So could you just give me your name and what your current position is?
So my name is Christine Roman. I'm a postdoctoral research assistant at the Institute of Biomedical Engineering in London through Sancho's Group.
Great. Thanks very much. So first, tell me a little bit about yourself.
Where did you come from originally? How did you first get interested in engineering?
So I'm born in Romania and I moved with my parents when I was 12 in France.
My dad got a position to work as a computer scientist, so we moved when I was 12.
I spent nine years in France doing my middle school, high school and first three years of university and then as part of the engineering degree.
The final did you. Why did you pick engineering? Was that your father's influence?
Well, no, I think I was.
I always enjoyed maths at school is probably the the subject where I found that I didn't have to put as much effort as I did in the others.
And then naturally I did I did follow in that in that path.
I remember growing up with computers at home all the time because they were always there.
Even in the early nineties, we had different computers at home.
But my my parents never influenced the decision of what to do.
I just remember one discussion when I thought about going into finance,
and then my dad had a serious conversation with me saying, maybe I should rethink this.
The next day, I decided to continue with the engineering.
So I, I then went to the US to do a one year exchange.
As part of this five year course, I thought I should take advantage of this mobility that was offered.
And then I went to the US for one year in San Francisco and then for the last year there was another opportunity to do an exchange at Oxford.
Brookes and I decided to go for it, and so that's how I ended up in Oxford.
That was in 2011. So the plan was to come and stay in Oxford for one year, and now 11 years later, I'm still here.
And by that time, had you begun to specialise in a particular branch of engineering at all, or were you still doing a general engineering?
So it was already very specialised in computer science and I, I didn't enjoy programming during university,
so I chose the other option which was available, which was telecommunications.
Rather than doing the programming, I would just do very minimal programming,
but do the application of how do you make things communicate between them, what we currently call Internet of Things.
So I did that, and the course at Brookes was broadband networks for my MSE.
Now, while I was at Brookes, I always had this idea of going back to the US and continuing working in a Start-Up in San Francisco.
But I got offered a scholarship for a Ph.D. and given I didn't know what it was, I decided to take it and it was more difficult than I anticipated.
But it was it was probably worth it.
And I did enjoy the the experience. So what was the subject?
And the subject so is the subject of the PhD was scheduling algorithms in autonomous vehicles.
So what technologies could vehicle use to communicate effectively between them to share information so that they can do less computation
or less prediction on board and therefore reduce cost and have this cooperative system where they just communicate between them.
Um, now, with the expansion of 5G and the advances of technology, it seems something that a level that has been reached.
But ten years ago it was still exploratory research.
You and I and I did my PhD even in, in autonomous vehicles or wireless communications for autonomous vehicles.
But I wanted to once I finished, I felt I wanted to apply this in a different area.
And I also saw that the autonomous vehicles field wasn't probably going to be applied on a larger scale for many more years to come.
So I started looking for alternatives in the digital health space, and there was a lecturer at Brooks that was doing a project on diabetes,
a European project on diabetes, and they were also looking for people.
And that was an excellent opportunity, I think, to move into the health care space.
So what how would you apply digital technologies in in diabetes in.
Diabetes. So the the link between the two is that in that diabetes project, there was a Bluetooth, uh, insulin pump that was connected to a phone.
Now to the same phone there was a insulin, um, blood glucose reader.
And that blue blood glucose reader would send readings automatically every 6 minutes to the phone.
The phone would compute what insulin level was needed, and then it would send the command this pump to to provide the insulin level automatically.
All right. So the patient didn't need to do any decision making. They just left it to the they just left it to the device.
So there was a lot of wireless communication involved, but there was a company doing doing mainly all this integration.
So I joined more on the what they called the work pay, the management work package.
Um, and I oversaw this project, how it, um, how it progressed.
I was an assistant. I wasn't doing, I was assisting the pi in over managing this project.
So, but I did get to learn how machine learning is being integrated in the systems, um,
and how to apply also these wireless technologies into a product that is used by the end users.
What I had done for my PhD was, was theoretical also applied, but no one used it in a way.
I did the simulations, I applied them into hardware. I compare the results between hardware and simulation.
I published the paper and then my algorithm stayed there while in this project.
Um, maybe the complexity of the algorithms, the communication ones,
was one that wasn't as high as what I did, but at least I could see that it works and people can, can use it.
It has some utility in the, um.
In the general well-being of humankind.
Well-Being of humankind. Yes, that's right. And I got tested and I said, this is actually what I want to do.
I want to apply. I want to do applied. I want to apply my skills into something that people use.
And what was digital health looking like at that point globally?
I mean, it was it's a growing field, presumably. It is.
I think at the time it was still very exploratory in the sense that there were just pockets of research being done here and there.
But there wasn't a large companies hadn't got interested in this yet, you know.
So you could I would say maybe we would have that Start-Up feeling that you're building something that at some point might become.
Although, I must admit, I did not have the vision of saying, Oh, this will become big.
And at some point I just enjoyed the tech side and I just enjoyed the project on itself.
I realised the difficulty that it was with diabetes because this insulin pump had to be extremely failsafe.
If you gave too much insulin it would be quite dangerous if you didn't provide enough would have the same level of the interest.
So not only I notice that communication is important, but everything needs to work together.
Otherwise, taking the individual system, the individual parts won't bring any any benefit overall.
And. I think since there has been more interest in in well, all this area, digital health has gained traction, but not a lot of the time.
At the time, I only know about universities or research projects, right?
Yes. Yes. So. So what next?
What next? So after while doing this diabetes project, I,
I wasn't doing very much technical work because I was in this management package stream and I, I wanted to apply a much more of this.
I wanted to apply much more of the skills. And this opportunity came to, to join Lionel's group.
There was an opening, uh, and I knew one of the, one of the post-docs that was working in Linus group at the time before me,
the Jobling, and said, Why don't you have, have a go see what happens.
And I applied and I was very happy to well want to be invited for an interview and
then to after the interview to be told that I'm accepted to join to join the group.
And that was in 2018, right? Yeah, in February.
And I started in the beginning of April. And just tell me a bit more about the group as a whole.
What does Lionel's group do? So Lionel's group is the biomedical signal processing and machine learning group.
They we are experts in signal processing.
How do we take raw signal,
apply different algorithms and filters on it to make it more suitable for machine learning algorithms or for interpretation in clinical settings?
So the reason why we applied such as all these filters before we put data into machine learning algorithms,
is that we want to have clean data in a way.
You might have heard this already. Garbage in, garbage out.
That comes right now.
We want to make sure we put as the garbage in as possible and then we have a good outcome that's in the machine learning context.
But you can do a lot of useful things just by applying noise filtering in signals that you get in in medical devices.
So what sort of signals are you looking for? What's the raw data coming from? For instance, EKGs signals and signals from the heart.
If it's if the patient is moving or the signal is very noisy,
you would either discard those that signal from appearing or you would try to filter it so that it has a
smoother curve so that the clinician can have better interpretation of lots of what's what's going on.
That's probably one example that everyone would be familiar with and which project we use specifically working on when you joined the group?
So when I joined the group, I was working on a remote monitoring project with blood pressure monitoring in patients that I that had had a stroke,
and that is with Professor Richard McManus in Primary Care.
Um, the idea was to have these patients monitor their blood pressure at least three times over the well, three days over the period of one month,
so that they can get better follow up from their clinician and reduce the risk of having a subsequent, um, tia or transmit.
I think that, I think I'm missing a word there. Transient ischaemic attack.
Transient ischaemic attack or stroke? Yes. So that was the that was the idea of the project.
The objectives are also to reduce hopefully their systolic and diastolic blood pressure after the the intervention.
So I mean, patient I mean, I've got one patients you can just buy a cheap blood pressure monitor from boots and do a reading and paste it in.
How did your remote system improve on that?
So that's a very good question. You have self-monitoring and then you have tele monitoring.
Now, I think what self-monitoring is,
is the scenario you just mentioned where someone takes their blood pressure reading right there on a piece of paper,
and then whenever they go to the GP practice, they hand in the piece of paper.
So these are my readings. The difference between self-monitoring and monitoring is that rather than writing these values on a piece of paper,
you input them on a mobile phone to simplify, and then these readings get sent automatically to the GP practice.
There's also some automatic algorithms in the back.
On that, do some safety checks. So if the blood pressure reading is too high, they would have an automated message that you can take another reading.
And then if the second reading is high,
then an alert will be triggered both at the GP and also on the patient's participant side to seek assistance as soon as possible.
So you can shorten the time that you get to see a clinician when the when the.
Health situation deteriorate concern.
Yes. If there's concern and having this integrated loop of of communication between participant and GP's also makes the participant a little bit more,
more self aware about their condition.
And I think it improves their medication adherence and also the way they um they approach their, their condition.
So I think there are multiple benefits on this though the main one is probably that the participant knows that there's
someone looking at their readings and they're under supervision and it probably provides us with some reassurance in a way.
The I mentioned earlier that there was only you would input the readings on a mobile app.
But in this specific scenario with people that had a stroke, they might have some consequences of that stroke, either reduced mobility, aphasia.
So there were different options that had to be developed.
And not just using a mobile phone, which you'd have to install an app, you had to open the app, you have to click here in the readings.
And the other options were either sending an SMS or going onto a computer with on a website where they could also input the readings where everything,
everything would be slightly more aphasia friendly.
So providing these options, I think is key to these digital interventions.
There is that you didn't get as far as the um the blood pressure monitor itself automatically sending the readings to the GP not,
not in that project that we've had it done in the project further down the line.
Like we'll talk about that when we get. Yes. Okay. Yeah.
So for that project it was the main objective was to prove that this digital intervention can help
these people lower their blood pressure and also lower the risk of having another another stroke.
And did you has it been going on long enough for you to have collected that data or is that still in progress?
Unfortunately, because of the pandemic funding was, um, funding was withdrawn by the British Heart Foundation, um, I think in May 2020.
Right. Okay. So I was arrested halfway through.
It was okay. So we've got, we've arrived at the pandemic.
So, so can, can you remember when you first heard that there was something serious happening in Lucan and,
and, and how long was it before the group realised that there was work they could do that would be relevant.
So the first time I heard about this was when my father called me one evening,
I think it was in February, and he said, You heard about the virus in China.
This is quite serious. Now my dad follows the news very much and when I heard first thought about it, I said, Oh,
it's probably going to be something that a week as the bird flu in India, I think 28.
29,000. Yes, the bird flu. And there was silence before that.
Exactly. So I thought, oh, well, it's probably going to stay in that part of the world.
We will have similar to what happens with the bird flu and then that's that.
But I think ten days or two weeks later I was in the office and the phone rang at around 4 p.m.
The phone usually never rings and I picked up and it was Leila's assistant and she said,
Christian, there's Lionel for you on the phone if she wants to speak with you.
And I said, Yes, of course.
No, I didn't know what to expect, as I think I've never spoken with Lionel on the phone, although I hadn't been in the group for two years,
and then Lionel was put through the line and said, Hi, Christian, I don't know if you've heard about the virus.
You need to drop everything you're doing absolutely everything and focus on the voodoo you, meaning the virtual high dependency unit.
And this is this project about monitoring vital signs with, um, with wearable devices.
And I remember saying, oh, I know, but I have this deadline for this project.
Drop everything, he said. Also speak with Mauro and Marco if they're around, which are my colleagues and you need to work on this.
I think we'll be meeting at the hospital tomorrow at 5 p.m. to discuss about this.
And that was almost as if.
In the general sense.
And I close the phone and then I just remember having my colleague Mark on the side of and I told him, we have to drop everything.
We're working on this. We do now full time.
And what what once that was what it was in February.
And I think it was a Wednesday because we met at the hospital on Thursday at 5 p.m. and I don't remember quite a lot.
I also had to contact some of the former colleagues of of the group because I needed the Bluetooth
protocols for some of the wearable devices which were integrated into the into the view at the time,
but only as prototypes. So we were also looking at integrating, for example, Bluetooth temperature problem, which wasn't part of the project.
So the virtual high dependency unit was a project that was already up and running.
Yes, thought started but but presumably just as something that was one of many projects in the in the group and without a particular sense
of urgency until one not so there wasn't any particular sense of urgency at the time the project was already going since 2017.
It's a project which took a lot of took a lot of time to build up.
I think I know and research colleagues from the clinical research group led by Professor Peter Watkinson,
were working on this I think for the past ten years on trying to build such as a virtual high dependency unit.
And in 2017 I think with the new BRC funding they they managed to do a um to set up a
project that will end in a randomised controlled trial to see if such interventions work.
Now when this phone call occurred in 2020, out of the five phases that the project had, we had already gone through three phases.
The first phase was the Wearability phase where we would see the acceptability of such wearables.
The second phase was testing the accuracy of these devices to be used in the clinical setting.
And then the third phase was seeing if this can be used on the ward and any data losses and communication issues that we have in the overall system,
which links to what I spoke to at the beginning about how to integrate these systems in
a useful manner in the hospital and to cook the wireless communication between them.
So at this point in in time,
we had already been through these three steps which were quite important to give us the confidence that this system does work,
that the wearables are accurate. The wear ability has passed our test and we had already started testing it in the hospital,
the phases four and five that were still meant to be done and therefore there was no urgency at the time was phase four was to test it on the ward,
on patients with the clinical staff being blinded and then phase five having it in a full
randomised controlled trial where some patients would be blinded and otherwise wouldn't,
others wouldn't be blinded. But there's, there is a big step from having a system under constant supervision from research staff,
either be engineers or research nurses and clinicians interested in research and having it placed in a hospital for use in Bailey,
for use in daily care and in an emergency on top of that.
In an emergency on top of that. And the next day that we did go to the hospital for that meeting at five,
we went to the infectious disease walk and they there were a few senior people from the hospital there.
We had the system and I was wearing some of the wearables.
And then at some point I remember Lionel saying, Christine, can you please give a demo?
And at that point, I think my heart rate skyrocketed to about 190.
And as the my heart rate wouldn't go down below 190, I remember one of the clinicians came next to me and took took my hand to see for now,
I don't know if they were concerned about my health, but they wanted to see that be 190 matches.
Actually, it was actually that the the the the conclusion was that they agreed for the
system to be implemented on the on the infectious disease ward and weren't.
And we had approximately three weeks from then to to get it to to get it fixed.
Now I say three weeks now in hindsight, but we didn't really know when the first COVID patients was going to come to the UK and.
We didn't know how fast it was going to spread. Then we we have to remember that no one knew what was going to happen at the time.
There was concerns about staff safety. There were concerns about the dangerous ity of this virus.
And probably it was seen that this system could help with the exposure that the staff might have in monitoring these patients,
but also having a closer and keeping a close eye on these on these.
On these patients that got infected at the beginning.
So we should but we just talk a little bit more about the wearables themselves.
So what the what what was the the full package of wearables looked like?
What did they do? So the full package of wearables is a it's composed of two of two components.
The first one is a patch, um, manufactured by, um, vital connect in the United States and it's placed on the left side of the chest.
And with this patch you get the EKG and you get heart rate, you get respiratory rate.
And you also at the time got skin temperature, which we didn't use.
And then the second the second wearable is the is the pulse oximeter that you attach to the rest of the the main component is on the wrist.
And then it is linked to a very soft plasticky finger probe that you place on the finger.
And with this device, you managed to get the heart rate and the blood oxygen saturation.
So the level of oxygen that you have in your blood with COVID, that seemed to be extremely relevant.
You needed the you had these patients that were doing fine.
And then all of a sudden they deteriorated to levels which were below accepted.
And then the the pulse oximeter was was probably the key in this in this scenario.
And those both those two things transmit wirelessly to a central monitor somewhere else, a monitor.
So these both these devices transmits to a tablet which is placed in the same in the in the vicinity of the of the patient.
And then this tablet transmits all the data to a dashboard which is at the central nurse's station.
So you would have multiple tablets with different patients, which would then all transmit this information to the central to the central station.
So essentially the nurses can see how the patient is doing without actually having to come in and make those recordings themselves.
Exactly. So they would be able to stay at the at the nurse's station and then assess if the patient is doing well,
if they're improving, deteriorating now because this device this system hasn't been ce mark on the time,
we wouldn't we weren't able to have audible alerts,
meaning whenever there was a duration detected automatically by the system that would alert the nurses,
but they would still be able to see the trend that the patient was having over time.
And initially, every time that the nurse had to assess the patient, they had to use the full, um, the full clinical gear.
And this system probably allowed them to go to therapy, especially to go in a bit less often into the isolation room than, uh, than an otherwise.
But it is important to note that this wasn't replacing their usual care.
I mean, if they had to go in to take their observations, they would still go in and take the observations,
but it would allow a better time management in the ward and also allowed them to keep an eye if something
went wrong rather than going and having a look through the window constantly going around the world.
Now, these patients that the system was placed on weren't extremely sick patients, extremely sick patients.
They were either in intensive care or the people, the patients that were doing very, very well.
They were in this infectious disease ward at the beginning, but maybe not placed on the monitor.
As we've all learned afterwards. We were all told to stay at home if we got we got sick.
So the patient,
the system was probably placed on patients that were at risk of deteriorating or that that the clinical staff wanted to keep a closer eye.
And what the system allows you on top of all the things we've said is rather than having snapshots of how the patient is every four or five,
6 hours from the observations that nurses take,
you would be able to get a data every 5 minutes and you would be able to get at a trend of what
happens even in between those observations that are taken on track and trace systems in the hospital.
So, um, one funny thing was funny is that we.
Interesting is that some of the younger patients would take their oxygen mask off at some point and this would immediately be picked
up by the system because their CO2 would drop and the nurses would know that this happened just by looking at the dashboard.
So they would immediately go and probably say, put the mask back on and then they would put it on.
But if you didn't have such a system,
then you'll be more difficult to pick up the instances where patients to deteriorate in between between observations.
So I slightly interrupted you to talk about that. So you talked about this.
You had this three week window to. Yes. To get the whole thing set up.
What what kind of a challenge was that? It was a it was a big challenge, I think.
I don't think I've worked so intensely ever before or even after.
So I think from from that frontline phone call up until June,
they were probably the most intense working period of my life that we have to build a system that was 24 seven reliable.
And that was the difficulty of it.
They there couldn't be a nurse that went and pressed the button if something went wrong, because that was the whole point of the system.
The point was systems that you would have that tablet inside the isolation room with the patient and then they would constantly monitor.
You can expect that if the app or if our system crashes, that they would go to the patient and say,
Can you please press that button and follow this procedure?
You can also expect a nurse to ask a nurse to go in to the isolation room and say, Oh, can you press those buttons on the tablet?
Because the whole point of the system was to expose, to reduce exposure.
So both Mauro, Marco and myself worked very, very hard in trying to create this reliability of the system,
but also provide a user friendly interface for the nurse, for the clinical staff to use.
Up until then, I think it was engineers that were mainly looking at the data and we had a dashboard designed for engineers.
There is a you can have the best system ever if you don't provide the good
user interface for people from other domains to use and understand the data.
It won't work. And Marco focussed specifically on creating this user friendly dashboard and he did an amazing job.
We split the tasks amongst us with Marco working specifically on the user interface model,
working on all the back end of of getting the data, making sure it is in a suitable form to be presented on the dashboard.
And then I focussed on the app on the tablet side of getting this data from these wearable from these wearable devices reliably with,
with Bluetooth, which was already the case.
But we all needed to make sure that none of our sections break at any point and if it breaks, they automatically recover.
Um, and there was very little overlap between our work which focussed very hard.
We spoke, there was very intense communication.
Um, but we each worked individually and then we put the pieces together and I think there were without exaggeration,
between 18 and 20 work hours per day working at least until mid of April, by which time there were COVID patients in the hospital.
The first COVID patient, I think was on Monday, 23rd of March.
Um, which ones?
That first patient got registered. We got an extra level of adrenaline.
At least they got and we worked even on it because then we could see that the system
is used and then we had to fix everything that that wasn't entirely working.
It was almost compulsive at some point of checking to see how the system works there.
I don't think there was one hour where we wouldn't check either one of the three of us and we would call This isn't working.
This the button needs to be so. Yeah, this is how it happened.
Ooh. And did you have to interact a lot with the nurses as well in this phase?
Absolutely. Yes. Yes. So the nurses were key in this because the the link between the staff at the hospital and the engineering team were.
Nurses from the Critical Care Research Group, and they were the ones that one provided us with the context of what was happening and gave us.
The mean. We even translated the needs to something that we would understand a bit better.
Yeah. The nurses. This wouldn't have been possible without the nurses I've got.
I focussed on the engineering side to start with,
but this was a full collaboration with the people at the Critical Care Research Group and we worked very, very closely with them as well.
Um, I remember the weekends having to call or we would message an email, the nurses as well.
So yeah, we would, we would call and message the nurses.
And then if, if we thought it was something worth discussing with, then they would go to the ward and also discuss with the staff there.
So there was always this flow of.
Communication between between us. Yeah, we would.
For example, we wouldn't go as engineers just directly onto the world on our own.
But we went a few times, but it was just an extreme and urgent situations.
Otherwise we would always go with, uh, with the research nurses and research stuff.
And so were once COVID patients started coming in,
we're all those who weren't actually in the ICU being fitted with the wearable technology, or was it were you trying to do a comparison?
So initially, I think they were placing all these patients that came in with COVID on the system.
But as things evolved, I think they started selecting more of which patients they placed the system.
Now the patch is very well accepted by patients, but the finger probe is a bit less because the finger gets a little bit moist.
Now, depending on the frailty of the patient, they might accept it or might not accept it, depending on their mobility.
The one advantage of this system is that the patients can remain mobile and in all respiratory diseases.
It is important for people to remain mobile. But if a patient is bedbound and is also a bit frail and doesn't, um, doesn't want to wear it,
they probably made a decision that they wouldn't wear if they wanted to because this patient is a bit frail and this is no non-mobile.
Maybe they wanted to keep an extra eye. So this was a decision left for the clinical staff.
But we did see an evolution from being placed on everyone in the beginning to selecting on who it is placed on.
And this definitely evolved over time. And and the I mean, there have been a couple of publications now.
So so how did the evaluation look once you had the system in place throughout, certainly the first wave.
So, um, so in terms of, um, I think there's been this publication on the engineering side,
there's further publications coming out on uh, the qualitative aspect of what the nurses did, what the nurses thought of the system.
Um, there were a lot of interviews took place with the research nurses, uh,
to try to understand if they found that useful in the who did those interviews.
So, um, the team led by Sarah Wallem.
All right, Peter Watkiss is the research group. Um, and I think hopefully that that would be they'll be released soon.
I mean, has been submitted for review. And I think the system was useful.
The, the main, the main things I would take is that it allowed them to have better time management.
It allowed them to have some reassurance.
Whenever they were a bit short staffed, they would place these devices on the patients and then they would be able to look, um,
as they were passing at the nurses station, they would be able to look at the patient quickly and assess if they need further attention or not.
And if they not, they could go to see the patients that actually needed attention, then come back 10 minutes later, see if the situation is the same.
They would go see another patient. And the, the, the third aspect is the, um.
This. Benefit of having a little bit more time.
So I think I would I would say these are the main ones.
Yeah. The I wouldn't be able to to say more without further analysis.
I don't know. And I'll be continuing to use the system in the hospital at the moment.
So, no, the system moved on to the next phases that we've discussed in the system was stopped in April 2021,
and the use of the system could be matched on the waves of the of the pandemic
that were happening in the UK with each wave in which each peak of admissions.
We could also see a peak of people registered on the video system, which shows that the system was used by staff in an appreciated.
I cannot say I think by everyone, but I think by the majority of of the.
So it was entirely up to them whether they chose to use it. It was entirely up to them if they chose to use it.
Yes. The in April 2021, the system stopped being used on the infectious disease ward and we continued with our work on the phase four and phase five.
And now when we were speaking,
we are now in the randomised controlled trial phase of the project and the system is deployed on the post-surgery ward at the hospital.
So these are patients that have had a surgery and the system is placed on it and then to detect early deterioration that occurs,
which is the main focus of the of the system and that as you say, that's a randomised controlled trial.
So even some some patients are on the system and some are not.
Yes. Yes. So and you also you mentioned blinding AI.
It would be difficult to blind when you've got something obvious like a patch.
So it's open. Open, blind, meaning they they, they have the patch and the pulse oximetry.
But the values of those patients in the control group aren't being shown the right that are being shown at the nurses station.
Right. Yeah. So you have some patients which have the patch and the pulse oximeter and also a blood pressure
device which we've integrated and that have all these vitals shown at the nurses station.
And whenever the system detects a deterioration, it has an audible alert for the nurse to say patient is deteriorating.
And then there's another arm which has all these devices, but there is no audible alerts and values aren't being shown at the nurse station.
And at the end, we'll be able to compare the two groups and see the outcome of does the wearable technology actually improve patient outcome?
Oh yeah, that's very good. So I read that in addition to this, you did find an application for your community monitoring,
blood pressure monitoring, and that was relevant to what was going on during COVID.
Yes. So we discussed about them monitoring or remote monitoring of patients that had stroke.
But there's also a large part of interest in our group about remote monitoring of blood pressure and gestational.
Um, so in, um, in pregnancy, postpartum,
but also during pregnancy and this work that happened at the same time with both Professor Richard Mamas and Professor Lucy McKillop, um,
gained traction with having these, having pregnant women being monitored for their blood pressure at home because the
number of appointments or face to face appointments at the hospital suddenly dropped.
And they still wanted to know that these these women are being done,
are being monitored and don't have high blood pressure because of the risk of pre-eclampsia.
Because of the risk of pre-eclampsia. Exactly.
And the work that the group has been has been doing a lot of work on this in trials which were called bump and pop HD.
And when the pandemic hit, the work from bump went on to being spun out into a product that was acquired by Send Sign Health,
and that went on to being deployed in in several trusts across the country and also at the UAH here in Oxford.
And the principle was again quite simple,
similar to the monitoring in in in stroke patients were pregnant women would take their blood pressure readings one.
Once a day or once a week, depending on the schedule set by their doctor.
And these readings would be sent automatically to a dashboard that can be reviewed by the clinician.
But if their blood pressure was very high, then they would be told to seek immediate medical advice.
And I think from the feedback that we've had, there was at least one instance where this proved to be extremely,
extremely useful because maybe had very, very high blood pressure that she didn't know.
And if it wasn't for such a system, she would have probably would have stayed the blood pressure high from multiple days before being picked up.
Bye bye bye by an appointment.
So those that also added an extra workload that Maura and myself had to work
in the same period of March to June when we worked very closely with people.
That sense in order to have this knowledge transfer of bump to what they called was BPM health was their commercial side.
And then we did also a bump plus, which was the research project that we made.
So what was so you had your your research team working with the commercial company.
What were the particular tasks that you and your colleagues had to had to deal with for them?
So it was mainly on the on the technical side of porting this code from being into a from being a research project,
which is done up to a certain level of standard,
but it is an industry standard up to a the product which would go through CE marking and would go
through all the regulatory approvals to be classed as a to be classed as a medical use software,
not only approved from a standardised point, but also to be able to scale to multiple thousands of patients or to go live nationwide.
As much as we want to, we we cannot with with the system that we had built,
we would only probably go without completely slowing down everything, maybe to a thousand or 2000 patients.
While with the solution that Samsung and the engineers, then you could go to hundreds of thousands of patients and scale very easily.
So this transition was was extremely, extremely useful even for us to see how how things are done in industry.
And it was I think we've learned a lot. So maybe the the engineers from Genzyme learned a little bit about the product,
but we learned how how things are done on an on a large scale, how to do, how to deploy products on a.
And is that envisaged as being useful even when there isn't a pandemic going on?
Absolutely. I think that's continued to be useful even now because of the pressure on GP's
presumably at the moment and hospitals because the pressure groups of hospitals,
it also provides reassurance to patients. It it, it allows probably a reduction in appointments and less needed to.
Now there's this high pressure on GP's that even I think the patient experience going to
the hospital at Oxford is sometimes not ideal because the parking issues that take time,
so people mention all sorts of reasons of why they don't want to maybe go away from their home or from their local area.
For those people that do want to go, there should always be an option.
But for those that still prefer to be home and have this remote monitoring solution,
I think it's great that now the hospital does have an option of monitoring these patients remotely.
And even even if the dashboard is not the dashboard where all these blood pressure readings are monitored constantly by GP's,
by having these automated algorithms that provide instructions on the next step to do.
E You can have this failsafe mechanism where people are told,
please seek urgent assessment within 4 hours of your maternity unit or please
go and see your GP called GP now because your blood pressure is very high. So simple steps can have big impact.
And I think this is what works the best, especially in an area where this is being deployed on a larger scale, maybe in 30 years,
or will speak about having automated passive algorithms and patients waking up in the
morning and taking all their vitals by being in the bathroom sitting on the scale.
But we need to start with something simple and probably this is something simple is what has been implemented up until now.
And this is I mean, how satisfied do you feel that you've met, you know,
what you said after your do so you really wanted to do something where you could see an impact.
Do you feel you've achieved that? Mm hmm.
Um, I. I don't know if I. I wouldn't say I've achieved it.
I'm still working on it. I'm very I'm very happy and feel one overly privileged of the position I'm in, the group.
I'm working over the privilege also for the fact that I had the opportunity to help during the pandemic.
But, um, if I think about achieving it, it almost means that I'm closing the chapter and I'm still working on it.
I still want to continue my efforts. I still want to go I want to go further.
I want to go further in applying this technology and pushing it forward.
Uh, you know, I don't want to think that it's finished yet because then I think it will become lazy.
So I always have to be on the, um, my toes.
They know I want more. I want to push more, I want to integrate more.
Um, I want to deploy these systems more. I know this isn't about, um, just engineering work.
I think we need interdisciplinary collaborations with clinicians.
As much as I try to understand the I won't be able to get out the soul, the subtleties of what's going on,
and I want to continue collaborating with people to say this is the solutions that we have can be useful in your domain and keep,
keep, keep doing that. But I am I am happy. I am very happy that I managed to apply some of it.
Uh, what project are you working on now?
So, um, I'm working mainly on this phase five of the randomised controlled trial and then we're continuing the work with primary care on,
on remote monitoring of blood pressure in pregnancy.
So that is, that is the it's Wednesday.
So the, the primary care project's on, uh, remote blood pressure monitoring in this time, also including medication.
So automatic obliteration and down duration of medication.
Then these are my two main areas of, of work.
And on the video side, interesting, we, we've been applying this on the challenge trials at the university where um,
we've been placing these wearable devices actually only one the patch,
um,
the patch with the another wristband that monitors blood pressure on these patients that are exposed to the virus in a very controlled environment.
And that is also to get a better understanding of their of the vitals evolution while exposed to
the virus with hopefully some interesting results on predicting on when one might be infectious.
So we are very eager to see. Um, great.
Can we just go back to, um, you know, how the, how working through the pandemic impacted on you personally?
I mean, to what extent did you feel threatened by the virus itself? Did you did you feel you might become ill yourself?
I didn't feel threatened by it until one episode, which was quite revealing of how scared I was up to that point.
But we during this period of implementation, we would go to the ward and present the system to the to the to the clinical staff.
Patients had already been registered. And I went to the ward with my colleagues from the clinical side with the siren cross,
and there were around ten, 15 clinicians in front of the dashboard.
And I was there giving a very short presentation, usually less than 5 minutes because they were busy.
Um, of course they were obviously overly stretched.
One of the things they had to do so the shortest, the better.
And during that five minute that there was a port they're passing by behind with a, um, fortunately with someone that had just died,
wrapped up in the, um, in a black bag and oh, I stopped talking and everyone well looked then.
But while the portal passed, no one said a word.
And then once the water passed, we just continue the conversation.
But as soon as I got back to the office, then I realised actually this is very serious and yeah, and we will masked in that meeting no less.
So at the time the, the masks there were, there was this lack of PPE even for clinicians I think maybe.
Some clinicians were, most especially the ones that were constantly going in and out.
But as an engineer, I wasn't most of the time. I think the masks came in much later, but I didn't feel the fear of the mask.
The mask wasn't something natural at the time and the windows were open.
The bottom line is, I didn't catch COVID until much later, a year and a half later, and I caught it four months ago.
But even after this episode, I still went to the ward without mask.
I would never go into the patient isolation. It was only in the main corridor to the nurse's station for five or 10 minutes, and then I'd come out.
And that's what the other clinicians said, that as soon as they started wearing a mask,
my research colleagues from the research nurses, I also started wearing one.
But at the time it wasn't the mask policy. Yeah, I got scared I think for that evening.
But then there were so many things that had to be done that I forgot about it.
And I just went on and I constantly thought, I'm young and fit and I mean, I should, you know, I should be.
I'm happy that I could help. Um, and what about your family members?
I mean, I don't know how things were in Romania. Sorry.
In in France. In France, yes. But my, my, my parents were, um, staying at home mainly.
I think my dad went to work a few times because he, he worked for the fire men for the fire department as a computer scientist.
But I think he had to go a few times. But my mom, my mother stayed at home, which I was quite reassured that they weren't travelling anymore.
Um, and they were very supportive. Um, I, I cannot, yeah.
Thinking that, you know, knowing that they're there, seeing their only child is working in this hospital with a virus that no one knows.
I think they, they reacted really well. They never showed their, um, emotions or anger.
Oh, no, not anger. Anger is the wrong word. There is an alarm.
Yes, alarm. Yeah, they that they they called me, I remember only once the evening,
but this was a bit I think probably they looked at on TV and they got a bit panicked and I spoke with them.
Everything's fine, you know, the way and that was it. But none of they were very supportive.
So, um, yeah, yeah. And you mentioned that worked very, very intensely between March and June.
How did that impact on your wellbeing and did you have to take steps to try and retain your sanity and not during the time?
No, no. So I worked very, very closely with, um, with Moreau at the time.
We also, we were close to Mark Colvin. Marco.
We could do ourselves some of the things remotely, but with Mauro I worked very closely and I would meet him every day.
I think even though he was coming into the lab every day,
we were coming into the lab up to a certain point where it wasn't, um, where we couldn't come any more.
Although we always, we always had the opportunity because we got the letters of being.
You were, you had the key work. We had the key work letter very, very early.
Um, but I think, um, it was much more difficult to come here.
So we started meeting at my place with Mauro, also Moros nursery class.
He had a, a young child that at the time.
And then with all these key workers being repositioned with the nursery, I think he got a nursery closer to where I live.
So, um, we started working at my, at my house for, for a very long period of time, a long period, 2 to 3 months.
But we would also come to the hospital.
So I think how it worked is Monday to Friday we would work in my place and we would meet Saturday and Sunday at the hospital on our work days,
would finish at midnight or one or two and morrow would drive me back and then he would go home and then the back at eight would be meeting again.
Um, so I think that was our schedule for up until mid-May, early June.
Um, you mentioned about impact, but I didn't see it as such.
I enjoyed it during the time I was in the adrenaline rush.
I'm, I'm a competitive person.
Um, and I, well, I was much more competitive when I was in my early twenties and, but um, I only realised the impact it had after once it slowed down.
So the first wave was very intense. We continued over the summer to implement these features.
The second one came Wave. And I kept going to the hospital.
But then I think in 2021, in January, I didn't have to go to the hospital that much or work as hard.
And when it slowed down, then I had noticed how how tired I am.
And then with the next lockdown that followed, where I didn't have to go to the office or to the hospital,
and I said, well, given I don't have to go, I should maybe just stay at home and follow the rules like everyone.
Then it got tough. It actually got tougher when I had just had to stay at home and work on my things but not be as active.
And yeah, so this is not a it's the I know.
This is the I think that's how I would summarise it.
It was tougher after not doing during. I was very happy to be able to tell.
Yeah. Yeah, no it was again that's I mean, I think you've answered the question that I've been asking everyone whether the
fact that you were doing something that was contributing to the the the fighting,
the virus helped to support your sense of well-being?
Definitely. Yeah. Yeah. Felt useful.
Yeah, it might be. We all look for this sense of utility.
I had that sense of utility. I cannot compare my utility with the with the clinicians that were exposed to this every day.
And they but it may be it was a false sense of utility that I enjoyed it.
By the way, the impact of the system, maybe it's minimal in the large scale of things in my day had may well looking at the scale
that we've had only 160 patients it might have had if it had an impact on some of those.
It's already it was all worth the effort, I think. Oh, great.
Um, I think we've just about got to the end so that the yeah,
my final question is whether your involvement in this work over the pandemic has changed your thinking about what you might want to do in the future,
and is there anything that you'd like to see change as a result of that experience?
So for the future, it probably just strengthens my belief that I want to continue continue doing applied digital health or applied engineering.
I was always keen on finding the next.
Algorithm. Algorithm. The next thing that will can be published.
Or that would have. I would go into a high impact journal.
I'm less keen on that now and I'm working on getting applied things, small things that work, but getting applied.
I just have a high interest of building up these models and simulating testing.
But always in my mind now the objective is, can this be applied?
And I'm trying to build things which are easy to to change so that they can easily be integrated into a product that can be used.
So I think this is the one thing I reduce a little bit, the exploratory research for the applicability one.
And number two is. I think it helped with, um, acceptance from all.
For data from the entire spectrum of society of how these remote monitoring solutions are seen.
If before people wouldn't probably trust them more be see the utility of them.
Now they can probably see that. The can can.
Save money and it can improve the health of the whole system by probably by hopefully saving lives and improving patients outcomes.
So there is a I mean, yes, there is a fear.
I mean, it's something you read in the media that, you know, robots will take over and there'll be a loss of human contact in health care.
But that that's you feel that this kind of work is is managing to dispel that kind of thinking?
I think that fear is probably coming from the unknown.
Once you start to know the robots, you realise that there is.
And the human contact is a very good point and I don't think it should replace the human contact.
It should be used complementary to what's already there and help clinicians in their workload, which keeps increasing.
It's not about replacing the coalition whatsoever.
It is about giving them more filtered information so that they can make better informed decisions about it.
And um, there are, there's one thing of, of looking at it only from a national perspective,
and there's also one thing of looking at scaling this to other to other environments where they aren't as developed as
in the health care system and where these types of monitoring can help detect conditions that they might not have.
And if we look at surveys across the world, in other countries where where people don't have access to health care as well,
their level of agreement of tech and what people called robots is much higher
because they see the benefit of it might not be the same as seeing a person,
but at least if there is something really bad with me, this machine will tell me that I have to see someone.
And this is, I think, what the flow will always be. The the human will never be replaced in this.
It will be the machine will tell me I have something really bad or something worth looking at.
The human will look at, it will confirm, and then it will go further. It won't be the machine detected something.
I have to go on the surgery table immediately. So. Yeah.
No, I don't think robots, you know, I don't think it'll happen.
The analogy that I keep in my mind is similar to agriculture. I think the same fears were happening when the optimisation of agriculture occurred, um,
mainly in the year after the war and people were worried were going to get out of jobs.
And, and in the end now we managed to have better food variety and better health because of this, um, intense.
Well, that's what, which also has a lot of back falls, but that it allows us to have the standard of living that we have now.
Um, and the society adapts. I think it will be be the same with this, um, with digital health.
It will hopefully be part of people's life, but something passive.
And we never know when the world is going to close again. Hopefully not soon.
But uh, yeah, it is one other tool that we have now in our bag to say that we're ready for what happened, what occurs if we need to.
I think that's how I would I would remember it.
Remember it?