Not Much Deep Thinking Evident Behind NHS Trust’s Data Share with Google DeepMind

Not for the first time, the NHS has come under fire from patients, patient groups and the scrutiny of the UK’s National Data Guardian (NDG), Dame Fiona Caldicott – and the ICO’s chief Elizabeth Denham.

The Royal Free Hospital in London commissioned Google’s DeepMind division in 2015 to help develop a Streams app to detect acute kidney injury through a blood test to identify deterioration. They provided DeepMind with 1.6 million patient records in the process to enabling ‘real time’ testing.

• Patients at the Royal Free Hospital in London were mainly unaware that their details were being used by a third party, nor how it was being used.
• No details on the financial terms of the deal have been disclosed publicly.

To Dame Fiona Caldicott, whose letter to the Royal Free was recently leaked, laid out her  concern that the data had been transferred on a ‘legally inappropriate’ (read ‘unlawful’) basis.  The app being developed was not ‘central’ to patient clinical care.  Caldicott shared her concerns with the ICO.

Caldicott does not dispute the app’s ability to help clinicians save lives today, but added in her letter: “Given that Streams was going through testing and therefore could not be relied upon for patient care, any role the application may have played in supporting the provision of direct care would have been limited and secondary to the purpose of the data transfer.  My considered opinion therefore remains that it would not have been within this reasonable expectation of patients that their records would have been shared for this purpose.”

Google DeepMind’s clinical lead Dominic King, was swift to distance any cross-use of the patient data with other Google products or services, or use for commercial purposes.

The ICO’s Elizabeth Denham has yet to give her judgement on misuse under the Data Protection Act, but the issue underlines the importance of individual consent.  This will be evermore intensely examined with the forthcoming GDPR regulations in 2018.  As it stands though, the ICO nonetheless has powers to fine a company up to £500,000 for the misuse of personal data as well as seek individual criminal prosecution.

Irrespective of the worthiness and potential benefit to patients in the longer term from the app, Dominic King agrees: “I think one thing that we do recognise that we could have done better is make sure that the public are really informed about how their data is used.”

It may prove a costly oversight to the Royal Free at a time of increasing NHS budget constraints, as well as prompting an ignominious slap in the face to the Trust from its patient body through damage reputation.

Amicus ITS is continuing its series of thought leadership events, this time on GDPR through 2017 for its customers and invited guests.  Further information on the programme can be found by contact Marketing (email) or calling Lindsay Burden on 02380 429475.

Barcode technology putting the patient at the heart of process as its most important asset

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The Department of Health has announced a pilot scheme that has just reported its first results using barcode technology.  The £12m scheme which started in 2016 has been used to track patients and improve asset management through the hospital system.

Use of barcode technology (GS1) has been common practice in most major industries and transformed the retail sector as an effective way for companies to identify and track their assets and provide an accurate digital audit trail for stock, equipment and movements between sites.  The difference for healthcare is that this ensures integrated and agnostic patient-centric care provision, focusing not on short term activity targets, but long term patient outcomes.  This was a central theme in the Department of Health’s e-Procurement strategy in April 2014 and with today’s stretched NHS, connecting patient safety, identification of a person, product, place and administrator, creates truth, greater accuracy and ultimately accountability – and comes not a moment too soon.

The barcodes are being placed on wristbands of patients on entering hospital and used variously on breast implants, replacement hips, medical and surgical tools and pharmaceuticals etc. to track treatment and staff administering the treatment.

The pilot scheme which has been running initially at Salisbury, Derby, Leeds, Cornwall, North Tees and Plymouth is reported to be showing early signs of impact, with reductions in waste, effective management of health stocks and reduced staff time trying to locate medical supplies on shift, thereby freeing them up to spend more time with patients.

By using barcodes, it will also help with remediation should any faults develop in future years.  For example, a screw used in a knee operation would be traceable and details, such as when it was used and the surgeon who carried out the procedure, could be found quickly and easily.

The Health Secretary Jeremy Hunt believes this could help save the NHS over £1bn over the next seven years.    In an example of stock recall, back in 2012, breast implants made by French firm Poly Implant Prothese (PIP) were found to have double the rupture rate, affecting roughly 300,000 women globally and 47,000 in the UK.  Had this barcode system been in place at the time, tracing those patients to make the necessary remedial checks on their wellbeing would have been simpler, potentially less costly and less stressful for those involved had early intervention been possible.

3D printing gets smarter in healthcare

Since we last reported an amazing 3D printing story in January 2015, the technology continues to demonstrate its extraordinary enabling powers in the operating theatre for the NHS, with another life transformed as reported this week.

Surgeons were able to use 3D printers to replicate body parts in a kidney transplant from father to daughter at Guy’s and St Thomas’ NHS Foundation Trust in London recently.  With the contrast in size of the organs, 3D printers were used to make models of the daughter’s abdomen and father’s kidney from CT and MRI scans. This enabled the surgeons to accurately plan and rehearse the complex operation.

Hard printouts created the girl’s pelvis, whilst her liver was made softer in a liquid plastic model to enable the doctors to practice pushing it out of the way to make way for the new kidney. Happily, the little girl can now run around and eat normally and enjoy a very different outcome and normal childhood, whilst her parents have the simple joy of planning for her nursery integration in the Autumn.

Unlike in medical robotics where there have been more than two million operations since 2000 the robotics arena still carries challenges in winning over patient confidence.  Here however, the winning smiles of father and daughter amply reflect the achievement of partnership between the human hand and advanced printing technology that shows there is plenty more in store in the future of 3D printing.

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How on target is the NHS to going paperless in 2018?

Health Secretary Jeremy Hunt has been seeking a paperless records target of 2018 for the NHS since 2013.   In a recent focused healthcare survey of 67 members of the Health CIO Network and CCIO Leaders Network of clinicians and digital health IT leaders, there remains a mixed response:

•  67% stated they were ‘quite confident’ or ‘extremely confident’ their organisation will be paper-light by 2020.
•  14% stated they are ‘not at all confident’ or ‘not very confident’ of achieving the target.

However, on the question of having “integrated health and care records, enabling effective co-ordination of health and social care, by 2020” there was less certainty:

•  56% said they were ‘extremely confident’ or ‘quite confident’ of achieving this, but a quarter (24%), said they were ‘not at all confident’ or ‘not very confident’.
•  28% said they were confident of giving patients read/write access to their records, while 53% said they were not confident.

The top priorities for most of those involved focused on:

  • moving to paperless working – 73%
  • improving quality of services – 68%
  • supporting new models of care – 67%

When asked about their next major IT project, these were reported as:

1.  Top ranking for personal health records and patient portals, to give patients access to their medical record and test results, plus services such as appointment booking and email consultations.
2.  Next were shared record initiatives
3.  Third were e-prescribing and medicines management.
4.  In fourth place finally, one-third of respondents said Electronic Patient Records (EPR) – suggesting many are perhaps already some way down the line with this already?

Not surprisingly, with all the other cutbacks facing the NHS, this drive to go paperless might have a lot of goodwill in the sector to deliver, but the barriers facing NHS providers can be summarised by two principle points of feedback:

  • lack of adequate resource (73% affirmed that their IT budget was insufficient)
  • lack of staffing resource

With the breakup of the NHS from a truly national health service to a regional health service, primary and secondary healthcare organisations around the country will need to start showing they are making this work and that we are benefitting.  Then, we may wonder why it took so long when other major data institutions such as banks and industries such as insurance groups have managed to do this.  After all a 100-1 shot just won the Melbourne Cup.

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Joined up healthcare technology putting patients at the heart of consultations

With the advent of wearable technology and health trackers, along with social media and the power of Google, many patients are turning to personal investigation to check out their personal health symptons and conditions online using Google, Bing, Yahoo and others.  This marks the evolution of the e-patient.

US cancer sufferer and blogger Dave de Bronkart whose moniker is ‘e-patient Dave’, originally rose to prominence in 2009 and recently spoke at the Intersystems joined-up healthcare event in the US to advocate greater openness in the worldwide healthcare community between patient and the doctor as the patient seeks to know more.

Patients are able to access their digital health records (though relatively few do – 0.4% of GP patients thus far in the UK) and by doing so are best placed to identify any errors in separately held records across service providers and regions.  With access to online services, cost savings for booking appointments online, obtaining referrals, and even doctors using wifi to track patient flow through a hospital, this creates massive savings for primary care providers and hospital trusts.

The mainly holistic but equally powerful change however comes through the doctor being open to suggestion from the patient during consultations, as a result of today’s vast wealth of data available online. This offers patients access to research resources which can supplement practioner’s knowledge as well as reinforce or challenge, which should not be written off.  As e-patient Dave argues, this should bring doctor and patient closer together but could be seen by some GPs as a threat. The patient should be welcomed in bringing their own healthcare research and knowledge to the table.  By being open to this he argues, it increases interaction and creates a more educated dialogue, involving better informed questions and greater degree of insight whether a good or bad prognosis. This ultimately provides the opportunity for perceived delivery of a greater level of personal care through proper and open consultation.

These are concepts advocated by UK health minister Jeremy Hunt, who as the NHS seeks to go paperless by 2018, has tasked Martha Lane Fox with putting together a proposal on increasing the uptake of digital innovation in the NHS.  This will no doubt include proposals to involve greater use of social media or webex consultations, other than the existing social media use of just inviting views or questions by the healthcare organisations which a number have already undertaken.  With the higher motive of saving billions of pounds, there is nonetheless an argument that greater empowerment and enablement will assist trusts as they seek to save money bluntly through technology on the one hand and enable the patient to be more involved in their own care and outcomes.  Just keep a weather eye on the critical issue of the handling of patient data and privacy as this direction evolves.

ePatient-Strategien_1900x800    Dave-deBronkart

IBM and Apple monitor our health

We first reported IBM and Apple’s JV partnership in our blog of 18th July 2014 with AppleCare for enterprises.

The boom in fitness trackers and health apps has prompted the tech giants to make commercial inroads on the opportunities arising from analytic technologies.  IBM has set up a new health unit to create “a secure, cloud-based data sharing hub” as part of their “employee health and wellness management solutions” with the aim that it will provide diagnoses or health alerts for GPs, carers and insurers in future, with the user’s permission.

IBM aspires to offer greater individual insights into people’s health and to advance this strategy, has bought Explorys (which owns one of the largest healthcare databases in the world) and healthcare specialist Phytel (which works with digital medical record systems to reduce hospital readmissions and automate communications).  Added to this, Apple iPhones provide ResearchKit, free software for gathering health data, which Apple states has already been used to develop apps to study asthma, breast cancer, cardiovascular disease, diabetes and Parkinson’s disease.

US consumer technology and wearables supplier Jawbone is trying to engage businesses with its fitness trackers as a way to monitor the health of a company’s workforce.  How does this leave the end user/employee?  For a start, if a company sought to monitor the health of an employee, consent has to be given freely, with the ability to withdraw that consent at any time.

Insurers are also keen to get in on the act, with companies like UK’s Vitality offering rewards to policy holders for undergoing certain activities whilst wearing their devices.  Are we reaching the point though where data analytics lead ultimately to cover being withheld, other than premiums going up or down.

The latest UK Government stats show that 61.9% of adults and 28% of children aged between 2 and 15 are overweight with a higher risk of developing Type 2 diabetes, heart disease and certain cancers.  The cost of health problems associated with being overweight and obese is estimated to cost the NHS more than £5billion every year.

For GPs, gathering data which gives a broader and more accurate picture of exercise undertaken and calories consumed, could alter health directives on the amount of sleep we need, or which exercises are most effective.

Gazing into the NHS’ future, a carrot and stick approach accompanied by bold education messaging for health reform of UK citizens may be the tough approach needed by the next Government.  However, to succeed, with an NHS in crisis on funding and struggling to hold onto its GPs through which the future frontline is directed, many parts of its processes and systems will have to go digital. This comes back to having data shared securely with privacy maintained and strict governance on who it is share by – and that is a big promise to keep.

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This Week’s Technology News – 24h November 2014

3D Printing – refreshing the parts other printers cannot reach
The 3D printing sector has seen interesting advances over 2014 with this growing technology in use on earth and in space.  The International Space Station (ISS) has installed its first 3D printer. Before the installation, start up company Made in Space tested the printer in zero-gravity on an airplane. With the printer on-board, astronauts will be able to print physical parts themselves without needing to commission them from earth and get rocketed into space (both costly and time consuming).     Printed parts in theory will be able to replace faulty parts or maintain certain equipment in the ISS.

In parallel, researchers from the University of Oslo have designed bots that can already adapt to unforeseen problems and 3D-print new parts for themselves (ie. self healing manufacture) and apply intelligent best adaptation to its environment.   The options are limitless the scientists believe, based on a few limited instructions ie. what to do, how fast to go, its size and energy consumption.  The ingenuity for an autonomous computer being able to consider thousands of options simultaneously and 3D-print parts to create a new model, creates an intriguing possibility perhaps for ‘3-D Printing as a Service’ for MSPs?

 

Is business ready to accept ‘Facebook at Work’?
Although not formally announced, ‘Facebook at Work’ has been heavily rumoured to be used internally at the company, with a worldwide launch for business imminent.    Apparently, it is distinct from its current consumer model by barring personal details and helping overcome being blacklisted by organisations which disallow social media engagement at work. With the rise of social networking and collaboration, Facebook is cleverly poised through its dominant position with over one billion Facebook accounts, to try to take on the likes of LinkedIn and other corporate-focused social networks like Microsoft’s  Lync and Skype.   The diversification opportunities deepen, as collaboration leads to online storage where users upload and collaborate on documents with other users of the service.

The real question is whether, despite all their canny commercial plans, and even accounting for proper security and governance procedures, will the sheer name of ‘Facebook’ simply scare off a lot of companies?   Ultimately, the scale and impact of social networking cannot be ignored, but overcoming assumptions about the brand and how it will advocate its handling of public and private information will be the largest hurdle facing Facebook as it stares out from this mirror of opportunity.

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Dictat to go digital in healthcare – or warning NHS funding will be pulled
NHS England’s National Director for Patients & Information, Tim Kelsey, has announced the publication of its ‘Personalised Health and Care 2020 Strategy’.  This paper confirms NHS England’s intention to go paperless by 2018-20, or face having its funding pulled.

At its heart, patient care records must be available across urgent care services by 2018 and throughout all NHS organisations by 2020 to create joined up practice amongst professionals, speed and efficiencies and avoidance of errors (ie. in prescriptions).  Only 4% of records are currently accessible online.

The technical challenge around IT remains that many of the NHS’s PCs are still running the soon to be defunct Windows XP.  If as stated, financial resources will be made available to assist healthcare organisations, this will come as good news for IT teams and MSPs to help support any such migration to make the NHS fit for digital.  However, it must remain an integrated and secure approach.  The BMA’s GP Committee Chair Chaand Nagpaul concluded that “..the most critical aspects to get right beforehand are the safeguards, confidence and trust of patients”.   Added to this, should be the strict management of patient data to prevent it being sold unknowingly to third party commercial organisations for private profit.

Following errors on the Care.data scheme debacle earlier in 2014 which failed to have appropriate data privacy safeguards in place, this is a very valid point, but should not stop  future rollout if armed with correct good practice and security and governance policies. Hopefully, with National Data Guardian Dame Fiona Caldicott now on board, this will no longer be an issue. The key obstacle instead will be how much money healthcare organisations can secure to cover the necessary IT ‘fit for future’ upgrade investments.

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NHS kitemarks for apps
In a separate move, with the rapid increase in health-related apps for mobile phones and other personal devices available in the market, NHS chiefs are backing a “kitemark” for health-related smartphone apps to validate those deemed as safe to use by patients to help them manage health conditions.  It also includes an e-version of the red book recording baby’s immunisations and development to be online from 2016, to counter the loss of key info if the actual book goes missing and the child requires vaccination, review or emergency treatment.

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