Delivering a TeleMedicine Outpatient Shoulder Clinic within the NHS

1. Delivering a TeleMedicine Outpatient Shoulder Clinic within the NHS • Prof W Angus Wallace • (Consultant Shoulder Surgeon)Julie Walton (NHS Secretary) Paul Cook (Cisco Systems)Ian Smith (NHS IT Manager)Paula Wilson (Cisco Systems)Will Monaghan (Business Manager T&O NUH)

2. Traditional Telemedicine

3. Consultations anywhere in Nottinghamshire (or the rest of England)

4. The Challenge of Change

5. The Challenges • Connections • The Visual system – Skype v Webex • The Audio system – Skype v BT NHS MeetMe • Computer confidentialitySecurity of ConnectionSecurity of StorageThe Ethics problemsRisk Assessment & Management • Infrastructure - Community

6. The NHS Change Agenda • Never underestimate the obstruction to changes within NHS practice • The introduction of a pilot project to use TeleMedicine for NHS patients required a total of 17 meetings involving either WAW or Will Monaghan (Business Manager) including the IT “police”John Peach, Corporate Operations ManagerRory King, Information Governance Manager • Hugh Porter, PCT Service Change Group

7. Next Steps -The Pilot Project • To evaluate the benefits and problems with running a new Shoulder TeleMedicine Clinic at NUH • 4 Pilot cases have been successful • Now scheduled on “Choose & Book” • The pilot clinic will start on Tuesday 5th July 2011. • Show value to the commissioners & patients

8. Requirements for successful TeleMedicine Shoulder Consultations • 1) An NHS referral of patient with an appropriate shoulder condition • 2) Either a GP with a computer, camera & N3 link prepared to facilitate the consultation or A computer literate patient with a good computer, broadband link and camera • 3) X-rays of the relevant shoulder – either on NUH PACS or transferred to NUH PACS. These will then need downloaded onto a PowerPoint presentation to share with the patient. • 4) A facility to trial the audio-visual link before the consultation • 5) Consent and approval of the GP and the patient.

9. The Oxford Shoulder Score (= PROM)

10. Shoulder conditions suitable for TeleMedicine • 1) Traumatic instability (i.e. dislocation) problems plus xrays (with a completed Oxford Instability Score). • 2) Arthritic shoulders with significant shoulder disability and confirmatory x-rays (with a completed Oxford Shoulder Score). • 3) Post fracture shoulders with significant shoulder disability and confirmatory x-rays (with a completed Oxford Shoulder Score). • 4) Clavicle malunion patients with significant shoulder disability and confirmatory x-rays (with a completed Nottingham ACJ Score). • 5) Acromio-Clavicular Joint Dislocations and confirmatory x-rays (with a completed Nottingham ACJ Score).

11. NHS TeleMedicine Consultation 4th April 2011

12. Validation of a patient-based modification of the Constant-Murley scoreAccepted Shoulder & Elbow 2011 – Abduction & Flexion

13. Validation of a patient-based modification of the Constant-Murley scoreAccepted Shoulder & Elbow 2011 – External & Internal Rotation

14. TeleMedicine Improvements • Getting GP’s computers installed with a Webcam • An Idiot’s Guide to logging on to Webex • Resolving firewall and Java script problems • Perhaps changing from the WEBEX to the MOVI platform

15. The End