Autonomous Telemedicine

Supply and demand

Due to an ageing population and increased expectation, the demand for many services is exceeding the capacity of the clinical workforce. As a result, health workers are facing a crisis of burnout from being pressured to deliver high volume workloads, driving increasing costs for health and care providers. The COVID-19 pandemic has further exacerbated the demand / capacity mismatch due to the widespread cancellation of elective care creating a large backlog of clinical work (Illman, 2020).
Cataract surgery is the most common operation at most hospitals and the NHS sees 450,000 procedures every year. With an increasingly ageing population, the number of patients with cataracts is set to double by 2050. With high levels of patient safety and few complications, cataract surgery still requires a post-operative checks to monitor complications and assess success which is normally done with face-to-face appointments. Not only do these appointments add pressure to already stretched services but they are also high risk for the virus transmission due to the close proximity of clinician and patient. 
Artificial intelligence, in the form of conversational agents, presents a possible opportunity to enable efficiencies in the delivery of care.

AI technology to enhance care

 Autonomous telemedicine company, Ufonia has developed AI technology in a natural language AI assistant and call system - DORA. The system will conduct a real-time two-way conversation with patients that will substitute a face-to-face outpatient appointment. It will capture key clinical information and patients will be able to ask questions about the next steps in their recovery e.g. when to drive, swim and stop using their eye drops.
The 'Autonomous Telemedicine' project will evaluate the effectiveness, usability and acceptability of DORA, comparing to an expert human clinician.
It is funded by an Artificial Intelligence in Health and Care Award (part of the NHS Artificial Intelligence Lab managed by the Accelerated Access Collaborative in partnership with NHSX and the National Institute for Health and Care Research (NIHR) and will be evaluated by Dr Edward Meinert and his team at the University's Centre for Health Technology.
View DORA in action.
<p>A side view of a nurse checking an x-ray.<br></p>

</p><div>Macro Eye - Abstract extreme close up shot. Beautiful eye colored by a rainbow of colors by Laura Lee Cobb, courtesy of Shutterstock</div><p></p>
<p>Optometry equipment</p>

A standard of care

Dr Edward Meinert from the University's Centre for Health Technology leads the evaluation of the project that will see the implementation of Ufonia’s automated telemedicine platform to deliver calls to cataract surgery patients at two large NHS hospital trusts.

Dr Meinert and his team will be evaluating the efficacy of DORA’s decision making in comparison to an expert human clinician; baseline sensitivity and specificity for detection of true complications; evaluation of patient acceptability; evidence for cost-effectiveness; and to capture data that may support further studies.

Results are expected to be published in 2022.

Reduce the burden, benefit the patient

Fitting in with the NHS Long Term Plan, the project aims to reduce the clinical burden on health staff by reducing the number of patients who require face-to-face follow-ups with clinicians with the aim to reduce this by 90%. This task has been proven to contribute to health staff burnout as a high volume, repetitive task and will allow them to focus on other outputs that will have a greater impact on the patient journey.  Providing the follow up over the telephone reduces the risk of COVID-19 transmission from face-to-face reviews, and frees up hospital space which will be at a premium due to social distancing measures and lack of capacity for increasing patient demand.

For the patient, it is hoped this intervention will be accessible for an older demographic as it doesn't require patients to download any application, be provided with any device or receive any training. They receive a call and have a conversation just as they would have done with a human clinician. It will mean they do not need to travel to hospital and can arrange a call for a convenient time.

Dr Edward Meinert

Dr Edward Meinert is Associate Professor of eHealth at the University of Plymouth. A chartered engineer, European Engineer, a Fellow of the British Computer Society and Chartered Management Institute, Edward was previously Sir David Cooksey Fellow in Healthcare Translation at the University of Oxford. 

With extensive experience in data science, his research focuses on the use of digital technology in healthcare including mobile digital apps, wearables, robotics and clinical artificial intelligence with a primary aim to enable preventive healthcare.

Find out more about Dr Meinert.

<p>Dr Edward Meinert, Associate Professor of eHealth, Centre for Health Technology</p>

Centre for Health Technology

Bringing together digital health and health technology expertise from across the University to drive the development, evaluation and implementation of innovative technologies, products, services and approaches to transform health and social care.

Find out more about the Centre for Health Technology
<p>Online tele medicine isometric concept. Medical consultation and treatment via application of smartphone connected internet clinic.<br></p>