Health services around the world are scrambling to deal with COVID-19. The virus massively disrupts services. Modelling the spread of the disease is allowing governments to formulate public policy. Modelling patient flows – operations research – is helping health care organisations to manage the surge in demand – for example by releasing spare capacity and redeploying human and physical resources from elective to emergency care. Infectious diseases create a conundrum for the services since sick people need to attend facilities, but congregation of infected cases in health facilitates increases transmission of the infectious agent. So the trick is to visit facilities virtually (mobile [m] consulting) rather than physically. Enter ARC West Midlands.

We have a well-established programme of m-Health including (but not limited to):

1. Our host hospital, University Hospitals Birmingham NHS Foundation Trust (UHBFT), is working with Babylon Health to enhance its virtual clinic capacity.
2. Building on work of Gill Combes, Sarah Damery and James Ferguson, we plan a more extensive evaluation of the UHBFT m-Consulting programme that is expanding rapidly to cope with COVID-19.
3. From her UK work on m-Consulting Frances Griffiths has quick guides freely available for specialist teams maintaining contact with their patients managing long-term health conditions at home.[1] She leads projects on m-Consulting in Africa and South Asia and, with her collaborators, is developing policy briefs underpinned by evidence-based principles to guide application.
4. Melanie Calvert is an international authority on Patient-Reported Outcome Measures, which could help determine who should attend facilities and who should not. Modern aeroplane engines incorporate sensors that send signals to land-based workshops. This real-time monitoring, rather than just the schedule, determines the need for repairs. Likewise, patients in future will be monitored by their symptoms and test results, and these will be used to trigger visits to the clinic.

ARC WM members are planning a suite of studies in this country and abroad. The COVID-19 pandemic has precipitated a sharp shift towards m-Health / m-Consulting that is likely to prove indelible. In UK general practice all patients are now having phone consultations before any necessary face-to-face contact. Many practices have systems in place for video-conferencing. Last week, author FG took just ten minutes to learn how to use the secure and confidential system via her own phone so she could set eyes on an immune-compromised patient with infection, without asking the patient to leave her place of safety. Patients are learning rapidly too. The same patient could not get their sound to work so they used the landline too – but that patient is now urgently sorting out the sound.

We know that many other centres are also gearing up to study the organisational issues of epidemics generally, and m-Health specifically. M-Consulting warrants study – it is open to abuse/fraud, poor quality control and medical error, and can result in inequalities in care received. Experienced health professionals are good at mitigating these dangers,[2] but we need to understand how to systematise and embed m-Consulting to optimise health gains. We warmly invite other people in the UK and beyond to join our enterprise to share ideas and formulate research plans. In the meantime James Ferguson is leading an initiative to track use of m-Consulting to identify opportunities and barriers, and identify training needs for staff and patients.

Richard Lilford, ARC WM Director
Frances Griffiths, Professor of Medicine in Society

References:

1. LYNC study team. LYNC Study Quick Reference e-book and Topic Guides. Warwick: University of Warwick; 2017.
2. Griffiths F, Bryce C, Cave J, et al. Timely digital patient-clinician communication in specialist clinical services for young people: a mixed-methods study (the LYNC study). J Med Internet Res. 2017; 19(4): e102.