Galway University Hospital (GUH) recently launched a virtual hospital trial in a ground-breaking endeavour bringing engineering and medicine together to rethink healthcare. Speaking with Dr. Derek O’Keeffe, the project’s principal investigator, Trinity News heard how this ongoing innovation is reshaping healthcare delivery. Dr. O’Keeffe is a dual professor of medicine and engineering at University of Galway with a PhD in biomedical engineering, and a member of the HSE’s digital health committee.
The virtual hospital project aims to tackle challenges across healthcare by making virtual wards, clinics, and therapies viable treatment options. To transform care provision we must first investigate its challenges, Dr. O’Keeffe explains. Why are patients left on trolleys for prolonged periods? Why are emergency departments (EDs) overcrowded? O’Keeffe invokes Desmond Tutu’s wisdom: “There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in.” When Dr. O’Keeffe went upstream, he discovered that patients who “fall in” are generally those with chronic diseases such as diabetes, heart failure and Chronic Obstructive Pulmonary Disease (COPD). Emergency admissions for chronic illnesses are often easily preventable with consistent outpatient care. Data, however, shows such preventative care is not being received.
“Last year GUH performed a trial to test this with COPD patients, recording symptoms and track health metrics using a household kit”
To mitigate this, GUH’s project trialled the “Red Amber Green (RAG) system”. RAG allows acute monitoring of patients remotely via biomedical instruments, reducing ED overcrowding. Last year GUH performed a trial to test this with COPD patients, recording symptoms and track health metrics using a household kit and the “MyPatientSpace” app. With specialist monitoring and rapid home intervention, a patient can be brought back to the “green” zone before they fall downstream into the “river” of the ED. Hospital stay complications are thus avoided and national expenses reduced.
Monitoring 30 patients, the trial found RAG saved 300 bed nights in total averaging 10 days per patient and €300,000 in immediate monetary saving. Quick to scale simply by distributing more kits, RAG aligns with Ireland’s 10-year health and social care reform plan “Sláintecare” (signed by all parties), which aims to provide care closer to home.
“Since introducing the service in April 2024, GUH has delivered 30 episodes of care, saving 205.4 bed days with a 35.5% improvement on the length of stay compared to the inpatient national average”
Another reform GUH’s trial is testing is the development of virtual wards, a technology-enhanced alternative to bedded care. The “wards” use telehealth to allow 24/7 remotely monitored home recovery. A stable recovering individual is swapped from an IV antibiotic to an oral one and sent home with a virtual kit to carefully track their recovery, alleviating demand for more physical infrastructure and reducing overcrowding. Transferring to a virtual ward may curate shorter inpatient stays, freeing up critical resources. Since introduction in April 2024 this GUH service delivered 30 episodes of care, saving 205.4 bed days with a 35.5% length of stay improvement compared to the inpatient national average.
GUH’s virtual trial is also revolutionizing clinical care. 30 years ago, Dr. O’Keefe’s diabetes clinic was built to accommodate 25 patients. Today, he treats up to 50 daily with infrastructure unfit for a growing population: half O’Keefe’s patients are left standing or travel long-distance only to spend an additional hour in the waiting room for a 10 minute consultation. Virtual consultations offer more sustainable solutions to the inefficiencies of traditional in-person care than building more seats or parking space. CISCO’s platform Webex and their investment in GUH’s virtual hospital has reduced the need for in person visits and only 10 out of 50 patients may now need to visit Dr. O’Keeffe in person.
The virtual hospital is also trialling digitally enhanced therapy such as occupational, speech, or physical therapy to help remove the need for travel. AI-powered apps guide patients through hat-home treatment, assessing mobility using camera technology like Google’s TensorFlow: performing exercises incorrectly warrants a red X, prompting the patient to repeat them correctly in imitation of the in-clinic process.
“One honey bee can’t make honey, it needs a hive”
Science Foundation Ireland and CiISCO funded research for the project. “[We] need to get and share knowledge from other people,” says Dr. O’Keeffe. In 2018, he began to establish what is now known as the Health Innovation Via Engineering (HIVE) Lab, employing 10 professors and numerous students from faculties such as engineering, computing, medicine, education and psychology. Collaboration across disciplines was essential. “Like one honey bee can’t make honey, it needs a hive.”
For decades, digital health projects have launched small-scale pilots without fully committing to large-scale implementations. The pandemic forced quick scaling, making digital projects more mainstream and proving the benefits of rapid expansion. For those close to the research it can be difficult to appreciate the value of collaboration through scaling; HIVE shows how partnership between engineers and healthcare professionals drives faster advancements in healthcare.
The GUH virtual project inevitably raised concerns about security and privacy of patient information. An essential part of research is adequate storage and collection of data: all software in GUH’s research is HSE-approved and patients assured their data is handled appropriately, medical information stored within the HSE firewall for added security. To ensure compliance with General Data Protection Regulation (GDPR), all studies conducted are registered on clinicaltrials.gov, an international platform providing information about clinical research studies to the public and healthcare professionals.
“Dr. O’Keeffe is optimistic this decade will see digital health become mainstream, and believes it will happen sooner rather than later”
Healthcare is one of the few industries yet to fully migrate online. But asking how long it will take for healthcare reform to “officially” begin is meaningless: “No matter how close you get to it, it’s still a horizon.” Still, Dr. O’Keeffe is optimistic this decade will see digital health become mainstream, and believes it will happen sooner rather than later.
The past two years have seen leaders of the GUH project heavily influence concrete policy change. The HSE recently invested in two new virtual wards at University Hospital Limerick and St. Vincent’s University Hospital, Dublin. Both opened in July as Ireland’s first real investment in a clinical virtual pathway. Dr. O’Keeffe, a member of the digital health committee, stated that part of the HSE’s five-year plan to roll out more such virtual care. Success requires strategy, and he noted the HSE’s current approach is a strong declaration of the organization’s commitment to the potential of digital health.
Dr. O’Keeffe emphasises that virtual hospitals do not replace traditional care but augment it. These online platforms, devices, and AI are merely “tools in a doctor’s bag”. The tasks AI handles in this virtual hospital are primarily manual jobs, allowing technology to take over roles once labour-intensive and parallelling change brought by the birth of the internet.
“There is no better time to be a doctor”
Students today often feel confined by an outdated education system. This systematic struggle to keep up with rapid technological development might make revolutionising healthcare seem out of reach. However, disconnect between evolving professional landscapes and outdated systems does not imply total loss of opportunities for healthcare students. In fact, “there is no better time to be a doctor,” O’Keeffe says. We are now equipped with the life rafts necessary to navigate and rescue our patients from this current of challenges.
We have reached the point where damming the river no longer benefits patients or our healthcare system. GUH’s virtual hospital trial, with its integrated blend of engineering and medicine, marks a transformative shift away from traditional healthcare. Its innovative approaches like the RAG system, virtual wards, and telehealth could redefine the future of healthcare delivery and allow us to move beyond the constant ebb and flow of the river.
