Title: Autonomous Telemedicine - Cataract Surgery Follow-up at Two NHS Trusts
Funder: Department of Health and Social Care

Abstract: Background Due to an ageing population and increased expectation, the demand for many services is exceeding the capacity of the clinical workforce. As a result, staff are facing a crisis of burnout from being pressured to deliver high-volume workloads, driving increasing costs for providers. Artificial intelligence, in the form of conversational agents, presents a possible opportunity to enable efficiencies in the delivery of care. Aims and Objectives This study aims to evaluate the effectiveness, usability and acceptability of DORA - an AI-enabled autonomous telemedicine call - for detection of post-operative cataract surgery patients who require further assessment. The study s objectives are: to establish efficacy of DORA s decision making in comparison to an expert human clinician; baseline sensitivity and specificity for detection of true complications; evaluation of patient acceptability; evidence for cost-effectiveness; and to capture data that may support further studies. Project plan and methods used Based on implementation science, the interdisciplinary study will be a mixed-methods phase one pilot establishing inter-observer reliability; as well as usability and acceptability using the following scales and theoretical models/frameworks: the system usability scale; assessment of Health Information Technology Interventions in Evidence-Based Medicine Evaluation Framework; the telehealth usability questionnaire (TUQ); the Non-Adoption, Abandonment and Challenges to the Scale-up, Spread and Suitability (NASSS) framework. Timelines for delivery The study will last eighteen months: seven months of evaluation and intervention refinement, nine months of implementation and follow-up, and two months of post-evaluation analysis and write-up. Anticipated Impact and Dissemination The project s key contributions will be evidence on artificial intelligence voice conversational agent effectiveness, and associated usability and acceptability. Results will be disseminated in peer-reviewed journals and at international medical sciences and engineering conferences.

Lay abstract: This project will apply AI technology to meet the gap between increasing demand and limited capacity of high-volume healthcare services. The project will develop evidence that will support the safe deployment of Ufonia s automated telemedicine platform to deliver calls to cataract surgery patients at two large NHS hospital trusts. Ufonia proposes to replace routine clinical follow-up with DORA - a natural-language AI assistant delivered via a regular telephone call. The solution doesn't require patients to download any application, be provided with any device or receive any training. They simply receive a call and have a conversation just as they would have done with a human clinician. It is particularly well suited for the relatively digitally disenfranchised populations who utilise the majority of healthcare services. DORA is a like-for-like replacement for existing operational processes. It removes stereotyped, repetitive work, allowing clinicians to be deployed to higher value activities elsewhere in the care pathway. The first clinical scenario DORA is being built for is follow-up after cataract surgery. Cataract surgery is the most common operation in most hospitals, in the NHS as a whole (450,000 cases per year) and globally. Cataracts are predominantly a disease of old age and their prevalence is increasing with an ageing population. This demand is putting significant strain on resource constrained services. DORA arose as the winner of a hackathon run by IBM Watson and has been supported by Innovate UK. Currently the prototype system is being deployed at Buckinghamshire Healthcare NHS Trust (BHT). This work is funded by an Innovate UK Digital Health Catalyst award in partnership with the Trust, Oxford AHSN, Oxford University Innovation and STFC s High Performance Computing Centre. It will conclude in the roll-out of the system to all BHT cataract patients. The final six months of that grant will overlap this study. This will facilitate synergies between the projects: permissions and contracts for this study will be established as the system completes development and testing at BHT. The proposed study will implement DORA in addition to the current standard of care for a cohort of patients at Imperial College Healthcare Trust and Oxford University Hospitals NHS Foundation Trust. The study will evaluate the agreement of DORA s decision with an expert clinician. In addition it will test the acceptability of the solution for patients and clinicians; the sensitivity and specificity of the system in deciding if a patient requires additional review; and the health economic benefits of the solution to patients (reduced time and travel) and the local healthcare system. If successful, a proposal will be developed to roll the solution out to all patients at each site in anticipation of an application to a late phase award for wider NHS deployment.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;6.4 SURGERY;6.3 MEDICAL DEVICES
Health categories: EYE