{"id":35874,"date":"2020-07-03T16:22:22","date_gmt":"2020-07-03T15:22:22","guid":{"rendered":""},"modified":"2020-07-07T15:46:27","modified_gmt":"2020-07-07T14:46:27","slug":"defining-and-implementing-hololens-and-remote-assist-use-cases","status":"publish","type":"post","link":"https:\/\/cm-edgetun.pages.dev\/en-gb\/industry\/blog\/health\/2020\/07\/03\/defining-and-implementing-hololens-and-remote-assist-use-cases\/","title":{"rendered":"Defining and implementing HoloLens and Dynamics 365 Remote Assist use cases"},"content":{"rendered":"

\"An<\/span>This is a part of a series of posts about how the HoloLens and Dynamics 365 Remote Assist helps the NHS provide patient care. See the other blog posts here<\/a>.<\/em><\/p>\n

Starting from the beginning of March, we’ve learned a tremendous amount<\/a> around the use of the HoloLens 2. We now want to use this to help inform our journey as we move forward with more NHS Trusts and more use cases.<\/p>\n

Defining the objectives for the remote assist use case<\/h2>\n

The healthcare service faces unprecedented challenge when necessities such as physical contact with patients, close teamwork, and regular face-to-face communication suddenly become a luxury.<\/p>\n

One of our partners, Imperial College Healthcare NHS Trust defined their objectives as:<\/p>\n

\u201cThe overriding priority for Imperial was to utilise the technology to improve staff safety, and as a secondary output reduce PPE use. This needed to be achieved whilst at least maintaining the same quality of care for patients. The individual use cases then were found based on team structures and staff who were keen to participate and drive the project forward.\u201d<\/p>\n

Guy Martin, Department of Surgery and Cancer, Imperial College Healthcare NHS Trust<\/em><\/p><\/blockquote>\n

\"DoctorOn the other side of the country at Alder Hey Children\u2019s Hospital, Rafael Guerrero and his team look after children with congenital heart disease in the North West of England, Cumbria, and North Wales. \u201cWe have to quickly adopt the HoloLens 2 and the Remote Assist platform to help our local specialists look after these sick children when they are waiting for the operation,” Guerrero said. “The parents need to be assured that the care of their children is not compromised, and to do this, we need good technology that is proven to work.\u201d<\/p>\n

Process for choosing wards and use cases<\/h2>\n

Patient care and staff safety<\/h3>\n

Imperial’s objective was to create \u201centirely virtual ward rounds\u201d, using the HoloLens 2 as a way to share information and communicate more effectively \u201cat the bedside\u201d.<\/p>\n

The first ward the team focussed on was the COVID-19 ward. It was flooded with patients and general medical teams would have high exposure rates. A classic ward round would include a consultant physician, with two or three juniors plus nurses. That makes a potential seven or eight frontline NHS staff exposed with each patient.<\/p>\n

In the second ward, the team focused on an area delivering specialist invasive respiratory support. Experts are often distributed throughout the hospital so that the value of bringing in an expert into the bedside virtually is invaluable. In addition, the aerosol generating procedures utilised whilst providing respiratory support placed staff at a much higher risk of infection.<\/p>\n

These two examples were also adopted at the Heart Centre at Alder Hey. The number of staff contact per patient during the ward round was five or seven. This was reduced to just one or two with the use of the HoloLens 2 with Dynamics 365 Remote Assist.<\/p>\n

St. Mary\u2019s within Imperial Healthcare NHS Trust, is also a major trauma centre, so that was another key area, alongside the surgery department. The ability for quick remote collaboration with an expert from any discipline, can have major benefits. Not only was the interpretation of the main operator communicated to the external experts, but the entire team can share direct visuals of the problem. This saves time and improves the accuracy.<\/p>\n

Cardiac unit doctors and nurses promptly adopted this unique communication platform. This helped to deliver care at the same standard as it was before social distancing was enforced. Expert care, efficiency, or staff safety were not compromised by the physical barrier imposed by infection control.<\/p>\n

Each of the four use cases were up and running by the end of March and in consistent use with results covered.<\/p>\n

Remote expert advice<\/h3>\n

\"Woman<\/p>\n

Morecambe Bay are a group of small, district general hospitals with limited staffing in a semi-rural area. Because of this, their use cases are focused on using Dynamics 365 Remote Assist to train middle-level clinicians such as Specialist Registrars and clinical nurse specialists. They can then make Teams calls to their on-call Respiratory Consultant Physician, who may be in a different part of the hospital, or on call overnight at home, or in a different hospital in the region. This allows them to take the bedside and patient, wherever they are, and support assessments and appropriate treatment plans, including where necessary, rapid escalations of care.<\/p>\n

The Alder Hey Heart team has also carried out a pilot supporting non-expert echocardiographers (middle grade cardiology trainees, or paediatricians with interest, or non-paediatric echocardiocardiographers) to perform complex ultrasound scans of children\u2019s hearts remotely. Cardiologist Dr Phuoc Duong has articulated that there was \u201cperfect vision\u201d of the echo machine screen and the ability to guide the non-expert operator in real-time. These are also perceived as excellent training opportunities for novices. They are aiming to run a follow-up study on the benefit of training once the pandemic is downgraded.<\/p>\n

Clinical education<\/h2>\n

Like many teaching hospitals in the country, the Imperial College NHS Trust team undertakes vital training roles to future undergraduate and postgraduate doctors. Virtual training rounds have now started to be implemented with positive initial feedback.<\/p>\n

For Leeds Teaching Hospital Trust:<\/p>\n

\u201cOur aim is to explore new technologies to improve medical education. We have partnered with the Microsoft lead ResilientXR consortium alongside Health Education England to build COVID-19 content. In addition, we see a significant opportunity to train the next generation of medical students and have developed a core team of trainees and fourth year medical students to explore mixed reality use cases across the hospital including applications in oncology, intensive care, surgery, and also engage with colleagues in the community\u201d<\/p>\n

Andrew Lewington, Associate Medical Director of Education, Leeds Teaching Hospital Trust<\/p><\/blockquote>\n

What were keys to successful implementation?<\/h2>\n

\"Back<\/p>\n

James Kinross and Rafael Guerrero both shared that in the beginning, there was a fair degree of anxiety. To actually try to deploy new technology in the middle of a storm is hard to do. There\u2019s less resources and less in-person IT support. You\u2019re asking your frontline care workers to do technically difficult things while they\u2019re cognitively over-burdened and stressed and sometimes can\u2019t conceptualise what new technologies can do.<\/p>\n

To this end, there are key tips that are worth calling out:<\/p>\n