vCreate Neuro may add value to the delivery of care for people (adults and children) suffering from 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
- No direct evidence was identified that discusses the advantages and disadvantages of using an asynchronous video-recording service such as vCreate Neuro.
- 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 evidence 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.
A quantitative analysis of responses to closed questions from the clinician and service user surveys was undertaken to gauge opinion on ease and usefulness of using vCreate Neuro, if it affected quality of care, ease of communication and how ‘connected’ were
the service user and clinician.
- Patients and cares who used vCreate Neuro within paediatric 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 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. Use of 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 a treatment, 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 clinicians indicated that using vCreate Neuro led to a shorter time to diagnosis and treatment selection and none indicated the opposite. Similar findings were observed across adult service clinicians, apart from one instance where a clinician felt that use of vCreate Neuro led to a longer time to diagnosis.
A qualitative analysis of the free text comments from the clinician and service user surveys was undertaken to understand the user experience of vCreate Neuro and to
identify suggestions for improvements to the app.
- The clinicians, patients and carers valued vCreate Neuro and found it useful. Users felt that that vCreate Neuro saved time and resources for the NHS, patients, and carers, and has a positive impact on the clinician-patient/carer relationship. One carer shared their concern about vCreate Neuro replacing faceto-face appointments rather than being used as an adjunct diagnostic tool.
- Clinicians found vCreate Neuro particularly useful for diagnoses and identifying cases for which urgent treatment or investigation is required. By identifying nonepileptic events, clinicians suggest that it can prevent unnecessary investigations, treatment and travel; and provide rapid reassurance for patients and carers, especially in the case of those who live remotely or in rural settings.
- Patients and carers from vulnerable groups (such as people with neurological conditions who live alone) and people without access to high-speed internet may require assistance with accessing vCreate Neuro.
- A number of improvements were suggested by users including the facility to upload multiple videos, receiving a consistent form of feedback, the facility to leave longer free text responses, a ‘not applicable’ response option, the ability to edit submissions and a clearer method of uploading videos.
- Sentiment analysis revealed that 59% of clinician’s comments were positive in tone, 18% were neutral and 23% were negative. Carers and patients tone was more balanced between positive (44%) and negative (53%) and just 3% of their comments were neutral. Most negative comments by carers and patients were about the experience of technical issues while trying to log onto vCreate Neuro or upload their videos.
- Economic analyses based on the survey and 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.
- The findings were sensitive to the cost and number of inpatient admissions and the cost of consultant time estimated to review the uploaded videos. Any change
in these parameters simultaneously creates substantial uncertainty in the conclusions.
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 due to COVID-19 had a profound effect on access to health and care, and necessitated the exploration of both synchronous and asynchronous remote consultations (see Glossary) across Scotland. vCreate Neuro is an asynchronous service that was developed by clinicians within the Royal Hospital for Children, Glasgow (RHCG). 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. The objective assessment of data collected during this extension period will inform a decision on the potential nationwide procurement of vCreate Neuro.
What are the costs and benefits of using vCreateNeuro in diagnosing and treating people (children and adults) with epilepsy and other neurological disorders?
vCreateNeuro is a cloud-based service which enables transfer of short recorded (asynchronous) videos in healthcare settings.