Enhancing rural patient care with 5G in Inverclyde

Description of the problem or challenge:
Inverclyde faces some of the highest levels of deprivation in Scotland, with life expectancy and health outcomes significantly below the national average.  One in four residents is aged over 65, with this figure expected to rise by 38% by 2050.  Chronic conditions such as COPD, diabetes, and heart failure are disproportionately prevalent, placing immense pressure on overstretched services.  Meanwhile, traditional care pathways struggle with delayed access to GPs, A&E, and hospital-based support.

Care homes in the region had no previous remote monitoring infrastructure in place.  In the community, existing telehealth services relied on dated PSTN infrastructure or broadband Wi-Fi, which limited access to high-quality video consultations, particularly for digitally excluded or low-income households.

Barriers to development or adoption:

• Inconsistent broadband and limited 5G penetration in some areas
• Building infrastructure obstructing in-building 5G signal
• Limited digital skills and confidence among staff and patients
• Technical integration with NHS clinical systems
• Short pilot duration limiting full outcome measurement

Who are the sector operators and suppliers involved?

• Docobo Ltd: Supplier of the DOC@HOME platform, patient app, hardware, and implementation support
• Inverclyde Health and Social Care Partnership (HSCP): Clinical delivery and care pathway coordination
• Vodafone: 5G connectivity provider, supporting technical enhancements such as antenna reconfiguration

The I-FIVE project was designed to address these issues by trialling high-speed 5G-supported remote patient monitoring and video consultations in the homes of 20 COPD patients and across two residential care homes supporting up to 120 residents with complex health needs.

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Care Home Patient being assisted by Care Staff to capture the Patient Data using the DocoboApp

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Vodafone 5G Coverage Map for Care Homes Located in Greenock West

Detailed technical solution:

• Community COPD patients were issued 5G-enabled tablets preloaded with DOC@HOME and a structured COPD question set.
• Patients submitted daily data from home to the DOC@HOME platform via the 5G Network which was triaged at the Clinicians Portal.
• Video consultations were initiated by the care team when alerts were triggered or for routine wellbeing checks.
• In care homes, staff used multi-resident tablets to input data and complete assessments using tools like RESTORE2.
• Clinical teams accessed submitted data in real time and could initiate video consultations with staff and patients directly.
• A Patient Clinician Workflow example is shown below. 

Implementation and deployment:

• 20 COPD patients received 5G tablet kits for home use.
• Two care homes (Little Sisters of the Poor and Alt-Na-Craig House) received four shared-use tablets, supporting approximately 120 residents.
• Cellular modems were installed to mitigate weak indoor 5G signals caused by stone buildings and concrete infrastructure.
• Clinical staff were trained in use of the platform, video calling, and interpreting patient-reported data.

Suppliers involved:

• Docobo Ltd: remote monitoring platform, app development, and medical hardware.
• Vodafone: 5G infrastructure and network engineering (e.g. antenna down-tilt for coverage improvement).
• Inverclyde HSCP: frontline delivery, training, and clinical triage.

Connectivity requirements:

• Video consultations and high-bandwidth data transfers required a stable 5G connection, ideally at speeds of 10 Mbps or higher.
• In areas where 5G penetration was low, Vodafone installed Gigacube cellular modems or adjusted antenna configurations to ensure signal quality.
• Where buildings presented signal attenuation challenges (e.g. Faraday cage effect), signal boosters and powerline Wi-Fi extenders were trialled.

Network options and considerations:

• 5G offered reliable and fast communication for video consultations without requiring home broadband—especially beneficial in low-income areas.
• In-building Wi-Fi generated from 5G cellular modems helped increase compatibility with existing devices in care homes.
• PSTN and 4G were used as fallback options in locations where 5G coverage remained poor.

Key enablers:

• 5G-enabled Android tablets (DocoboAPP preloaded)
• Medical-grade vital signs monitors (BP, SPO2, thermometer)
• Secure cloud infrastructure (data presented to clinicians via portal)
• RESTORE2 and NEWS2 scoring integration in care homes

Energy consumption:

1. The devices used were low-power tablets designed for continuous monitoring and were supported with regular charging infrastructure.
2. Cellular modems added minimal energy load and were installed in accessible locations.

Safety considerations:

1. DOC@HOME is a medical device regulated under CE marking.
2. All clinical data is encrypted and stored securely.
3. The system includes escalation protocols for clinical review in the event of alerts or deteriorations.

Product integration:

• Plans are in place for future integration with NHS systems such as TrakCare and EMIS to improve data flow across care settings.
• RESTORE2 scoring is embedded in the platform to support ambulance service referrals.

Patient Clinician Workflow Example

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1. Patient enters Blood Pressure Data using the DocoboApp on the 5G Tablet Device and it is transmitted to the DOC@HOME Platform via the 5G Network

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2. Clinician views the Patient Data using the DOC@HOME Clinicians Portal

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3. Clinician Triages Patient Data and Alerts displayed on the Clinicians Portal

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4. Clinician generates NEWS2 Score on the Clinicians Portal from the Patient Data if required

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5. Clinician makes a secure Video Call Directly to the Patient via the DocoboApp in response to the NEWS2 Score and alerts and determines if an intervention is required

Financial returns and efficiencies:

• Evidence from Inverclyde’s original 2009–2010 pilot showed a 78% reduction in hospital admissions among COPD patients using telehealth.
• Whilst the I-FIVE project was too short to replicate those reductions across a broader population, early feedback from patients, clinicians, and carers indicates reductions in unplanned face-to-face contact and A&E attendance are likely to follow.
• This premise is supported by the evidence from another Docobo/Graphnet Health Customer - Frimley Health and Care Integrated Care System who have enrolled over 8,000 patients onto their remote monitoring programme (before the introduction of the 5G enabled Video Call).
• An initial independent analysis of early outcome data for the first 3,673 patients enrolled is showing benefits including a 38.6% reduction in A&E attendances, 53.7% reduction in admissions and a 26.7% reduction in outpatient appointments.  The reporting also shows a 19.4% reduction in GP contacts, a 36.1% reduction in 999 calls, a 36.9% reduction in 111 calls and 7.6% reduction in the volume of prescriptions issued for remotely monitored patients. A parallel programme, which enrolled over 1,000 patients in 13 care homes had similar results.
• The report concluded that the direct savings from the first three of these measures concerning hospital attendance will be in the region of £5m-£8m annually.
• 5G enabled Video consultations introduced in the I-FIVE Project add another dimension of care particularly for deprived and rural communities where broadband penetration may be low allows clinicians to triage more efficiently, prioritising in-person visits only where clinically necessary so further savings can be anticipated in Inverclyde  
• Conditions to realise savings:
• Ongoing engagement and support for digital adoption among patients and care staff.
• Continued rollout of enhanced connectivity infrastructure (e.g. 5G modems, antenna adjustments).
• Integration with local referral pathways and emergency services.
• Timescales to realise savings:
• Some operational efficiencies were realised within the four-month pilot period, particularly through reduced delays in assessments and prescriptions.
• Broader system-level savings (e.g. reduced hospitalisations, long-term condition stabilisation) are expected over 12 - 24 months with sustained rollout and wider adoption.
• Experience from other Docobo deployments indicates that timescales to deliver impact could be as little as 3 – 6 months. 
• Estimated size of market:
• The current I-FIVE Project solution addresses 120 care home residents and 20 COPD patients in Inverclyde.
• With 25% of Inverclyde’s population aged over 65, and significant levels of multimorbidity, the solution is scalable across the region and in the shorter term the aim for the Docobo and Inverclyde HSCP partnership is to address the 11 additional Care Homes in the Inverclyde Region.
• Potential exists to expand across the Glasgow City Region and replicate the approach in other rural or digitally excluded areas.
• The new 5G Enhanced DOC@HOME Remote Patient Monitoring Solution also offers greater potential to address the overseas market opportunities for chronic disease management.  
• The global burden of chronic disease is immense and continues to grow, affecting individuals, health systems, and economies worldwide, with an increasingly ageing population experiencing increasing co-morbidities, aligned with an increasingly limited clinical and financial resource requiring innovative solutions to maximize efficiencies 
• Chronic diseases are responsible for 74% of deaths globally, and in the UK and US alone, over 7 million people suffer from Heart Failure, and over 20 million suffer from respiratory diseases such as COPD.
• Globally, this increasing burden of disease is replicated to a lesser or greater degree across all healthcare systems as the table below shows for UK, Austria, Germany and USA.
• The Docobo DOC@HOME Remote Patient Monitoring System is a flexible system that can be configured to support patients with multi-morbidities concurrently thus increasing the market potential.
• Investment options – CAPEX vs OPEX:
• Initial equipment costs were funded through a grant of £63,000 5G Innovation Fund.
• Inverclyde HSCP has secured additional funding for FY25/26 to support the ongoing use of the system, enabling a move toward sustainable operational expenditure (OPEX) models.
• For a wider deployment, the experience from other implementations is that our customers lean towards a mix of CAPEX for the equipment and OPEX for the service. 
• Procurement considerations:
• The Docobo DOC@HOME Remote Patient Monitoring System is a CE-marked medical device and Docobo together with its parent company Graphnet Health Ltd already meet all the NHS procurement standards (e.g. DTAC) and are approved suppliers to the NHS.
• Docobo/Graphnet Health are fully accredited to ISO 27001 and ISO 9001 plus ISO 27018 and CyberEssentials Plus.

• Device compatibility, Android updates, and Knox security integration need to be reviewed as part of procurement. While some patients may choose their own devices the use of the devices supplied by Docobo which are locked down after addressing any such issues beforehand greatly adds to the security and ease of use.

  Sources of funding:

• 5G SCSP Innovation Fund (initial pilot).
• FY25/26 continuation funding secured by Inverclyde HSCP for service expansion.

• Further funding opportunities are being explored in collaboration with regional partners and academic institutions.

  Upskilling and training costs:

• Initial training was provided to clinical staff and care home workers as part of implementation.

• Training will continue as part of business-as-usual rollout, including support for digital literacy and use of clinical scoring tools.

  Cost to scale up:

• The Costs comprise both CAPEX and OPEX elements, 
  • CAPEX: Equipment costs – Patient Devices- Phone or Tablet, Medical Peripherals - Thermometers, Blood Pressure Machines etc. 5G Cellular Coverage Enhancing Devices e.g Cellular Modems.
  • OPEX: Running Costs – Device SIMs Airtime costs, DOC@HOME Platform Server Costs in the form of a Licence for Community or Care Home patients, Video Service Licence, Training Courses, Installation Costs.
• Each overall Contract and the cost thereof are therefore unique and will depend upon the requirements of the Contracting Health Authority, the length of contract, location and numbers of patients, community or care home and their individual clinical need and the quality of the 5G coverage.
• Also to be noted that some OPEX items such as the SIMs are subject to a minimum contract length set by the Cellular Network Provider
• Please contact info@graphnethealth.com should you require further details and specific pricing for your requirements.

• As a non-committal example at the time of wiring for sustained monitoring and based purely on the deployment in the I-FIVE Project with 20 COPD Community Patients and 2 Care Homes with 120 patients the annual cost per patient is estimated to be in the order of £550 per annum. [Note: This does not constitute a quotation and is provided as an example].

  Can a business case calculator tool be provided?

• The business case calculator tool would be unique to each contracting authority, so a generic tool is not available. 
• Examples for the proof of the business case are given in Case Studies from other Docobo customers which are available on the Graphnet Health Ltd Website www.graphnethealth.com or contact info@graphnethealth.com
• Docobo Ltd offer support to develop the business case for future deployments

• Engagement with the MNO enabled the enhancement of the signal strength through the modification of antenna parameters to focus the 5G signal in rural or signal-poor areas bringing cellular network coverage to specific points such as Care Homes where none previously existed.  In turn this enabled the use of 5G Cellular Modems to provide indoor wifi in buildings again where none was previously available particularly those whose construction tends to block direct cellular connection, thus improving general Health and Wellbeing for all the residents.     

Health and wellbeing:

• Early detection of health deterioration through daily monitoring of vital signs and symptoms.
• Reduced delays in treatment and faster access to antibiotics or urgent intervention.
• Increased confidence among patients in managing their conditions, improving independence and quality of life.
• Improved continuity of care through consistent data sharing between patients, carers, and clinicians.

Efficiency:

• Clinicians can triage remotely using real-time data, reducing unnecessary face-to-face appointments.
• Care home staff have clearer clinical guidance to escalate concerns using RESTORE2 and NEWS2 scoring.
• Integrated video consultations have streamlined care pathways and reduced the need for in-person assessments.

Social and emotional:

• Patients and families reported reduced anxiety due to more frequent monitoring and digital access to care teams.
• Clinicians noted stronger connections with patients through regular virtual check-ins.
• Families expressed reassurance knowing that loved ones were supported by a digitally connected care team.

Environmental:

• Reduction in clinician travel supports the NHS’s net zero goals.
• Fewer ambulance callouts and A&E visits reduce carbon emissions associated with emergency response.

Economic and system-level:

• Avoided emergency admissions and same-day GP appointments relieve pressure on overstretched services.
• Potential for long-term cost savings as demonstrated by earlier telehealth studies (e.g. 78% reduction in hospital admissions during 2009–2010 pilot).
• Foundation laid for wider rollout across Glasgow City Region and replication across other clinical pathways.

The Clinicians Perspective: 

Quotes from the Care Homes - The Benefits of the System

Little Sisters of the Poor Care Home – Clinical Lead – Cristina Minda

 “We did have a resident with a chest infection.  Usually, the protocol is you do your observations in the morning, then eight o'clock you are on the phone with the GP, and you usually wait around half an hour, an hour to get through the receptionist.  Then the receptionist will pass to the GP who can take around five, six hours to come in.  Then for the GP to come leave us a prescription for us to send it to Boots to the pharmacist, to then being delivered to the home.  So, it does take 10 hours.  I would say it can take exceptionally long.

While for this specific resident, we did our observation set in the morning.  We went on the Docobo, put the request to the liaison nurse who called in half an hour.  It's usually less than two hours when they would respond to an alert.  She was able to come in less than two hours,

assess the resident and prescribe an antibiotic.  We had antibiotic in the building within five hours.  The resident did receive the care really fast, and the resident had the best options to get healthy again.

James Gallagher – Senior Carer – Little Sisters of the Poor

“One of our residents was displaying symptoms of a UTI so when we picked that from the drop-down list, we then get questions, what are they displaying?  What are the symptoms?  You’re filling out a lot of information based on how that resident is reacting to what you initially think it is.  That information then will go straight to the district nurses who will get back to you in an agreed timeframe which is usually two hours.  So, with the UTI we got a phone call, and we explained some of the same answers again on Docobo and from that the district nurses were able to prescribe an antibiotic which were able to get that day which saved a lot of distress for our resident.  If we didn’t have that system in place what would normally happen is we would phone the GP with the same information who would request a sample first, which would be a day.  They would then decide whether they would issue an antibiotic which could be another day.  So, you’re adding two days of distress to a resident, which could be fixed in two hours with Docobo.”

Do’s:

• Engage parents early and meaningfully.  Personal conversations at pick-up and dedicated training sessions helped to achieve a high uptake rate (91%) and ensured parents were confident in supporting their children.
• Choose the right technology.  Selecting a durable, child-friendly fitness tracker with simple app functionality (Garmin Junior) was key to successful adoption.
• Use data to tailor activities.  Step count data and parent feedback directly informed the creation of new, more appealing physical activities, including inclusive options like drama and interactive video games.
• Work with local partners.  Collaborations with Get Active Coaching, local clubs, and OneRen allowed the project to deliver activities that staff alone could not have offered.
• Support digital inclusion.  Providing devices, offering flexible support options, and making paper surveys available ensured broad participation across different levels of digital confidence.
• Track wellbeing as well as physical activity. Using SHANARRI indicators and the Leuven Scale gave a fuller picture of impact beyond just step counts.

Don’ts:

• Do not underestimate the time required for data collection.  Without real-time syncing or a centralised dashboard, manual data gathering from multiple devices was time-consuming and could not be sustained long-term.
• Avoid relying solely on digital methods for engagement.  While digital tools were key to the project, maintaining face-to-face contact was vital for ongoing engagement and reducing drop-off in participation.

Don’t assume all children will engage equally.  A small number of children were reluctant to wear the devices or participate in activities, highlighting the need for flexibility and understanding individual preferences or needs.      Where children have sensory issues, different straps could be a consideration.

• Do not overlook the importance of post-launch momentum.  Parental engagement waned over time.  More check-ins or group sessions throughout the project may have improved data submission rates and maintained enthusiasm.      Equally having access to real-time leader boards, accessible through 5G connections may have maintained momentum.
• Do not wait to solve connectivity limitations.  The lack of a 5G connection limited the ability to share real-time data and create interactive elements such as leaderboards, which staff and children would have welcomed.

Best Practice Guidance:

• Combine technology with human connection and community support.
• Ensure all stakeholders, from children to club partners are involved in the design and feedback process.
• Design activities with inclusivity in mind to appeal to both sports-enthusiastic and less active children.
• Consider sustainability from the start, including device lifespan and opportunities for future funding or partnerships.