Clinician of the Month: Dr Keith Grimes

Dr Keith Grimes is a GP and Clinical Lead for IM&T and Innovation for Eastbourne, Hailsham & Seaford, and Hastings & Rother CCGs. A true digital health innovator and self-confessed geek, Keith is a strong believer in the ability of IM&T to not only support and augment the delivery of healthcare in its current form, but also in the need to radically review existing structures and perceptions of how care can be delivered globally.

Keith’s interest in the use of virtual reality (VR) in healthcare, led to him forming VRDoctors.net; a forum which brings together clinicians, patients and developers working in VR, with the aim of sharing ideas, research and tips about how VR could be used within the clinical space. He also blogs about digital healthcare at drkeithgrimes.co.uk

Here, Keith speaks to DigitalHealth.London about how his interest in VR has led to a project working with the Royal Brompton, his keenness for disruptive technologies, and how he’d love to embed a hacking group inside a GP practice!

Keith on being a digital healthcare innovator

“Digital healthcare, I understand, as being any application of technology in healthcare. That comprises all modern developments including the internet, cloud-based computing, and also m-health, use of video consultations, remote consultations, etc. Essentially, all modern IT developments that are in common use, but in healthcare.

“The innovator part is taking these technologies and applying them in a novel way within my clinical workspace.”

Using digital technology to automate manual processes

“I’ve done a lot of things in an informal or personal capacity to assist what I’m doing day to day, and that goes all the way back to medical school. For example, I was a very early adopter of using personal data assistance, so I had a Psion PDA that I would store phone numbers for different extensions in the ward, and write up notes and reminders to myself.

“When I was a Junior House Officer (JHO), a lot of the work was very manual; there was no computer order system so you’d have to hand-write all the blood tests etc. I wrote an access database to automate that process to save me time.”

“I was a clinical lead for the Electronic Communications Clinical Implementation (ECCI) Programme for a while. That involved electronic referrals, electronic discharges, electronic lab results, appointment bookings and a clinical advice line. We made good progress, including alot of the initial work in terms of helping GPs get access to lab results and radiology, making referrals, and the basics of the urgent care summary, which is operating in Scotland.”

“A great idea has to work well for everyone”

“You’re probably aware of Wikipedia? There’s a bit of software underpinning it called MediaWiki. When I took over a practice in St Leonards, I physically built a hardware server, I installed this software, configured it, and started to build a Wiki to capture everything. The idea was that it would become a sort of, knowledge base par excellence, which the staff in the practice could use. So instead of having a thousand pieces of paper with out of date phone numbers, we’d have an intranet which I could access from anywhere.

“It worked very well for me, but not very well for anyone else because it was a bit too techie; a bit too ahead of its time. This was in 2009/2010. When I moved to the Eastbourne Health Centre, I tried to transplant the Wiki across, and it didn’t immediately work well, for similar reasons.

“That’s a really important thing; it’s not good enough just to have what you think is a great idea that works well for you. It has to work well for everyone.”

How virtual reality (VR) reduced one patient’s pain by up to 90%

“I’d known about virtual reality (VR) for quite a long time. I was excited about this technology – I even had some of it at home that I used for gaming. One of my patients came in with a problem where I thought it could help. I asked them whether they wanted to give it a try, so we talked it through and discussed the risks and the benefits.

“It was used as a distraction method; this was a lady who was really traumatised by having her dressing changed. She’d just recently had a baby so couldn’t take much in the way of pain relief as she was breastfeeding. By simply using a smartphone and my VR headset, we were able to reduce her pain by between 50% and 90%. It was astonishing to watch.

“It’s this story that really highlights the gap between what’s possible… how much we could help if we listened to patients and worked with them, and were a bit more proactive rather than taking a traditional approach.”

VR in healthcare: the sky’s the limit

“You’ve got VR used to reduce pain; in its most simple sense it’s a distraction. It also reduces anxiety which subsequently reduces pain. There’s evidence to suggest that using VR offers pain relief that last beyond the session. We’re not entirely sure why as yet, but that’s really interesting.

“The other key area it can be involved with is mental health. Instead of having a person visualise a situation that makes them anxious, you can actually put them in that situation but in a controlled way. For example, if a person’s agoraphobic and they’re scared about going into a busy railway station. With VR you can teach them relaxation techniques and allow them to experience a quiet railway station, then a slightly busier one, then an even busier one, and get graded exposure.”

Reducing post-operative delirium: VR project with the Royal Brompton

“After I gave a talk at Health 2.0 in London, a doctor called Mr Sunil Bhudia – a consultant cardiothoracic surgeon at Royal Brompton – got in touch about his idea to reduce post-operative delirium.

“The ‘hotel room phenomenon’ provides a good analogy. You go away, it’s a new bedroom, you stay up late, have a drink, go to bed, and then wake up in the middle of the night needing the toilet. You don’t know where anything is and all of a sudden are confused as to where you are. That moment of confusion is a little bit like post-operative delirium.

“You’ve just had a big operation, you’re really unwell and in a lot of pain, you’re in a room where everything’s bleeping and you’re really confused; as you can imagine, you could be pretty distressed. If a person’s really distressed it takes a lot of care and attention to talk them down, and sometimes you have to physically sedate people. If you’re sedating people, you may have to take over their work of breathing so you have to intubate them. They’re in intensive care for longer, they’re taking more medicines, there’s more complications, etc. So managing post-operative delirium is important.

“Mr Bhudia thought that we could use VR to allow patients going into intensive care for a planned procedure, to experience being there beforehand, in a controlled way, so that they can see what it’s like. We could then see whether that helps reduce the rates of post-operative delirium.

“We’re not aware of anyone else having done any research into this. What we’re doing now is using off-the-shelf components – the Gear VR headset, a 360-degree camera – to put together a proof of concept, which we can then maybe formalise into a study. The great thing about using this technology is that it’s available. So that’s our plan.”

Keith on disruptive innovation

“The problem is in the word; disruptive sounds harmful or damaging. But of course it doesn’t mean that, it just means it’s quite an active reshuffling of how you do things – it’s quite extreme change. And of course people get worried about it.

“Disruptive innovation is about looking outside the traditional areas – thinking outside the box. We should be speaking with advertising executives, engineers, artists, patients, designers, and getting their take on health and social care, because they think about things in a different way.

“The world is seeing the benefits of disruptive change in all other fields. For example, when I go up to London, I like using Uber (online transportation network company), because it’s so amazingly useful, cheap and straightforward. All other politics aside, it’s amazing technology. And it’s a disruptive technology. If someone can do that in one field, why can’t we achieve the same in healthcare?”

Encouraging clinicians to embrace innovation

“We need to stop trying to micromanage innovation, so that every time someone has an idea, they don’t have to come cap-in-hand with a 300-page document to try and release the funds to do it. We need to start being a little more trusting, and saying, ‘ok, there’s a fund you can tap into’. Or giving people one day a week to work on innovative projects, like forward-thinking companies like Google do with their staff.”

“I love to embed a hacking group inside a GP practice”

“The thing I’d love to do is actually embed a start-up or a hacking group inside a GP practice. Whenever I mention that to people, they start to get very twitchy. But can you imagine; a modern GP surgery with an office space set aside, in which a start-up worked on something and then could come out and ask the questions they needed, and were supported. It would be an amazing thing!”