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Dr. Nadine Hachach-Haram FRCS (Plast), BEM, Consultant Plastic Surgeon and Head of Clinical Innovation at Guy’s and St. Thomas’ NHS Foundation Trust. She is the founder of Proximie.

There is little doubt that the complexities posed by COVID-19 have been unprecedented and that the pandemic has had a profound impact on the way healthcare is, and will be, provided.

It has tested the capabilities of healthcare systems all over the world, which has compelled pragmatism, collaboration and innovation in order to try and meet the varied challenges presented by this viral pandemic.

Necessity is the mother of invention and we have seen how COVID-19 has forced innovation at a pace that was previously unthinkable. The urgency that was needed to try and combat COVID-19 has been a catalyst for incredible collaboration. We have seen the blurring of lines between the private and public sectors for the greater good. This has certainly been the case at Proximie, where we have been deployed across a host of NHS sites to remotely connect surgeons and healthcare workers in the battle against COVID-19. As a frontline NHS surgeon myself, I’m immensely proud that we have been able to help in the acute phase of the pandemic.

Proximie is a technology platform that uses a combination of machine learning, artificial intelligence and augmented reality to empower surgeons and clinicians to virtually and practically interact with each other from anywhere in the world. As a training surgeon I grew increasingly frustrated with the widening variation in care that I not only witnessed in the developing world where I had dedicated my time to global surgical initiatives, but also across established health systems.

Disruption in healthcare has many challenges, but I can say with experience that if it is really solving a problem then adoption can be swift and decisive. Proximie was born out of a need, and my ambition as a surgeon was to find a solution and scale it using technology.

Using augmented reality, healthcare practitioners can remotely interact in a procedure or assessment from start to finish, and mentor a local clinician through a live operation, in a visually and intuitive way.

An internet-connected device allows them to view a live camera feed of the assessment or operation, provide verbal instructions, draw or overlay important patient scans or X-rays, and virtually reach into the clinical field to provide precise guidance.

We have been used to using digital technology to communicate and share information through voice, through text and through video. I had also been exposed to early-stage telecommunications platforms, but all of them are anchored to one moment in time. One meeting, one call, one conference, but then it’s gone. The options available did not enable a continuum of sharing knowledge and expertise, and they were too passive.

Orchestrating clinical collaboration

Proximie enables something deeper. It allows two people in remote locations to interact virtually in a way which mimics what they would experience if they were collaborating in the same room.

It means one can physically show the other where to make an incision, in real-time, or use gestures to illustrate a technique, rather than just talking about it. Last month, at a time when cath lab access was limited and travel is prohibited, Proximie orchestrated a successful transcatheter aortic valve implantation (TAVI) that involved a cardiologist at the American University of Beirut Medical Center, collaborating with a remote expert cardiologist in Copenhagen, whilst several Abbott Medical experts in the US watched on. It is evidence that during these turbulent times, where healthcare systems are strained and travel and access is restricted, technology can be the elixir.

Proximie is designed to scale in austere environments; it is already being deployed by the UK’s Ministry of Defence to enable military surgeons in the field to receive instant remote virtual assistance.

Battling COVID-19 remotely

Closer to home we have seen how it can form the basis of a responsive approach to some of the challenges being posed by COVID-19.

Due to the virus there has been an urgent need to incorporate integrated technologies into routine or complex practices, because of the requirement to find ways to seamlessly maximise healthcare resources, scale the delivery of expertise and reduce the transmission of the virus.

In many respects, Proximie was built for a pandemic of this nature. From enabling self-isolating clinicians to remotely support colleagues on the front line, to virtually connecting MDTs for hand trauma and cancer management, so that every clinician can connect and collaborate off site during COVID-19, we are finding new ways to apply our technology to amplify the skills of frontline clinicians. It is secure, easily integrated and works at low bandwidth, with existing or easy to resource hardware, which has meant we can — and have had to — be agile to meet the demands of this global imperative.

Over the last few weeks Proximie has been used to ensure clinicians have access to remote expertise, in order to help address the overwhelming needs of patients suffering from COVID-19, and also those patients suffering from treatable non-COVID-19-related conditions. The Proximie technology allows clinicians to demonstrate — in real time — the actions needed to be taken to ensure the best patient outcomes, and to do so without compromising the current effort to manage the pandemic. Using just a laptop or tablet with an in-built webcam, that can support video feeds from any medical device, Proximie can provide real-time redistribution of remote expertise.

The technology has been used to help mitigate the need for the constant changing of PPE equipment, dial-in clinical expertise, and ensure fewer numbers of people are physically required to be in the operating room.

Returning to a better new normal

Over the last few months agility and flexibility has taken precedence over perfection, which has been a tough pill to swallow for a plastic surgeon! But crucially, we can not just think about COVID-19’s impact on the here and now. We must consider what the new normal looks like, and that means thinking holistically about how technology can support us, not just in the short term, but once the acute phase of the pandemic is over.

The challenges posed by COVID-19 are going to endure for a long time following its conclusion. In the immediate phase, all resources have been channelled into stopping the pandemic, which has resulted in elective and semi-elective surgeries being cancelled. Health systems are going to need to adapt in order to manage the increased capacity which is imminent. We know that many clinicians are going to require support to re-engage with performing routine procedures after a period of deskilling, and we are already working with a number of societies and national bodies to plan for the re-engagement of clinicians into training.

We have recently been facilitating virtual masterclasses for different organisations — from anatomy sessions with Keele Anatomy and Surgical Training Centre to immersive webinars with The British Association of Aesthetic Plastic Surgeons, and also the International Hip Preservation Society (ISHA) — in order to maintain their respective education remotely. In addition to providing virtual training programmes in plastic surgery and urology at Guy’s and St Thomas’ NHS Foundation Trust, last week we announced our exciting new partnership with The Association of Surgeons in Training (ASiT). Whilst educational programmes and training have inevitably been disrupted due to the pandemic, we are already seeing the resilience, adaptability and collaborative spirit of the surgical community shine through. I’m proud that we can contribute to supporting the education of trainee surgeons during these difficult times.

As we reach the stage of addressing the backlog of patients that are in need of urgent treatment, Proximie will be deployed to enable clinical teams to connect and collaborate on a regional or global level. This can range from local hospitals, to regional surgical chapters to the medical device industry, and Proximie can ensure this expertise, normally siloed geographically or physically, can be shared as part of a continual cycle of learning. From promoting the safe adoption of new techniques, procedures or medical devices, to transforming the way knowledge is shared during the COVID-19 pandemic, we are changing the way clinicians interact, apply their expertise and provide optimum patient care now and in the future.

Finally, as COVID-19 has spread one of the most striking factors has been the displays of social solidarity, courage and collaboration amongst the healthcare community. Seeing the collective will and proactive endeavours to find a vaccine, create suitable and effective testing, develop protective equipment and produce short and long term solutions to the outbreak has been incredible. I’m incredibly supportive of all collaboration — it’s ultimately what Proximie facilitates — and all of these companies and individuals working round the clock deserve great credit. I’ve talked about Proximie and my colleagues at the NHS, but there are countless organisations creating more ventilation machines, masks and vaccines in this emergent time, and I think what they are doing is amazing. We’re here to support them and we’re here to help in any way we can.