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Tele Endoscopy E Health Modernising Cancer Services Rachael Hodson Nurse Practitioner Upper GI Disease Hull and East Yorkshire NHST

Telemedicine The use of electronic information and communication technology to provide and support health care when distance separates the participants

A brief history 1955 Nebraska Psychiatric Institute used CCTV 1964 Linked to a hospital 112 miles away 1967 Massachusetts General and Logan Institute used a two way audio visual microwave circuit 1971 Alaska Satellite Biomedicine  demonstrated a project on26 sites 1990s Co axial cable and fibreoptics lead to the growth of telemedicine

Application Pyramid

Delivery Approaches Teleconsultation outpatient visit

Delivery approaches Telemonitor - nurse care

Delivery approaches Store and forward - transmission of images such as endoscopy and radiology

Basic hardware Phone Off the shelf analogue system PCs and WWW for store and forward Desktop system with cameras and teleconference software Room size systems STANDARDS

Peripheral equipment Digicams Data collection devices monitors Sound devices digital stethoscope Visual scoping devices endoscopes Radiology devices ultrasound Wireless and handheld devices

"Asynchronous" Asynchronous store and forward. Time is the variable, image is the constant Synchronous real time image speed versus cost digital quality

Critical questions Is the image quality good enough to make a clinical decision? If required, is the audio quality satisfactory to allow real time , high level communication? Is the transmission speed of the image/ sound appropriate to the application required?

Considerations Where does the consultation take place? Is the relationship between the clinician and the patient, or between the clinician and clinician? Who is responsible - the referring or consulting clinician? Which site determines standards? What about technological updates/ disparity

Barriers to success Human factors local politics/ relationships Cost capital outlay/ sustainability Technical support network design/ management Interoperability Reimbursement Legal and liability aspects Confidentiality Audit/ evaluation

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Staffing solutions RECRUIT RETAIN RETRAIN 20,000 new nurses 1,000 new medical students each year Increased numbers of PAMS

Health Care Practitioners Complement the work of nurses Attractive pathway for under represented groups Facilitate optimal use of senior hospital staff for better acute patient care

The Future Healthcare Workforce Direct recruitment following degree level education Multiple entry points Two to three year training programme Based on “ Modern Apprenticeships” Access to Health care courses recruit better than traditional nursing courses

Duties of Health Care Practitioners Assessment and emergency treatment of patients Communication with patients and relatives Verifying expected deaths Ordering and undertaking diagnostic tests Admission or discharge of patients Giving first doses of drugs Performing ECGs Development and implementation of treatment plans Supervising/ teaching juniors Prescribing from a limited formulary

Considerations Practical training on wards and departments Post qualification, move to a particular professional stream Transferability of skills Registration of grade Accountability v responsibility

Community endoscopy 1% of the UK population have an endoscopy each year. Surveillance and screening programmes 28 endoscopy in primary care units identified in 1995. Annual throughput by 22 units ( 1995) 4506 upper GI endoscopies 3972 lower GI endoscopies

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New ways of working in surgery Project by Modernisation Agency Collaborative venture between education and clinical arena Endoscopy pilot for non medic, non nurse endoscopist Determine core skills required to competently perform flexible sigmoidoscopy

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Benefits Access Enhance efficiency of care provision Reduced time to treat Enhanced professional communications Cost savings Rural access improved

Benefits Reduced travel Reduced repeat endoscopies Reduced non attenders Cost system maintainance / compatibility endoscopist time

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Why progress to telemedicine? Just in time care Improved quality Enhanced efficiency Improved professional communication Catchment area increase Increased patient satisfaction cost saving

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Opportunities for tele endoscopy Transmission of endoscopy Direct and indirect supervision of HCP Complex communications Instigation of investigations/ admissions Reverse image transmission for teaching Conference supervision

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