EBME Expo
engineering to create the patient care pathway at home, and this new role could be key to delivering this. Patient-Enablement Engineers and
Technicians would work exclusively in the space between acute care and social care with their clinical colleagues. They would not only require the full remit of engineering qualifications and skills, but in-depth clinical and social care knowledge, as well as management and customer service experience.2 “With all of this wonderful technology that we
develop, we have to consider the engagement of the patient – right from its concept and development, through to its use. I think that’s something that engineers need to be thinking about now,” said Helen. “We have an opportunity to prepare the younger generation to ensure that they are ready to work alongside the patient in bringing this technology to the bedside – bringing it into people’s homes. This is an aspect of ethics that we need to consider in this conversation,” Helen Meese asserted.
Technology’s impact on care delivery The Network continued to talk about the wider impact of technology – including the hospital at home and telehealth. Tracking of medical devices in the community will need a strategic plan, supported by technological solutions. The Network discussed how maintenance and monitoring systems are being built into today’s technologies, which will allow predictive maintenance of devices and allow the assets to “monitor themselves”. The group pointed out that the scale of
technological change over the next decade will have a major impact on the way healthcare is delivered. We have already seen technology, in the form of social media, change our society dramatically, over the past decade, so we will need to be prepared and look ahead to see what is on the horizon – from AI, machine learning, and robotics, to personalised healthcare. The focus is likely to be on how to deliver healthcare at home, rather than patients having to go to their GP or the hospital, but it isn’t going to be a single technology that is going to deliver this change; it will be a combination of multiple technologies. One of the thought-leaders predicted that
“everything on the planet will have a chip” and will become connected to the internet. Robots will be “sat at reception desks in hospitals”, and they will have an increasing role in performing surgery. Due to advances in AI, surgical robots will become more intelligent and increasingly capable of making “decisions around which operation to perform” in order to improve patient survival and outcomes. Patients will have wearable devices to enable remote monitoring of their health – whether it is their vital signs or management of their disease. Others commented that the human element in patient care will still be important from an ethical perspective – giving a clinician’s perspective, Rob Brothwood, Chair of the EBME Expo Operating Theatres Conference, pointed out that patients experience high degrees of anxiety when undergoing surgery and anaesthesia. “If we removed all the human element and just relied on machines, I’m not sure how I
would feel about that. Certainly, machines are more accurate, they don’t get tired, and there’s no emotions in stressful situations. There is a role to play, therefore, but I think we should be slowing up on replacing actual skills of educated people,” he commented. Returning to the topic of the hospital at home, Aidan McIvor, Chief Clinical Engineer and Medical Device Safety Officer (MDSO) for Defence, pointed out that deploying equipment outside of the hospital setting is a major aspect of military operations.
“While the driving factor is going to be
different with the NHS, the more devices you put out there, the more you will have to consider in terms of how to support them from a workforce perspective,” he commented. He pointed out that as technology advances, engineers will need more IT skills – he wasn’t confident that today’s EBME workforce have the necessary training.
He highlighted some important considerations: l What happens if there is a problem with the Wi-Fi connectivity in the patient’s home? How will this affect the function of the medical technology and what needs to happen?
l Will the EBME workforce have the IT skills and knowledge to tackle this connectivity issue?
l As more devices are deployed outside of the hospital, will there be the workforce numbers to support this?
l How long is a piece of equipment going to be down with the patient connected to it and what is the potential patient impact?
He added that previously separate organisations will have to work together on achieving connectivity of these devices in patients’ homes – collaboration will be key. Joe Emmerson, Head of Clinical Engineering
at Manchester University NHS Foundation Trust cautioned against initiating Hospital at Home projects without early involvement of clinical engineers, without adequate guidance, and without the required resources to support this model of care. “We are not equipped to govern it. We don’t
have engineers that are readily available to send out to the community. There is no business continuity planning. What happens if that device fails? What about the device selection and the principles of managing devices?” he commented. To “jump aboard a moving train” is going to be very difficult for the clinical engineering community, he pointed out. “Patients don’t want to be in hospital. They want to be at home or treated in their local community. That is the way to treat patients, but we’re not equipped,”
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