Overview
Ufonia, an Oxford-based digital health company, has built an automated voice system powered by artificial intelligence (AI) for use in routine clinical conversations.
Since 2018 Health Innovation Oxford and Thames Valley has provided extensive support in developing the AI-powered tool called Dora, starting with partnering in successful funding applications and going on to carry out a feasibility study, assessing feedback from clinicians and patients and evaluating the cost benefits of incorporating Dora into the post-operative patient pathway for cataract surgery.
Where clinically appropriate, the automated phone call offers an alternative to a hospital appointment, freeing up skilled nurses to focus on patients with more complex needs, as well as reducing waiting lists and costs. Patients answer the phone in the way they would any other call – they do not need new devices, apps or training. Based on the subsequent conversation, Dora identifies those patients who are recovering well and those needing to be seen by a clinician. Calls can be scheduled for multiple times to track progress and intercept problems. For patients without complications it means fewer journeys to hospital appointments, improving convenience and bringing environmental benefits too.
Dora has been applied in operational bottlenecks, particularly high volume, low complexity routine care. The initial focus has been on cataract surgery, the most common operation in the NHS with 400,000 procedures carried out every year in the UK. It involves replacing the eye’s natural lens with an artificial one to deal with blurred vision. Thousands of automated calls have already been made to patients following cataract surgery with hundreds of hours of clinicians’ time freed up for face-to-face appointments with the patients who need them. A study published in The Lancet’s eClinicalMedicine journal in 2024 found Dora’s decisions in calls to patients after surgery strongly aligned with those of the supervising ophthalmologist. The number of NHS trusts using Dora has increased to more than ten nationwide including five in our region.
Input from Health Innovation Oxford and Thames Valley
Support from Health Innovation Oxford and Thames Valley (previously the Oxford AHSN) dates back to 2018. We helped Ufonia secure funding from Innovate UK, the NHS/NIHR AI in Health and Care Award, SBRI Healthcare and others.
We carried out a feasibility study to explore Dora’s utility in clinical practice and the potential barriers to adoption at two NHS trusts in our region. We interviewed clinical stakeholders about how the technology would integrate into the care pathway. The results were discussed with clinicians and commissioners to gain insights into how the potential barriers could be overcome. Read more about how we consulted clinical stakeholders.
We developed a health economics model comparing the cost of the Ufonia platform with the current standard care (nurse-led telephone calls) at Buckinghamshire Healthcare NHS Trust (BHT). The structured qualitative and quantitative analysis provided robust conclusions which have helped Ufonia gain further interest and investment.
We also explored patients’ experiences of the existing pathway and their views on Dora. Findings from this exercise highlighted the importance of including AI at the right stage of the pathway and the potential pros and cons as seen by patients.
Achievements
The number of NHS sites using Dora has grown from two to more than ten.
Frimley Health was highly commended in the HSJ Digital Awards in July 2024 in partnership with Ufonia in the ‘Driving change through AI and automation’ category.
Results based on the experiences of 200 cataract patients using Dora were published in The Lancet eClinicalMedicine in July 2024.
In August 2024 Dora was featured during a BBC South short multi-media series on digital and AI developments in healthcare.
What people said
“Oxford AHSN has helped to anchor us into the ecosystem of healthcare and research. Their supporting work has aided us in ensuring we are addressing the relevant needs. This credible information is able to be shared with and gives confidence to our potential partners whether they are individual hospitals, integrated care systems or central NHS teams.”
Nick de Pennington, CEO and Founder, Ufonia
“Since the trial, an updated version of Dora has been deployed at OUH as the default system for post-cataract surgery assessment for thousands of patients. We have now also expanded its use to pre-operative assessments, where Dora runs through a checklist of screening questions, including whether or not the patient wishes to have surgery for their cataract. The information is logged on our electronic medical records, thus speeding up the face-to-face nurse-led pre-assessment.”
Kanmin Xue, Honorary Consultant Ophthalmologist and co-Principal Investigator at Oxford University Hospitals (OUH)
Next steps
The focus is broadening to look at potential applications at other stages in the clinical pathway and in other clinical areas. These include triage of head and neck cancer and osteoporosis.