Key Findings

vCreate Neuro may add value to the delivery of care for people (adults and children) who have epilepsy and other neurological disorders by reducing people’s waiting times, more efficient triage and improving information available for diagnosis and treatment. In addition, vCreate Neuro may lead to resource savings for NHSScotland. 

Rapid review of the published literature 

• There is no directly applicable published evidence that evaluates the use of asynchronous video-recording services in people with neurological conditions. There is limited evidence to suggest that home-video recordings (HVRs) via smartphones are a promising and reliable complementary tool for diagnostic assessment of paroxysmal seizure like (non-epileptic) episodes. 
• There is some evidence to suggest that HVRs may be useful in distinguishing epileptic seizures from non-epileptic seizures, suggesting that an asynchronous service such as vCreate Neuro can potentially speed up the process of differential diagnoses or triage based on urgency and need. 

Quantitative analysis of survey responses 

A quantitative analysis of responses to closed questions from clinician and service user surveys was undertaken to gauge opinion on the ease and usefulness of using vCreate Neuro, if it affected quality of care, ease of communication and how ‘connected’ the service user and clinician were. 

• Parents and carers who used vCreate Neuro within paediatric and adult services were predominantly positive about the ease of use of vCreate Neuro, how ‘connected’ it made them feel to the clinical team, the impact on the quality of care, and the ease of communication with the clinical team. Being ‘connected’ was defined by the project team as ‘having easy access to the team and a positive relationship.’ ‘Access’ was not defined. For paediatric services users, vCreate Neuro avoided absence from school or work in approximately 20% of use cases. 
• Clinicians from both paediatric and adult services were predominantly positive about the ease of use of vCreate Neuro, its usefulness in the management of patients, its usefulness in making a diagnosis or selecting treatment options, the quality of the video uploaded, the impact on quality of care and feeling connected to the patient. 
• More than half of the responses from paediatric service and adult service clinicians indicated that using vCreate Neuro led to a shorter time to diagnosis and selection of treatment options. 

• Both paediatric and adult service clinicians reported that the most common investigation to be avoided was an electroencephalogram (EEG). 

Qualitative analysis 

A qualitative analysis of 16 semi-structured interviews and the free-text comments from the clinical and service user surveys was undertaken, to explore people’s experiences of using vCreate Neuro and its perceived impact on receiving and delivering care. 

• Service users and clinicians indicated that vCreate Neuro provided an easy and secure method of exchanging and storing videos. 
• A key theme in clinicians’ interviews and survey comments was vCreate Neuros usefulness at the time of initial diagnosis for newly referred patients and in the identification of urgent cases. 

• Access to expert and peer review via vCreate Neuro was highly valued by both secondary and tertiary clinicians. Clinicians and service users valued the opportunity to carry out rapid remote review of service users’ videos, using vCreate Neuro and thought that this led to more rapid diagnosis and could assist with ongoing care. 
• Clinicians described the impact of vCreate Neuro on pathways of care and on shifting some clinical tasks away from scheduled appointments. The direct access to clinicians via vCreate Neuro may shift some responsibilities for ongoing management from primary to secondary/tertiary services which should be recognised in job planning. 
• For service users more direct access to, and communication with, clinicians was a key benefit. The response to video sharing was perceived to be more rapid than other methods of contacting clinicians, and allows contact in-between appointments. A small number of service users were concerned that vCreate Neuro could be used to replace some face-to-face appointments rather than as an adjunct to them. 
• Some service users raised the concern that they may doubt themselves or find their concerns not taken seriously without video ‘evidence’. 
• Service users from vulnerable groups (such as people with neurological conditions who live alone), may be unable to use vCreate Neuro, or they may require assistance with its use. A lack of access to high speed internet may make it difficult to upload videos to vCreate Neuro. People who are less able with IT may need assistance to use vCreate Neuro. 

• A number of improvements were suggested by vCreate Neuro service users including the facility to upload multiple videos, a framework to guide expectations about feedback, more flexibility in responding to clinical questions, increased compatibility with different types of file and device, a more user friendly mobile phone based application (app), and the ability to edit submissions. 
• Clinicians believe that vCreate Neuro has great potential as a research and training tool, and for use in other specialities. Consent and clinical governance procedures should continue to be developed and adapted to fit the changing scale and ways in which it is used. 

Economic analysis 

• Economic analyses based on the paediatric clinic user survey and NHSScotland cost data illustrate that vCreate Neuro may lead to cost savings via a reduction in hospital resource use, for example fewer unnecessary clinical visits and investigations. Other benefits identified in the clinical user surveys, which could not be quantified in this economic evaluation, included potentially reduced time to diagnosis and treatment. 
• The robustness of monetary findings is limited by the use of expert opinion-assumptions. In deterministic scenario analyses, findings were most sensitive to the cost and number of inpatient admissions.  

What were we asked to look at

The Scottish Health Technologies Group (SHTG) was asked to assess the value of using vCreate Neuro, an asynchronous secure video messaging service, for delivering care to adults and children with epilepsy and other neurological disorders.

Why is this important

Societal restrictions as a result of the COVID-19 pandemic had a profound effect on access to health and care, and necessitated the exploration of both synchronous and asynchronous remote consultations across Scotland. vCreate Neuro is an asynchronous service that was developed by clinicians from the Royal Hospital for Children, Glasgow (RHCG) in partnership with colleagues in other NHSScotland centres and a technology partner vCreate Ltd. vCreate Neuro enables patients or carers to send videos of seizures that have been recorded on smartphones, and associated data, to their clinical team for remote clinical interpretation and management advice. 

In April 2020, the Digital Health and Care Directorate, Scottish Government funded a 6-month pilot project to test the use of vCreate Neuro in all tertiary adult and paediatric neurology services in Scotland. Based on initial positive feedback and to allow evaluation at test sites, the vCreate Neuro service was extended beyond the pilot to include all non-tertiary paediatric services. SHTG’s work will help to determine the value of the vCreate Neuro for patients and NHSScotland. 

Referred by

Scottish Government