Thursday, 06 December 2018
Professor James Ferguson, A&E Consultant, Aberdeen Royal Infirmary
Job Done! A reflection from 2020 on the impact of Technology Enabled Care.
Professor Ferguson was born in Aberdeen and educated at Robert Gordon's College and Aberdeen University, graduating in Medicine in 1983. He was appointed by NHS Grampian as Consultant in Accident and Emergency Medicine with a specialist interest in Paediatric A&E in 1994.
He is a visiting Professor of Remote Medicine to the Robert Gordon University and a Reader in Emergency Medicine with Aberdeen University. He is National Clinical Lead to both the Scottish Centre for Telehealth and Telecare and the Digital Health and Care Institute
As Professor Ferguson retires on the 2nd December 2020, he will take the opportunity to reflect on the drivers and impact of the rapid, widespread, implementation of Technology Enabled Care since late 2018, which has transformed healthcare as we know it.
The president welcomed everyone to the meeting and noted apologies and new members.
Forthcoming events were announced (Burns Supper and annual Jim Petrie Lecture), as well as noting the postponement of the President’s Medal Lecture, which is now likely to be delivered by Professor Youngson in the Spring.
The President then extended a welcome to the speaker, Professor James Ferguson. Professor Ferguson is professor of Remote Medicine at RGU, Clinical Lead at the Scottish Centre for Telehealth and Telecare Digital Health and Care Institute, and Consultant in Emergency Medicine at NHSG.
He delivered his lecture as if he was doing so at the end of 2020, following his own retirement, and with aspirations about what increased use of digital health care in the next few years might look like. Whilst he opted to deliver his lecture humourously, he expressed a strongly held belief that increased use of digital health care is essential for resilience within the NHS and improved health outcomes for patients. Professor Ferguson noted that even the most advanced technologies he mentioned and used as examples already exist and are in use in some countries. He frequently cited Denmark’s use of digital health technology.
There are numerous studies indicating that increasing waiting times in A&E lead to increased patient mortality. Professor Ferguson feels that overcrowding in A&E Departments is a reflection of a poorly running system. It is also known that although 86% of people wish to die at home, only 12% do so. When the current system fails, patients who have opted for “DNR” frequently end up being emergency admissions. Some studies have demonstrated that home monitoring of (at risk) patients reduces A&E visits and emergency admissions, reduces bed days and associated costs, and can result in a 45% decrease in mortality rates. With several studies showing that telehealth care would be effective, the Scottish Centre for Telehealth and Telecare was established in 2010. However, progress in this area of medicine has been slow; there is inertia in relation to the introduction of new practices. The centre advocates:
- Home health monitoring
- Expanding video consulting
- Building on emerging digital platforms e.g. for self-help
- Telecare with a focus on prevention
- Exploring the benefits of a switch from analogue to digital
All of this needs an infrastructure to be in place and the preparatory work for this was done by the Institute. It was felt that most people were not keen to change their current practice and encouraging people to do so has involved a lot of work. Professor Ferguson likened the reluctance to adopt telehealth to the discovery of penicillin, which occurred approximately 10 years before it became widely utilised in WW2.
It is recognised that many patients like technology and this is pushing forward digital health. There is a drive for Scotland-wide implementation of digital health with the following aims:
- Use technology
- Make admission a last resort
- Ensure ACPs are not over-ridden
- Provide support with clinical decision making
- Provide better access to records
- Have remote clinic monitoring systems (already widely used)
Professor Ferguson went on to give several examples of the use of digital technology in health care. All the examples are currently possible. Some are in use already, with some countries adopting the use of digital health care more rapidly than others.
- Use of drones in emergency medicine e.g. survey of the scene, delivery of defibrillator, delivery of medicines to remote sites
- Widely used Fitbits provide a wealth of physiological data, which could be captured and used for clinical research purposes
- Pre-hospital ultrasound-ultrasound probes can transmit data via i-phones, improving clinical decision making at the scene
- Patients with low risk MI could be left at home with the proper infrastructure and home support
- Digital suits can be used in orthopaedic prosthetics by providing accurate 3-D printing of prostheses
- Colon capsules (camera containing pills) can send pictures via a phone link to be analysed, allowing greater precision in deciding who needs colonoscopy
- Patches are available which can assess dehydration e.g. in the elderly
- Use of video clinics is very popular with patients and can allow clinicians time to focus on those most in need of care
- Uses in mental health care e.g. CBT platforms
- Digital platforms e.g. self-help, e-consulting (two GP practices in Grampian have already adopted this)
- Nanoparticles can accurately deliver cancer treatments with less side-effects
- Smart homes e.g. interactive clothing, augmented reality, passive monitoring (such as movements)
The evening concluded with Professor Ferguson answering questions and receiving thanks from the President.