Enables any NHS Hospital to provide a virtual cardiology outpatient experience remotely to any NHS General Practice

Introduction

The CLOUD describes a way to use the internet / intranet to store, host and share data and software. This means that it’s accessed through a computer network rather than on a local computer. Applications can run independently from particular computer and server configurations and be shared between users.

Overview

The ECG CLOUD telemedicine vehicle is operated by NHS Bradford and Airedale Information Technology Services and runs on software developed by Technomed Limited.

The ECG CLOUD infrastructure enables any UK cardiology service provider, whether NHS hospital, GPwSI service or private sector, to remotely provide cardiology outpatient services to any NHS GP practice within the UK.  This flexibility allows a commissioner to choose the most appropriate provider based on their offering of service levels and price. A list of “partner” cardiology service providers is available on request.

All software applications, for all end users, both for the GP and cardiology expert, are hosted centrally on NHS servers and are accessed via a browser based interface. All data is transmitted securely over the NHS N3 Network.  Information governance issues are managed by NHS Bradford and Airedale Information Governance Team.  This arrangement assures simplified deployment and ongoing operation together with system resilience.

Background

ECG reporting services to date have claimed they reduce secondary care referral reduction rates by approximately 60%. Part of this reduction has been achieved by ECG over-reading and partly by the provision of ECG equipment. A practice that does not have its own ECG machine would be expected to refer more patients to secondary care for basic cardiology investigation than one that has its own ECG machine, thus the expected rate of referral reduction due to the actions of the reporting service will be highly dependent on the current number of practice based ECG machines within the locality.

 Hospital outpatient departments still continue to see inappropriate secondary care referrals, even from those practices with an ECG over-reading service. 

The headline figure for secondary care referral (cardiology plus A&E) following use of an ECG reporting service is 9.5%^[1] (based on a dataset of 3422 ECG’s). In comparison, a specialist led primary care cardiology outpatient service, with access to the patient and patient history, in addition to the ECG, would be expected to refer 4.8%^[2] of its patients to secondary care (based on a dataset of 1954 ECG’s).

Service Provision

The ECG Cloud seeks to improve on remote ECG reporting through delivery of a virtual cardiology outpatient experience directly to the GP practice. This is achieved by:

1. Provision of hospital grade ECG and ECG holter equipment to the primary care site.
2. Secure digital high fidelity transmission to the analysis and interpretation service via NHS N3.
3. Transmission of the relevant patient history with the ECG data file so the interpretation of the ECG can be carried out in the context of the patient.
4. Delivery of a recommended action plan together with the diagnostic result.
5. Provision of a live audio visual consultation facility with a cardiologist allowing comprehensive remote assessment of the patient and enabling detailed management plan discussion with the practitioner.

By directly engaging specialist cardiology expertise at an early stage, secondary care referral only occurs if the diagnostic result indicates that secondary care attention is immediately required or that all diagnostic or treatment options have been exhausted in primary care.  This strategy has significant economical and patient healthcare benefits. 

Further information

[1] Karen Gibbons et al, Wireless Telemedicine in Primary Care Phase 1 Report, Greater Manchester & Cheshire Cardiac and Stroke network, 2008, estimates that a telemedicine 12 lead ECG interpretation service would prevent 64% of secondary care ECG referrals.
http://www.gmccsn.nhs.uk/cmsupload/Wireless_Telemedicine_in_Primary_Care_phase_1_report_v5.pdf

[2] Dr Matt Fay, Westcliffe Cardiology Service, Westcliffe Medical Centre, Westcliffe Road, Shipley, BD18 3EE, (01274) 580787. Results of internal audit of remote ECG service.