As part of ESCP’s ongoing #COVID19ESCP campaign, consultant colorectal surgeon and ESCP’s communication chair, Richard Brady, interviews Dr Nadine Hachach-Haram FRCS (Plast) to discuss her role in digital surgery innovation and the importance of her technology platform, Proximie, during this turbulent time.
Dr Nadine Hachach-Haram FRCS (Plast), BEM, is Consultant Plastic Surgeon and Head of Clinical Innovation at Guy's and St. Thomas' NHS Foundation Trust. In 2015, the NHS clinical entrepreneur drew on her surgical experiences and her passion for innovation and education, to create Proximie; a technology platform on a mission to save lives by sharing the world’s best clinical practice.
Proximie can empower every surgeon and healthcare practitioner to virtually and practically interact with each other. By remotely connecting healthcare teams in a live environment, Proximie promotes learning, reduces variation in care and facilitates the sharing of expertise and skills that can help to save lives. Proximie is currently deployed across colorectal surgery globally, supporting before, during and after surgery.
Nadine, as a plastic surgeon, firstly how has COVID-19 affected your own practice and life?
As COVID-19 has spread, one of the most striking factors during these turbulent times has been the displays of social solidarity, amongst families, businesses and of course, the wider healthcare community. Everyone is trying to protect their loved ones, often from afar, so families have been rallying together.
From my personal perspective, all healthcare practitioners have that adaptability and innate appetite to want to support and find solutions. This is why many of us became surgeons in the first place, and everyone is trying to muck-in and support where they can. In the last few days I’ve been doing things like portering to addressing bed sores and training as a respiratory clinician. That’s the reality for many of my colleagues.
As Head of Clinical Innovation, we are also looking at how technology can support us in the short, medium and long term phases. The need for innovative solutions to help mitigate the pandemic are critical, and I believe where healthcare systems are strained and travel and access is restricted, technology can be the elixir.
COVID-19 is going to have a profound and lasting impact on the future of surgical practice. In the immediate, we're seeing elective surgery postponed, but this doesn't remove the need for rapid assessment and treatment of surgical emergencies and trauma cases. This strain will only grow as more specialist surgeons are forced to self-isolate. As the world scrambles to react to COVID-19, Proximie is very much here to support and we are offering our services, not for profit, during this difficult time.
You mention self-isolating surgeons that you were working with, can you expand on this?
As surgery has become more sub-specialised, the expertise has become more constrained. So in times like these, with surgeons self isolating and many retired clinicians returning admirably to the fold, in order to provide the best possible patient care, all of them will need to be re-skilled, quickly, efficiently and at scale.
In many respects this is where the idea for Proximie came from originally. As a surgeon I was interested in how we could use technology to scale expertise. I wanted to try and create a solution that could empower surgeons to collaborate in real-time, in a very visual and engaging way. We designed the platform to be used in austere environments, which is why we are currently used in developing nations and by the UK military, connecting field hospitals with NHS surgeons, to provide even better care for front line military personnel. Proximie is built for a COVID-19 type crisis, being accessible and affordable, working at low bandwidth with existing or easy to resource hardware.
Can you tell me about your role in digital surgery innovation?
I was always a gamer as a child and got hooked on technology, yet due to family circumstances and having witnessed first-hand the transformative role surgery can play, I was drawn to wanting to become a surgeon. While completing my training, I began working with the Global Smile Foundation in Peru, supporting teams with cleft palate reconstructive surgery for children. I quickly realised that there must be a better way to support these patients, beyond occasional surgical visits. How could I scale surgical expertise and how could technology enable that to happen?
What became apparent is the need to connect surgeons to share best practice is the same in the UK, EU, US as it is in other countries. The issue of variation in surgical care remains a problem for all of us.. I wanted to try and see if we could create a solution that could empower surgeons to collaborate in real-time, in a very visual and engaging way, in order to address some of the challenges that we face in healthcare around variation in care and delivery of care.
For example, Proximie is being deployed extensively within Colorectal Surgery globally. We work with a number of hospitals to share best practice amongst the surgical team, to enable more trainees to see and learn procedures as well as connecting MDT’s live or post surgery. We also work with medical device companies to help them connect new users of a product or procedures to experts in the field.
Proximie is involved with TaTME, Robotic and Lap CME programmes with ACPGBI & ERCP. We also recently facilitated a Robotic CME case, with Mr Danilo Miskovic mentoring Dr Thalia Petropoulou, from London which meant that Mr Miskovic could support from London, without the cost and time of traveling in person, as well as enabling him to complete his afternoon clinic and be at home that evening.
Proximie is fully GDPR and HIPAA compliant and is already deployed in over 50 hospitals around the globe, completing more than 300 surgeries each month, in 30 countries. From promoting the safe adoption of new techniques, procedures or medical devices, to transforming the way surgical knowledge is shared, documented and optimised, we are transforming the way in which surgeons interact, learn and provide optimum patient care now and in the future
How is Proximie helping during COVID-19?
In the immediate phase, right now, Proximie is being deployed to connect self isolating surgeons to support those on the front line, to share expertise and provide the best possible patient care. In the medium term, we are working with surgical societies and national bodies to plan for the re-engagement of surgeons into training.
Finally, when we reach the stage of addressing the backlog of patients that are in need of urgent treatment, Proximie will be deployed to enable surgical 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.
In which case, what is the current use of digital technology and where do you see it going in the next five years?
Whatever the next development is, it’s vital we all start to understand the problem we are trying to fix and how technology can play a role in this. There is also the balance of urgency versus pragmatism; we need technology that can support us right now.
I was part of the Royal College of Surgeons 'Future of Surgery' Commission and we extensively reviewed a number of different elements, ranging from the role of genomics to advanced robotics. In my view, I foresee every MIS being recorded, allowing for the introduction of machine learning, artificial intelligence and augmented reality, to add true and lasting value to the surgeon and patient.
For example, to address the growing demand for colonoscopy with the need to train more experts and provide real-time support across MDT’s, Proximie has developed a tool - using a unique combination of machine learning, artificial intelligence and augmented reality, as well as real time connectivity - for colonoscopy polyp recognition and classification. This procedure can be remotely connected to any expert for training or real-time support which should mean the patient is treated correctly the first time, every time; resulting in a better patient outcome and experience as well as significant cost savings for the healthcare economy.
What specific advice do you have for members in trying to engage innovative companies during the pandemic era?
I would start with the problem that you are trying to fix, assess it from an urgent, important and feasibility stand point, and ultimately challenge whether or not it delivers value to the patient. Sometimes it is not about being perfect, so pragmatism must play a role, which is obviously tough to accept as a plastic surgeon! I would also urge them to collaborate with colleagues to get a complete picture of the needs as they can change rapidly.
What should ESCP members look for in digital technology products / how do we know they are quality?
ESCP members are very supportive of innovation, which has certainly been the case with Proximie. I think this is because of the link between the problem and solution. Ultimately, I think because quality or value is subjective, it can be difficult to compare solutions. I do return to the value we provide to the patient, as defined by Michael Porter’s Value-Based Healthcare equation, which focuses on maximising the value of care for patients whilst reducing the cost of delivery of healthcare.
