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