Developing telemedicine for head and neck cancer triage

Katrina Mason is an Ear, Nose and Throat Specialist Registrar training at St George’s University Hospital NHS Trust and a Digital Pioneer Fellow. She is currently collaborating with Ufonia to develop an autonomous telemedicine solution to the clinical application of urgent suspected head and neck cancer triage.

Whilst rotating through the sub-speciality of Head and Neck (H&N) cancer, I audited my department’s activity and was shocked by the year-on-year increase in workload, tangibly reflected in busy clinics which were often frustrating for patients. Having explored this further I saw that this local trend was reflected nationally, with annual increases in referrals of patients with urgent suspected cancer despite marginal increases in cancer rates.

It was during this process that the first wave of the COVID-19 pandemic hit, and I saw first-hand the dramatic effect on workforce capacity, and a profound shift in both the prioritisation and delivery of healthcare. A shift to non-contact interactions was needed to protect both our patients and ourselves, to prevent the disease spread. During this time my governing body, ENT UK, approved the use of a head and neck risk calculator, a set of symptomology-based questions, to triage suspected H&N cancer referrals via telephone clinics to ensure non-contact interactions demanded by the pandemic.

Collaboration

Concurrently I was studying for an MSc in Surgical Sciences & Practice at The University of Oxford. Here I met Ufonia, a digital health company developing Artificial Intelligence (AI) led autonomous natural language telephone calls. I approached Ufonia with a collaboration to develop their technology for my clinical problem: the triage of suspected H&N cancer referrals at my trust.

We then formally applied for an Innovate UK/UK Government Sustainable Innovation Fund Small Business Research Initiative (SBRI) grant supporting projects focusing on sustainable recovery from COVID-19 and were awarded £60,000 to develop this idea. During this project work to date has focussed on demonstrating the feasibility of the idea with movement towards formally undertaking a pilot trial and integrating it at my local trust.

Sustainability

Cognisant of the climate change global health emergency and the significant carbon footprint of the NHS (24.9 millions tonnes of carbon dioxide equivalent, CO2e, in 2020) we formally partnered with the Centre for Sustainable Healthcare to provide a carbon footprint analysis of a current face-to-face H&N cancer consultation versus proposed triage with Ufonia’s technology. The carbon footprint of a face-to-face outpatient appointment was estimated to be 53 kgCO2e, excluding patient travel, in comparison, the carbon footprint of Ufonia’s autonomous phone triage was estimated to be 0.43 kgCO2e (136x less), with no greenhouse-gas emissions from travel. This technology is also significantly cheaper (10-20x), meaning that rolling out this technology on a trust wide scale could provide savings of up to 17 tonnes of CO2 and £538,000 annually, with a potential saving of 19,000 tonnes CO2e and £61 million if rolled out nationally.

Patient involvement and trialling

A patient reference group, with patient-volunteers from the ‘Heads2gether’ H&N cancer support charity together with a clinical reference group from St George’s have helped develop a working prototype conversation through iterative feedback. I have been working on a departmental and trust level to garner support and sign-off for the formal trialling of this technology with support from the H&N Cancer MDT lead, Clinical Director for Cancer Services, Caldicott Guardian and the Clinical Information Change Group. We have applied for a further SBRI ‘Net Zero’ Healthcare grant to help fund a local pilot trial to realise the clinical translation of this digital innovation idea.

Looking to the future

This project has acutely highlighted that we work in an ever changing, ever complex healthcare system, and to enact meaningful change requires an army of experts, champions, and innovators. The DigitalHealth.London Pioneer Fellowship programme has provided me with that army. As a clinician I was a complete novice to the landscape of digital health transformation, however the invaluable knowledge and community gained through this programme has helped facilitate the delivery and continued drive for this project.

I hope that the application of this technology can provide a long-term sustainable solution to the rising demand of H&N cancer referrals, will provide patients with equitable, timely and convenient triage, whilst also supporting COVID-19 recovery by freeing up the medical workforce. I am looking forward to the exciting next steps of formally piloting this technology locally at my trust. 

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