THINK of the future of medical technology and the image of hand-held scanners from the world of Star Trek might come to mind – machines able to diagnose anything in a few moments.
But Star Trek did not show the practicalities of health care in the future. There was no washing of hands and no guard rails on beds to prevent falls – very much still issues in Scottish hospitals and elsewhere. The question now being asked is: how far can technology actually go in caring for patients?
A new project in the United States is looking to develop so-called "smart patient rooms", creating a constantly monitored and assessed treatment space to ensure patient safety and maximum efficiency.
GE Healthcare, the firm behind the project along with Bassett Healthcare, argues the technology will help reduce infections and falls, and thereby keep hospital beds from being taken up by repeat treatments.
Patients' groups and others sound a cautious note, insisting it is the human touch, and not hi-tech gadgetry, that is essential to healthcare.
Jeff Terry, GE's global general manager for clinical excellence, insists it is not a choice between technology or staff: "Our view is this will enable clinical staff to improve the quality of care they deliver and provide more care to their patients," he says.
The pilot programme, being carried out in New York State, focuses initially on hand hygiene, fall prevention, hourly rounding and pain. According to one nurse, cited in a promotional video, it was like having "your own guardian angel".
The smart room uses optical sensors to track the movement of staff and equipment and capture the time between events. Artificial intelligence and other sensing technology tracks when hands are washed, and when they should have been washed, such as if a nurse was within a certain distance of a patient.
Rather than wait for a patient to press a call button when they are in pain, the technology detects changes in the patient's temperature or position in bed to alert staff. And if a patient is close to the edge of the bed, it can warn carers before a fall occurs.
Mr Terry points out that, in the US, falls alone cost the healthcare system $1billion (600million) a year, and medical error is the eighth leading cause of death. The Institute of Medicine says that amounts to an estimated 44,000 to 100,000 preventable deaths each year.
In 2006, the British Medical Journal suggested medical errors could account for 40,000 deaths in the UK, and the Scottish Patient Safety Alliance says adverse events in hospitals are estimated to cost NHS Scotland about 200million each year in extra treatment and lost bed days.
Mr Terry says, rather than being a "Big Brother" constantly monitoring nurses' performances, the smart patient rooms reward those who have a high compliance rate with handwashing, while identifying those who might need improvement.
He says: "The system will know if you didn't wash your hands and will gently alert you. We are running pilots to find the most effective reminder. The most intensive would be a gentle vibration of tags, and the least intensive would be just a handwashing report. Care-givers are wonderful people who work tirelessly. If a typical nurse has to wash their hands 80 times a day, everyone could understand how that could slip to 70 or 60. Multiply that times thousands of nurses and thousands of interactions with patients and it adds up.
He continues: "The costs of not improving care more than justify the investment in the US. This will reduce wait times. If you're a nurse, would you rather deal with a patient who has broken their hip from a fall, or be reminded to raise the rail to prevent them falling out of their bed in the first place."
Testing of the smart patient rooms and an associated "patient-safety forecaster" will begin in the next few months in the US, but technological investment is a regular feature of the NHS in Scotland. It tends towards keeping patients out of hospital in the first place, deploying technology to the home to help monitor vitals in patients' own beds.
In February, the Scottish Government announced 16 pilot schemes for telecare and IT projects worth 1.6m. The largest is based in Edinburgh and the Lothians. Costing 700,000, it aims to allow patients to monitor their own conditions on a daily basis at home. It uses touch-screen technology and can test blood pressure, breathing, blood glucose and oxygen levels.
NHS Tayside and NHS Fife split 140,000 to use real-time management technology to meet waiting-time targets, and NHS Greater Glasgow and Clyde was given 136,000 to find new ways of getting clinical information directly to consulting rooms.
In announcing the cash, health secretary Nicola Sturgeon said: "Using technology in innovative ways like this can transform people's lives. This touch-screen technology … will save hundreds of people from making repeated trips into hospital, making a huge difference to their quality of life."
Professor Hugh Pennington, who chaired a public inquiry into the 2005 E coli outbreak in South Wales, believes there is a case to be made for using technology to monitor handwashing. "There has to be a balance struck between changing staff behaviour and having the technological side as well," he says. "I'm sure you have to have both. Technology has a critical role to play and can help to change behaviour by providing for an improving culture of safety.
"Operating theatres have had the technology for decades, but it has taken longer to make it into the wards. The attention to detail has been taken for granted since the beginning of the 20th century.
"Prevention is still a very cost effective way of reducing cost in the NHS, so the economic benefit from technology will outweigh the additional cost."
But patients' groups and nurses are more cautious about the use of technology and its limits in caring for Scots.
A spokeswoman for the Patients' Association says there are obvious dangers in replacing some staff with technology and that computers and sensors are not a substitute for best practice.
Ellen Hudson, associate director of the Royal College of Nursing Scotland, says: "All advances in technology that complement the clinical skills and expertise of nursing teams are welcome. New technologies can result in more time for nurses to care for patients but must be introduced in partnership with staff if their potential is to be fulfilled. Technology is never going to replace the human interaction that is required in high-quality patient care but can allow more time for nurses to effectively deliver hands-on care.
"The Scottish Government and NHS Scotland should carefully consider investing in any technological advances that will benefit patients and nursing teams."
But what of future generations of nurses? Will they more readily embrace the technology on offer?
Sean Murray, 23, a student nurse based in Paisley, is just setting out on a career caring for patients. He says there are obvious benefits to having technology that helps him do his job, but not at the expense of human interaction. "I think hospitals in Scotland would see this as a 'technology versus nurses' debate," he says. "But I don't see how technology can possibly win out. Computers can't move patients, wash or feed patients, talk to patients and all the proper basic stuff.
"Technology will in some ways help me do my job better – it will be quicker and easier to access patient information, and quicker and more accurate test results help to treat the patient better. But it still comes down to the whole care thing – machines and technology are cold; I often hold a patient's hand when giving bad news or if they are scared of some aspect of their care or of what's going to happen to them. A machine just can't do that."
• To see a demonstration of GE's smart room technology, visit www.youtube.com/watch? v>SmJfjrDVHe0.