier to get a second opinion.
“I had a patient who had been poked in the ear with a cotton bud and wanted to know if it was safe for them to fly. I’d usually have to direct someone to the hospital, but I could send the image straight to the ear, nose and throat doctor and get the OK immediately.
“There are huge benefits when it comes to patient reassurance as well because you can show them the images or play them the sounds and develop a common understanding,” Grimes adds. “To be fair, medicine has been quite paternalistic up until now, and this helps us become more collaborative with patients.”
As well as this bespoke medical equipment Grimes is using his own Samsung S7 mobile phone to introduce virtual reality into his practice, specifically around pain relief. On the day we spoke he’d used the phone’s Gear VR headset to provide a distracting immersive environment while a patient was having a wound dressing changed. In a similar vein, he’s currently involved in the development of a virtual reality app to reduce post-operative delirium for patients in intensive care.
While the uses of VR are currently quite limited, Grimes believes that this technology will pave the way for a new era of doctor/patient interaction, particularly as connectivity continues to mature.
“I’ve been looking into if you can consult in virtual reality,” he says, “because if you can you can control two things that aren’t possible in the physical world – the space itself and the flow of time. You can also save huge amounts of effort for both parties.
“If a consultation takes place in virtual space you can go back into the experience to review it, or even change the environment or the appearance of the doctor. Within that there’s probably some powerful clinical tools, and that’s not even considering the possibilities of augmented reality.”
The National Health Service is facing one of the most difficult periods in its 70-year history. While certainly not a cure all, it’s clear that judicious use of wireless communications can ease the burden in many different areas.