Artificial Intelligence (AI) in Primary Care

July 17, 2018

eGPLearning Podblast: Artificial Intelligence - Shownotes

 

This is a themed episode where we talk about Artificial Intelligence (AI) in primary care - the applications, risks and benefits to patients and clinicians.

eGPlearning Podblast is a health tech talk by two Nottingham based GPs covering recent topics, useful clinical apps, and interviews with primary care health tech innovators.

Hosted by Dr Hussain Gandhi (@drGandalf52) and Dr Andrew Foster (@drawfoster).

 

 Disclaimer  - We are not experts, but we are interested GPs, we are merely discussing our impressions, ideas and concerns and optimism in the hope that you may find this interesting.

 

Thank you:

@SonaliKinra @NottsLMC @NCGPANottm @jacey_melody @kalindikrishna @rcgpfaculties @2GPs_in_a_pod @mededbot @dme_health @karthikrishna86 @dr_zo

Update:

Andy: (1.15) - @ANorrisMP attended the practice

Gandhi: (1.38)



What is AI? (5.12)

Artificial intelligence (AI) in healthcare: is the use of algorithms and software to approximate human cognition in the analysis of complex medical data. Specifically, AI is the ability for computer algorithms to approximate conclusions without direct human input.

 

When thinking about A lot of people think of Artificial General Intelligence, an artificial agent that thinks like a human, but this is thought to be a long way off.

 

https://www.youtube.com/watch?v=qDrDUmuUBTo

HAL 9000 from 2001 A Space Odysey is a (rather sinister) example of Artificial General Intelligence.

 

AI is a combination of key technologies…

 

Key terms, definitions and technologies:

 

The 4th industrial revolution

Deep learning, algorithms, fast processing, storage capacity and ability to collect large amounts of data are the foundations of the 4th industrial revolution - AI.

 

Logic and rules based AI…

 

  • “Top down approach”- system designers provide the rules for computer to follow
  • Simpler than more modern approaches, but this can be very powerful
  • Examples include: Automatic tax return software, Qrisk, FeverPain, FRAX (7.16)
  • Already used for prescription safety like OptimizeRX (7.30) and advice, flagging investigation results
  • Could be useful for automating simple tasks like processing some blood results

 

Pattern based AI...

 

Machine Learning (7.53) - see our episode with Jon Brassey

  • Training a machine using data sets with known outcomes
  • The algorithm analyses lots of data with known outcomes, makes connections - thus training the model which changes its own approach as it learns
  • Eventually the software look at new novel data and reach reliable conclusion

 

Deep Learning (9.20)

 

Natural Language Processing

  • Key technology for understanding and communicating with humans naturally
  • Human communication is HARD to understand
  • Currently humans really have to adapt their behaviour to interact with computers, unnatural things - type on keyboard, use mouse, touch screen
  • Once can understand human speech and communication much more data available for training algorithms - progress in AI will accelerate.
  • Examples include: Dictation software - already here! - Dragon (13.30), Voice assistants (12.20) https://youtu.be/_ldoV5FQn0k , translation, learning from consultation transcripts

 

Computer vision

Similar to natural language processing in unlocking image and video data to train algorithms. Potential to initially impact, Radiology, dermatology, ENT(15.07), retinal imaging.



Implications for general practice…

Will it change things quickly or slowly?...

 

Some potential benefits of AI in General Practice:

  • Triage and screening supporting access and effective use of resources
  • Support medical practice, diagnosis and treatment. Big opportunity to improve quality, consistency, safety
  • Supporting and caring for patients - supporting social care
  • Accelerating medical research - data collection, processing, more data, quicker in new ways
  • Drug/treatment/device development

 

Special mention for...

@BabylonHealth - They are sometimes controversial, but are a British company leading the world in Medical AI!

Babylon to be installed as standard on Samsung mobile phones https://www.ft.com/content/e7035e0c-634e-11e8-a39d-4df188287fff

Partnership in  China https://www.digitalhealth.net/2018/04/babylon-ai-technology-china-tencent/



Potential problems with AI:

and Genomics(https://egplearning.co.uk/ramblings/podblast/egplearning-podblast-episode-10-genomics-and-bnf/) (19.10)




Effect on Jobs?

  • Mass unemployment or...
  • New problems and needs arise as old ones are surmounted
  • Potential new jobs in healthcare related to AI
    • Facilitating and explaining engagement with AI - Healthcare workers are complex communication experts
    • Training the AI
    • Maintaining the AI
    • Creativity in service design
    • Original thought and innovation
  • Focus on the right skills - creativity, innovation abilities, using and training technology



So… Are you feeling positive about AI in healthcare?

 

Thanks for listening and for your certificate of engagement click here

 

Subscribe, comment, share and keep eGPlearning. 



00:0000:00

Episode 10- Genomics and BNF

July 2, 2018

eGPLearning Podblast Personal Genomics Special Shownotes

 

In this episode, Andy describes his experience of using the 23andme’s personal genetics service. We discuss his impressions, both positive and not so positive as well as privacy concerns and what the future might hold for personal genetics and how General Practice might be involved. We also explore the use of the BNF clinical app.

eGPlearning Podblast is a health tech talk by two Nottingham based GPs covering recent topics, useful clinical apps, and interviews with primary care health tech innovators.

Hosted by Dr Hussain Gandhi (@drGandalf52) and Dr Andrew Foster (@drawfoster).

 

Shout outs:

@sonaliKinra, @ncgpaNottm, @nottsLMC

 

Gandhi update (1.50)

Fasting in Ramadan is not easy

Podcasting for innovait - the @rcgp AiT journal - check out the latest episode shortly with @doctormayur and @dr_zo

Thank you to all the #eGPlearners for helping with rebranding of @egplearning

 

 

Andy update (3.00)

On @nottstv talking about GP plus extended GP services in Nottingham.

 

App review: BNF Smartphone App (4.00)

https://www.bnf.org/products/bnfbnfcapp/

HANDI (Handbook of Non-drug interventions) website (10.00)

A useful collection of non-drug resources for clinicians and patients. 

 

Down to our Personal Genomics (10.30)

 

  • Definition: “Personal genomics or consumer genetics is the branch of genomics concerned with the sequencing, analysis and interpretation of the genome of an individual

 

Who are 23andMe?

US based startup founded 2006.

Direct to consumer personal genome testing

CEO Anne Wojcicki used to be married to google’s Sergy Brin, google an early investor

Spit in a tube and they will analyse your genetic material, mitochondiral and chromosomal and present the results

They give you the opportunity to:

  • See an ancestory report
  • Find genetic relations (who want to be found)
  • See a report about inherited traits - baldness, unibrow….
  • Be aware of genetics risks for serious health problems

 

The process?

  • Order the kit - £79 Ancestory, £149 full service
  • Register account
  • Spit in a tube and post back
  • Wait 2-3 weeks
  • HumanOmniExpress-24 format chip - partial SNP (single nucleotide polymorphisms) looks at parts of the genome known to vary between individuals.
  • Get an email saying results are ready
  • Look at results.
  • Can see
    • See an ancestry report
    • Find genetic relations (who want to be found)
    • See a report about inherited traits - baldness, unibrow….
    • Carrier status
    • Be aware of genetics risks for serious health problems

 

Ancestry

  • Allows users to view origins of mitochondrial DNA and nuclear DNA and see where ancestors came from around the world
  • Interesting, but beware unintended consequences and unwanted/unexpected information. May have implications for identity and family

 

Inherited traits

  • Largely for fun… Unibrows, Widows peaks, freckles and ability to smell asparagus and many more traits.

 

Carrier status

  • Innocently named, but quite serious stuff - Cystic Fibrosis and thalassemia carrier status for example. Information released without genetic counseling. Beware unexpected or unwanted information.

 

Genetic disease

  • When doing similar tests in this country within the NHS, an individual would undergo genetic counseling with an expert to ensure that the process and implications of testing are understood.
  • 23andMe allow you to see this information after clicking through just 8 screens, Beware unwanted information and remember that your family will share your genes, so you are also testing other family members as well. If you have a variant then a relative may have it too.
  • Explains that genetics is just one potential risk factor, environment important too, not diagnosis… “Talk to your healthcare provider to better understand how to manage your risk”...
  • If risk present then provides information about the test, the condition, treatments, how to manage risks and links to good quality information.

 

Privacy

  • Prominent information on website
  • Stated aim is to give you choice and control
  • Keep genetic information and personal information separate - linked via a confidential cipher
  • Under certain circumstances they may release data to law enforcement organisations
  • They will not share with insurance companies - Concordat and Moratorium on Genetics and Insurance - in effect until 2019!

 

What next for personal genomics?

  • 100,000 genomes project - people with established diagnosis of genetic disorder are having genes sequenced in search for new approaches to managing these conditions
  • Personalised medication and treatment?
  • Pre relationship testing/matching?
  • Insurance implications post 2019 moratorium
  • Pre-employment testing - Great film recommendation - GATACA

<iframe width="560" height="315" src="https://www.youtube.com/embed/DO_x-po_Nsc" frameborder="0" allow="autoplay; encrypted-media" allowfullscreen></iframe>

Correcting genetic mutations or treating more directly?

Would Andy recommend?

  • This was an interesting and in places fun process - There is a temptation to recommend it to those who fully understand the risk and are interested, particularly with regards to ancestry and traits.
  • BUT… Andy cannot recommended due to:
    • Risk of unexpected information
    • Lack of intervention for risks uncovered
    • Privacy concerns!!!

Please let us know what you think?

 

Listen, subscribe and follow and feedback

 

For a link to the certificate of engagement click to download from here.

 

Thanks for listening and catch you next time!

 

00:0000:00

Interview with Jon Brassey- Trip Database

June 16, 2018

eGPlearning Podblast is a health tech talk by two Nottingham based GPs covering recent topics, useful clinical apps, and interviews with primary care health tech innovators.

Hosted by Dr Hussain Gandhi (@drGandalf52) and Dr Andrew Foster (@drawfoster).

In this episode, Dr Hussain Gandhi talks to Jon Brassey (@JRBtrip) of Trip Database

Trip Database is the UKs key evidence-based medicine search engine. 

We talk about Jon's journey to develop a unique and effective clinical evidence search engine that is free for all NHS staff (on contacting Jon via jon.brassey@tripdatabase.com) , how failed ventures can sometimes need resurrecting ( #bringBackTILT) , how AI and machine learning is changing the searching for clinical information and Jon's own advice for new health tech entrepreneurs. 

Additionally, listeners are also able to download a free certificate of engagement for their appraisal portfolios. Click here to download. 

00:0000:00

eGPlearning Podblast episode 8 - GDPR

May 25, 2018

eGPlearning Podblast is a health tech talk by two Nottingham based GPs covering recent topics, useful clinical apps, and interviews with primary care health tech innovators.

Hosted by Dr Hussain Gandhi (@drGandalf52) and Dr Andrew Foster (@drawfoster).

This is a themed episode where we cover the new General Data Protection Regulations (GDPR) and how we feel they will impact primary care. A must listen episode for GDPR wary clinicians. 

 

Shout outs:

Ben Gowland : @BenXGowland and owner of General Practice Podcast which we will feature on shortly.

Jacey Meloday @jacey_melody -can not wait to list- after physical exercise- consider Welltory

 

Likes:

Moodpath @moodpath

Shubs Upadhyay (@2GPs_in_a_pod)

Todd Berner @tberner_md

Keck Graduate institute @keckgrad

 

March episode:

Twitter:

@digitalpharmacist Mohammed said he will have to listen

@drjongriffiths thanked us for the mention

Hope regular subscriber @sonalikinra and her husband enjoyed listening to us on the drive away

 

Podcast feedback:

Markado Escano of young entrepreneur lifestyle 2.0 wrote positive comments and asked about shownotes - well we have them https://itunes.apple.com/au/podcast/young-entrepreneur-lifestyle-2-0/id1105756640?mt=2

Jules Hannaford of hong kong confidential wrote how interesting and informative she found the podcast, particularly episode 2 and she will pass on to her students aiming for med school.

https://itunes.apple.com/hk/podcast/hong-kong-confidential/id1321295078?l=en&mt=2

 

Do feel free to leave a review as well if you enjoy our episodes.

 

Updates: (2.45)

To try the Facebook quiz click here

GDPR - (4.22)

What is GDPR, how it affects primary care.

BMA GDPR page: https://www.bma.org.uk/advice/employment/ethics/confidentiality-and-health-records/general-data-protection-regulation-gdpr

ICO GDPR page: https://ico.org.uk/for-organisations/guide-to-the-general-data-protection-regulation-gdpr/

Nottingham LMC GDRP page: https://www.nottinghamshirelmc.co.uk/guidance/resource/gdpr/

 

App reviews:(29.20)

Cupris: (33.10) http://www.cupris.com/cupris-platform/

Forward (33.35) https://forwardhealth.co/

Siilo (35.35) https://www.siilo.com/

 

00:0000:00

eGPlearning Podblast interview - Dr Keith Grimes the Medical Virtual Reality doctor

April 5, 2018

keith_grimes_egplearning.png

eGPLearning PodBlast-  Dr Keith Grimes & Medical VR Interview + Show Notes

 

In this episode of the eGPLearning Podblast, we interview Dr Keith Grimes, a GP and Medical Virtual Reality pioneer.

 

We talk about how Keith became interested in VR and how he has been using it in his clinical practice. We discuss the potential for VR in healthcare and also some of the pitfalls. Keith describes some of the projects and studies he is involved in.

 

Keith also explains how he built his skills to use social media to promote and build a community around his interest in Medical VR, and his tips for combining a career in healthcare with another interest or passion.

 

This is a great listen for your commute, on the treadmill or relaxing at home.

 

Enjoy...

iTunes link: https://itunes.apple.com/gb/podcast/egplearning-podblast/id1325540249?mt=2

Stitcher link: https://www.stitcher.com/podcast/egplearning

 

Show Notes…

 

How to contact Keith and get involved in the Medical VR community:

 

Keith’s first experience with VR was through the arcade version of  Dactyl Nightmare:

 https://youtu.be/v6t69mp0ZhE

 

Modern VR products such as the Oculus Rift are a much superior experience

Project CAR - Oculus Rift:

 https://www.youtube.com/watch?v=vY6QRN6hI-Y&feature=youtu.be

 

Keith describes the 5 use categories for Medical VR:

 

  1. VR as an adjunct to existing treatments - To improve pain and reduce anxiety during interventions
  2. VR as a form of therapy - e.g. to treat phobias, anxiety, mental health problems
  3. VR as a diagnostic tool - Eye tracking and assessing responses during simulations - e.g. eye tracking to diagnose Autistic Spectrum Disorders
  4. VR for education and training
    1. Medical Realities: https://www.medicalrealities.com
    2. Shafi Ahmed: @ShafiAhmed5
  5. VR expanding a patient's understanding - empathy - living in someone else's shoes. What's it like to have dementia.

 https://youtu.be/Zch3fg0orzo

Downsides and Risks of VR in medicine:

 

  • Nausea and sickness - patients may unable to tolerate VR
  • The intensity of experience not suitable for some
  • Minimum Age, perhaps as low as 7 yrs
  • Many application involve simulated violence - unsuitable for some
  • Infection control - equipment needs to be sterilised between users

 

Keith’s current projects:

  • PREVENT ICU Delirium - Psychological Resilience Using Virtual Reality Exposure as a Novel Therapy to reduce ICU Delirium

    • Does VR pre-experience of intensive care unit reduce incidence and severity of postoperative delirium - about to begin small-scale study.
  • “See What I See” - Kent and Surrey trial service
    • Use of “Expert Eye” based on Google Glass, to allow Doctors to remotely visit care homes. Carer wears smart glass and is provided with remote expert support by a GP.

 

Entry level equipment to get a taste of VR and start using it:

 

Equipment to take things to the “next level”:

Oculus Rift https://www.oculus.com/rift/

HTC Vive https://www.vive.com/us/product/vive-virtual-reality-system/

Also you need a fairly powerful PC

Connect

 

Programming and developing VR tools

Unity https://unity3d.com/learn/tutorials/s/xr

Vuphoria https://www.vuforia.com

Unreal https://www.unrealengine.com/en-US/vr

00:0000:00

eGPlearning Podblast episode 6

March 22, 2018

Health tech talk by two Nottingham based GPs covering recent topics, useful clinical apps, and interviews with primary care health tech innovators. Hosted by Dr Hussain Gandhi (@drGandalf52) and Dr Andrew Foster (@drawfoster). This episode recaps our latest contacts and activities including finding more resources for primary care clinicians (4.47)creating videos for patient education (5.30), then a review of the wellbeing app Welltory (7.50). We finish off covering some recent encounters with online pharmacies and their activities (21.00).

00:0000:00

EGPLearning PodBlast Ep5

February 19, 2018

Health tech talk by two Nottingham based GPs covering recent topics, useful clinical apps, and interviews with primary care health tech innovators. Hosted by Dr Hussain Gandhi (@drGandalf52) and Dr Andrew Foster (@drawfoster). This episode begins with a review of our previous episode and individual updates(2.00) and then we cover an ENT focussed app Cupris (3.22), a depression assessment tool app called Moodpath (11.16) and cover a Nottingham based news story on eprescribing that may bring in national changes (21.44).

00:0000:00

eGPlearning Podblast interview with Dr Aman Arora of Arora Medical Education

January 28, 2018

An interview with Dr Aman Arora of Arora Medical Education. We discuss the innovative use of social media and other technologies to help peers with GP training and the education process.

00:0000:00

eGPlearning Podblast Episode 3 - Jan 2018

January 7, 2018

Health tech talk by two Nottingham based GPs covering recent topics, useful clinical apps, and interviews with primary care health tech innovators. Hosted by Dr Hussain Gandhi (@drGandalf52) and Dr Andrew Foster (@drawfoster). This episode begins with a review of our previous episode and then we cover the mindfulness app Headspace (4.12), NHS hackathons (14.20), and NHS Quicker app (21.30). We also talk more about the concept of using digital triage and AI in a primary care setting (17.30).

00:0000:00

eGPlearning interview with Dr Kenny Livingstone from Zoomdoc

December 22, 2017

An eGPlearning interview with Dr. Kenny Livingstone the founder of Zoomdoc- an innovative geo-location home visiting app and service for primary care in the UK. Hosted by Dr Hussain Gandhi (@drgandalf52) they discuss how Zoomdoc was created and how Kenny innovated the service, including funding options for entrepreneurs like using Seedrs. As an example look up Zoomdoc on Seedrs at https://www.seedrs.com/zoomdoc

00:0000:00

eGPlearning Podblast episode 1

December 9, 2017

SHOW NOTES:

Introductions and declaration of interests

Dr Andrew Foster:

Dr Hussain Gandhi:

  • GP Partner Nottingham
  • Former Chair RCGP Vale of Trent Faculty
  • Treasurer GP Survival
  • Owner SystmOne Facebook User Group
  • Owner www.eGPLearning.co.uk
  • Twitter – @DrGandalf52

NICE HEALTH APP BRIEFINGS:

NEWS SUMMARY

GPatHand- Welcome improvement to access or cherry-picking healthy patients and destabilising General Practice?

Links:

Cancelled North West London CCG trial of Babylon AI symptom Checker

Links:

INTERVIEW: DR ANDY FOSTER @DRAWFOSTER

GP Partner with interests in general practice operating at scale and technology.

Leadership and other courses often available free of charge to GPs in East Midlands can be found at East Midlands Leadership Academy: http://www.leadershipeastmidlands.nhs.uk

Blog: www.avoidingpuddles.com

Innovative RCGP Vale of Trent Transitions 2017 day conference incorporating speed dating, showcase website, 360 video, presentation video and “Why GP, Why Vale of Trent” promotional video.

Event website –www.valeoftrent.org.uk

Blog post re. Speed Job Dating –http://avoidingpuddles.com/2016/07/03/the-worlds-of-speed-dating-and-gp-recruitment-together-at-last/

NCGPA Reception Active Signposting training product and website –www.signpostinghealth.com


Thanks for reading/listening, feel free to comment or share and look out for the next exciting episode

00:0000:00