The NHS app - an eGPlearning Podblast perspective

eGPlearning PodBlast - Introducing the NHS App

Welcome to our deep dive episode on the upcoming NHS app - which we cover multiple areas of primary care and patient care. A highly opinionated episode which we encourage your comments and feedback on. 

1.00 Thank you Sponsor - HTN The Health Tech Newspaper (HTN)- an innovative daily news and opinion website for the health tech network.

1.40 Thank you to our followers: @SonaliKinra  @NottsLMC @NCGPANottm @Jacey_Melody @JThambyrajah @KalindiKrishna  @RcgpFaculties @2GPs_in_a_Pod , @DME_Health, @BenXGowland , @EvilGP and @drNickHarvey -creator of Digitalis

2.25 Andy has had a cold and been on a cruise

2.40 Gandhi has also had a holiday, working on TipThursday especially the Kardia Alivekor episode with a free resource on the episode available here. 

3.30 Today we are talking about the upcoming NHS app

We are going to talk about the app. This was inspired by a great article by our friends at Gizmodo. http://www.gizmodo.co.uk/2018/08/exclusive-heres-what-the-new-nhs-app-will-look-like-and-why-it-could-have-been-so-much-worse/

The intentions behind the app are exactly what you might expect: Make it easier for patients to access healthcare services, cut down on administrative burden, and eventually provide a means to connect with other health apps, like Fitbit and Apple’s Health app.

Jeremy Hunt set out “8 challenges” for the app

• (7.20) Symptom checking and triage (i.e. figuring out if you’re just being a hypochondriac or whether you should be in an ambulance right now)- eConsultation, webGP, babylon AI
• (13.00) Access to your medical records and security issues. 
• (23.10) GP appointment booking
• (28.20) Repeat prescription ordering
• (29.50) Changing data sharing preferences
• (31.38) Changing organ donation preferences
• (33.38) Changing end of life care choices - DNAR medical decision
• (38.50) Promoting “approved apps” to patients - see the NHS app library and @OrchaUK
  

(42.50) Summary of our views (including a compliment for Jeremy Hunt!!!!) including the issue of photo ID verification to use the app. 

These are discussed in turn during the show...

(49.00) Sign off and next episode spoilers

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Artificial Intelligence (AI) in Primary Care

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)

• Thank you for electing me as @RCGP National Council representative
• 200 Followers on eGPlearning Facebook page: https://www.facebook.com/Egplearning/
• #TipThursday - https://egplearning.co.uk/tag/tipthursday/

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)

• A key technology behind machine learning
• Uses “neural networks”, inspired by neurons, to make connections between data as it learns.
• Connections strengthen and weaken as it processes data and learns.
• E.g. Facial recognition - Facebook, google Deepmind trouble for breaching data handling regulations (10.15) - https://www.theguardian.com/technology/2017/jul/03/google-deepmind-16m-patient-royal-free-deal-data-protection-act
• IBM Watson tackling cancer - connects presentations with knowledge from research papers.

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:

• Black box - does it matter if you don’t know how it works? - correlation is not causality.
• Bias in data sets:
  • See Tay, Microsoft’s obnoxious chatbot https://en.wikipedia.org/wiki/Tay_(bot) (16.40)
  • Normal laboratory ranges for blood tests based on young caucasian populations is a current example of potential bias due to the data used to calibrate a system.
• Risk management - who is responsible
• Security and privacy, data management - GDPR (https://egplearning.co.uk/ramblings/podblast/egplearning-podblast-episode-8-gdpr/)

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
  • “Computers” vs youtube vlogger - “hidden figures” film recommendations (28.34)
    • Taraji P. Henson - Katherine G. Johnson (29.10)
    • Octavia Spencer - Dorothy Vaughan (30.20)
  • Smallpox vs video game addiction
• 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?

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Episode 10- Genomics and BNF

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!

eGPlearning Podblast episode 8 - GDPR

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/

Welltory, patient education and online pharmacies.

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).

Cupris, Moodpath and e-prescibing

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).

Headspace, NHS hackathons and Quicker app and digital triage with AI

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).

Pilot - Sleepio, GDm app, news and interview with Dr Andy Foster

SHOW NOTES:

Introductions and declaration of interests

Dr Andrew Foster:

• GP Partner Nottingham
• Director NCGPA – Nottingham GP Federation
• Creator of SignpostingHealth
• RCGP Vale of Trent Faculty Honorary Secretary
• Blog – www.avoidingpuddles.com
• Twitter – @DrAWFoster

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:

• Sleepio Website
• NICE Sleepio Health App Briefing
• GDm App Website
• NICE GDm Health App Briefing

NEWS SUMMARY

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

Links:

• http://www.pulsetoday.co.uk/home/finance-and-practice-life-news/online-gp-provider-makes-push-for-patients-to-switch-from-their-practices/20035609.article
• http://www.pulsetoday.co.uk/your-practice/practice-topics/it/we-have-a-number-of-serious-concerns-about-the-gp-at-hand-service/20035632.article

Cancelled North West London CCG trial of Babylon AI symptom Checker

Links:

• http://www.pulsetoday.co.uk/your-practice/practice-topics/it/babylon-gp-appointment-app-ditched-over-fears-of-patients-manipulating-system/20035712.article
• http://www.pulsetoday.co.uk/your-practice/practice-topics/it/babylon-gp-appointment-app-raises-fears-of-patients-gaming-system/20035712.article
• http://avoidingpuddles.com/2017/11/30/chatbot-vs-nhs111-trial-cancelled-as-patients-game-the-system/

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