01.06.12
Keeping an eye on things
Source: National Health Executive May/June 2012
Mick Cole, consultant at Torbay Hospital, talks to NHE about the benefits of new diagnostic technology.
Diagnostic capabilities are set to improve at South Devon Healthcare NHS Foundation Trust, which has recently bought new digital imaging equipment for the eye clinic of Torbay Hospital.
Consultant Mick Cole told NHE that the new technology is set to transform services and allow greater research potential to be realised.
The equipment, developed by Spectralis, is “very high specification”, Cole said, offering the ability to produce high quality images. These added diagnostic capabilities are now required for participation in many clinical trials, he explained.
“You have to be competitive to be selected as a centre for national and international trials. The criteria they sometimes use to select their centres include the quality of the equipment available because of the quality of images that you can obtain from the new equipment; that’s why it’s really quite important.”
Open to opportunities
The types of research opportunities available with such technology are expanding, Cole said, with significant investment in trials for patients with age-related conditions such as macular degeneration and glaucoma. This is only set to increase as the average age of the population rises.
He added: “There’s a wealth of national and international clinical research trials going on in the ophthalmic field, and there’s an increasing demand because of the size of the population and the ageing of the population with all these age-related diseases.”
Developing this expertise locally is important, Cole suggests, as patients could get access to new treatments more quickly. He said: “We benefit from developing the expertise locally in terms of new treatments more readily and more rapidly than one would normally do in a clinical practice that wasn’t engaged in clinical research.
“Once you have experience in participating in trials and have the staff trained to provide a research service, it then opens up opportunities to generate local research. We hope that in years to come, engagement in research in this way will improve the standards of care locally and recruitment of staff.”
Virtual diagnostics
Apart from the opportunity to modernise and engage in clinical research, better equipment allows the use of ‘virtual’ diagnostics – which can save time and cut costs.
Cole commented: “If you’ve got a good enough image of the retina, it begs the question, is it actually necessary to see a clinician to make a diagnosis or to make a judgement in terms of management?”
This concept is currently being explored all over the UK to find ways of reducing the number of outpatient appointments required. Good quality images allow technicians to take some of the workload away from the clinician, who is then sent the images electronically, without having to attend the patient appointment. This benefits clinicians, whose workload is consequently reduced, as well as the patients, who will spend less time in the department.
He suggested that such imaging technology could be used beyond the eye clinic in the future, saying: “We’re exploring the quality of these images to see if virtualisation (i.e. patients are not seen by the clinician) is achievable and can then be potentially expanded and developed beyond the boundaries of the eye department.
“If a clinician can view 50 images in a very short time, instead of seeing those 50 patients in several clinics taking a lot longer, it can radically alter the whole patient pathway, the framework and the funding of services. It opens up new ways of providing a clinical service in the modern era. This is why digital images can change the way clinical services are provided.”
Another advantage of obtaining newer and more modern equipment is that it is generally easier for technicians to use, meaning savings can be obtained in terms of training.
Cole said “Quite frequently it is more userfriendly for the patients as the photographs, images and scans generated by the new equipment are completed much more quickly and with greater patient comfort. These are additional reasons for trying to keep up to pace with new changes in technology.”
Keeping up
The issue with such rapidly advancing technology is that new equipment is constantly being developed, with cost constraints limiting trusts’ ability to buy the newest model. This means it can be difficult to stay up to date, especially at times of major financial pressure.
Cole said: “The technology is changing all the time; it’s like computers coming out every year. That’s an issue. To keep up to date with the quality of the equipment one has to change them and in order to change them you have to find the capital outlay to do that. That can come from a number of funding streams, one of which is the potential generated by research, or generated by the local community.”
The funding for the equipment at Torbay’s eye clinic included major donations from both the Torbay Hospital League of Friends and the Torbay Medical Research Trust Fund. Although reduced budgets can make it more difficult to maintain the newest level of technology, Cole suggested that opening up possibilities in research could lead to further fields of revenue, which in turn could help to sustain diagnostic equipment.
He explained: “I think the financial pressure makes the whole environment more challenging. It is probably relevant to think in terms of modernising a clinical service in conjunction with engagement in research and involvement in the community. There is a collaborative networking requirement, in order to take forward a department.
“Developing research has to go hand-in-hand with modernising clinical services. I hope new imaging techniques are going to be one of the things that can modernise a clinical service and make it more cost effective as well as of a higher calibre.”
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