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A University College London Hospitals (UCLH) project to provide tuberculosis (TB) screening services to vulnerable people has been extended to other medical conditions – and is evidence of how the latest information and medical technologies can combine to change the way healthcare is delivered.
UCLH and its IT partners developed a mobile screening service that consists of a van carrying software designed to support TB diagnosis and treatment. The scheme visits groups susceptible to the disease – such as the homeless, drug addicts, destitute migrants and people in prison – screens for TB and instigates treatment if needed.
According to Alistair Story, founder and clinical lead of the pan-London Find & Treat service, the combination of vulnerability to certain conditions among some groups of people, and the difficulty for them to identify symptoms and visit hospitals, made an outreach programme vital in finding and treating the disease.
Now in its second phase, the project – which uses mobile devices, networking, storage and security IT to complement medical technology – has moved beyond TB to include other conditions, including influenza, hepatitis C and HIV. And rather than just store the results of tests, it will share data across the NHS in real time.
On the project's extension, Story described the service as essential, particularly with the UK facing a “hepatitis C timebomb”. This is the only disease that is increasing in the UK, he said, and the liver condition could be found and treated more effectively if the screening services go to potential sufferers rather than waiting for them to visit hospitals.
Story added that through mobile screening, diagnosis and treatment of the condition can be started in as little as eight weeks rather than six months or more. “The learnings we got from the TB programme we can directly apply to the treatment of hepatitis C," he said.
Story explained that during the 1970s and 1980s the NHS reduced its fleet of vans that would provide TB screening services because cases of the infection reduced.
But in 2002 UCLH borrowed a mobile screening van from the Netherlands, which – despite its small population – continued to invest in these services at a time when the UK offered no mobile screening at all. “We borrowed a van and found three cases of TB in three days. It was clear there was a lot of undiagnosed TB out there,” said Story.
In 2005 the UCLH got its own van and has since screened 135,000 people, finding 500 cases of the disease.
But the project that uses mobile devices, networking, storage and security IT to complement medical technology is now going beyond TB.
The software used, known as iTrics, was developed by Spargonet and UCHL. It is a modular system with a registration at the front end and then a workflow.
Mobile devices, which are connected to the van, are used by medical staff to screen people and the results send for secure storage in a cloud provided by cloud hosting service provider 4D. The van is Wi-Fi enabled to ensure that it can connect at different locations but also doubles up as a 4G receiver to guarantee connectivity. The devices become useless when they move a certain distance from the vans for security reasons.
Story describes how the service has evolved from being about finding cases of TB to ensuring that patients are taken through treatment. “When we first started in 2005 we just had a van and over 50% of cases were lost. We needed to find and treat.”
The system was designed to be modular and therefore flexible enough to use for other conditions and the project will be repeated in other parts of the UK.
According to Story, the project could contribute to a new approach to healthcare in the UK. “The future of healthcare is moving away from building massive hospitals and waiting for people to come to them,” he said.
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