Jenny Sims reports back on the key topics under discussion at this year’s King’s Fund Digital Health and Care Congress
The NHS in England aims to be paperless by 2020. Appropriate then, that a review of data security in the NHS should be launched at this year’s King’s Fund Digital Health and Care Congress in London on 5 and 6 July. It was no surprise that the person asked by the Health Secretary to carry out the review with the Care Quality Commission (CQC) was Dame Fiona Caldicott, National Data Guardian for Health and Care and author of two previous reviews on confidentiality and data sharing in the NHS. And no surprise that data sharing and new ways for technology to improve health services were the major congress themes addressed by policy experts, IT specialists, researchers and patients.
The whole spectrum of stakeholders agreed that with technology developing so fast, new guidance is urgently needed – not least to allay the public’s fears about confidentiality breaches and who their NHS data is shared with. A key finding of the Review of Data Security, Consent and Opt-outs was that, in general, people trusted the NHS and what it did with their health data. But, they were more cautious about sharing their social care data.
‘The review looks at data security both in terms of safeguarding data from careless misuse and awareness of possible cyber threats,’ Caldicott said. It also looks at ‘good technology systems’ for sharing information in both health and social care sectors – and consent. Importantly, the review contains ‘a new simple model for consent and opt-out’ to replace the current confusing range of more than 40 different possible opt-outs across the NHS.
Keynote speaker Matthew Swindells, National Director of Commissioning Operations and Information, NHS England, said that Big Data was needed to run a smarter NHS. One of his key messages was that: ‘IT no longer belongs to the IT department. IT and information is the ownership of the board and senior management.’ It was the lever for transformational change and crucial for the implementation of the NHS Five Year Forward View.
In a live web-link from San Francisco, Dr Robert Wachter, author of The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, said: ‘Digital changes everything – including the geography of care.’
Dr Wachter, Professor and Interim Chairman, Department of Medicine, University of California, and head of an NHS England review on the digital future of the NHS (to be published on 7 September) offered some key messages from its findings, including:
‘The thing about health is there is an incredible margin for improvement. There really is no other sector in the world that is so far behind in cutting-edge technology,’ claimed Mustafa Suleyman, Co-founder and Head of Applied AI, Google DeepMind.
But Suleyman hopes to help change all that. ‘There are massive opportunities for machine learning and IT to have a beneficial impact in the NHS,’ he said.
And he went on to describe his and some of the world’s best AI researchers’ work with the NHS, which will transform patient care. As background, he explained that the British AI research company he started six years ago was acquired by Google in 2014, and is now responsible for all Google’s general-purpose AI efforts. From that sprang DeepMind Health (DMH), launched just six months ago at the Royal Society of Medicine.
‘Our mantra is ABC: Always be clinician-led. All the projects we’ve worked on so far have been brought to us by a nurse or doctor who had some idea or insight into how they can change behaviour in their day-to-day operation and how a technology solution might actually work,’ he said.
‘Our mantra is ABC: Always be clinician-led. All the projects we’ve worked on so far have been brought to us by a nurse or doctor who had some idea or insight’
It is interesting to see the changes that digital sharing is making already, two examples of which were discussed at the King’s Fund congress.
Following an approach from consultant ophthalmologists at London’s Moorfields, DMH has been working with clinical staff on a project applying machine learning to age-related macular degeneration (AMD) and diabetic retinopathy. It’s hoped that the use of collected data for standardising the diagnosis of these conditions will lead to faster diagnosis and prevent sight loss in some patients – AMD affects 250,000 people in the UK. Results won’t be published until later this year, but it’s hoped that the project will lead to the prevention of sight loss for many more patients.
DMH is also working with NHS staff on an AI project involving blood testing for acute kidney infections. Information sharing in the NHS could and should be greatly improved with the help of machine learning and AI, says Suleyman, who is trying ‘to build apps to put information in the palm of a clinician’s hand. We hope that some of the things we are doing in clinical support will lead to better intervention and patient care,’ he said.
Camden Clinical Commissioning Group (CCG) launched its integrated care programme in 2013 to digitally connect health and social care services, and enable sharing of electronic patients’ records. It contracted Orion Health Systems to carry out the transformation of services and deliver a new model of care. Geographically, the area includes two acute hospitals, 36 GP practices and multiple community services in the London Borough of Camden.
Three years on, Dr Neel Gupta, Camden GP and CCG board member, says of the clinician-led project: ‘We are pleased with where we’re at and excited about future possible developments.’
Chief among these is that GPs and other health and care staff now have just a single sign-on to their IT systems, and patients can access their records online (helping them self-manage their care, resulting in better outcomes). Hasib Aftab, the CCG’s Head of Informatics and IT, admits: ‘It’s been a very, very difficult journey, and there have been many challenges connecting multiple services.’ But Aftab says it has been ‘a worthwhile exercise’. He stresses that ‘it’s not all about IT, but improving quality of care and services’.
One lesson that has been learned is that to ensure success, it’s important to develop trusting and collaborative relationships, to get the right people on board from the beginning and to keep them there. It took two years for the CCG to develop a level of trust to get the right data it needed from social services, for example. Its future plans including integrating digitally with other clinical commissioning groups and services including London Ambulance Service NHS Trust. But it’s a model that could be rolled out regionally and nationally, said Aftab.
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