Pictured above: Margaret Whoriskey, the Scottish Government’s Head of Technology Enabled Care and Digital Healthcare Innovation; Iain Trayner, TEC Project Manager; Dr David Ross, Respiratory Consultant; and Steven Jardine, BBC Scotland.
Innovation often begins with a flash of inspiration — a light bulb moment. For Iain Trayner, his light bulb moment came in 2016 while watching a demonstration of a Clinical Video Telehealth encounter during a tour of the Minneapolis VA Health Care System.
Trayner, the technology-enabled care manager for National Health Service (NHS) Western Isles in Scotland, marveled at how VA could remotely connect patients with their providers through mobile telehealth carts outfitted with diagnostic tools and video equipment.
The wheels began to turn in Trayner’s head as he thought about how his team at NHS Western Isles could use VA’s telehealth model to improve health care access for the facility’s remote and rural patients, many of whom traveled half a day or more for a 10-minute consultation.
“I saw how VA could reach people in very remote areas and provide equity of service to those who may live quite a distance from the main health centers,” said Trayner. “I thought, ‘This is absolutely perfect.’”
Roadblocks and Breakthroughs
After returning to Scotland from Minneapolis, Trayner set about implementing a video telehealth model at NHS Western Isles similar to VA’s, but he found himself facing a significant roadblock: equipment.
“I tried to find video equipment like the VA telehealth mobile carts with monitors and all the diagnostics that were a part of it,” said Trayner. “I couldn’t find anything like that in the U.K., which I thought was quite bizarre, but it just wasn’t available.”
Left with no other options, Trayner and his team assembled their own telehealth cart. They obtained a high-definition video camera, the same model as the one used with the VA carts, which served as the cart’s centerpiece. Once the team had a workable telehealth system, they were ready to hit the ground running.
The first health care specialty the team tackled was dermatology. Providers in Scotland had been using video consultations for some time, but the inability to perform accurate diagnostics had always proved a major barrier. Now with the HD camera, a remote provider could perform common dermatology exams on a patient aided by an on-site telehealth technician as if they were all in the same room, such as looking at individual hair follicles on a patient’s skin or peering into the patient’s ears or throat.
After seeing success with dermatology video consultations, Trayner and his team applied a similar approach to hand surgery. The new telehealth model enabled health care teams to perform minor procedures and injections on patients under the supervision of a remote telehealth clinician, transforming the hand surgery assessment process. NHS Western Isles’ hand surgery telehealth model earned the facility the Innovative Remote and Rural Service Award at the 2019 Holyrood’s Annual Scottish Digital Health & Care Awards.
Increased Access for All
Trayner and his team have put the patient experience at the center of their telehealth efforts, seeking to relieve them of the burdens associated with rigid schedules and lengthy travel. Video consultations have also removed some patients’ obstacles to receiving care.
Instead of traveling up to 14 hours to sign a form or for a 10-minute consultation, patients can talk with their provider in a setting that is convenient and familiar to them. Before, they would dedicate an entire day to attending a consultation, often having to take time off work, arrange childcare, or figure out transportation.
Patients with limited-to-no mobility, like older adults and patients with disabilities or progressive conditions, are all especially benefitting from having the option of video consultations. Trayner said, “We now have patients asking, ‘Can we do this on video?’”
Trayner and his team’s work has also given clinicians more flexibility, allowing NHS Western Isles to use its limited staff of specialty clinicians more efficiently. Previously, a provider from Glasgow, Scotland, would venture out to the Western Isles once a month to complete assessments or perform procedures. Now that same provider can see patients in different locations within Scotland and across the U.K. all in a single day.
“We are a small island health board. A lot of our consultants and clinicians are based on the mainland,” explained Trayner. “We have to fly patients to the mainland or fly clinicians to the island to receive care. Embarking on a video telehealth model has allowed us to reduce the travel time for both the patients and the clinicians.”
Looking Backward and Forward
Reflecting on the progress NHS Western Isles has made in providing telehealth services over the past three years, Trayner attests that none of it would have been possible if it hadn’t been for his initial visit to VA.
“A few years ago, we hardly had anything. Now we have 21 services using video consultation, and it’s all pretty much a result of that initial engagement with VA,” Trayner said. “It was only when I got to the VA facility that I realized these people have been doing this for years and years, and we are only just starting to do it. It was a great opportunity to be able to draw on that level of expertise.”
Trayner and his team plan to continue developing NHS Western Isles’ telehealth capabilities and demonstrating the service’s impact. The team has begun collecting data showing the savings in cost, time, and carbon footprint from the reduction in patient and provider travel. The guiding light for NHS Western Isles’ innovation is the idea that their team, like VA, can continue making health care more efficient and continue improving patients’ lives in the years to come.
About the author: Treva Lutes is a communications specialist for VA’s Office of Connected Care.