Smith & Nephew plc is a British multinational medical equipment manufacturing company headquartered in Watford. It is an international producer of advanced wound management, arthroscopy, trauma and clinical therapy, and orthopaedic reconstruction products. It is also a front-runner in digital health innovation and connected medical devices – including data-driven, robotic-assisted surgical systems for use in routine operations such as knee surgery, as a means of giving more people access to the best techniques and surgical outcomes.
In 2015 Smith & Nephew made a significant and strategic acquisition, purchasing US robot-assisted surgery company Blue Belt Technologies – the maker of NAVIO, a handheld robotic surgical system. The acquisition was followed by a second in 2019 of Brainlab’s orthopaedic joint reconstruction business to expand the robotics platform across a broader range of applications. These strategic acquisitions signalled the company’s intentions to lead the way in solutions for next-generation, digitally-assisted surgery. For routine procedures, practitioners with less experience can perform operations at the same level as senior consultants assisted by robotics; which increases surgical efficiency and improves outcomes across a broader patient population.
Each time the NAVIO system is used in a procedure, it generates rich data, which could offer surgeons – and ultimately patients – valuable insights into operating performance and outcomes. But the data is so complex that, until now, only specialist engineers at Smith & Nephew could interpret it. To drive targeted insights that would help surgeons in their work, and in future guide patients to more informed decisions about the benefits and outcomes of robot-assisted surgery, Smith & Nephew needed a way of transforming the complex, procedural data generated by the NAVIO system into intuitive dashboards that could be easily visualized by their customers.
Smith & Nephew’s own internal software development resources were tied up with other immediate projects, so the company needed external support to ensure that the Dashboard could be developed at the same time as the newest software version of the NAVIO 7.0 surgical system. It applied for Government funding via Innovate UK, under the category of Precision Medicine to investigate the feasibility of developing prototype dashboard software for future commercial use by Smith & Nephew. Thanks to the digital health emphasis of the project, and the use of robotics, mobile technology, cloud computing, the Internet-of-Things, 3D printing and analytics, Smith & Nephew secured a grant of £699,531. The terms of the award were that Smith & Nephew could only spend the money with financially-sound British SME technology companies.
After a formal tender and vetting process, Smith & Nephew engaged three partners: DCSL Software to translate the sophisticated data feeds from NAVIO into intuitive web and mobile dashboards; additive manufacturing consulting specialist Euriscus Ltd; and Imperial College London to oversee the coding requirements for a new surgical workflow assisted by augmented reality that centred on osteoarthritis treatment of the knee joint.
DCSL Software was a strong contender from the outset. “As well as ticking all of the Government boxes on size, turnover and solvency, DCSL was an experienced Microsoft Azure Cloud service provider-, with a direct relationship with Microsoft” explains Darren Wilson, Project Manager and Senior Scientist within Orthopaedics Research Technology and Innovation at Smith & Nephew. “This was important for Smith & Nephew because we wanted to collaborate with a Microsoft approved company to help us progress from initial concept to beta testing as part of our journey to launch a cloud-ready application with both back-end and front-end architecture that could host and analyse the NAVIO data securely.”
DCSL also had extensive experience of creating dashboards for use in a wide range of industries, including healthcare. “They were local, too, and use an agile/sprint-based product development approach as standard, which is our favoured way of collaborative working,” Darren adds.
DCSL’s ability to get to grips with the complex structure of the NAVIO case files for logging procedural data produced by NAVIO was astonishing, he notes. “This spoke volumes about the people we were dealing with. The information they have to compile and process in the cloud to create the database schema behind the dashboards is incredibly complex, but DCSL’s developers grasped this extremely quickly.”
The beta version of the Digital Dashboard web application that DCSL has created collates NAVIO case log files during each surgical procedure, extracting information used for analytics and displaying key findings in a visually attractive format for clinical and other healthcare users.
DCSL has also created a beta version of the mobile app in addition to the web-browser, for iOS and Android devices, which could act as a companion for surgeons in the future, so they can access their own data and performance trends. Further into the future, Smith & Nephew hopes to add a patient portal, so that anyone can understand more about robotics-assisted surgery and the many associated benefits – including faster recovery time and less time in hospital.
The information they have to compile and process in the cloud to create the database schema behind the dashboards is incredibly complex, but DCSL’s developers grasped this extremely quickly. Read more.
As a Government-backed project, this programme of work had to meet certain deliverables: fortunately everything has gone to plan. “DCSL even finished the beta software ahead of time, creating an opportunity for us to take things further with them, exploring the possibility of developing intelligent, proactive dashboards powered by machine learning algorithms,” Darren says. “The beta version of the mobile app can take photos, so it’s possible we could interpret information from these images automatically, rather than relying solely on human analysis.”
On the value DCSL has brought to the project, Darren is effusive. “Keeping our products on the market, and improving its performance and outcomes, depends on being able to understand, interpret and act on the data NAVIO is collecting, and that’s what DCSL has given us,” he explains.
“While this is a robotics project, the real value is in the ability to collect and process large amounts of complex data to drive discovery and insights. It addresses pain points for everyone connected to the NAVIO, the Smith & Nephew engineers in Pittsburgh, the local sales reps, the surgeons; GPs and patients.”
The smooth-running of the project bodes well, as Smith & Nephew’s ambitions remain high. “Without question, digital health is the future of healthcare,” Darren concludes. “Having access to skills like DCSL’s is critical to our future strategy to improve efficiency and outcomes in the OR. Their work is highly professional – plus they are great communicators, and very easy to work with. They have made light work of a complex requirement, and we’re excited to see where this could take us.”