Virtual healthcare: Care over IP
The Covid-19 outbreak has put working from home centre stage, but what happens when you work in a hospital or doctor’s surgery? Paul Milligan speaks to those proving remote/virtual alternatives for patient care.
2020 was the year the world embraced remote working, albeit an enforced change driven by the Covid-19 pandemic. For most that meant a fairly straightforward transition from office to home. In other industries where that shift isn’t possible, like retail or live events, everything was shut down. When you are caring for sick people, especially during a global pandemic, shutting down isn’t possible so those in charge of healthcare organisations were forced to investigate remote technology to help keep things running as normal.
The modern form of telemedicine has been around since the internet became widespread at the start of the 21st century, with various degrees of success it has to be said. A major issue back then, which is still an issue today is IT infrastructure. Healthcare organisations are not rolling in cash, so investment in IT/AV is always subject to strict budget limitations. Hospitals budgets are directed where they are needed most and that is keeping people alive. But with the emergence of AVoIP, technology is now able to do more for less and that is where the opportunity lies for both buyers of this tech (administrators of healthcare organisations) and the sellers (system integrators). If we look at just India alone, a recent EY-IPA study said the domestic telemedicine market there will reach €4.6 billion by 2025, with 15-20% of the healthcare ecosystem expected to shift to virtual care. So the opportunity is definitely there.
Two great examples of technology currently pushing the envelope in healthcare can be found in the cities of Adelaide (pictured above) and Liverpool. The University of Adelaide’s Faculty of Health Science has used Igloo immersive technology to create a shared immersive space without the use of VR headsets. In the centre of the Immersion Room students see a live hospital simulation and view scenarios such as basic life support, the remaining walls display presentation slides, and 360° footage of a hospital ward. By being able to capture and play 360-deg video from anywhere, students can be transported to healthcare facilities in other locations, or they can follow medical procedures in the 360-deg environment.
In Liverpool, Alder Hey Children’s NHS Foundation Trust, with the help of Insight, is using Microsoft’s MR products (HoloLens 2 and Dynamics 365 Remote Assist) for a number of acute care use cases. The Heart Centre at Alder Hey is using HoloLens 2 to support clinicians in acute care scenarios whilst remaining heads-up and hands-free to concentrate on their tasks – allowing users to share information and their exact view in HD without pausing their work or holding additional devices. This has helped to reduce the number of clinicians around the bedside during ward visits, support emergency procedures by dialling in additional expertise when required and enhance surgery by using visualisation of 3D models to aid clinicians when performing heart procedures.
These two examples have really proved their worth during the Covid-19 outbreak, but was there demand for virtual healthcare systems before the outbreak, or has interest purely been trigged by the pandemic? “What Covid-19 has done is speed up that rate of change. The demand was always there, we’re just seeing an acceleration of plans for virtual/remote healthcare requirements,” says Darren Clayman, MD of UK-based integrator IDNS. The requirement for new healthcare AV systems has even evolved during the time of Covid adds Clayman. “At the start of the outbreak it was very much about finding the easiest solution to virtual/remote healthcare. This meant purchasing high volumes of webcams and headsets, but as time has gone on, we’re seeing requests for more innovative systems across the entire healthcare spectrum.”
The demand was clearly there before Covid, and encouragingly for the AV sector, the demand’s there in a variety of ways; “Before Covid hospitals were experimenting with remote operations to allow specialists to operate on people in areas that are difficult to reach. There are also experiments going on with AI and triage robots in the ER,” says Stijn Ooms, director, product strategy AV and digital workplace, Crestron.
“We saw hospitals asking for more and more remote solutions, for example a radiologist in a hospital is often on standby in case an emergency case comes in, but in many cases they live close to the hospital, so they were asking for a remote reading system so they could read images from home with the same accuracy as they would in a hospital,” says Filip Pintelon, Barco’s senior VP and GM healthcare. “When Covid hit that desire became an absolute requirement for many hospitals because they didn’t want the radiologists to fall sick,” he adds.
Pre-Covid the initial use of video in healthcare was to enable collaboration within hospitals, across Trusts and across specialist clinical networks says Sam McMaster, director of telehealth for Hospital Services Limited (HSL), a UK and Ireland-based specialist distributor of medical and surgical equipment. “This gave them the confidence to adopt the technology for external patient monitoring use such as remote paediatric and neurological care. This was driven by more affordable and improved performance of consumer and computing electronics, and faster bandwidth.”
It may sound crazy to even ask, but have those supplying technology to healthcare clients actually seen an uplift in business since the pandemic hit, or has everyone just moved to (free/trial versions of) Zoom/Teams to keep in touch? And will this demand last once the outbreak is over, could Covid do for virtual healthcare what it has done for corporate video for example? “When the crisis began there was a rush to use all sorts of expedient, easy-to-access, non-integrated video clients,” says McMaster. “Our service operations centre was called upon to help unsupported, and in many cases, unsupportable connection scenarios. The biggest demand we saw was to support a much larger number of outpatient virtual consultations in the time immediately following the initial wave of the Covid-19.”
HSL does expect the use of tech to sustain once the outbreak has subsided and is actively planning ‘much more’ business post-Covid, but virtual healthcare isn’t suitable for all patients says McMaster. “Peoples’ expectations and awareness has shifted quite dramatically. Most people see the shift towards video as a benefit, others will still want to be treated in the conventional way. Not all patient interactions can be achieved in a telehealth manner, therefore hospitals/GP surgeries will still need to stay operational for some time. In one community we support the expectation is that 30% of all patient visits can be moved to telehealth. This is a huge number and will change the NHS forever,” (The NHS is the UK’s health system).
Things have change irrevocably says Ingo Aicher, MD of specialist UK-based healthcare integrator Jones AV. “We’ve seen a paradigm shift in remote healthcare applications. Systems previously deemed unacceptable even for more basic applications such as interdisciplinary team meetings have suddenly got the go ahead. We now see the use of Teams, Zoom or Webex, which pre-Covid would have been unthinkable. Surgeons have taken to consult with patients through Teams/Zoom/Webex etc which also seemed impossible. Covid has already done for healthcare what it has done for the video meetings market. It’s revolutionised a long dormant lying subject. And it’s not only the meetings, it’s in areas like remote consultations with patients and also fields such as home diagnostics.”
One absolutely key issue here is infrastructure, as mentioned already, budgets are very limited, and many hospitals were built pre-internet (pre-World War II sometimes), so network infrastructure is often basic (and that is being kind). Is the infrastructure in place often a barrier to installing the type of systems mentioned above, is it capable of transmitting HD/4K scans/video? “We have seen hospitals in the UK where a 100mbit network is still the standard and this limits the transmission and quality immensely, given that there is already plenty of traffic on the hospital networks,” says Aicher. Infrastructure is often a barrier confirms Ooms, “A delaying factor in the adoption rate is how high the resolution is that is needed in virtual healthcare, for instance to analyse medical imagery or assist remotely in a surgery. The resolution that can currently be offered reliable through unified communication tools, is not sufficient.” This is something Crestron is actively looking to address adds Ooms, “If you remain in the same building, working on the standard 1Gb network infrastructure, Crestron NVX can help in healthcare. Suddenly a doctor can operate from a different room or consult with a specialist in another part of the hospital.” It is when you want the images/video to leave the building you may encounter problems he adds, “If you want to perform a remote operation from another side of the country or globe, stabile 5G adoption is a must, everywhere around the globe you need a 100% guarantee that your network is reliable and stable, because latency could literally mean the difference between life and dead in these cases.”
There are other factors around infrastructure too, and the problem gets worse once you move out of major cites explains Clayman, “In the less affluent areas and those with a large senior population, access to the internet and connected devices can be limited. This can also be the case in more rural areas.” To address this IDNS is currently working with a large hospital to provide remote healthcare via pods setup in public locations.
Are there any workarounds if the infrastructure isn’t reliable? “In the event that no suitable network is available then the devices and their host application will store the images locally and then forward them into the patient record and imaging system within the hospital network. Most imaging systems in use support a mode known as ‘light view’ which allows the clinicians in the telehealth session to look at parts of the image as necessary, basically to focus in on a particular part of the image,” says McMaster.
Another major issue with the adoption of virtual healthcare systems is security, if you are transmitting intimate medical details over a global network the legalities when that goes wrong (hacking, leaks etc) can be highly damaging in a myriad of ways. How do you set the internal IT teams at ease so that the AV systems you’re installing are not going to make the network vulnerable? You have to get your internal processes right first says Pintelon. “Within Barco we have a programme around ISO27001 to really make sure that all of our internal processes are secure and the way we develop code and the way we test code. Then we have test protocols on the software to validate and verify it, and one the components and open source software we use, so it’s all managed by us and controlled by us.”
The good news is that IT teams within healthcare organisations are starting to soften their stance to new tech says Aicher, “The sudden acceptance and use of conferencing software has significantly changed the thinking in many IT departments. A lot of the concerns and stumbling blocks have shifted. Where it used to take months of risk assessments and having to alleviate fears, deployments are becoming easier and more the norm.”
Finally, are there any tips to convince those in purchasing for healthcare organisation to make the leap? “You need to demonstrate how your product is going to help with clinical benefits and efficiency. Efficiency benefits are nice but the clinical benefits are really what gets traction and gets them interested,” says Pintelon. The good news is the outlook is bright according to Clayman, “We have found is a real thirst for new technology. Most professionals agree that the systems they are using are outdated and need improving. They are already using far more sophisticated technology in their day to day lives and can see the benefit of transferring this to their working practice.”