Autonomous Telemedicine

Due to an ageing population and increased expectation to live longer, the demand for many services is exceeding the capacity of the clinical workforce. As a result, health workers are being pressured to deliver high volume workloads which in turn drives increasing costs for health care providers. The COVID-19 pandemic has further exacerbated the demand / capacity mismatch due to the widespread cancellation of elective care which has created a large backlog of clinical work (Illman, 2020).

Cataract surgery is the most common operation in the UK, with the NHS seeing 450,000 procedures every year and the number of patients with cataracts set to double by 2050. With high levels of patient safety and few complications, cataract surgery still requires post-operative checks to monitor complications and assess success. This 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 virus transmission due to the proximity of clinicians and patients.

Artificial intelligence, in the form of conversational agents, presents a possible opportunity to enable efficiencies in the delivery of care.

Autonomous telemedicine company, Ufonia has developed AI technology in a natural language AI assistant and call system - DORA. The system conducts a real-time two-way conversation with patients that substitutes for a face-to-face outpatient appointment. It captures key clinical information and patients are 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 aims to 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.

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

Dr Meinert and his team are 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 they are capturing data that may support further studies.

Results are expected to be published in 2022.

 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. The overall aim is to reduce this by 90%. A high number of face-to-face appointments has been found to contribute to health-staff burnout as it is a high-volume, repetitive task. Removing this will allow practitioners to focus on other outputs that will have a greater impact on the patient journey, and will be beneficial for patients as it reduces the possibility of virus transmission.

For the patient, it is hoped this intervention will be accessible for an older demographic as it doesn't require patients to download applications, 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.