Point of Care Blog Series 1 – Blog 1. Diagnostics on the Move: Community Hubs and Mobile Testing Explained

Welcome to our readers.

We are joined today by Olusegun Olayemi (POCT Cross-site Manager for Bradford and Airedale Teaching Hospitals).

Moderator – Tony Cambridge

TC: Hi Olusegun, it’s a pleasure to have you participate in our new series of blogs focussed on exploring hot topics in the point of care, rapid diagnostics, and in-vitro diagnostics sector. You have significant experience and knowledge around today’s topic. Thank you for sharing your insights.

OO: Thank you for the opportunity to share my experience. Community Hubs and Mobile Testing are new initiatives of the NHS aimed at building capacity for diagnostic testing in the community and relieving pressure on hospitals concerning diagnostic testing. Hub presents an opportunity to prevent adverse health conditions and the worsening of existing ones.

That’s exciting, and we’re honoured that you’ve contributed your time to our blog series, so let’s jump straight in…

How are mobile testing units improving access to diagnostics in remote and underserved areas? How can they contribute to equality and equity of healthcare access?

OO: One of the main aims of mobile testing units is to address the barriers to accessing healthcare services in remote and underserved areas, which can lead to and exacerbate health inequalities. A certain group of people struggle to access traditional NHS services because of physical disability, communication barriers, and a lack of trust towards healthcare services. Mobile testing units reduce health inequalities by improving access to diagnostic testing for people in health inequality groups.

They can contribute to equality and equity of healthcare access by removing barriers to diagnostic testing and focus on reducing health inequalities by undertaking estates modelling based on population demand and needs, and involving patients, service users and carers in the design of services to ensure that they reflect local needs.

The testing units are physically accessible, have disability-friendly premises, and are reachable online via telephone. They have appointment availability and are conveniently located near the community. They provide a timely service by making it easy to see a healthcare professional quickly and receive care out of hours.

What types of rapid diagnostic tests are most commonly deployed in mobile health hubs?

OO: MRSA Screening, INR Monitoring, NT-proBNP, Diabetes, Sexual Health, Drug of Abuse testing, Respiratory medicine, Prostate cancer, and Well-being clinics like Lipids and Blood pressure to mention few.

How do community health hubs integrate diagnostics with other primary care services?

OO: Community health hubs should be operated as a ‘one-stop shop’ where possible, with enough space for consulting rooms to support patients with concerning diagnoses. The consulting rooms may be valuable for the assessment of patients with a range of conditions and for explaining the findings of the investigation. Hubs should also offer training and opportunities for staff to work in multidisciplinary teams, which will help the hubs to integrate diagnostics with other primary care services.

What logistical challenges come with operating diagnostics on the move, and how are teams overcoming them?

OO: Challenge- Lack of privacy for patients with concerns about sensitive diagnostic/personal tests (e.g., breast examination or smear test) being conducted on the same site.

Solution- The layout of Hubs should be sensitive to patients’ discretion and privacy. The use of neutral signage to keep diagnostics discrete should be encouraged, so it is not obvious which diagnostic test patients are attending the Hub for. Separate changing rooms for males and females would also help maintain privacy.

Challenge – Lack of emergency backup should complications arise during procedures; a typical example is endoscopies being carried out at Hubs.

Solution – The best way to overcome this challenge is by separating simple and basic tests from specialists and more complicated tests into different Hubs, taking into consideration the seriousness and sensitivity of specific diagnostic testing. This way, additional support can be made available, depending on the type of diagnosis and how appropriate.

Challenge – Diagnostic Appointment Backlogs

Solution – Telephone appointments can help reduce diagnostic appointment backlogs.

Challenge – Problem with duplication of tests and delay in accessing the results from Hub.

Solution – This can be mitigated by providing clear and real-time communication to referrers, supported by digital transfer to avoid duplication of test. Using a joined-up IT system will ensure communications between referrers and diagnostics work well. The Hub should provide clear instructions and expected timescales for receiving results.

Challenge – Patient being anxious over abnormal results.

Solution – There must be structures in place for trained staff to communicate unexpected clinically significant results. Normal and abnormal results should be treated differently. Abnormal results if serious should be communicated by a specialist/clinician, ideally by GP/consultant who understands the needs of their patients.

What role does digital connectivity play in ensuring results from mobile units are linked to patient records?

OO: Connectivity plays a key role in ensuring that results from mobile hubs are linked to patient electronic records and to achieve this, there must be systems in place to work with relevant local networks (including imaging and pathology networks, and endoscopy and cardio-respiratory networks) to support data sharing. Joined-up IT system can be used to provide unified solutions that allow centralised hub booking and image sharing, as well as offering a more personalised experience for the patient and enabling easier co-ordination of tests. In other for the hub unit to report results in a timely way to referrers there must be in place a digital connectivity between diagnostic IT systems and organisations across health systems to allow the appropriate sharing of information.

How do patients perceive and respond to diagnostics delivered via mobile units or community hubs?

OO: The information from early adopters suggest that patients respond to diagnostics delivered via mobile units or community hubs in a positive manner. The following are ways to improve patient perception even more.

The location must be accessible, with ramps and drop-off/pick-up points for taxis near entrances.

Community hubs must be near a public transport station/stop and/or close to affordable and plentiful car parking to enable access for patients and staff.

Ensure there are patient transport services provided for those on low income, or for people with disabilities.

Patients should be within 45 minutes travel (via public transport) to their nearest hub unit.

The surrounding neighbourhood of the hub unit (e.g. high street location) does not matter to patients, as long as the other design principles are adhered to

What funding models support the expansion of diagnostics on the move?

OO: Community hubs are delivered in collaboration with system partners, faith organisations, the social enterprise sector (VCFSE), and the community. It can be funded from these sources. Also, they can benefit from the National NHSE CDC funding and national DDC public dividend capital funding.

In your experience, do you see a lot of coordination between mobile testing and community hubs with local hospitals and labs to ensure continuity of care?

OO: The community hubs and mobile testing units will struggle without coordination with local hospitals and laboratory, especially in the area of staffing. Hub units work with partners and NHS regions to ensure coordinated workforce planning, including the modelling of workforce needs (both clinical and non-clinical). This includes engaging with relevant system and provider boards and networks to agree on priorities in relation to diagnostic services, including the use of any shared staffing models. The local community hubs and mobile testing unit’s workforce should reflect the diversity of the population it serves.

What innovations are emerging in mobile diagnostic technology that could transform future community care delivery? Are services ready for the changes that could be proposed in the 10-year plan?

OO: The below innovations are emerging in mobile diagnostic technology and could transform the future of community care delivery.

• GI Genius AI device – a computer module powered by AI to help detect cancerous tumours during colonoscopy.
• Boneview technology- AI that help to support bone fracture detection
• The Skin Analytics DERM system- AI that helps skin cancer detection
• Heart Rate and Blood Pressure Monitors which continuously track cardiovascular health, enabling timely interventions if abnormalities are detected.
• Glucose Monitoring Systems which provide real-time data on blood sugar levels for individuals with diabetes, facilitating better management of the condition
• Clinical Decision Support Systems (CDSS) this provide clinicians with evidence-based recommendations and insights based on patient data, improving diagnostic accuracy and treatment planning.
• Image Analysis is an AI algorithm that can analyse medical images (X-rays, CT scans, MRIs) with high accuracy, aiding in the early detection of diseases like cancer.
• Robotics: Assist with surgical procedures, rehabilitation, and other medical tasks, enhancing precision and efficiency

Services are still evolving and we are at the early stages of the transformation we hope to see in the next 10 years.

Thank you to Olusegun Olayemi for sharing his expertise and insights on this topic. Many thanks for your participation in this blog series.

Follow Olusegun on LinkedIn.

Point of Care Blog series 1 : Blog 2 coming soon…

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