Diagnostics: into innovation
Last week Miles Ayling, Director of Innovation and Service Improvement at the Department of Health, launched a fantastic new website. It is aimed at helping NHS staff to implement the high impact innovations (HIIs) outlined in Innovation, Health & Wealth. The, very user and touch-screen friendly, site provides advice on tough challenges such as evidence gathering, assessing population need and redesigning pathways, as well as proving access to case studies on the implementation of the six HIIs. These include:
3 million lives – 3 million people are estimated to be living with a long-term condition and could benefit from the use of telehealth or telecare services.
Digital by default – aimed at reducing unnecessary face-to-face time, this is the use of technology in providing flexible and convenient modes of communication between patients and healthcare professionals.
International and commercial – the aim of this section of the website is to provide a network which will enable NHS staff to consider the role of the NHS in more broad economical and industrial terms.
Child in a chair in a day – This is a dynamic virtual space for healthcare professionals, commissioners, suppliers, parents and carers to help facilitate better access to mobility services for children and young people.
All this innovations are great – BIVDA is really keen to see the NHS and patients benefit from the most up-to-date technologies – but 3 million lives is really the most exciting HII for BIVDA. Telehealth is the treatment and management of diseases and conditions via the use of telecommunications technology. We see it is having the potential to be a real game-changer as many of these technologies are utilised to collect and transport data or information in order to prevent severe complications and resultant hospital visits. BIVDA loves monitoring and management.
There are some fantastic examples of telehealth being used to help patients self-manage Chronic Obstructive Pulmonary Embolism, Multiple Sclerosis and heart failure, in trusts from Gloucestershire to Yorkshire. 3 million people are estimated to be living with a long-term conditions and could benefit from the use of telehealth or telecare services. As was pointed in our blog on pregnancy tests, testing in the home is not new – patients with diabetes have long been pioneers – but the adoption of technologies which redesign pathways and empower patients to self-manage conditions has not been spread far or wide enough yet. At BIVDA we take this challenge seriously. We are always working to improve our relationships with the NHS and raise awareness for the amazing innovations that our sector provides.
Miles Ayling said recently:
"Innovation, Health & Wealth is all about improving, extending and saving lives by accelerating the spread and adoption of innovation, including new technologies. It is essential, now more than ever, to make better use of high value technologies which improve quality and value in the NHS. This is especially true as the NHS faces the combined challenges of a growing and ageing population, in a much tighter economic climate.
In meeting that challenge, good relationships between the NHS and industry will be key. The UK life sciences Industry has always made available a constant supply of new medicines, devices and technologies, and we need to close the gap between commercial availability and NHS adoption. Diagnostics have a significant role to play here, as they have the potential to enable early diagnosis, streamline pathways and empower patients to self manage long-term conditions. These are exactly the kinds of technologies that I want to see gain easier access to the NHS. We must encourage patients to be given new and innovative choices in their treatments, and I see diagnostics as truly capable of offering this."
So today for this week’s Testing Tuesday, we would like to welcome the launch of the new High Impact Innovations website by taking a look at some of our favourite diagnostic innovations which we want to see become widely adopted and thought of as the norm!
"Breaking an old business model is always going to require leaders to follow their instinct. There will always be persuasive reasons not to take a risk. But if you only do what worked in the past, you will wake up one day and find that you’ve been passed by.” Clayton Christensen, an authority on disruptive innovation - Innovation Health and Wealth
This is the use of computer technology to convert analogue microscopic images into digital images. This innovative approach to the storing and dissemination of images encountered everyday by laboratory pathologists has so many uses. For instance, the digital images suddenly make microscopic images much more durable and portable; they can be viewed on computers without the risk of being damaged in transit. They therefore become tools for education and training much more readily; not to mention easier tools for diagnosis due to the possibility of enlargement and easy sharing. Digital pathology can also be utilized for intra-operative diagnosis.
Unsurprisingly, digital pathology also fits into the aims of 'digital by default'. These 'digital specimens' can be stored for as long as they are needed, with no 'shelf life'. They can be viewed multiple times without having to ask for another sample. Additionally, they can be compared to later samples in order to compare the patient's disease progression.
If you would like to know more about digital pathology, the Digital Pathology Association in the USA has a website.
The Wheezometer® for asthma
One in eight children will develop asthma. However the severity of this condition varies greatly over short periods of time – day to day, night to night, even hour to hour. Therefore effective monitoring of breathing patterns is a good way of evaluating the severity of the condition and response to treatment.
The Wheezometer® measures breathing patterns with great accuracy. This device requires no active cooperation on the part of the patient, they simply record breath sounds for analysis during normal quiet breathing. This is a great example of a technology which could be used in a telehealth approach to asthma as the device can be attached for prolonged recording by day or night and the readings can be transported electronically to the physician, in order for them to obtain a true picture of the variation of breath patterns. This enables a preventative approach to treatment as healthcare professionals can treat the patient with a view to avoiding attacks, rather than treating them when one occurs.
Intra-operative Lymph Node Assay for breast cancer
The Breast Lymph Node Assay (BLNA) is a test which can diagnose the spread of metastatic breast cancer cells to the sentinel lymph nodes of a patient during a lumpectomy. Usually, the lumpectomy will take place and afterwards a sample of tissue will go to the laboratory where a histopathologist will diagnose if cancer has spread or metastasised to the lymph nodes. If it has, there will be a second operation. This methods means, should the news be bad, two operations are needed.
If the BLNA is used, the surgical and pathological team take a biopsy of the patient’s lymph nodes and conducts the test in situ during the initial lumpectomy. Results can be ready in 30-40 minutes. If metastasis of the lymph nodes has occurred the breast surgery can be continued to allow the lymph nodes to be removed. Whether it’s good or bad news, there is only the need for one operation – therefore only one recovery period for the patient!
We like this especially because we view it as having the capacity to work in conjunction with digital pathology methods.
Self-monitoring of International Normalised Ratio (INR) for patients on warfarin
Patients diagnosed with Atrial Fibrilation have to be on long-term oral anticoagulation therapy – often warfarin. This is a toxic compound and needs careful monitoring as the blood needs to be kept within a very specific range. Typically patients will attend a GP surgery or hospital clinic for blood tests every four weeks. However, the use of this point of care device by competent patients to monitor INR from home saves inconvenient trips to the GP surgery and saves NHS resources too.
Like the Wheezometer, this has great telehealth potential, as well as having the ability to contribute toward the aims of ‘digital by default’.
Calprotectin for measuring inflammation in suspected bowel disease patients
This test discriminates between Inflammatory Bowel Diseases (IBDs) (such as Ulcerative Colitis and Chron’s Disease) and Irritable Bowel Syndrome (IBS). Inflammatory bowel conditions require further investigations, such as endoscopy or colonoscopy but by detecting the inflammatory component of IBDs which is lacking in IBS, this test avoids the need for expensive and invasive procedures in a large proportion of those who do not require them. There are clear patient benefits and cost benefits for the NHS – no one wants to use a colonoscopy unnecessarily.
We'll be tweeting about innovation all day on Tuesday 14th August, using the hashtags #TestingTuesday and #in – follow us @BIVDA and interact if you'd like us to tweet YOUR innovations.