The smartphone: an evolution or revolution in virtual patient healthcare during and beyond the COVID-19 pandemic ? An evaluation and comparison of the smartphone against other currently available wearable technologies in a secondary care setting during the COVID-19 pandemic

  1. Asif Raza
  2. Subhabrata Mukherjee
  3. Vikash Patel
  4. Naila Kamal
  5. Ewa Lichtarowicz-Krynska

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Abstract

Smartphones are now commonly used, for virtual outpatient consultations, to help reduce disease transmission during the COVID-19 pandemic. Nosocomial spread of COVID 19 and hospital acquired infections are usually from staff or students to patients. Reducing non- essential staff numbers on ward rounds may reduce the risk.

We describe the novel use of smartphones, with Microsoft Teams, to live stream inpatient interactions, radiological images, pathology results, charts and patient review between an office-based and ward team (virtual ward round) and for teaching medical students in secondary care. After Research and Ethics, Digital services and Information Governance approval we compared a smartphone and head-worn device (Realwear HMT-1). Data collection was by participant questionnaire. Statistical analysis was performed using the Mann – Whitney test.

There was no statistically significant difference in audio and video feed quality between the smart phone (p value = 0.3) and Realwear device (p value = 0.41). However the smartphone was preferred during ward rounds and was 85% cheaper than the Realwear device. Urology medical staff numbers on the ward were reduced by 50%. Ward round efficiency improved as administrative tasks could be performed by the office team during the virtual ward round.

Virtual ward rounds using smartphones can facilitate remote communication between staff, students and patients. Staff in isolation or shielding can also assist front line colleagues from home. Smarter use of the smart phone may help reduce staff numbers on wards and reduce the number COVID-19 and nosocomial infections, potentially reducing morbidity and mortality locally and globally.

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  1. ScreenIT

    SciScore for 10.1101/2020.11.06.20223206: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Fig 1 Our local Research and Ethics committee approved the study as a service evaluation and proof of concept study.
    Consent: No recording or storing of video or images during or after the mock or real-life patient interaction was allowed for the study unless separate written consent was obtained for video or images to be kept for teaching purposes or publication.
    RandomizationThe device worn was randomly allocated to the (RWT) by using an online randomisation programme (Graph Pads: Quickcalc) The same mock clinical scenario was used for teaching medical students (Fig 1.) for each device to ensure devices could be compared in the same location ensuring Wi-Fi signal strength and network characteristics were similar for both devices.
    BlindingThe (OBT) and students were blinded to the device being used by the (RWT).
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations in our study included the small number of study participants, the use of older model hospital iphones without a sim, with lower screen resolution, smaller screen size and shorter battery life than current models. Evaluation of the Realwear device with proposed future software updates, with better image resolution and a fix for noise cancellation, would have allowed a better comparison with the smartphone. The local information governance and Digital services team did not approve video recording or taking pictures on the device. This limited the full evaluation of devices as teaching aids. Our local digital health services team had concerns about the amount of data that would be generated from multiple device use, saving video clips and were and how long the data would be kept i.e. cloud or local servers. Network coverage was patchy in certain parts of the hospital leading to poor streaming quality and occasional dropped calls. The local trust was conducting a network survey during the study with plans to install multiple wireless access points in areas of poor network coverage. Our infection control team raised concerns about the disinfection of chest harnesses however these can be worn under sterile gowns however would still need to be cleaned as per local trust guidelines. We used lanyards as an alternative as these are easier to disinfect after use and less bulky to wear.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.11.06.20223206v1 on medRxiv