Delivering a TeleMedicine Outpatient Shoulder Clinic within the NHS
Prof W Angus Wallace (Consultant Shoulder Surgeon)
Julie Walton (NHS Secretary) Paul Cook (Cisco Systems)Ian Smith (NHS IT Manager) Paula Wilson (Cisco Systems)
Will Monaghan (Business Manager T&O NUH)
Traditional Telemedicine
Consultations anywhere in Nottinghamshire (or the rest of England)
The Challenge of Change
The Challenges• Connections– The Visual system – Skype v Webex– The Audio system – Skype v BT NHS MeetMe
• Computer confidentialitySecurity of ConnectionSecurity of StorageThe Ethics problemsRisk Assessment & Management
• Infrastructure - Community
The NHS Change Agenda• Never underestimate the obstruction to
changes within NHS practice• The introduction of a pilot project to use
TeleMedicine for NHS patients required a total of 17 meetings involving either WAW or Will Monaghan (Business Manager) including the IT “police”
John Peach, Corporate Operations ManagerRory King, Information Governance Manager
• Hugh Porter, PCT Service Change Group•
Next Steps -The Pilot Project
• To evaluate the benefits and problems with running a new Shoulder TeleMedicine Clinic at NUH
• 4 Pilot cases have been successful• Now scheduled on “Choose & Book”• The pilot clinic will start on Tuesday 5th July
2011.• Show value to the commissioners & patients
Requirements for successful TeleMedicine Shoulder
Consultations• 1) An NHS referral of patient with an appropriate
shoulder condition• 2) Either a GP with a computer, camera & N3
link prepared to facilitate the consultation or A computer literate patient with a good computer, broadband link and camera
• 3) X-rays of the relevant shoulder – either on NUH PACS or transferred to NUH PACS. These will then need downloaded onto a PowerPoint presentation to share with the patient.
• 4) A facility to trial the audio-visual link before the consultation
• 5) Consent and approval of the GP and the patient.
The Oxford Shoulder Score (= PROM)
Shoulder conditions suitable for TeleMedicine
• 1) Traumatic instability (i.e. dislocation) problems plus xrays (with a completed Oxford Instability Score).
• 2) Arthritic shoulders with significant shoulder disability and confirmatory x-rays (with a completed Oxford Shoulder Score).
• 3) Post fracture shoulders with significant shoulder disability and confirmatory x-rays (with a completed Oxford Shoulder Score).
• 4) Clavicle malunion patients with significant shoulder disability and confirmatory x-rays (with a completed Nottingham ACJ Score).
• 5) Acromio-Clavicular Joint Dislocations and confirmatory x-rays (with a completed Nottingham ACJ Score).
NHS TeleMedicine Consultation 4th April 2011
Validation of a patient-based modification of the Constant-Murley
scoreAccepted Shoulder & Elbow 2011 – Abduction & Flexion
Validation of a patient-based modification of the Constant-Murley
scoreAccepted Shoulder & Elbow 2011 – External & Internal
Rotation
TeleMedicine Improvements1. Getting GP’s computers installed
with a Webcam2. An Idiot’s Guide to logging on to
Webex3. Resolving firewall and Java script
problems 4. Perhaps changing from the WEBEX to
the MOVI platform
The End