At the beginning of March, I began a conversation around the #PowerOfDigital in healthcare, sharing my thoughts and experience as a CTO working with many of the country’s healthcare leaders. It’s clear that innovation in digital technology is delivering huge opportunity for true transformation within health and social care, but in some instances adoption can be slow. As Trust’s navigate to what I’m referring to as a ‘new normal’, I’ll be looking at the five areas that should already be harnessing the power of digital technology to deliver this transformation, beginning here with Multi Disciplinary Team (MDT) meetings.
MDT’s come in all shapes and sizes, teams are formed of a number of different healthcare professionals with each participant bringing a particular specialism. These individuals collaborate to form a pool of expertise, experience and skill to make recommendations, decisions and facilitate the highest standards of patient care. This collaboration often extends to multiple Trust’s within region, the community and nationally across numerous disciplines, and can occur at various regularities, often weekly.
With MDT’s across Oncology, Cardiology, Neurology and Gastroenterology to name but a few, there are a variety of participants both within the core team, and extended. Each case review is key to the determined patient care pathway and plan, therefore access to important patient data including radiology images, pathology reports, PACS, PAS and database of proforma is critical if appropriate real time recommendations are to be made. The characteristics of an effective MDT are defined here by the NHS National Cancer Action Team.
In a recent report from the independent Cancer Taskforce, it was stated that the MDT model has revolutionised cancer care treatment over the last 15 years delivering significant improvements in the quality of care, equality of access and overall patient outcomes, yet it also highlights that despite this notable success there still remains some way to go before MDTs are operating to their optimum.
With ever-increasing efficiency improvements expected of the NHS, the dependency of MDTs on infrastructure and technology is increasing. Trusts today not only have to make accurate recommendations, but they must do so quickly. Not only must they determine the best treatment plan, they must implement it right away, all the while maintaining consistent care across primary, secondary and tertiary channels. The optimisation of cost, time and quality is critical if both duty of care and efficiency is to be met.
The Status Quo
The use of video conferencing is far from a new concept, but existing video capability does not necessarily allow for a true collaborative experience, in many instances the video technology underpinning MDT sessions is aged, unreliable and needs replacing. Having now been recognised by national bodies, there is a calling for new standards and interoperability. The challenge facing many Trust’s today is the existence of solutions often born of a point tactical investment or historical purchasing without the underlying buy-in or support of ICT. Solutions can be diverse in user experience, difficult to navigate, overly complex in their deployment, inflexible and easy to break. Many connect to other organisations using just voice (no video) or use low-bandwidth video links resulting in a poor experience, and often do not support the flexibility to connect with mobile participants. In many cases even if there is a good MDT solution in place in one part of the Trust, the end-to-end user experience is still hindered due to inadequate MDT video provisioning both within and outside of the Trust.
This type of deployment concludes in a static solution that is unfit for purpose, expensive to run and poorly maintained. The impact of this is inefficiency and poor performance along with the introduction of risk to patient care. This status quo causes frustration with many participants using workarounds to get their job done.
A New Normal
The good news is that this certainly doesn’t have to be the case. The pace of innovation within collaboration technology in particular has increased in recent years. The level of user experience we are all afforded with personal applications such as FaceTime or WhatsApp i
s rapidly becoming the norm now in enterprise, if not amplified. Much improved hardware and software with commitments to open interoperable standards has resulted in vast improvements. Gone are the days of choppy video, poor audio, delays and people struggling with wires to set a call up.
Those MDTs embracing this new digital technology are enjoying the benefits of a dramatically improved user experience that demands less overall cost and enables more informed clinical decisions. Many are benefiting from taking a holistic view of MDT across their organisation and neighbouring organisations to create a new common baseline user experience, rather than tactically addressing one room at a time. Below, you’ll see one of our MDT community deployments and a great example of an MDT Lecture Theatre. This cancer network is part and the Yorkshire and Humber region serving a population of around 5 million across 6 district hospitals. Take a look at this recent coverage around the great benefits deployments like this deliver.
Whilst we can clearly see the optimum room setup the solution provides, what the picture can’t tell us is just how simple the technology is to use. The host is able to initiate the meeting using a tablet with preconfigured settings optimised for the MDT type, whether than be Oncology, Cardiology or so on. Participant rooms or individual participants can connect quickly and easily at the click of a mouse or tap of a tablet.
Image with thanks to Richard Hill
At the core of MDT is IP based collaboration technology, allowing all participants to connect with ease regardless of their location. This means that clinicians, junior doctors and healthcare professionals no longer have to leave their immediate workspace to participate in the meeting resulting in multiple cost savings such as travel time and expense. No less important, but in many ways more significant, the digital MDT leads to greater satisfaction for those taking part who no longer have to battle the weather, transport and their own workloads. MDTs can be recorded, attached or linked to the patient record or for educational/training purposes.
MDTs are ran efficiently and securely with easy access to information and specialists required to plan and agree care. Within many of the organisations we work with, we see specialists join from all around the world. We have also seen examples of MDTs engaging directly with the patient at their bedside using a video unit on wheels. This type of communication is of great benefit to those trying to understand the psychological impact upon the patient. In a similar manner, innovation such as speaker track also affords participants with insight into a speaker’s body language. Speaker track provides seamless, direct camera switching between active speakers providing a high-quality clear image of the individual speaking. Behavioural observations such as this are often very telling for those making important clinical decisions and diagnosis.
The solution is carefully designed and configured around the functional needs and stands as a centralised collaboration platform fully integrated with ICT. The rooms are simple to support, adaptable and can easily scale over time as those needs develop or change. Carefully designed MDT rooms are also often able to facilitate further functions such as clinician-to-clinician video, external patient consultation or even doctor interviews.
Realising the Possible
We recently worked with a large NHS Trust who are a great example of how a Trust can achieve this type of change. The Team’s had become increasingly dependent on existing technology but this dependence was beginning to impact clinical care and patient risk. The Trust delivered its services across several major hospitals and also partnered with many community providers across the country. An initial assessment established that over 40 rooms were being used for MDT purposes in some form. Standards were variable, not only in the technology itself but also ownership and accountability for the equipment, technical support and service contracts. The video rooms in operation functioned to varying capacities and those that were of a relative standard were so over-subscribed that teams were forced to resort to travel between sites simply to participate in the meeting.
Following this period of observation, we then met with all the relevant stakeholders including both clinical and IT representatives to present our findings. We then guided the Trust through the technology and support service options best suited to their circumstance, business challenges and desired outcomes. A series of room types were defined that had the capability to seamlessly integrate potential future state requirements such as In-Theatre capability. The analysed data and scheduling information combined with the agreed target architecture formed the basis of the business case. The Trust was able to validate both cost and the business case providing an ROI within 9 months. This investment provides an architecture that is able to be repurposed and utilised enabling the financial ROI for other disciplines, but also improve the user experience and ultimately provide better safety and quality outcomes.
So what’s the first step on the transformative journey to a new normal for MDTs? To begin realising the benefits we’ve discussed today and deliver a truly measurable business outcome, I believe a proven methodology must be applied. At the core of this methodology is engagement with key stakeholders, especially those outside of ICT. Existing data and metrics must be gathered and logically analysed to determine the true requirements (both functional and technical). These requirements must then be fully mapped and aligned against what is technically possible and able to be supported. Then the relatively easy parts can begin; design, integration and user adoption.