Innovation in Surgery – Proximie and UCLP

Continuing with the theme of my previous post, once again I will be discussing medical technology and how it is gradually being integrated into care.

On Tuesday evening, we were fortunate to have Dr Nadine Hachach-Haram, co-founder of Proximie, and Dr Charlie Davie, interim managing director at UCLP, give us insight to the type of the work they do and how their work has an impact on the way healthcare is delivered.

The first talk was given by Dr Charlie Davie. The organisation he works for, UCLP, serves as a platform which provides healthcare professionals the support they need in order to increase the speed at which they get their innovation/ideas into practice. Dr Davie nicely summed it up by stating that UCLP provides a “package” in the form of skill set, funding and the network in order to boost the rate at which these start-ups get going. He clearly highlighted that the NHS can be quite a complicated landscape to understand for a beginner, therefore UCLP offers the “ecosystem” that can provide innovators a clearer sense of direction.

However, the biggest challenge that he finds is common amongst the medical profession, is the need to overcome behavioural changes. As medical technology and innovation is such a new concept, most clinicians reject the idea of choosing to integrate it within their care. I found this very interesting and can somewhat understand as to why this would be the case. For example, at the recent MedTech conference, one of the innovative ideas involved the use of “StethoCloud” i.e. a stethoscope plugged into a phone and connected to an app. The app listens to the patient’s breathing and using its algorithm it determines the diagnosis and possible treatment options (at the moment it is strongly aimed at targeting pneumonia in children). It is an ingenious idea and once perfected it looks like a potential product that could diagnose very efficiently, however I must admit I was a little saddened. Just recently, during our clinical skills sessions, I learnt how to perform a respiratory examination and I really enjoyed being able to use the basic combination of observation, percussion and ausculatation to determine a possible diagnosis. As medical students, it gives you this great sense of achievement and appreciation as to what a doctor, with years of practice and refining of their skills, is able to do for their patient. Therefore, the fact that this new piece of technology is able master the art of diagnosing within months and take over, could be one of the reasons for hesitance to accept the idea. It sheds light upon the fact that many clinicians still perceive medicine as a very traditional profession, where they highly value being able to put their skills to the test and most importantly where they are still able to maintain the patient contact, which after all is what medicine is all about. Nonetheless, as Mr Davie pointed out, as the populations’ demographics and needs are constantly changing, the current healthcare system cannot keep up, therefore practice needs to change. Regardless of how much we value this traditional system that we have/are being trained in, we need to ensure that we can provide the best quality of care for our patients, and the only way this is possible is if we accept and adopt innovation. Naturally, innovation that can work alongside this traditional approach to medicine would be ideal.

After the first talk, we were then introduced to Proximie. I must admit, prior to this session, I had very little knowledge as to what Proximie involved. However, Dr Hachach’s talk left me both informed and inspired.

In summary, Proximie is an AR platform which allows specialist surgeons or clinicians who are unable to access remote areas to provide their knowledge and skill expertise through this secure cloud system. It aims to democratize access for patients globally, from the Royal Free to Gaza, Peru and Vietnam, so patients everywhere can receive the best care without the need to wait or the extra finances. Additionally, it also serves as a learning platform for students and trainee doctors alike. The live streams of the surgical procedures, which are recorded and stored in a library, allow medical students to gain insight to the surgical field whilst also learning their anatomy and it enables trainee surgeons all over the world to observe how procedures should be done. Furthermore, it enables specialists to provide feedback on each other’s work and hence allowing for improvements.

Although I have yet to try out Proximie, I think the programme is fantastic. It definitely works to create a community where every professional in the medical field can strongly benefit. As Dr Hachach mentioned, their aim is to hopefully get the platform to become a strong teaching material at medical schools. Currently, UCL funds for the platform however I was completely unaware. It is a shame such a great programme has not been promoted enough as I know lots of medical students would strongly appreciate and benefit from being able to observe surgery in real time as it would help put the medical degree into context and it would serve as a great reminder for the type of work that we are training towards.

I also posed a few questions to Dr Hachach – here are the summary answers:

1) When you started Proximie, did you consider/imagine it would become a solution to many problems?

Dr Hachach suggested always conducting “synergistic work”, i.e. when you set out with an innovation always work towards perfecting it towards one purpose and hopefully along the way you can accommodate many solutions. In Proximie’s case it started out as a platform where it can provide live streams of AR surgery but now it is used as: a teaching material in the NHS/medical schools, a platform to help those in remote areas access good care and it also allows for feedback and improvement. It has had a “snowball effect”.

2) Surgeons are usually known for not wanting to make their mistakes transparent due to wanting to maintain their reputation. How did you overcome this barrier and get surgeons to use Proximie?

Anyone applying to access Proximie must agree to the license agreement therefore it provides surgeons with a safe data stream. As well as that patients also consent for the procedure to be filmed.

3) Has there been evidence that through specialists being able to provide feedback to one another, Proximie has improved practice?

Proximie are currently in the process of collecting data on the patients’ outcomes and date of discharge. All of which will determine whether it has been able to help surgeons improve their skills and hence ensure better outcomes for the patient.

4) What was the biggest challenge you faced in the whole process of setting up Proximie?

Dr Hachach mentioned learning the system was her biggest obstacle as she did not understand the financial side or the agreements required. However, with the support of many accelerator programmes and her colleagues, who all retain a wide range of skills and come from different fields, she was able to combine their knowledge along with her clinical knowledge/perspective to create the final product.

Overall, it was really nice to hear more about the role of medical technology in care from two professionals who are currently working in the field. Although medical technology still needs time before it can become properly integrated into care, establishments like Proximie and UCLP are beginning to pave the way. One of the biggest lessons I learnt today (and one both Dr Hachach and Dr Davie mentioned) is that the best ideas usually come from the use of existing innovation/technology and being able to integrate them into different pathways to see where they best fit. Through this application you are able to become disruptive in a positive way.

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