An NHS doctor at St. Mary’s Hospital speaks with a patient on a COVID-19 ward during the pandemic whilst wearing a Microsoft HoloLens 2

Microsoft Stories podcast: episode 6 – Imperial College Healthcare NHS Trust

Hello and welcome to Microsoft Stories, a new podcast about technology and innovation.

In this episode we focus on Imperial College Healthcare NHS Trust, which runs some of the busiest hospitals in London. Staff are wearing Microsoft HoloLens, the mixed-reality headset, as they work in high-risk areas. This has been useful during the COVID-19 pandemic, as only one person wearing a HoloLens has to be close to patients, while the rest of the medical team can watch a live feed in another room.

You will hear from James Kinross, a consultant surgeon and senior lecturer at Imperial College London who was on the frontlines of medical care during the pandemic.

You will also hear from Annette Garner, an Azure specialist focused on data and AI in health, and Laura Robinson, Health and Life Sciences Lead at Microsoft UK, who reveal how technology can help doctors, nurses and GPs, and ease pressure on the NHS.

Click the play button and join us on our journey.

Click here to visit our Podcast page.

Transcript of this episode


Hi, I’m Andy Trotman, Head of News at Microsoft UK. Welcome to Microsoft Stories – a new podcast looking at technology and the people who use it.

In this series, I’m trying to answer the question: what is innovation? It means different things to different people. Innovation can be as simple as adding an eraser to the end of a pencil or as complex as sending people to the Moon.

What does it mean to be innovative? How do you know you’re being innovative? Along my journey, I meet people using technology in amazing ways, and discover what innovation means to them.

Join me on my journey.

A close-up of an NHS doctor wearing a HoloLens


JAMES: My job was to look after sick people coming into the hospital that week. And that was probably the second week in March, I think. And it really became obvious then that we had a big problem. So we were seeing patients come in who were really, really sick. We were seeing patients coming in who were absolutely well, who had awful looking lungs on their scans and their images. And we were starting to worry about the best way to protect and to look after our staff. And we were starting to see our staff getting sick, and probably around the second or third week of March… I think all Hell broke loose is probably a fair way to describe it.

That was James Kinross, a consultant surgeon and senior lecturer at Imperial College London, one of the busiest NHS trusts in the UK and one of the top 10 medical research centres in the world.

He’s describing what it was like on the frontlines of a major hospital as the COVID-19 pandemic swept across the country. Patients and staff, his colleagues and friends, were dying around him every day, and those who were left fought back against the virus as best they could as wave after wave of people turned up at A&E, struggling to breathe.

JAMES: … one of the things that became apparent is that my NHS colleagues who were just exceptional people, they’re brilliant people, but they were just getting hammered and they were getting hammered, and they were just cognitively completely overburdened. So their ability to think outside of the immediate problem that they were having to face was just very, very difficult.

With no vaccine, just keeping people alive became the goal, so ventilators for patients and protective equipment for medical staff were critical. But every hospital in the world was trying to obtain the same things. Despite the best efforts of manufacturers, who stepped up production of PPE, there simply wasn’t enough life-saving equipment to go around.

JAMES: I was sat there at the beginning of the COVID pandemic, and I counted 29 people in a close proximity in a single trauma call, and I was thinking, “well, if this is how we’re going to run the next few weeks, a lot of people are going to get sick and we have to change this really dramatically”.

Imperial is home to some of the leading healthcare experts in the world. James knew that if there was a team who could think creatively and come up with solution to help medical staff stay safe as they treated patients, they would be based at that hospital.

Around the same time, Microsoft approached Imperial and asked if there was a way the company could help during the crisis. The two organisations have a close working relationship and often collaborate on projects. St Mary’s Hospital in Paddington is just a stone’s throw from Microsoft’s London office.

The call led to Microsoft offering Imperial 10 HoloLens Two headsets, which would allow medical staff to hold Teams calls, place virtual replicas of patient files and scans in their line of sight, and collaborate virtually – all without using their hands.

Microsoft and Imperial came together to create solutions for doctors and nurses during this global pandemic. And that’s where the innovation really began.

NHS surgeon prepares for surgery during the COVID-19 outbreak wearing a Microsoft HoloLens and full PPE

JAMES: So the use case for it was reducing potential COVID contacts. So to give you a kind of an idea, we had COVID wards that were very difficult to operate in. I don’t mean surgically, I mean clinically, so you had to wear very heavy PPE. Going in and out of these rooms is very, very difficult and you consume an enormous amount PPE, so the simple concept was that we’re going to create completely virtual ward rounds. Rather than sending four people, a consultant or an attending physician or doctor with a team of juniors and nurses, we’re going to send one doctor in. And we did that. And the response that we had was immediate because it just worked.

The interesting thing for me was how the innovation here was different from every other company and organisation I’ve spoken to. I think that was because the situation was so unique. Lives were literally being lost, so every second counted. It all happened incredibly quickly, which doesn’t usually happen in the NHS.

James and his teams focused on three things: the safety of patients and staff, cleaning the HoloLens after each use, and keeping patient data secure.

Once those were in place, they showed their plan to the people in charge, got the sign-offs they needed and started using HoloLens on COVID wards.

That might sound straightforward, but James described it as “digital revolution”. Because the NHS is very careful about innovation. It has to be because lives could be lost if the wrong decision is made. So, for Imperial to launch this HoloLens innovation was an innovation in itself.

Here’s Laura Robinson, Health and Life Sciences Lead at Microsoft UK.

LAURA: Yeah, healthcare is very high risk, and so it is not one of those industries where you can fly the plane and build it as well, because I think to the point you mentioned, it is life and death in many cases. So there’s a lot of caution that needs to be applied.

I think it allows them to stray away from maybe looking at innovation, but when put under the ultimate pressure, which is a global pandemic, what we did see is probably an advancement of three years in the adoption of technology to what we otherwise would have seen under normal times and circumstances.

COVID speeding up innovation in the healthcare sector by three years is incredible. It’s rare that technology is adopted this quickly in any sector. Then again, no one has ever seen a pandemic like this before.

Laura touched on the same point as James – amid the spike in patients and the chaos of A&E departments during the early days of COVID, healthcare professionals had to find new way to cope with the increased workloads.

Microsoft’s cloud platform, Azure, was used to store data, Artificial Intelligence was used to analyse it, while the company’s data visualisation tool, Power BI, was used to show that information to doctors and nurses in a way that could be easily understood and acted upon.

The NHS leapt into action, rolling out Teams to 1.3 million employees. That led to doctors at University Hospital Southampton choosing to receive Coronavirus test results straight to their mobile phones. No longer would they have to queue up to use a computer on a ward, discover the results weren’t available yet and come back two hours later to look again.

Think of all the time they saved by receiving results straight to their phone, the second they were ready. That time could be spent treating patients.

Because, at the end of the day, innovation has to put the patient first. It has to give people a more accurate diagnosis, or ensure treatment is less invasive or make appointments easier to attend. If it doesn’t benefit the patient, it won’t be used.

A doctor wearing a HoloLens enters a COVID-19 ward

LAURA: In healthcare, how I see innovation working is taking the need of the clinician, taking the need away from them of having to document, taking the need away from them of having to consult books. Wouldn’t it be neat or great if through a wearable device, a patient’s information is captured and provided real time to a clinician, and during a consultation with a clinician, they could transcribe through my voice into text, the medical information that I’m providing, so that on the back end, through artificial intelligence, there are bots who are able to offer up real time insights or questions to be asked.

So innovation to me is not removing the steps or the need for what happens, but facilitating it in a different or unique way to lessen the administrative burden and to enable the clinician to be more effective to allow real-time insights to be provided, and then to reduce the time to a diagnosis or to a medical output.

Earlier this year, the UK government released a report entitled Personalised Health and Care 2020 – Using Data and Technology to Transform Outcomes for Patients and Citizens.

It states, and I quote: One of the greatest opportunities of the 21 Century is the potential to safely harness the power of the technology revolution to meet the challenges of improving health and providing better, safer, sustainable care for all. It continues: To date the health and care system has only begun to exploit the potential of using data and technology at a national or local level.

However, wanting to transform healthcare through innovation and technology is one thing. Actually doing it is another.

Annette Garner, an Azure specialist focused on data and AI in health, agreed that there is a desire from government to help the NHS embark on a wider digital transformation but there are still hurdles to overcome on the frontlines.

ANNETTE: From the centre, there’s an understanding that they want the NHS to harness this, alongside industry. But then on the flip side, you see the kind of business as usual of how the NHS has to deliver care, and still buying a lot of fax machines, faxing results from GP surgeries into hospitals. And paper is still prevalent. Some services are digitalized, some aren’t. How we book our appointments, there’s the NHS app that’s been developed, which is brilliant, that allows you to put your appointments and have some level of communication as a patient into your GP but that’s not been adopted everywhere. So I think as a citizen of the UK and a user of the NHS, your experience will vary as to how you interact with the NHS and the innovation that you see. And people can often make the assumption that, “I can’t see this innovation as a patient”, but it’s happening in pockets, and I think it will just grow and grow and grow.

It’s fascinating that innovation in hospitals and GP surgeries has to start small. You have to slowly grow it by winning people over and showing how it will benefit them directly. There’s no other way to do it. That’s very different to a company in the private sector, for example, where innovation, and trial and error is more common.

The public sector is careful when deciding to fund innovation, because at the end of the day, it’s using public money. So if you’re a clinician, doctor or nurse at a hospital and want to use technology in an innovative way to improve how you and your team works, you have to start small.

Imperial’s rollout of technology was brilliantly executed. Here’s James Kinross talking about the introduction of Teams and then using that as a springboard to encourage people to use HoloLens, as well as the Remote Assist function that lets people video-call experts to help them.

JAMES: Teams really is now, I would say, an essential tool. So we could not run our organisation pretty much without it.

That was very important here, because when you’re saying to someone who’s already been over the technical barrier of adopting Teams, “hey, all you got to do is put a headset on, and it’s kinda like Teams with a headset”, and they get it. And actually, Remote Assist works through Teams, and our clinical staff just consider it as that.

And actually, what we find is that when our clinicians start to use the system, they become quite adept at adapting it to their needs. So they found ways of putting in lots of other kind of useful functions. And it’s worked really very effectively.

I’ve learned that in healthcare, if you want to be innovative and roll out new ways of working, you have to take people on that journey with you, get them to understand the benefits of your innovation.

A doctor puts on PPE before entering the COVID-19 ward

Microsoft is on a journey with healthcare professionals too. Laura, the Head of Health and Life Science at Microsoft, spoke to me about five key pillars in how the company works with the healthcare sector: Enhancing patient engagement, supporting care teams, improving clinical and operational insights, reimagining healthcare and protecting health information. That last one is incredibly important. Only by ensuring that patient data is secure, do you build trust in the systems that doctors and nurses are using. That’s critical if you want those members of staff to be innovative with your technology. People will only use technology they trust, especially in the healthcare sector.

In the healthcare sector, trust and innovation go hand in hand. Here’s Annette again:

ANNETTE: And I think the trust is a lot higher with out there with patients. And I think that’s shifted in the last 15 years I’ve been working in data and technology and health. I think the broader public want to see tech innovation and technology adopted faster. Because I think they use it in our normal lives and in our commercial lives so much. I think they’re the ones questioning, “hey, why can’t I use this to book an appointment? Why wouldn’t a surgeon use a HoloLens if it’s going to help me? And it’s going to help my surgery? Why not? Tell me? Why not?” And I think the trust level is really high out in the public at the moment.

I think this is true, especially during the COVID pandemic. During lockdown, innovation has been adopted at an incredible pace, because the circumstances required it – that’s another key part of innovation, especially in healthcare: the environment you’re working in needs to be right.

I had a video call with my GP recently, and I ended that call thinking: why isn’t this the norm? Why do I have to ensure I’m calling my GP surgery at exactly 8am to join a queue and then ask a receptionist if my doctor has an appointment that day, then drive to the appointment, find somewhere to park, pay for parking, see my GP for 10 minutes and then drive home again?

Of course, video calls wouldn’t work with every medical issue, but they could be used for many appointments.

A survey of GPs by the British Medical Association in June revealed that 95% of respondents were providing remote consultations, and 88% wanted this to continue in the future.

That would not only benefit patients like me, but also healthcare professionals, too. Prior to the pandemic, a record number of GPs were quitting due to long hours and large workloads, while a recent report from the Royal College of Nursing said more than a third of respondents were considering leaving the profession.

Here’s Laura talking about how introducing innovative technology into the sector could help staff directly.

LAURA: When I think about digitising; just the simple process of taking things that have historically been done by paper and pen and putting it into an electronic format. The intention there is that it relieves some of the administrative burden. You can imagine that clinicians and nurses, care providers, they spend a lot of time going to school to become certified for the profession that they want to make their career on. And yet a clinician in the UK spends on average 70% of their time doing administrative work.

I would hope that if we removed that administrative burden and we can give them the power of time to do more of what they want to do, which is, you know, meet with patients and solve problems, that would improve the work environment.

I think in a collaborative care environment, if you were making it easier for different care providers to share information about a patient, to be more real time, to be more succinct, to have a more holistic view, I would hope that that would improve their work experience, because it should remove some of the challenges they face, it would remove some of the frustrations, it would remove some of the isolation.

An NHS doctor at St Mary’s hospital performs a ward round on a COVID-19 ward whilst wearing a Microsoft HoloLens 2

James Kinross, the consultant surgeon and senior lecturer at Imperial College London, agrees. He said clinicians at his hospital don’t really care about technology as a product. They care about what it can do for them. Anything that makes their job easier and helps them treat patients more effectively and in a safer way is good and likely to be adopted.

Many healthcare professionals have told me that COVID has been a turning point for the sector in the UK, and they expect to see more technology in hospitals and GP surgeries. More data will be used more to help medical professionals treat patients as individuals. AI and machine learning will ensure doctors, nurses and GPs can automate mundane and repetitive tasks, freeing them up to spend more time with patients. Video calls with GPs will become the norm, and data from wearable devices will be included into medical records to assist with personalised healthcare.

Here’s James, first talking about HoloLens and then about using technology in healthcare more widely.

JAMES: I can see a point where these sorts of tools will be the norm, where you will go on a ward round, or you will go into a clinic or you will go into an environment that might be high risk, that might be challenging, or where you might need specific capabilities of these sorts of technologies, and it will be there and you’ll just use it and it won’t be a novelty.

And what I really want now is for this to be the starting point. I think the one of the most important lessons from all of this is that if we’re going to solve the biggest healthcare problems that we’ve got globally, this can only happen if we find ways that the NHS, academia and industry can work together, they have to work together. We can’t solve it without each other. And we need to find ways that are equitable.

This has been a fascinating look at innovation in healthcare but I’m afraid that’s all the time we have for today. Thanks to James, Laura and Annette for chatting to me. And thank you for listening. Don’t forget to look out for the next episode of Microsoft Stories soon.