Cambridge has been recognised as an important cluster for technology start-ups since the Cambridge Phenomenon Report was published in 1985. Although traditionally associated with electronics and life sciences, the region has now also grown into a major centre for the development of healthcare systems of all ilks.
Many of the ideas behind such ventures come from research projects undertaken at, or migrated to, Cambridge University. Others have been spawned from research undertaken at, or because of proximity to, Addenbrooke's Hospital, the base of Cambridge University Hospitals NHS Foundation Trust, which has produced seven Nobel Prize winners in medicine.
An example of the latter is Patientsknowbest.com, which on 23 September 2009 started the first year-long trial of its cloud-based service at Addenbrooke's. This aims to enable clinicians to undertake online consultations with patients suffering from genetic immunodeficiency problems.
The service means that patients can log onto PKB's web site to email specialists updated information about their medical condition or request advice if needed. Email petitions for help are given the same 24-hour response time guarantee currently accorded to voicemail messages.
This ability to share detailed data before an appointment, however, means that clinicians need spend less face-to-face time reviewing information and more on making decisions based on it. Being able to take preventative action may also reduce the number of overall appointments that patients require.
But such a service is only the start of it. In August, PKB signed another pilot contract with a second UK teaching hospital to enable patients to securely access their medical records or test results. If this pilot is successful, a further 15 teaching hospitals have also agreed to join the initiative, with the goal of enabling clinicians to share medication information more effectively with both patients and other clinicians.
Mohammad Al-Ubaydii, the company's founder – and also a computer sciences graduate and a qualified physician who trained in Cambridge – says: "We've set up a small social network that patients with long-term illnesses can access securely. Once they've consented to join, they'll get a copy of their data and will be able to invite others that are involved in arranging their care needs to access it too, for example, clinicians, friends, family or social workers."
This process should reduce the time that trusts have to spend both on handling the documentation required to obtain consent and ensuring that data transfer is secure. PKB's back-end system is the first of its type to be housed in an NHS data centre behind the NHS secure network's firewall.
The system also automatically uploads a copy of patients' records, which means that no manual intervention on the part of clinicians is required. It has also been certified by the Royal National Institute for the Blind as being suitable for use by people with disabilities.
But the service is also expected to cut costs. Research in the US indicates that online consultations can result in clinicians spending 25% less time on face-to-face meetings, while early monitoring may prevent incidents that result in a patients ending up in accident and emergency – which apart from the effect on the individual often costs a hospital thousands of pounds. Findings from the trial will be published in journals next year.
PKB was set up in July 2008 and currently employs about 10 people. The company charges for its service on a negotiable annual subscription basis, but expects to standardise fees over the next one to two years. Each subscription covers an unlimited number of patients.
A plus for brains
Also in Cambridge, ICM+ involves university researchers developing their real-time data collection and analysis software into an extensible neurological intensive care monitoring environment that can be used by medical researchers for international collaboration.
The aim is to create a common platform through which researchers at multiple centres can plug in their own or third party-developed information analysis and visualisation tools. Application programming interfaces have already been and are currently being developed to this end. Users will also be able to share and exchange research data and ideas through a portal, which has to date been set up but not actively marketed.
Peter Smielewski, a senior research associate at Cambridge University and key developer of the ICM+ system, says that the original goal was to create a configurable environment for the extraction and real-time processing of signal data from bedside monitors, so that it could be presented in an easily understandable format.
The initial focus was to aggregate information relating to intracranial and arterial pressure, which was generated by patients with head injuries and hydrocephalus. The data itself and the interaction between the two variables is currently presented in the form of statistical charts, which can be plotted and analysed to look for underlying trends.
"Wave forms and interactions carry important physiological information that is not visible on bedside monitors and there's no way that doctors could link the complex, constantly changing information on the monitors and interpret it without intervention," he says.
ICM+ is currently being used by 38 institutions in 17 countries, mainly in central Europe, to analyse conditions ranging from severe strokes and subarachnoid haemorrhages to liver failure. It has been available under a commercial licence from Cambridge Enterprise, a technology transfer company wholly owned by the university, since 2004 and costs £6,000 for a one-off site licence, which includes ongoing maintenance and upgrades.
The system is also used for clinical diagnostic and decision-making purposes in some instances, but at organisations' own risk due to the configurability of its settings and parameters. A locked-down version of the product may be made available at some point in the future, however.
A DOS version of the software was first build by Marek Czosnyka, a reader in brain physics at Cambridge, when working at the University of Warsaw in Poland during the early 1980s. The system was rewritten and further developed for the Microsoft Windows environment in 2000 when its name was changed from ICM to ICM+.
Czosnyka is still actively involved with ICM+, but as usage increases, the aim is to hire an additional programmer to develop further the core product. The aim is also to encourage PhD-level engineering and computer scientist students to work on projects based around the software as a means of facilitating the creation of additional extensions and plug-in modules.
