Computers to diagnose disease and cut waiting time in NHS

Experts working on the iCAIRD project at NHS Greater Glasgow and Clyde are in the process of developing algorithms which can mimic pathologists' knowledge of disease, enabling computers to scan for anomalies using digital images of biopsies and tissue samples.

William Edwards, NHSGGC's director of eHealth, said: "Rather than slices being made available on glass slides and looked at under a microscope, what the board is keen to do in put in place the ability for these images to be captured digitally. That way you can look at the pathology sample on a computer.

"That should take us to a situation where clinicians are only being presented with the significant scans and images that need more interpretation, rather than some of the more mundane or routine ones.

"In order for the computer to come up to speed around that, however, it has to learn how clinicians work.

"There is a whole exercise underway now with ourselves and other partners to make sure that we can train the algorithms to read these images going forward.

"In the same way as a pathologist, the algorithm needs to understand when additional information is required or when to zoom into images, and where they might make decision based on the information presented."

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Overall, the goal is to increase the turnaround times for pathology results so that patients can get faster diagnoses and treatment.

It should also ease the workload for pathologists by enabling them to focus on priority cases.

As part of the ehealth agenda, NHS GGC has also just set a target to deliver 20 per cent of all clinical appointments by 2021 via videolink or phone.

This will apply to consultations in seven "priority services": respiratory, rheumatology, diabetic, dermatology, neurology, orthopaedics and the Beatson West of Scotland Cancer Centre.

It builds on pilot schemes such as the trial of 'Attend Anywhere' technology for antenatal care in the Argyll region.

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The scheme allowed consultant obstetrician Dr Liz Blair to run clinics over videolink from the Royal Alexandra Hospital in Paisley, instead of making a 180-mile round trip once a week from Glasgow to Oban.

The mothers would be joined by their midwife who had already taken blood pressure, urine tests, and could update the doctor on any anomalies.

As well as saving time, video consultations are seen as a way of cutting missed appointments.

Mr Edwards said: "We've had some interesting examples so far. There was a patient who found it really useful because he was attending an outpatient appointment with an elderly relative at another hospital site, but was still able to attend his own outpatient appointment at the same time because he could do it virtually - via a videolink - from that site.

"Previously that might have resulted in a cancellation for us because he couldn't have been in two places at once."

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One of the most promising ehealth ventures to date, however, has emerged among patients suffering chronic obstructive pulmonary disease (COPD) - an umbrella term for progressive lung diseases where patients become increasingly breathless.

It affects around 129,000 people in Scotland and remains a major cause of death.

Dr Chris Carlin, a respiratory consultant at Gartnavel General hospital, embarked on a trial in 2017 to monitor - and treat - patients remotely using non-invasive ventilation (NIV).

Doctors already knew that patients with COPD who were admitted into acute units and placed on this type of ventilation would go on to have fewer complications and subsequent hospital admissions if NIV could be established as a treatment for use at home overnight.

The problem was that patients would have to spend several nights in hospital first so that clinicians could monitor their condition and fine-tune the ventilator to suit each individual.

This proved so unappealing to COPD patients in Glasgow that a plans to take part in a UK-wide clinical trial had to be abandoned.

Instead, Dr Carlin recruited 42 patients and set them up with NIV machines and masks at home which were fitted with chip enabling data to be relayed wirelessly to the medics at Gartnavel.

Dr Carlin said: "We can see the data, see how the patient is getting on, and we can adjust the settings remotely."

Results from the pilot show a significant reduction in both hospital admissions and hospital bed days among the participants.

Dr Carlin said: "The median time to next admission improved from seven weeks to 52 weeks. There was a also median reduction of 14 days in hospital per patient per year.

"The results are in line with the randomised trial, but slightly better.

"It's very encouraging to have been able to match a randomised control trial in the real world using a more realistic method - remote management instead of inpatient."