Improving access to remote examination in general practice during COVID-19 with EMIS partner Arc Health

As an innovative practice in a forward thinking CCG (Bromley), Knoll Medical Practice (KMP) in Orpington has pioneered the way in integrating Arc Health remote examination technology to transform and improve access to general practice.

KMP rapidly found that the benefits of using Arc Health remote examination technology included:

  • improved access to care for patients
  • collaborative working to promote safety and infection control measures
  • potential reduction in antibiotics stewardship and prescribing for ENT complaints 
  • implementation of a mini “hot hub” stations to promote care within their practice
  • effective management and communication with unwell patients
  • managing GP workload more effectively

What was the challenge?

An estimated 60% of normal general practice (GP) consultations required examination prior to Covid-19 however, only 5-10% patients at present are being examined face to face in practice (1).

Although technology has aided us in streamlining consultations more fluidly, some fairly alarming examples of “missed diagnosis” with our new normal in remote consulting include persistent cough missed as heart failure without stethoscope examination, lung fibrosis or pleural effusion misdiagnosed and treated for chest infection, worsening dyspepsia despite treatment which was an ovarian mass due to missed palpation opportunities and skin lesions missed due to technical quality of sub-optimal video or photographs; all of which have been recognized as medico-legally disadvantageous. 

In addition to missed diagnosis without the conventional face to face consultations, there is a diminished doctor-patient relationship, missed subtle non-verbal cues and powerful signs of watching the patient’s demeanor to determine gait and missed signs of domestic violence. “There is an absolute need for examination technology like Arc Health which can support our patients with remote consulting in this climate.” Dr Prashanth Sathiagnanam, GP Partner from Knoll Medical Practice.

What were the opportunities?

Recognizing these detrimental implications without regular consultations, KMP introduced the Arc Health station into their practice, providing a platform for remote examination of blood pressure, oxygen saturations, temperature, auscultation of heart and lungs, ENT examination using an otoscope and dermatology examinations using a fibre optic handheld camera to facilitate their consultations in a safe and innovative way.

During the unprecedented service changes, the practice realised they were able to use the novel technology advances to offer safe and effective access for patients, reduce workload, create a greater resilience for practices, and an improved primary care offering for the CCG.

What did they do?

KMP used a 2-layer triage system with initial use of e-consultation or telephone triage followed by remote examination with Arc technology. They have been able to safely examine suspected Covid-19 positive patients creating their own valuable in-house mini “hot hub” dedicated centre using an Arc Health station. A service in addition to existing measures already provided by the CCG. 

Feedback from use of Arc suggested that the oxygen saturation probe was a key diagnostic tool for management of suspect Covid-19 patients, particularly useful in sign-posting patients to hospital or providing reassuring safety net advice for home care.

The most valuable asset has been the Arc otoscope. Clinicians have been hesitant to examine ENT given the Covid-19 risk and have been more inclined to prescribe antibiotics via telephone triage. With the use of the Arc otoscope for imaging, KMP hypothesized that there will be a significant reduction in the prescription of antibiotics issued for ENT presenting complaints.  

Dr. Sathiagnanam has also been “impressed with the stethoscope technology and the ability to alter the volume for use in heart sounds and lung sounds” creating an experience that was similar to the face to face use of chest examination. 

How did Arc Health improve case outcomes?

KMP demonstrated a poignant case example in an asthmatic suspect Covid-19 infection patient with increasing shortness of breath. Following telephone triage, the patient attended for examination using the Arc station. With one way entry and minimal contact to practice staff, the patient was safely able to enter the premises and stay isolated in the Arc dedicated examination room. Using the patient self-examination equipment, KMP clinicians were able to remotely assess the patient’s status, review his chest to clearly ascultate audible wheeze, measure his reduced oxygen saturations, high temperature and fluctuating blood pressure as part of a thorough remote examination assessment.

The patient was extremely reluctant to attend A&E during triage, however with the detailed vital sign monitoring, the clinician was able to quantitatively share their level of concern with the patient, finally convincing them for an appropriate hospital admission. Dr. Sathiagnanam stated “when the Arc station was used to examine the patient’s chest, the detailed examination data received meant that there was no further value a GP could add by being present face to face in the consultation”

Where can Arc Health fit into the wider practice?

“During the covid-19 era, there is undoubtedly added value with the use of Arc in practice.”  Arc Health can have additional value in extended hours services, out of hours services (OOH), urgent care centre (UCC) models, digital “hot hub” models, A&E minors and potentially care homes. Models of utilization could:

  • increase access to care by promote safe working measures in out of hours settings
  • provide remote examination data which would the burden of home visits in care homes
  • reduce the chain of transmission of covid-19 with safe social distance measures 
  • improve streamlining of patients more effectively. 

What potential future outcomes could Arc Health achieve?

Arc Health can potentially facilitate clinicians working from home either due to high risk categories or if child care is an issue, which will be particularly useful should the second wave arise. This impacts on clinician well-being and maintains an overall high-positive energy workforce. 

Additional opportunities for safe GP locum working use Arc technology is a future goal. Locum doctors may be reluctant to work in practices in view of safety concerns, which can be mitigated with the use of Arc remote examination technology. 

What does the future of remote examination look like beyond Covid-19?

Clinical pharmacists, nurse practitioners and GPs could be enabled to remotely manage long term conditions such as hypertension, asthma, contraceptive pill check and heart failure with use of Arc heath and hence augment admission avoidance strategies. 

The future use of asynchronous consulting with Arc where patient self-examination data could be collected and stored for a timely review by the health care professional, could revolutionize the way general practice operates and delivers their quality of care and service. Arc Health is a great asset to have within a CCG and beyond to ensure business continuity and better use of funding and resources. 

What are the key messages to take away from Arc Health technology?

  • Patient examination is the absent aspect in the current novel way of remote consulting
  • Robust triage systems with invaluable Arc Health examination data, unobtainable from pure remote consulting, allows the effective evaluation of patients and provides them with tangible outcomes.
  • Improvements to practice with Arc Health include: alleviated missed diagnosis, safely created infection controlled “hot hubs” and improved patient access to care.
  • Arc Health offers future further benefits of support in working from home, service delivery across a CCG within UCC, pharmacy venues, A&E and many other sites.  

References: (1)RCGP College Update July 2020 

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