Objectives In the ever-evolving landscape of healthcare, the integration of digital systems and medical devices is increasingly important for modernising healthcare delivery. However, the acceptance and adoption of emerging technologies by healthcare staff present challenges. The purpose of this research was to apply relevant knowledge to inform and improve a conceptual framework (ARC): early exploration and agile adoption of emerging healthcare technology. We report on an expert-led Delphi study to evaluate consensus regarding the framework.Method The ARC conceptual framework, presented as four successive phases: imagine, educate, validate and score, was evaluated by 23 experts over two rounds. Experts first agreed/disagreed with 31 enabling statements relating to the early exploration and evaluation of new technology. The expert panel made recommendations (n=20), which were incorporated into round 2 with a checklist to evaluate the potential of a new technology.Results All participating experts completed round 1, and 13 completed round 2. Consensus (defined as >75% agreement) was achieved for 93.4% (n=57) of statements, with consensus without exception achieved for 34.4% (n=21) items and 16 new items added to the improved ARC framework, including on the appropriate use of simulation studies.Discussion The main findings highlight the importance of demonstration spaces, time in clinical environments with clinical teams, data-driven benefits and structured debriefs with staff.Conclusion A Delphi approach achieved expert consensus regarding the ARC framework for engaging with new technology and preparing the healthcare workforce for its use. Further advocacy is required to negotiate stakeholder involvement and interdisciplinary cooperation.

It can be overwhelming and frightening to deal with health issues for children and young people. They are often intimidated by hospitals and information given by clinicians that is beyond their comprehension. The fear of unknowing often associates hospitals with anxiety and uncertainty in children and young people. The purpose of this study is to identify needs, so that it is possible to address concerns and reduce anxiety in children and young people to make their healthcare journey well informed. We conducted scenario-based interviews and co-design sessions with a group of children (n=9) aged between 12-17 who were members of GOSH Young Persons’ Advisory Group (YPAG). The sessions focused on gathering thoughts and emotions they feel when visiting a hospital and identifying their information needs. Our findings revealed that the entire group associated negative emotions when given a scenario about diagnosis and treatment of a long-term health condition. Many participants admitted they’ll feel ‘nervous, stressed, confused and discouraged’ before going for a treatment or procedure, while some expressed concerns about its effect on their mental and physical health and how painful it would be. They also probed about the short term and long-term prognosis of the condition, if they can refuse treatment and how long will they have to miss school. When asked about what will help them prepare better for their hospital visits, 86% of the participants voted for data visualizations of their condition and risk levels and 71% expressed interest in knowing details about the procedure and an ideal recovery timeline. 57% of the participants agreed that knowing the environment of the hospital and the people they’ll be meeting beforehand will help in reducing anxiety. These findings support the use of digital information systems for children undergoing medical treatment to reduce pre-operative anxiety and negative emotions.

new working model, has been the requirement to wear, ‘Personal Protective Equipment.’ (PPE). Seeing healthcare workers in full PPE is a new experience for most children and it became obvious, early on during the pandemic, that we needed to find ways to make PPE more,’ child-friendly,’ to minimise anxiety as much as possible for children presenting to hospital and in particular to theatre. Methods Discussion with colleagues working in the operating theatres at Great Ormond Street Hospital revealed various adaptations to make PPE more, ‘child-friendly.’ Some children were asked for feedback related to this. A PubMed literature search regarding PPE use in paediatric settings and also the wearing of face masks by children was also conducted. In addition to this, an internet search provided information from other NHS Trusts. Results Inventive solutions such as cartoon characters on visors and drawing on them have been very well received. Videos about PPE were also helpful. In addition, the importance of non-verbal communication has become very apparent. Discussion Creating, ‘child-friendly,’ PPE has been hugely beneficial to children presenting to hospital during the pandemic. It helps to allay their fears and increases their understanding of the current, challenging world that they are living in.

ABSTRACT Coupled with advances to federated on-device computer vision, the convenience of use and ease of access of cameras integrated into existing computers and tablets will increase touchless computing uptake in the form of gesture recognition software in healthcare for both clinicians and patients.

BACKGROUND:The successful implementation of clinical smartphone apps in hospital settings requires close collaboration with industry partners. A large-scale, hospital-wide implementation of a clinical mobile app for health care professionals developed in partnership with Google Health and academic partners was deployed on a bring-your-own-device basis using mobile device management at our UK academic hospital. As this was the first large-scale implementation of this type of innovation in the UK health system, important insights and lessons learned from the deployment may be useful to other organizations considering implementing similar technology in partnership with commercial companies. OBJECTIVE:The aims of this study are to define the key enablers and barriers and to propose a road map for the implementation of a hospital-wide clinical mobile app developed in collaboration with an industry partner as a data processor and an academic partner for independent evaluation. METHODS:Semistructured interviews were conducted with high-level stakeholders from industry, academia, and health care providers who had instrumental roles in the implementation of the app at our hospital. The interviews explored the participants' views on the enablers and barriers to the implementation process. The interviews were analyzed using a broadly deductive approach to thematic analysis. RESULTS:In total, 14 participants were interviewed. Key enablers identified were the establishment of a steering committee with high-level clinical involvement, well-defined roles and responsibilities between partners, effective communication strategies with end users, safe information governance precautions, and increased patient engagement and transparency. Barriers identified were the lack of dedicated resources for mobile change at our hospital, risk aversion, unclear strategy and regulation, and the implications of bring-your-own-device and mobile device management policies. The key lessons learned from the deployment process were highlighted, and a road map for the implementation of large-scale clinical mobile apps in hospital settings was proposed. CONCLUSIONS:Despite partnering with one of the world's biggest technology companies, the cultural and technological change required for mobile working and implementation in health care was found to be a significant challenge. With an increasing requirement for health care organizations to partner with industry for advanced mobile technologies, the lessons learned from our implementation can influence how other health care organizations undertake a similar mobile change and improve the chances of successful widespread mobile transformation.

Touchless technologies are going through a revival. Sheena Visram tells Johanna Hamilton AMBCS about this new era in inclusive and intuitive touchless computing.

INTRODUCTION:There is increasing interest in Artificial Intelligence (AI) and its application to medicine. Perceptions of AI are less well-known, notably amongst children and young people (CYP). This workshop investigates attitudes towards AI and its future applications in medicine and healthcare at a specialised paediatric hospital using practical design scenarios.METHOD:Twenty-one members of a Young Persons Advisory Group for research contributed to an engagement workshop to ascertain potential opportunities, apprehensions, and priorities.RESULTS:When presented as a selection of practical design scenarios, we found that CYP were more open to some applications of AI in healthcare than others. Human-centeredness, governance and trust emerged as early themes, with empathy and safety considered as important when introducing AI to healthcare. Educational workshops with practical examples using AI to help, but not replace humans were suggested to address issues, build trust, and effectively communicate about AI.CONCLUSION:Whilst policy guidelines acknowledge the need to include children and young people to develop AI, this requires an enabling environment for human-centred AI involving children and young people with lived experiences of healthcare. Future research should focus on building consensus on enablers for an intelligent healthcare system designed for the next generation, which fundamentally, allows co-creation.IMPACT:Children and young people (CYP) want to be included to share their insights about the development of research on the potential role of Artificial Intelligence (AI) in medicine and healthcare and are more open to some applications of AI than others. Whilst it is acknowledged that a research gap on involving and engaging CYP in developing AI policies exists, there is little in the way of pragmatic and practical guidance for healthcare staff on this topic. This requires research on enabling environments for ongoing digital cooperation to identify and prioritise unmet needs in the application and development of AI.

Introduction Population health and wellbeing is a priority in the UK, with new initiatives that empower children to live healthier lives. Excess weight has also been associated to worse outcomes during the COVID-19 pandemic period, complicated by reduced activity within the confinements of a home environment and coupled by increased screen time with remote classroom practices. As a result, children and young people now interact with computer interfaces in their home environment for education, gaming and healthcare purposes for prolonged periods and in new ways. Method There is a growing interest in Natural User Interfaces (NUIs) that use natural hand and body gestures to interact with computers. Advances to these technologies mean that they are now more accurate, easier to use and instead of requiring expensive depth cameras, can be operated using simple webcams. In this study, OpenCV library is used to track user movement by calculating the pixel difference between two frames and create a catalogue of exercises. We use PyTorch exercise recognition model to check the status of the user every 8 frames. These are recognised by using Convolutional Neural Networks (CNNs) with static training from datasets and offer users the option to create personalised exercises. Result We present University College London’s (UCL) Motion- Input supporting DirectX: Gestures for at-home exercises. This exercise module can recognise six repetitious static exercises, such as running on the spot, squatting, cycling on an exercise bike, and rowing on a rowing machine using a webcam. This is intended for integrated exercise triggers during gaming in place of a handheld control panel (i.e., jumping to trigger commands), remote coaching for fitness and bespoke treatment plans for physical rehabilitation. Conclusion Webcam-based computer vision exercise catalogues using everyday devices like webcams, hold the potential to encourage healthier and more active behaviours during screen-based activities.

IntroductionThe COVID-19 pandemic response has accelerated adoption of digital health technologies to support social distancing. In part, this involves repurposing technologies that were not originally developed for healthcare application. In the hospital setting, this includes the appropriation of ‘Off the Shelf’ (OTS) digital products that facilitate video-based clinical consultations, diagnostics and communication during ward rounds and multi-disciplinary team meetings. Such technologies were implemented within weeks at GOSH where video consultations were implemented for >90% of outpatient appointments.MethodsHere we present the findings from a Debrief-After Action Review (AAR) lasting two hours, supplemented with speculative questions on how lessons learned from the rapid deployment of one technology could inform the adoption practices of other emerging technologies.ResultsFifteen participants, who were members of a Transforming Care Links working group and interested in the impact of digital systems on patient care, contributed to the AAR. Five themes were identified from thematic analysis of this bottom-up approach: (i) Clinical: Planning and redesigning workflows with clear purpose, intent, and communication with clinical teams (ii) Technology: Infrastructure and equipment available across the team based on the needs of the workspace, with security and governance processes (iii) Capability mapping: Building core capability in a structured way across the entire team with space and time to trial out technologies as part of a progressive learning path and supported by clinical champions (iv) Benefits: Demonstrable benefits with new technology enabled ways of working based on preliminary small-scale deployments that deliver measurable value (v) Environment and Context: Context-specific workflow redesign for technology enabled interactions that consider optimum conditions of the physical environment.ConclusionThis user-centred approach identified routine training pathways, equity of access to training opportunities and equipment, a period of trialability and demonstrable benefits as enablers for the successful adoption of emerging technologies.

Introduction Recent research has identified exponential interest in Artificial Intelligence (AI) and its application to medicine. Perceptions of AI are less clear, notably amongst children and young people. This exploratory study investigates attitudes towards AI and its future applications in healthcare. Method Members of Great Ormond Street Hospital for Children’s (GOSH), Young Persons Advisory Group for research (YPAG) were invited to contribute to an exploratory workshop on AI lasting one hour. Quantitative polling of comfort with a series of AI-driven and autonomous design scenarios were scored anonymously on a 10-point Likert scale. Mechanisms for effectively engaging with patients and families on the potential for AI with healthcare professionals were then discussed. Results 21 YPAG members aged between 10 and 21 years participated. Sensor technology to reduce overcrowding (M 7.4, SD 2.7), cleaning robots (M 7.9, SD 2.4), virtual reality visits (M 6.5, SD 2.8) and 3D printed organs (M 6.2, SD 3.5) were the most accepted scenarios, whilst AI-powered nurses the least (M 2.4, SD 2.3). Educational workshops with practical examples that use AI to help, but not replace humans were suggested to address common worries, build trust and to effectively communicate about AI. Human-centredness, empathy and safety are important when introducing AI to healthcare, one participant quoting: ‘YPAG members are keen to be involved, for our perspective and ideas, especially as AI is our future.’ Conclusion Whilst policy guidelines now acknowledge the need to include children and young people to develop AI, this ignores the complex needs of patients. This requires creating an enabling environment for human-centred AI that involves children and young people with lived experiences of healthcare. Future research will build consensus on enablers for an intelligent healthcare system designed for the next generation. We believe that consortiums like YPAG are well placed to achieve this goal.

There is increasing interest in Artificial Intelligence and its application to medicine. Perceptions are less well-known, notably amongst children and young people. 21 members of a Young Persons Advisory Group for research, recommend creating an enabling environment with children and young people, through educational workshops with practical examples that use Artificial Intelligence to help, but not replace humans, address issues, build trust, and effectively communicate about potential opportunities.

Touchless computer interaction has become an important consideration during the COVID-19 pandemic period. Despite progress in machine learning and computer vision that allows for advanced gesture recognition, an integrated collection of such open-source methods and a user-customisable approach to utilising them in a low-cost solution for touchless interaction in existing software is still missing. In this paper, we introduce the MotionInput v2.0 application. This application utilises published open-source libraries and additional gesture definitions developed to take the video stream from a standard RGB webcam as input. It then maps human motion gestures to input operations for existing applications and games. The user can choose their own preferred way of interacting from a series of motion types, including single and bi-modal hand gesturing, full-body repetitive or extremities-based exercises, head and facial movements, eye tracking, and combinations of the above. We also introduce a series of bespoke gesture recognition classifications as DirectInput triggers, including gestures for idle states, auto calibration, depth capture from a 2D RGB webcam stream and tracking of facial motions such as mouth motions, winking, and head direction with rotation. Three use case areas assisted the development of the modules: creativity software, office and clinical software, and gaming software. A collection of open-source libraries has been integrated and provide a layer of modular gesture mapping on top of existing mouse and keyboard controls in Windows via DirectX. With ease of access to webcams integrated into most laptops and desktop computers, touchless computing becomes more available with MotionInput v2.0, in a federated and locally processed method.

Introduction Imagine entering an operating theatre or developing clinical skills in empathy and communication through Virtual Reality. To enhance the experience of learning, novel methods using VR have been researched and simulated for clinicians. This is because some aspects of clinical training, like conducting procedures and effective team communication focus on ‘learning by doing’ which is difficult to recreate remotely. Here we present a proof-of-concept prototype of a 360°-video editor that augments 360° videos with media to create a mixed reality learning experience. Method An editor was built inside Unity to augment 360°-videos of real-world scenarios in healthcare with interactive data. Unity is a cross-platform games engine used to create two-dimension, three-dimension, virtual reality, and augmented reality games, as well as video players to play panoramic 360°-videos. The video player is attached to a Render Texture and a Skybox material that provides the spherical surface for the 360°-video achieving an immersive experience. Results The editor comprises two software packages, one for the trainer, another for the learner. As a unique feature, we introduce clickable Hotspots. This enables users to annotate the 360° film by tagging specific artefacts in the environment and create a place-based interaction. These Hotspots are anchored to a position and can display text and images, and form part of a novel branched timeline of nested data. The intention being the trainer would create the film and annotate the environment with interactive media. This would then be available to the learner, who would use the player to view a bespoke teaching package. Conclusion Situated Cognition 360 Editor 2021 envisages trainers creating interactive 360°-video learning experiences using real life scenarios in healthcare. Future steps involve user experience evaluations, co-design and development of new learner interactions that deliver low cost, remote and easily deployed healthcare education through immersive learning environments.

Introduction There have been several attempts to integrate touchless interactions with computer interfaces in operating theatres and interventional radiology. Whilst motivated by infection prevention gains, this type of technology is yet to mainstream in healthcare as depth camera are historically expensive. Here we present MotionInput supporting DirectX for desk gestures. The key idea behind this prototype project is to ‘use the tech and tools you already have’, to provide touchless interactive interfaces to existing Windows software. Method This proof-of-concept prototype features Visual Studio based modules that use a regular webcam (e.g., on a laptop) and open-source computer vision libraries to deliver low-latency input on Microsoft Windows 10. The functioning software prototype focuses on several image-processing algorithms, leading to desk-based gestures with in-air pen and gloved hand navigation. Results Discrete hand motions are tracked via x and y coordinates. These coordinates are then mapped and processed by PyDirectInput functions to replicate movements of the mouse or press keys on the keyboard and click with the mouse. This is extended to recognition of 2 fingers that are gloved, which would apply to healthcare scenarios in which clinicians use one hand to navigate clinical applications including an electronic patient record or scan with one hand, whilst maintaining the second hand as free for other tasks. The prototype has been shown to work with UCL’s HoloRepository – an open-source project that enables 3D viewing of CT and MRI DICOM scans of the brain, lungs, chest, abdomen and kidneys. Conclusion Further research is exploring the application of MotionInput to design touchless interactions with computer interfaces in clinical spaces. Coupled with advances in computer vision, we believe that the convenience of use and ease of access of cameras integrated into existing hardware will improve uptake and help bring gesture recognition software into the mainstream.

Introduction Patients with Epidermolysis Bullosa (EB) or rare dermatological conditions have complex and on-going medical needs, requiring the involvement of multiple healthcare professionals. Patients currently attend a large Multi-Disciplinary Team (MDT) review day which includes appointments with up to eight different clinicians. This can be overwhelming for the patient and difficult to address all clinical priorities. Here we present a smartphone App that encourages patients to interact with MDT members prior to their appointment and score the in-clinic experiences thereafter. Methods An interactive and high-fidelity proof-of-concept prototype was developed by UCL Computer Science using Angular to implement both web and mobile applications. The back end of the system is deployed on an Azure VM, including an HTTP server (Nginx) and a container of Java Servlets (Tomcat). To ensure secure exchange of data, actions are sent to the back end via RESTful APIs to only exchange JSON format strings between server and clients. Results By taking a human-centred design approach, a fun and intuitive digital interaction was developed for children to express their complex needs in a safe and remote way. This was co-designed with eight specialised healthcare professionals including a Dietitian, Occupational Therapist, Consultant Paediatrician and dermatologist, clinical nurse specialist, Physiotherapist, Psychologist, Ophthalmologist and Dentist. It has been adapted for use in children with severe types of EB who may have reduced manual dexterity using mobile touchscreens, covers frequently asked questions and aligns with the colourful, underwater-themed outdoor play area, characteristic of the GOSH reception area Conclusion This mobile App and web-based prototype has been created to encourage patient involvement and collect measures of patient experience. Next steps involve user experience evaluation and validation within our patient cohort, and consultation to inform future outcome measures to provide a more patient-centred approach to experiences of healthcare in a digital age.

Introduction Augmented Reality (AR) overlays context-sensitive information onto the real world in a meaningful way. As AR bridges the gap between the real and virtual world, it holds potential to enhance the learning experience of users. This is because AR can offer contextually enriched interactions with content to illustrate complex concepts more intuitively and provide unique discovery paths for individual exploration. Diseases like Cystic Fibrosis (CF) require strict compliance to pancreatic enzyme replacement therapy (PERT), which plays an important role in the body’s digestive process. This requires patients to be aware of their condition and to participate in their care. For cases such as these, one possibility is a medication bottle with interactive AR attributes serving as a supplementary way of providing patients with essential medical guidance/education. Method A co-design process with Specialist Dietitians (x3) used sketches, storyboards, personas, paper prototypes and a digital prototype to develop and deliver the concept of an interactive medication label for PERT education. Results A proof of concept smartphone AR application for children with CF was designed to supplement current guidance for PERT. Based on the results of user research, 7 key design decisions to meet primary user needs were evolved during the process, leading the final design to a cartoon-style, marker-based AR application with a narrative structure, consisting of four main parts triggering by various markers: (i) an introduction to the digestive process, (ii) Mechanisms of PERT action (iii) instructions for taking PERT and (iv) extra precautions like dose and allergy. Conclusion Early evaluation with clinicians showed that interactive narrative holds potential for delivering educational content to patients about their medications and care. Future research will involve patient advisory groups to explore whether these types of technologies can help to reduce anxiety, medication errors, and offer engaging experiences of care through interactive experiences

Introduction Hospitalisation is a stressful experience for children. While parents and hospital staff are critical in helping to alleviate fear and manage expectations, here we present a Mobile Augmented Reality (MAR) App running on a smartphone to help manage this rollercoaster of emotions by overlaying digital content onto the physical world. Method Co-designed with Hospital Guides and the Young Persons Advisory Group (YPAG), we developed an interactive MAR prototype to guide children on their hospital admission. Called ‘GOSH garden’, we visualise a series of four short, contextualised, interlinked moments with four unique plant characters and a wayfinding butterfly. The AR experience begins from when children first receive their admissions letter at home, to arriving at the hospital, waiting for an appointment, and their first encounter with a clinician. Results Unity3D engine was used as a development platform for fast prototyping using scene building tools and good support for AR libraries, such as AR Core and Vuforia which were used for marker detection and extended tracking. By using smartphone device rear-facing cameras, this allows users to observe the scene ‘through’ their device. Our initial user feedback from 10 YPAG members supported plant characters that celebrate imperfections, recommended for more greenery and interactive play, and revealed that MAR companions have the potential to make children entering hospital feel more comfortable with the uncertainty that lies ahead. This led to six new voiceovers narrated by YPAG members. Conclusion The persuasive strength of interactive narratives has been shown to foster engagement, enjoyment, and creativity in children with increased benefits to traditional storytelling. We propose that a series of moments for positive distraction, that use interactive media, is one technological approach and a ‘gentle’ kind of user distraction that can be designed to help children as they enter the unknown world of a hospital.

Understanding human behaviour is essential to the successful adoption of new technologies, and for the promotion of safer care. This requires capturing the detail of clinical workflows to inform the design of new human–technology interactions. We are interested particularly in the possibilities for touchless technologies that can decipher human speech, gesture and motion and allow for interactions that are free of contact. Here, we employ a new approach by installing a single 360° camera into a clinical environment to analyse touch patterns and human–environment interactions across a clinical team to recommend design considerations for new technologies with the potential to reduce avoidable touch.

Introduction A transition from face-to-face to virtual consultations occurred in response to the COVID-19 pandemic. Evaluation of outcome data is essential for future healthcare modelling. Methods Clinicians at a children's hospital evaluated perceptions of face-to-face video and telephone appointments by questionnaire. Responses were compared with operational outcomes from June 2019 and June 2020. Results Ninety-three clinicians responded from 28 subspecialties. Virtual consultations increased from 6% (2019) to 67% (2020). No differences were found between appointment types for recording a medical and social history; a significant difference (p<0.001) was seen for the perceived ability to detect clinical signs, organise investigations and make a diagnosis. The proportion of appointments resulting in discharge compared with face-to-face visits was unchanged. The proportion of patients requiring further contact increased from 35% (32% face-to-face and 3% telephone) to 46% (14% face-to-face; 21% telephone and 11% video; chi-squared 426; p<0.0001). The percentage of patients offered an appointment following two ‘was not brought’ appointments increased from 71% (2019) to 81% (2020) and was most common following telephone appointments (20% face-to-face, 43% telephone and 18% video; chi-squared 474; p<0.0001). Conclusion The perception of clinicians is that virtual appointments enabled continuity of paediatric care with improved clinical assessment capability and attendance during video consultations compared with telephone consultations.