Tekihub – remote GP diagnostics

West Midlands 5G (WM5G) partnered with telemedicine company, Tekihealth to explore how 5G can support the provision of GP care in care homes via the use of connected diagnostics tools.

Eighteen residential care homes across the West Midlands set out to trial the TekiHub, a connected diagnostics kit that allows GPs to conduct full patient check-ups and remote ward rounds. Thanks to the high bandwidth and low latency of the 5G networks, the care solution can move far beyond the capacities of a standard video consultations, allowing the GP to assess and record clinical information in real-time via the device to a degree as accurate as an in person check-up. This contact-free solution supported care home staff in safeguarding residents, limiting the Covid-19 infection risk, while maintaining high standards of care and continuous access and assistance of GPs. 

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What is the problem to be solved?

Care home residents have varied and often complex care needs, so the role of the GP is incredibly important. Access to GPs can often be limited and dependent on attending the care home to undertake check-ups and assessments. GP time and resources are often at capacity with travel time between visits limiting the number of patients that can be seen. 

GP practices are mandated to carry-out regular ward rounds for care homes in their area and, as highlighted, this takes significant time and resource. But there is an additional challenge in relation to ad-hoc needs. If care home staff cannot access GP resource, a default response is generally to call for an ambulance and convey the care home resident to hospital. This can not only consume valuable ambulance time, and then bed and care resource in the hospital, but often the trip is detrimental to the patient’s health and sometimes is terminal. Patients are generally better left at the care home but a GP diagnosis is essential in confirming this choice.

During Covid the challenging situation was further aggravated, highlighting the vulnerability of residents within care home settings. This further emphasised the value of remote monitoring in avoiding limitations in  access to GPs and other medical professionals.

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What is the solution to the problem?

The aim was to create a fully-connected remote care solution, enabling GPs to remotely assess their patients while limiting the risk of Covid or other illnesses to vulnerable patients. 

Thanks to the superior speed and reliability of 5G, the solution is capable of moving far beyond a standard video-consultation allowing the clinician to assess and record clinical information about the patient’s health via the connected Tekihub device. 

The Tekihub device provides a full range of diagnostic equipment usable at the point of need. This includes:

• A hand-held modular device with high-resolution video and still camera, a no-touch basal thermometer, digital stethoscope, otoscope and tongue depressor attachments
• An electrocardiogram (ECG) device to check heart rhythms and electrical activity
• A spirometry test for pulmonary function and breathing assessment.

Commercial model (Business Case)

The business case here is based on three core cost-savings which can be realised through remote ward rounds and ad hoc responses for GPs at Care Homes:

• Time, expense and opportunity cost for GPs travelling to care homes
• Reduced ambulance callouts to care homes 
• Reductions in hospital attendance, admissions and length of stays 

Of these, the first is difficult to quantify accurately but in any case the remaining points are more significant.

Data from the US and the UK Care Quality Commission (CQC) confirm that regular GP engagement and visits to care homes reduces hospital admissions by 40%. Moreover, as of early 2023, at least a quarter of GPs said they were not carrying out care home visits. There is clearly then a gap that remote care home monitoring can fill to deliver ‘visits’ which in turn reduce hospital admittance.

Benefits

The financial benefits of virtual care home engagement flow from the costs associated with unnecessary hospital attendance, admittance and stays – that could be avoided through regular remote visits.

The corresponding health benefits are clear for patients.  World Health Organisation data from 2022 shows that in developed countries out of every 100 patients in acute-care hospitals, seven patients will acquire at least one health care-associated infection (HAI) during their hospital stay. On average, 1 in every 10 affected patients will die from their HAI. Frail and elderly care home residents admitted to hospital are at higher risk than average.. Early or preventative identification of potential health issues is preferred.

Visiting remotely has pollution and carbon reduction benefits through minimising GP travel, and reductions of unnecessary ambulance conveyance.

Lessons Learnt 

• Never underestimate Data Protection Impact Assessment(DPIA) and Information Governance(IG) requirements in NHS organisations – they will take longer and have more complications than anyone suggests.
• Similarly allow ample time for agreeing any required integration into IT systems and procedures.
• Multiple stakeholders with differing objectives need careful and repeated engagement.
• Take care on capital and revenue balance. Here the provision was initially through capital budgets wrapping in the connectivity for a fixed duration but longer-term the ownership and payment for ongoing connectivity was not clear and should have been sorted earlier.
• If using public 5G in urban areas fully check real coverage rather than relying on providers assertions.
• When working with SMEs providing the technology ensure they have appropriate commercial arrangements in place with their own suppliers and/or have alternative providers lined up.