AI assistant shows great promise in cataract care pathway

Dora, an AI-powered automated speech system, can call patients, ask them questions, comprehend their responses, and recognise with precision which ones call for a clinical review. Researchers from Imperial College Healthcare NHS Trust, Oxford University Hospitals (OUH) NHS Foundation Trust, and Newcastle University conducted the study, which was published in the open access journal eClinicalMedicine of The Lancet. The study included more than 200 patients who had recently undergone cataract surgery, the most common procedure done by the NHS. Three weeks following the procedure, Dora called to ask them to perform a follow-up evaluation, which was observed by an ophthalmologist specifically for the study. Researchers evaluated the independent judgements on the clinical relevance of five symptoms and whether the patient needed more evaluation made by Dora and the supervising ophthalmologist. Dora’s choices throughout the trial closely matched those made by the physicians.

The study’s co-principal investigator, Newcastle University Professor of Digital Health and Clinical AI, Edward Meinert, led the acceptability assessment. He said: “The way in which patients responded to the AI system suggests that it may be expanded and used in other clinical paths, potentially saving the NHS time and money. The study assessed the cost impact of Dora in comparison to traditional treatment, as well as its usability and acceptance to patients. The AI follow-up was accepted by the majority of participants, however some expressed worry about the absence of a “human element” in situations with problems.”

Co-Principal Investigator at OUH and honorary consultant ophthalmologist Kanmin Xue stated: “The Dora system is able to call patients autonomously by telephone and conduct a conversation that gathers the key information needed to determine whether a patient is recovering well or requires further medical assessment.” Those that required further clinical input were successfully identified and given a higher priority. Thousands of patients at OUH have had their post-cataract surgery assessments conducted using an updated version of Dora, which was implemented following the trial. We are now using it for pre-operative evaluations as well, in which Dora asks the patient a series of screening questions, one of which is whether or not they want surgery for their cataract. The information is recorded in our electronic health records, which expedites the in-person pre-assessment guided by a nurse. Compared to traditional care, using this telemedicine follow-up examination was projected to have saved each patient about £35 in costs. “

Health Innovation Oxford and Thames Valley provided assistance for the development of Dora by the Oxford spin-out business Ufonia. These organisations conducted a feasibility study, examined physician comments, and assessed the financial benefits of integrating Dora into the post-operative patient route. CEO of Ufonia, Dr Nick de Pennington, stated: “This research demonstrates unequivocally Dora’s high accuracy in identifying patients who require human clinical input.” We are currently extending Dora’s “Artificial Clinical Intelligence” throughout the National Health Service’s and other countries’ eye care pathways. In terms of cost- effectiveness, acceptability, and safety, the system provides a lot of advantages. In addition, it  helps hospitals lower their carbon impact, and most significantly, it makes healthcare more accessible to patients.”

The National Institute for Health and Care Research (NIHR) Artificial Intelligence in Health and Care Award is providing funding for this study.