1 0 T U E S D AY @ M E D I C A Drones take laboratory logistics to a new level A Swiss hospital group is using drones to fly medical laboratory specimens between its key centres, Mark Nicholls reports In what is believed to be a world first, the eight-hospital Ticino EOC organisation has partnered with Swiss Post and US drone manufac- turer Matternet to spearhead faster, more efficient specimens transport. The trial is being held for flights covering the 1.3 km between two of its Lugano hospitals, the Ospedale Civico and Ospedale Italiano. While each hospital has its own emergency room and laboratory, the laboratory at Ospedale Italiano, in the city centre, closes at 5pm and at weekends. ‘Presently the blood samples are transported between the two hospitals by local taxis,’ explained hospital director Luca Jelmoni. ‘This is, of course, subject to the availability and to traffic condi- tions. Therefore, to ensure transport that’s always available and economi- cally more interesting, we decided to apply the new technologies and use drones to transport our blood sam- ples in those time slots when one of the laboratories is closed.’ There are already clear benefits from using drones in this way: the transport time does not depend on traffic conditions or third parties, cost is lower than by taxi, and the drone can fly over hills and mountains, considerably reducing the length of transportation compared to the road. In addition, when snow makes road driving more difficult, drones will still operate and avoid delays in delivering specimens and test results. Whilst the distance between the hos- pitals is relatively small, Jelmoni told European Hospital that the drone can actually fly as far as 20 km, which means Ticino EOC is already consid- ering a future possibility of transport- ing laboratory samples from other hospitals even further away. The first phase of the initiative involved proving the technical feasi- bility and acquiring official licenses and permits for the autonomous flights over populated areas, and this has been completed. With the approval of the Federal Office for Civil Aviation (FOCA), the trial will now move to the second phase later this year, which will see drone trans- port integrated into the hospital pro- cesses. ‘That will be to test the integra- tion of drone transport with the Point-of-care testing enters the community The Laboratory Anywhere program Report: Mark Nicholls Point-of-care testing is being used to successfully deliver diagnostics to hard- to-access patients in a community in northwest England. The ‘Laboratory Anywhere’ pro- gramme initially targeted the Gujarati community to aid them with timely diagnosis for diabetes and cardiovascu- lar disease, but it is now being extend- ed to people with mental health issues and learning disabilities, and also to offer additional tests. Led by Dr Martin Myers, Associate Divisional Medical Director for Pathology for Lancashire Teaching Hospitals, he explained that the Laboratory Anywhere program is a value-orientated approach to delivering diagnostics where needed for a patient or a clinician to make decisions. Whilst central laboratories may offer economies of scale and special- ist testing, he suggests they can be remote from the patient pathway. The Laboratory Anywhere initiative bridges this gap. This is delivered via a multi- disciplinary team, with the Associate Divisional Medical Director of Pathology supported by healthcare scientists for the choice and verification of the diag- nostic devices, training, delivery, and informatics. The program also involves close liaison with clinical support staff and patients to ensure that the service is relevant and appropriate. Myers first set up the Point of Care Testing (POCT) Committee more than 20 years ago at Lancashire Teaching Hospitals and successfully implemented it in local hos- pitals and the community before the focus shifted, in 2001, towards deliv- ering diagnostics to ‘hard-to-access’ patients, such as the Gujarati commu- nity, which was seen as at a high risk of diabetes and cardiovascular disease but were not always accessing the tra- ditional patient pathways. ‘Our principle was simple; we would take healthcare to the people rather than expect the people to follow our patient pathways,’ he explained. With Professors Romesh Gupta and Satyan Rajbhandari and others, the Lancashire Gujarat Health Users’ Forum was set up and Health Melas (health festivals) established to deliver health checks including glucose, cholesterol (performed by Healthcare Scientists) and physiological checks (performed by medical students from Manchester University) to identify at-risk patients. Now in its 15th year, the Health Mela has been extended to all mem- bers of society, with 4-6 events annu- ally. Learning and mental health issues From the initial tests for the Gujarati groups, Laboratory Anywhere now reaches patients with learning disabili- ties and will be rolled out to patients with mental health issues. ‘Both these groups are at risk of diabetes and cardiovascular disease and are dying 10-20 years earlier than expected due to physical disease because of lack of access to simple diagnostic tests, or being needle pho- bic,’ Myers said. ‘This is unacceptable Martin Myers MBE is a Consultant Clinical Biochemist and Associate Divisional Medical Director for Pathology at Lancashire Teaching Hospitals, where he continuously addresses pathology re-design, using advanced automation and point of care testing (POCT). His scientific interests include the use of automation, POC testing and informatics in improving the quality of the diagnostic process, while his clinical interests include the use of laboratory testing to improve patient pathways. Luca Jelmoni became CEO of the two public 300+-bed hospitals in Lugano, Switzerland (Ospedale regionale di Lugano) in 2012. He graduated from the ETH Zurich (Swiss Federal Institute of Technology) in 1992 and gained his MBA from Kellogg University in Chicago, USA. Initially he worked in the pharma- ceutical retail, business development and corpora te finance. In 2007 he became CEO of a leading Swiss clinic specialised in repro ductive medicine. industry, then in emergency room and laboratory pro- cesses,’ Jelmoni explained. ‘This will be supported by a specific device, being developed by the supplier, which will autonomously load and unload the drone and charge the batteries.’ Phase three will see day-to-day usage of drones to transport blood samples between the hospitals, with hospital staff launching the drone via a smartphone application. The drone will then fly autonomously along the predefined route to its destination, where another staff member will receive the box. Some observers have raised con- cerns that the acceleration and movement of drones might affect the quality and integrity of blood samples but, in a separate study con- ducted at John Hopkins University in Baltimore, researchers have shown this is not the case. The Matternet logistics drone used in Lugano is a quadrocopter, 80 cm in diameter (without rotor blades). Able to carry up to 2 kg, and with a top speed of 36 kmh, the drone can operate in temperatures of -10 to +40°C and at an altitude of 50-100 m above the ground. Safety features include a para- chute in case of total drone failure, but all the drones’ on-board critical components are replicated in case of malfunction. However, the test phase has seen more than 80 flights with- out any problems and the hospital believes transportation with drones will be as secure as transportation with a taxi. Once the drone meets all the strict requirements regarding safety, practicality and reliability, they will be in daily use between the two Ticino EOC hospitals – some time in 2018. Transportable equipment is a key factor for the Laboratory Anywhere program. C o urte sy of O rio n and the value-orientated Laboratory Anywhere model is designed to bring diagnosis to these patients.’ A Clinical Advisor to the Chief Scientific Officer of NHS England, Myers is leading a national pilot for the National Health Service (NHS) to deliver the Laboratory Anywhere model to these patient groups, with HbA1c, Total Cholesterol and HDL cholesterol measured. The hope is that the Laboratory Anywhere concept will be adopted throughout the UK and beyond, to diagnose and monitor diabetes and cardiovascular disease in hard-to-access groups in developing countries, where socio-economic and political issues have resulted in lack of laboratory ser- vices, Myers added. Laboratory Anywhere uses portable Lab-in-a-bag or Lab-in-a-Box technol- ogy to take to the patient. The devices vary depending on the purpose; for dia- betes and cardiovascular disease, sim- ple devices to measure HbA1c, glucose, cholesterol and HDL cholesterol on a finger prick blood sample are used, whilst for more complicated questions, such as assessing renal function, blood gases, and calcium, cartridge-based devices can measure up to 20 analytes at the same time from one blood sample. In a Health Mela, his team screens more than 200 people in six hours. However, he acknowledges that whilst measuring HbA1c and lipids in 4-8 minutes is good and glucose meters take seconds, he is keen to see devel- opments where the analytical time can come down to less than a minute for some tests. Into outreach services The Laboratory Anywhere model is also being used by outreach services (Sepsis and Acute Kidney Injury teams) with Myers’ team now about to implement the Lab oratory Anywhere for frailty units, care homes, urgent care centres and GP surgeries, with results captured on the patient record. Overall, the impact of Laboratory ‘remarkable’, Anywhere has been Myers said. ‘Patients enjoy the concept, and support what we are doing. As well as diagnosing some patients with diabetes and elevated lipids, many patients are identified as at risk and therefore we can intervene before disease develops. ‘Advances in technology,’ he con- cluded, ‘mean healthcare scientists can bring the laboratory wherever it’s need- ed and no longer can lack of access be used as an excuse for not reaching out to patients’. EH @ MEDICA No 2 2017