Fast ASsessment and Treatment in Healthcare (FAST Healthcare)

Lead Research Organisation: University of Cambridge
Department Name: Engineering

Abstract

NHS England produced a publication in its 65th anniversary year (2013) entitled 'The NHS Belongs to the People: A Call to Action'. It articulates the aspiration to deliver the very highest standards of patient care against the reality that the projected total cost of running NHS England will rise from £95Bn in 2013 to £137Bn in 2020, whilst the resource will only rise to £108Bn in the same period. There are a number of factors that are leading to rising costs, and the Call to Action highlights poorly joined-up care between adult social care, community services and hospitals as one of these. This project aims to address this issue.

The NHS currently delivers healthcare to patients across a number of different levels depending on need, from non-specialist treatment in GP surgeries and community health centres through to specialised treatment at local or regional hospitals. As a patient moves from community treatment towards hospital-based treatment, both the length of time for treatment and the cost increase. Therefore, it is important that patients are treated as close to their own communities as possible for as long as that is effective as this will reduce cost. There is a benefit to patient experience too. Moving treatment back to a community-delivered level increases patient involvement. This means that they are better informed as they have to take greater responsibility for themselves. Therefore, reducing the cost of healthcare does not mean a poorer service. Quite the reverse can be true and the potential to both improve the experience of patients and reduce the cost could be made possible by developing a new methodology for the clinical diagnostics and treatment process.

This can be realised by taking a systems-based engineering approach to designing such a new methodology which is then enabled by appropriate technological and medical advances and permits a holistic approach to care delivered in a joined-up fashion across the health service.

The result will be Fast ASsessment and Treatment in Healthcare (FAST Healthcare). Fast assessment is essential to the process. At whatever point a patient enters the healthcare system, a decision is required as to how treatment should progress and subsequently how and where it should be delivered. A holistic view of the healthcare system would permit seamless care from communities to hospitals. This is then followed up by fast delivery of treatment, and overall optimised treatment.

Our Aim can therefore be summarised as follows: to initiate systems-based engineered methodologies for providing joined-up treatment in the public health sector.

Planned Impact

In the context of the overall Network's Objectives, the impact aims of this project are:
1. building a research community. This is achieved by bringing clinical and engineering and physical sciences researchers together in roadmapping workshops. In addition, we aim to establish FAST Heathcare as a strategic theme in one of our partner Universities by building on the highly interdisciplinary nature of the research field.
2. developing early-career researchers. One of the assessment criteria of the initiator projects will be the extent to which they include early-career researchers in the collaborative team, so that they can develop their research portfolio in the healthcare sector and learn from more experienced coleagues.
3. fostering new research collaborations. The initiator projects will allow new research collaborations to form, but we will also follow up these projects with a funded programme to help them translate this initial research into a lasting, funded research activity. Action Teams will be appointed with the sole aim of making this transition.
4. directing the research agenda in optimising treatment. The Roadmaps will be made publicly available with an associated commentary in plain English directed at a non-EPS community. We will make a particular effort to publicise this widely to the EPS and clinical research communities in the UK.
5. transforming treatment processes. We aim to partner the initiator project research teams with clinicians who would employ the research outputs and to engage both parties in the process of taking the results of the projects forward into more significant research activity. We will also run Clinical Roadshows to showcase both initiator project reseault and the roadmaps to clinicians, patient groups and policy-makers.

Publications

10 25 50
 
Description We have published four Roadmaps for Engineering and Physical Sciences research in the field of healthcare technologies. One is on cardiovascular disease, another is on the use of digital health for remote monitoring and self-management of conditions, the third is on the clinical application of Raman spectroscopy and the fourth is onearly detection of cancer . All Roadmaps are freely available to download from the FAST Healthcare website. We have also funded two projects in the field of cardiovascular disease. One is looking at improving the analysis of ECG data to idenfity myocardial infarction whist the other is looking at the use of 3D printing to manufacture stents for use in heart surgery which naturally biodegrade in the body. We have funded one project on the use of Rama micro-spectroscopy for detecting antimicrobial resistance. This project was set up in collaboration with NHS England's Knowledge Transfer Partnership scheme (2018 programme). We have also funded a project on smart wearables for children with asthma. The device aims to motivate children with asthma to be more active. Based on the sensor output, an intelligent algorithm will generate a smart management plan for individual users to allow better management of the condition. We have also funded two projects in the digital health area: one on using simple tests for stratification of stroke survivors and another on helping people with osteoarthritis to sustain physical activity for long-term self-management of their condition. Finally, we have funded two projects on early detection of cancer. One is on a tool to use mobile phone camera data coupled with electronic health record analysis to allow for early detection of skin cancer and the other is to develop a replacement for the current FIT Test for colorectal cancer detection based on Raman spectroscopy of bodily fluids that do not require faecal analysis.

The EPSRC FAST Healthcare NetworksPlus was set up with the aim of taking a systems-based engineering approach to enable improved patient treatment at lower cost through appropriate technological and medical advances. The Network has brought together researchers from a diverse range of backgrounds through our workshops to set out clinically-motivated research challenges and it has allowed new research teams to form to carry out initiator projects to build momentum.

By taking systems-based engineering as our common theme, the Network has a portfolio of projects covering some of the most pressing health conditions that individuals face in their lives: cardiovascular disease, cancer, osteoarthritis, stroke, asthma and even anti-microbial resistance. Engineering and physical sciences researchers have been able to make a difference in all of these areas, but only through effective collaboration with clinicians. In addition, the importance of engaging with the people who will be expected to use whatever is developed at the earliest stage is essential for long-term success, and this has been a persistent theme from the first workshop onwards.

Although the projects have been clinically very diverse, some common themes have emerged.

One is the opportunity that technology and AI is affording to allow people to be more precisely treated as unique individuals. The ability to collect personalised data and then compare this with what is known at population level opens up new possibilities for greater effectiveness of treatment at lower cost. This does not always need new physical technology: often we can use the data that is already generated around us or the hardware that currently exists for getting new data.

Another area is the power of longitudinal monitoring to understand an individual's condition over time. This creates new challenges for data management, data security and personal privacy; therefore a system-based engineering approach is essential, but the opportunities for optimising treatment of conditions like cardiovascular disease are significant.

And this provides a direction for where the FAST Healthcare NetworksPlus goes next.

In the main, medicine is largely reactive. We develop a new symptom and seek treatment. Our focus in FAST has been on optimising this. However, there has long been a desire to move towards a preventative approach where we try and keep people healthier for longer by assisting them to understand their general wellbeing and advising on appropriate actions that could be taken to ensure a higher standard of wellbeing for longer. Just as precision medicine is all about understanding people as individuals, the same is true for this emerging area of 'precision health'.

The University of Cambridge has therefore set up a new Strategic Research Initiative: the Precision Health Initiative (https://www.precisionhealth.cam.ac.uk). Precision health will need to place the lived experience of real people at its heart if it is to make a difference to society broadly. This new initiative will therefore build on the multidisciplinary experience of FAST but aims to draw in new communities of researchers from the social sciences in particular, and still with a strong systems-level understanding. This new initiative will launch in early 2022
Exploitation Route This project will lead to new research collaborations in the area of Fast Assessment and Treatment in Healthcare. It is already leading to new work between engineers and clinical managers looking at assessment and treatment pathways. We have also developed links with NHS England to help with the translation of technology into clinical practice and with key UK charities: Cancer Research UK and Asthma UK.
This project has also directly led to the establishment of a new Strategic Research Initiative in Precision Health which the University of Cambridge is funding. This is leading to new research collaborations being established and a programme of work to influence both the research and policy agenda to raise the profile of precision healthcare, both in research and practice.
Sectors Healthcare

URL http://www.fast-healthcare.org.uk/
 
Description The outputs from our last Roadmap have been picked up by the Office of the Chief Scientific Officer for NHS England and led to a project in the detection of antimicrobial resistance with one of their Knowledge Transfer Associates in an area that is of priority to NHS England. We have also been working with Asthma UK to instigate new research relevant to improving the lives of people with asthma. We have also worked with Cancer research UK on forming new research collaborations to address the research priorities that they have identified in early detection. In addition, the specfic projects that have been funded have led to a mixture of non-academic impacts, including two patent applications, two web-based apps and several outreach activities. The University of Cambridge has set up a new Strategic Research Initiative: the Precision Health Initiative (https://www.precisionhealth.cam.ac.uk). Precision health will need to place the lived experience of real people at its heart if it is to make a difference to society broadly. This new initiative will therefore build on the multidisciplinary experience of FAST but aims to draw in new communities of researchers from the social sciences in particular, and still with a strong systems-level understanding.
First Year Of Impact 2018
Sector Healthcare
Impact Types Societal,Economic,Policy & public services

 
Description Colorectal Neoplasia Edinburgh Follow-on
Amount £10,000 (GBP)
Organisation The Royal College of Surgeons of Edinburgh 
Sector Charity/Non Profit
Country United Kingdom
Start  
 
Description Computational Assessment of Stroke Survivors
Amount £125,000 (GBP)
Organisation Rosetrees Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 03/2020 
End 02/2023
 
Description PhD Studentship
Amount £59,076 (GBP)
Organisation Engineering and Physical Sciences Research Council (EPSRC) 
Sector Public
Country United Kingdom
Start 09/2019 
End 09/2022
 
Description Precision Health Stratgic Research Initiative
Amount £165,000 (GBP)
Organisation University of Cambridge 
Sector Academic/University
Country United Kingdom
Start 09/2021 
End 09/2024
 
Title CognoSpeak Website 
Description The online CognoSpeak website is currently in use to collect data from participants at home remotely. The questions and cognitive tests have been adapted for the stroke survivors, They also complete two questionnaires on the website afterwards: PHQ9 and GAD7. 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2021 
Provided To Others? Yes  
Impact We have now got around 50 recordings and we have been working on the data and publishing results of analysing the data on the next coming Interspeech conference. 
URL https://cognospeak.github.io/website/
 
Description Asthma UK 
Organisation Asthma UK
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution We organised a workshop in collaboration with Asthma UK targetted at early career researchers to try and encourage engineers and physical scientists to engage in research relevant to improving the lives of people with asthma.
Collaborator Contribution Three people from AsthmaUK attended our workshop and presented a series of research challenges to the attendees.
Impact This resulted in a call for proposals for a project addressing these challenges. A project based at Oxford University has been funded and this is ongoing.
Start Year 2018
 
Description Cancer Research UK 
Organisation Cancer Research UK
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution The FAST Healthcare NetworksPlus works by hosting workshops focussed on specific clinical areas which lead to establishing new research collaborations and publicly-available reports provinding information on the engineering and physical sciences research landscape in each of these areas. in Febriary 2020 we ran a workshop in partnership with Cancer Reserch UK's Early Detection Programme on Early Detection of Cancer focussing specifically on: 1) extracting added value from electronic health records for early detection, 2) the use of wearable and point-of-care devices in early detection; and 3) the use of digital health twins in early detection. The report from this workshop will be published in March 2020.
Collaborator Contribution Cancer Research UK were critical for this workshop. They have been investigating reseach interventions for the early detection area, and defined the three areas for this workshop from these. They assisted with finding speakers for the workshop and atende to help with the facilitation. They will be involved with the report preparation and collaboration building efforts that follow.
Impact The output from this has been the workshop which ran on 18 February 2020 in Cambridge.
Start Year 2019
 
Description Multimorbidity extensions of iKOALA prototype and clinical trials 
Organisation Royal College of Surgeons in Ireland
Country Ireland 
Sector Academic/University 
PI Contribution Professor Maria Stokes and Dr Paul Clarkson (Southampton University), Professor Suzanne McDonough (Royal College of Surgeons in Ireland, Dublin). Collaboration to explore opportunities for multimorbidity extensions of iKOALA prototype and clinical trials
Collaborator Contribution Professor Maria Stokes and Dr Paul Clarkson (Southampton University), Professor Suzanne McDonough (Royal College of Surgeons in Ireland, Dublin). Collaboration to explore opportunities for multimorbidity extensions of iKOALA prototype and clinical trials
Impact Exploring opportunity for clinical trial
Start Year 2020
 
Description Multimorbidity extensions of iKOALA prototype and clinical trials 
Organisation University of Southampton
Country United Kingdom 
Sector Academic/University 
PI Contribution Professor Maria Stokes and Dr Paul Clarkson (Southampton University), Professor Suzanne McDonough (Royal College of Surgeons in Ireland, Dublin). Collaboration to explore opportunities for multimorbidity extensions of iKOALA prototype and clinical trials
Collaborator Contribution Professor Maria Stokes and Dr Paul Clarkson (Southampton University), Professor Suzanne McDonough (Royal College of Surgeons in Ireland, Dublin). Collaboration to explore opportunities for multimorbidity extensions of iKOALA prototype and clinical trials
Impact Exploring opportunity for clinical trial
Start Year 2020
 
Description NHS England 
Organisation NHS England
Country United Kingdom 
Sector Public 
PI Contribution We have contributed to the NHS England Knowledge Transfer Partnership 2018 programme. We participated in interviews for KTP associates and identified one person to work with to advance Raman spectroscopy as a clinical tool with a particular focus on detection of antimicrobial resistent pathogens.
Collaborator Contribution NHS England facilitated our partnership in their KTP programme, advertising the Network's participation and facilitating project management.
Impact THis collaboration is ongoing but it has already resulted in a workshop bringing together key stakeholders in the UK to try and advance Raman spectroscopy to clinical practice. A project in this area bringin together new research collaborators in ongoing.
Start Year 2018
 
Description Versus Arthritis 
Organisation Versus Arthritis
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution Rhian Horlock and Ashleigh Ahlquist (Versus Arthritis Physical Activity team). Joint application for further evaluation of the iKOALA app using Versus Arthritis networks
Collaborator Contribution Rhian Horlock and Ashleigh Ahlquist (Versus Arthritis Physical Activity team). Joint application for further evaluation of the iKOALA app using Versus Arthritis networks
Impact Joint application for further evaluation of the iKOALA app using Versus Arthritis networks
Start Year 2020
 
Title Method and Apparatus for Classifying Heart Diseases 
Description Method and Apparatus for Classifying Heart Diseases 
IP Reference GB1910657.4 
Protection Patent application published
Year Protection Granted 2019
Licensed Commercial In Confidence
Impact Filing with Oxford University Innovation.
 
Title Method of additive layer manufacturing 
Description Method for producing implanted medical devices. 
IP Reference GB2005046.4 
Protection Patent application published
Year Protection Granted 2020
Licensed No
Impact The explotation of this intellectual property is currently being explored by Cambridge Enterprise
 
Title Resorbable cardac stent 
Description A resorbable stent that can be printed is currently in development. It is the subject of a patent application which is currently being finalised by Cambridge Enterprise (the university's technology transfer company). 
Type Therapeutic Intervention - Medical Devices
Current Stage Of Development Initial development
Year Development Stage Completed 2020
Development Status Under active development/distribution
Impact None yet. 
 
Title Wearable asthma tracker 
Description Wearable device for monitoring activity in children with asthma 
Type Management of Diseases and Conditions
Current Stage Of Development Refinement. Clinical
Year Development Stage Completed 2020
Development Status Under active development/distribution
Impact None yet 
 
Title CognoSpeak 
Description Tool to assess people with memory problems 
Type Of Technology Webtool/Application 
Year Produced 2020 
Impact The questions and cognitive tests have been adapted for the stroke survivors. They also complete two questionnaires on the website afterwards: PHQ9 and GAD7. 
URL https://cognospeak.github.io/website/
 
Title iKOALA 
Description The iKOALA app is a smartphone app for supporting knee Osteoarthritis self-management designed to work on the Android operating system. It provides physical activity planning, support and feedback tools. Other features include symptom recording and alerts, social features and educational resources 
Type Of Technology Webtool/Application 
Year Produced 2020 
Impact App available via research team 
 
Description Can we diagnose heart attacks faster? 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Public dissemination of research at Oxford university.
Year(s) Of Engagement Activity 2020
URL https://www.oxfordsparks.ox.ac.uk/content/can-we-diagnose-heart-attacks-faster
 
Description EPSRC FAST Healthcare Workshop on Digital Health for Remote Monitoring and Self-Management of Disease 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact 30 people attended this roadmapping workshop to set out the engineering and physical sciences research opportunities in the field of digital health for remote monitoring and self-management of disease, with speakers from academia, the clinical sector and industry.
Year(s) Of Engagement Activity 2017
URL http://www.fast-healthcare.org.uk/digital-health-workshop/
 
Description Early Career Researchers/Asthma UK Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact Around 30 early-career researchers attended this workshop at which four people from AsthmaUK set out four research challenges which would have an impact on improving the lives of people with asthma. The workshop was divided into two sessions, covering two asthma innovation challenges in each session. Both sessions started with the presentation of two challenges (including the background to the challenges) by an Asthma UK representative and were followed by structured road mapping and proposal development session, into which all participants contributed.
Year(s) Of Engagement Activity 2018
URL http://www.fast-healthcare.org.uk/ercasthma/
 
Description FAST Healthcare NetworksPlus Project Videos 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Each of the projects funded through the NetworksPlus produced a video on the work and details on how to engage with the project team to follow up. The videos are designed to be accessible, in particular to clinicians who might be interested in finding out more.
Year(s) Of Engagement Activity 2021
URL http://www.fast-healthcare.org.uk/outcomes/
 
Description Fast Assessment and Treatment of Cardiovascular Disease Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact This was the first Workshop of the FAST Healthcare NetworksPlus. It brought together a mixture of engineers and physical scientists (~1/3 of participants) with clinicians (~1/3 of participants) with clinical managers and industrialists (~1/3 of participants) to discuss and roadmap the assessment and treatment of cardiovascular disease. The roadmap is being written up for public disemmination via the Network website. It has already resulted in follow-up meetings between participants leading to new research activities between engineers/physical scientists and medics/clinical managers.
Year(s) Of Engagement Activity 2017
URL http://www.fast-healthcare.org.uk/
 
Description PHG Foundation Annual Conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact PHG Foundation (specialising in healthcare policy) run an annual conference to bring together academics, industry, clinicians and policy makers to discuss aspactes of healthcare. I was invited to present the FAST Healthcare Digital Health Roadmap.
Year(s) Of Engagement Activity 2017
URL http://www.phgfoundation.org/events/healthy-futures-genomics-and-beyond
 
Description Participation in a workshop on the application of engineering and physical sciences research to early cancer detection 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact The workshop introduced prioritised research interventions in the engineering and physical sciences space addressing early detection of cancer. The workshop allowed research pathways to be identified and new research collaborations to form.
Year(s) Of Engagement Activity 2020
URL http://www.fast-healthcare.org.uk/early-cancer-detection/
 
Description Sandpit on Raman Spectroscopy as a Tool for Clinical Applications 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact The purpose of this Sandpit, which was attende by ~30 people, was threefold:
1) To bring together a new group of clinicians, engineers and physical scientists who would be interested in being part of a new National Expert Group on the clinical application of Raman spectroscopy.
2) To identify the clinical opportunities for Raman in the short, medium and long-term which the Group could look to address.
3) To work up an engineering-focussed mini project to pump prime the Group's activity in the area of detection of antimicrobial resistant pathogens in a clinical setting with £60,000 (fEC) seed funding from the EPSRC FAST Healthcare NetworksPlus.
The Sandpit was divided into three Sessions. In the first session, the background to the application of Raman Spectroscopy was presented and participants performed a 'SWOT' analysis. In the second session, a few clinical scenarios to which Raman Spectroscopy may be applied were presented and participants put together a simple short, medium and long-term roadmap for development of the technique. In the third session, groups worked up a pump priming project proposal to address the application of Raman Spectroscopy for the detection of antimicrobial resistant pathogens.
Year(s) Of Engagement Activity 2018
URL http://www.fast-healthcare.org.uk/sandpit-on-the-development-of-raman-spectroscopy-as-a-tool-for-cli...