Digital primary care update 14.3.20 - Coronavirus special

Coronavirus tech support, telephone and video consultation tips for your Digital Primary Care update by the eGPlearning Podblast team of Andy and Gandhi.

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Simple  video consultation skills for doctors: Monday 16th March 8pm: https://www.youtube.com/watch?v=F8PccszVoyk

NHS X Information Governance update: https://www.nhsx.nhs.uk/key-information-and-tools/information-governance-guidance

RCGP resources:https://www.rcgp.org.uk/policy/rcgp-policy-areas/covid-19-coronavirus.aspx

Resources to help with telephone and video consultations. 

Quick telephone consultation tips: https://egplearning.co.uk/quick-telephone-consultation-tips-for-primary-care/

Which webcam do you need for video consultations: https://youtu.be/4IyM3e24ffk

Video consultation tips for GPs: https://youtu.be/MxIDHfHwDU0

TPP SystmOne Airmed video consultation demo: https://www.youtube.com/watch?v=Fvnx6tDo1nk&feature=youtu.be

TPP SystmOne Airmed NHS login for patients: https://www.youtube.com/watch?v=3djIAPwmIRk&feature=youtu.be

How to use AccuRx video in under 5 minutes: https://youtu.be/aryAqMqdHg0

Zoom Masterclass for your practice: https://youtu.be/UWPd2Dsr5kI

Sign up to Zoom:  https://bit.ly/eGPlearningZoom (affiliate link)

⭐Star posts⭐:

👨🏾‍⚕️Dr Gandalf’s Top medical equipment for General practice 👨🏾‍⚕️ see here: 

YouTube: https://youtu.be/JddoeK5JcRw

Website: https://egplearning.co.uk/ramblings/dr-gandalfs-essential-gp-equipment-list/

Subscribe to or follow the eGPlearning platform for more videos, app reviews and content to support technology-enhanced primary care and learning. 

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Digital Primary Care update by eGPlearning Podblast 29th Feb 2020

Improving the Primary Care Network DES service specification

Improving the Primary Care Network DES service specification

How to improve the PCN DES

Welcome, please comment and I will try an answer

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Check out my original review where I went through the DES: here--https://youtu.be/K1qwyxt63f0

Declaration - I am not involved in the negotiations. I am Nottingham City East PCN Clinical director but these are my own thoughts. For some backstory in 2015 I wrote a further Blueprint for Primary care : https://egplearning.co.uk/a-further-blueprint-for-primary-care/ with a colleague as Jeremy Hunt launched the five year forward view. Some of these aims have been achieved (indemnity) but much can still be done. 

How to improve the DES- I will talk firstly about general changes and the headline points. Then each specification in turn with my more innovative (controversial) ideas at the end.

Ethos

The release time of the specification has caused a lot of frustration. Even more so in the first webinar where little engagement was offered, just reading the spec. This led in part to one CD resigning live. NHSE doing an open consultation on the draft is a good thing. Feigning listening is not. 

At points, the specification makes reference to evidence. In particular vanguard projects. However, it neglects to mention that vanguard projects have had significant higher levels of funding for each aspect and therefore converting this to specifications for networks to follow is a fallacy. 

You cant use a recipe that feeds four people that costs £10 and say provide the same meal for £2 all the time - even with using foodbanks. 

The original outline of the DES was to stabilise primary care. This draft does not do this but further destabilises it by utilising the additional roles above the capacity of work the can create and negates the fact networks will be part funding them. This was a poor way to show that NHSE/I was listening to the needs of general practice. Many comment the draft is intentionally too far to the right to allow any softening to be accepted as better than the original. This is a sceptics dream. 

For this process to work- show General Practice that NHSE is truly listening. Much of this has been done amazingly by Dr Nikki Kanani and I do not envy her position. I am mindful of do not shoot the messenger being very apt here. 

Lets move on. The following is a combination of my views and those from the various forums I engage in. 

Trust 

General practice. If I had control I would keep existing structures that could help foster better collaborative working and simply offer the resources to networks to use for their local area. 

General Practice has proved to be the most cost-effective method of delivering healthcare currently doing 90% of the NHS workload for less than 9% of the funding. Trust the networks to deliver primary care with the simple metric of improving the health of the network population. 

Ideally to the global sum but is not then to the networks directly to use as they seem fit to provide roles or services for better patient care along them 5 categories as best for their population. 

However, we do not live in a world of trust despite GPs consistently being the most trusted role in the country. 

So if working towards the confines of adjusting the existing DES and its specification let us have a look. 

Worth looking at the Berkshire, Buckinghamshire and Oxfordshire LMC document link: https://drive.google.com/file/d/1Bj7hkuCQasbXs-Mk7MOKpDq-lfjl3YSK/view?usp=sharing

This outlines workload implications and makes the case for each average practice to lose £100k over the term of the network DES. My thoughts do align with some of this document, however I do not agree with the principle of withdrawing from the DES at this point as this is still a draft version and the final specs may differ. It also does not include AFAIK  the overlap of patients in the DES which would reduce some of the work. 

Other LMCs and organisations have also been verbal on their views including GPSurvival who have started a formal petition about the service specifications.

See this link.: https://docs.google.com/forms/d/1uUa25fyz1Y8vCNTXP17pDvi3G26NQ1q8iOp64P0vfw8/viewform?fbclid=IwAR1w6EGJZ86AtuFWDafMWlXCRPAILHGHHkrs8ElqCQgGSiyodmCajhwfC78&edit_requested=true

DOI I am treasurer of GPSurvival. 

Headline improvements

Time:

• Delay the specifications. The timelines for agreeing the spec, the short consultation time and the level of response has shown the the draft spec is way of the mark. Take a breath and take a while longer to action this. Aim for a July Launch as per the start of the DES with networks able to look at funding from April for the ARRS. 
• Clarify the specification before releasing them. The above will allow time for the spec to be clear, unlike several lines in anticipatory and personalisation which are ‘to be confirmed’. This does not instil confidence that goal posts may change again - do not do this. 
• Stratify the spec for a category a year rather than two in year one with the others to run parallel. Let the network decide which to begin with as they can adapt to what local services can focus on. If one had to be chosen first given the current ARRS and recruitment options looking at the SMRs first may be an option. 
• Solve interoperability and IT. Many of the metrics and outcomes are based on interoperability of IT systems within primary care and between primary care and other sectors. Fix this first then ask for more. At present we can not explore a digital hub as the IT systems do not allow EPS prescriptions from a hub model. Our community teams are on fragmented systems that do not talk with ours complicating care. This duplicates and complicates healthcare and needs resolution to enable effective care.
• Reduce the metrics. With over 30 metrics, keeping track and monitoring them alone will be a challenge. Simplify and reduce these to one or two per spec, or let the networks decide the metrics that are important to their population.

Funding

• Remove the requirement that funding can only be used for additional roles. In many places other ways of funding care may be more useful such as systems to engage with patients, nursing roles, estate management - let the network truly decide how to spend its funds
• If this is not possible, open the funding to all roles and not specified ones so networks can recruit the workforce they need rather than what others think they may need. If the GP role is still not acceptable then roles like nursing, occupational therapists, pharmacy technicians and data analysts. 
• Remove the 70/30 split and fully fund the additional roles from NHSE/I. This will reduce the available workforce but would answer the issue of local practices having to supplement the roles and mean they can do work greater specified by the spec. 
• Remove the necessity for named clinical leads for each spec. If this is a red line then fund them appropriately similar to the clinical director role. Assuming the CD role can do this is false and sharing the funding is not an option to have an effective CD. 
• If a red line then allow the leads to work across networks. In Nottingham city we have a close working of network of networks and the option to share these lead roles across multiple networks is more achievable than each network finding 5 people - however the draft spec prohibits this. 

SMR

Looked at this in my area. Patients on 10+ meds alone was about 5% practice population. 

• Clarify what ‘significantly longer than a routine GP appointment’ is. This line is used to explain how long an SMR would be. Is this 15 mins, 20 mins, 30 mins, and hour? This has clear implications on workload and should be clarified if this area is to be monitored. 
• Do not specify that the review has to be by a prescriber. Many practice and network pharmacists and chronic disease nurses may not have independent prescribing rights yet and this puts a significant burden on training times and availability. This then pushes the work back to GPs adding to the workload. This also would eliminate innovation such as using community pharmacy colleagues from supporting this work and makes a mockery of the MURS programme of recent years. 
• Make SMRs a paid for service. Given this is an extra service above that offered by primary care with no additional funding - allow practices to charge for them commensurate to the workload involved to offer higher quality of care. This can be commissioned by local CCGs or patients. 
• Align SMRs with QoF to prevent duplication of work. This would allow funding for the work to be evident but reduce the burden of work on practices while still offering effective care on a national perspective. 
• Clarify how patients may be contacted for SMRs. Ensure that written communication is clarified to include digital means such as notifications or texts as this in unclear and would further help with reducing climate impact and sensible patient flow. 

EHCH

This specification could have been effective but its prescriptive and ludicrous nature truly raises questions about the aims of the specs. It outlines a staggering increase in workload and specifies being led by roles not funded in the DES ad only on a F2F basis. It also is discriminatory to frail patients who live in their own home. 

To improve it:

• Do not use location or age as the denominator of healthcare need as these may not be good predictors for individual patients. Use validated metrics such on frailty instead to capture patients in and out of nursing homes. 
• Remove the ridiculous premise that a GP/ geriatric consultant must lead the team. Allow the network to source the role best suited based on local recruitment availability in need. 
• Remove pedantic requirements of weekly/ fortnightly visits. Let the network decide the frequency needed to offer appropriate care to its population
• Remove the requirement for care to be only face to face. Allow the increasing use of digital consultations to flourish and be effective. This can be by direct video consultation supported by the home, or with assisted clinicians as a virtual ward round. Additionally allow for funding to be used to facilitate this. Ie a simple webcam like the logitech C920 HD in each nursing home would work effectively on a Zoom system for a basic telemedicine ward round.
  Logitech C920 HD: https://amzn.to/2R7BbTw
  Zoom: https://bit.ly/eGPlearningZoom
• Review the spread of NH in PCNs. The requirement that NHS are aligned to PCNs while seemingly sensible proposes significant challenges. Nursing homes traditionally are denser in areas of low land cost ie more deprived or secluded areas. This can create significant imbalance.  In Nottingham city, Two PCNs have the majority of nursing homes in their network areas. One network has 24 care homes, double that of all the others and is not the largest network. This creates a clear funding deficit to deliver the outlined level of care and WILL DESTABILISE this network (it is not mine - we are next down the list at 12 care homes). 
• Make these reviews paid for service. Several areas of the country already have care homes paying additional to practices to offer an extra level of care above the GMS contract. This aspect of the DES will remove that element. Given an existing precedent, one suggestion is to make this service paid for service to allow the funding to occur. This can be commissioned either by the CCGs or care homes.

Anticipatory Care

Anticipatory care is manageable pending relationships with ICS, CCGs and ICPs, and if appropriate tools exist to support the population based care. I will admit my knowledge gap in this area which leads me to my first improvement. 

• Push back the time frames to allow all networks to develop the local links and priorities. This is a simple fix as with more time much more of this aim is likely to be possible due to its synergy with the EHCH. 
• Be specific over the monitoring aspects at the outset. Several aspects of this spec are ‘to be confirmed’. As mentioned earlier this is not acceptable as it indicates a possibility of shifting goal posts or more work if not in the correct format. Start as you mean to go on. 
• Clarify the responsibility of who is paying for the tools. This spec mentions several tools that could be used, some of which are beyond the scope of a PCN to access individually. A clear direction on the responsibility of costing of these tools needs to be established. In many arenas the PCNs are viewed as the solution to all the problems in primary care. NHS England need to ensure they are not overburdened with destabilising costs and responsibilities due to poorly worded contracts. 
• Clarify the evidence behind using care plans and the need for monitoring delirium assessments etc. This is not provided in the DES specification document and if no evidence that these care plans and assessments lead to impact on reduction of clinician workload and/ or patient demand then they should be removed and replaced with something that does. 

Personalised Care

I mentioned in my first video this harkens back to the failed unplanned admissions DES for a few years back. The reliance on care plans and monitoring are lessens still not learned. However this is the first mention of tackling inequality - albeit on a minor scale. 

• If personal health budgets are to be continued and monitored - offer national training to all with a public campaign to education patients rather than passing this cost to networks. I have limited knowledge of patient health budgets. Again no evidence is offered in the document of their impact or effectiveness but this seems more like a public health priority funneled into the DES. Remove or support nationally with education and training. A national website checklist would offer many patients the correct information and evaluate more effectively than spending clinician time doing an administrative task. 
• Remove the target for social prescriber referrals. A target is not necessary for a role billed to have a significant impact on care. 
• Clarify which PAM is to be used - 100 vs 22 vs 13 point version. Clear difference in workload and monitoring outcomes based on these. 
• Clarify the monitoring requirements at the outset as per earlier specifications. 
• Remove the metrics. The metrics for this specification are vague and talk about quality- something that is hard to measure when you do not know what the test is. Given the DES is metric heavy simply remove these and replace with either trust as per earlier or linked population based outcomes like reduction in amputations in diabetic patients, reduced hospital stays in frail patients - essentially let the networks decide their metric for their populations. 

Supporting early cancer diagnosis

Much of this specification I find sensible in its aims. My only question is the time needed to action it given the repeat requirements for a lead and oversight. 

• Provide data analyst support for networks to look at their data. This would help clarify how networks can proceed based on evidence. This could be provided locally by CCGs/ ICS etc, but do not make networks hunt for this. Provide universal validated  metrics so that shared learning can occur.
• Provide social media engagement and community education sessions to networks. Much of the strength of this specification is mobilising the community. This can be achieved with face time with the community outside the confines or practices and via local media and social media. Provide networks with the tools to do this. 
• Provide translation services support. One key challenge is non-english speaking cohorts. Given CQCs hate for Google Translate as a tool, provide support and resources for networks to use to convert resources into other languages to support their networks ie bowel screening videos in Polish or Vietnamese languages. 
• Clarify the safety net metric. This metric is unclear to me no matter how many times I read it. How will this be monitored?

So that is my suggestions for adaptations for the specifications. But what if we were rewriting it? These are suggestions for NHS England which are in their domain to consider, but not covered in the existing DES. 

• Create a national acute visiting service (AVS). Using the funding for ARRS share working on how to deliver a footprint wide AVS using roles such as physician associates and paramedics that can release GPs to offer care to patients while providing equity across the country. Ideas like those of Dr Paul Bennet as shown in the General Practice Podcast could be adapted across the entire country : https://ockham.healthcare/innovation-in-general-practice-time-saving-begins-at-home/
• Create a national formulary. This would help prevent variation and align purchasing to tackle supply issues and allow larger bulk buying for medication supplies. 
• Charge for all prescriptions or charge for none. This would have the plastic bag effect for the need for items on prescription at reduced cost ie £1 per item with pre-payment certificates being an option for all. Bring in equity- charge for all or charge for none. 
• Re-design prescription exemption process. It is ridiculous that a patient with one specific chronic health condition can have all prescriptions free for life, but a patient with a more acute on chronic condition like COPD or asthma is not eligible which will cause greater acute damage to the patient and cost to the system via an admission. At least update the prescriptions to reflect modern times ie universal credit as an exemption so patients are not committing fraud, or adjust the age limits in line with national pension age. 
• National self care for health and finance education programme. Many patients expect the health care system of old -today. A national education programme both in schools and a public campaign identifying the new roles and how to use our NHS effectively would have a greater impact than requiring each area to generate the same resources several times over. Created and delivered centrally offers the uniform message and cheaper costs to deliver public level education about how to use our NHS and how to manage your health responsibility including services. Adding finance at the same time is just further cost saving. 
• National campaign to use NHS app. The NHS app is meant to be the doorway to our NHS and the focus of our digital healthcare revolution. However central support for its use is lacking and limited in information - even for a techy like me. A targeted approach with resources and support (again in multiple languages) could deliver a much-needed kickstart to the digital push we need. 
• Equal funded clinical director (CD) time for all networks. The CD roles are based on network size. While there is some logic to larger networks needing more time, it is evident that one session a week for smaller networks is a drop in the ocean. Offer equal CD funding to all networks ie three-session up to 75k patient population size and 4 session over that. 

What do you think?

Which did you think were sensible and which did you think were lunacy?

eGPlearning Podblast Review 2019

In this episode, we will be looking forward to 2020 and what health technology and eGPlearning PodBlast will be bringing to the world, and our survey: https://bit.ly/podblastsurvey19 ....

eGPlearning Podblast 2019 Review and Looking forward to 2020

HAPPY NEW YEAR!!!!

We looked back and reminisced in our Xmas episode with Ben Gowland of The General Practice Podcast - friend of the podblast: https://egplearning.co.uk/primary-care-networks-in-2019-a-review-with-the-general-practice-podcasts-ben-gowland/

Now looking to the future.

A word about our partners - HTN, The Health Technology Newspaper, your daily dose of news for the health tech community, join us for HTN digital Week on 23.1.20: https://www.youtube.com/watch?v=a62XTayLIX8

Changes over the last year

PCNs

Event Speaking 

Video Conferencing: https://www.youtube.com/watch?v=a62XTayLIX8

Digital GP Fellowship: 

Using the new practice website and video 

Changes and highlights with eGPlearning Podblast in 2019

Great Guests :

Nikki Kanani of NHS England: https://youtu.be/fynHxaebnSo

Liz Ashel-Payne of ORCHA: https://youtu.be/Ou2HKPJ2He4

Changes behind the scenes - Learnt lessons

Tried to improve quality

Found a regular base, experimenting with audio-video capture - new equipment!!!!

Experimenting with episode format - different types of episode

Survey - Help us shape our style, format, and content by completing the listening survey

Survey: https://bit.ly/podblastsurvey19

 🏆 eGPlearning Podblast Awards 2019 🏆

📳 Innovative tech company 📳

🏆 ORCHA sign up: https://youtu.be/K3wjjja8y2g

📈 Disruptor of the year - not bad or good - shakes things up 📈

🏆 NHSE with PCNs - Hello Nikki Kanani

And our honourable mention to Babylon

🚫 Trickiest episode to film - 🚫

🏆 Zoom episode: https://youtu.be/UWPd2Dsr5kI

honourable mention Jeff and Consumer wearables: https://youtu.be/Cmg2ky4XLCw

Future - Hoping to do with podblast and beyond

More interviews

Deep dives

Update episodes

Serving Primary Care Health Tech Community - Aims for 2020

Online courses and toolkits

Health Innovation East Midlands: https://www.eventbrite.co.uk/e/health-innovation-east-midlands-meet-up-registration-85912132501?aff=ebdssbeac

Conference - TEPCAL2020

Productive General Practice - using video more

Social media in primary care

Online consultations

What are we excited about in Primary Care GP Health Tech

Andy - NHSApp - critical mass allowing digital healthcare to go mainstream

Gandhi - Organisations beginning to embrace technology - LMC, NCGPA, RCGP - video, podcast, LMC app

Andy- Consumer health devices becoming mainstream and integrated with primary care

Gandhi - Connectivity - everyone

Predictions for 2020…

But first recap 2019 predictions - true or false.

Andy - Peak AI Hype - we will be talking less about AI…

Gandhi - Rise of personalised medicine

Shout out to Shubz - improving and providing time for communication between primary and secondary care and beyond - How did your prediction come along?

Predictions for 2020...

Andy - Increase in workload resulting from Digital-first agenda and NHS app

Gandhi - Online consultations mainstream

Thanks for listening

Please remember to complete our survey 

https://bit.ly/podblastsurvey19

Looking forward to journeying into the future of primary care with you all in 2020!

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⭐Top posts⭐:

👨🏾‍⚕️Dr Gandalf’s essential GP equipment list 👨🏾‍⚕️ see here: https://egplearning.co.uk/ramblings/dr-gandalfs-essential-gp-equipment-list/

📸Equipment to record patient consultations for teaching – a guide📸:

https://egplearning.co.uk/technology/equipment-to-record-patient-consultations-for-teaching-a-guide/

Subscribe to or follow the eGPlearning platform for more videos, app reviews and content to support technology-enhanced primary care and learning. 

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Some links may contain affiliate links to help support eGPlearning see our disclaimer at https://egplearning.co.uk/contact/disclaimer/

Digital Health update Nov 2019

eGPlearning Podblast Digital Health update Nov 2019

Welcome to our new quick update episode format. We discuss topical health tech news and stories… and provide some tips for apps, podcasts, books or otherwise that we have come across in the last few weeks.

Today’s news stories….

Pulse - 27/9/19 - GP at Hand to be broken up into local practices under new NHSE digital plans
http://www.pulsetoday.co.uk/news/hot-topics/gp-contract-2019/20/gp-at-hand-to-be-broken-up-into-local-practices-under-nhs-england-digital-plans/20039458.article

Digital Health.net - 16/10/19 - Several barriers prevent the adoption of technology in the NHS CQC finds

https://www.digitalhealth.net/2019/10/barriers-prevent-adoption-of-technology-nhs-cqc/

Episode Tips

Gandhi - Lastpass: Manage your passwords easily. https://egplearningLastpass #ad

Andy - Podcast - Harvard Business Review - Episode 701 https://hbr.org/ideacast/2019/09/how-to-be-less-distracted-at-work-and-in-life.html

About Focus - Interview Nir Eyal, wrote the book on creating addictive products - “How to build habit forming products”

Gandhi Featured on Ask Pat - https://www.smartpassiveincome.com/askpat/with-no-extra-time-how-do-i-increase-engagement-and-grow-my-business/

New group for health innovators in the East Midlands - Join us for first event 12/12/19
http://healthinnovationem.co.uk

Thanks for watching!

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⭐Top posts⭐:

👨🏾‍⚕️Dr Gandalf’s essential GP equipment list 👨🏾‍⚕️ see here: https://egplearning.co.uk/ramblings/dr-gandalfs-essential-gp-equipment-list/

📸Equipment to record patient consultations for teaching – a guide📸:
https://egplearning.co.uk/technology/equipment-to-record-patient-consultations-for-teaching-a-guide/

Subscribe to or follow the eGPlearning platform for more videos, app reviews and content to support technology-enhanced primary care and learning.

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Other networks:

👍 Facebook - https://www.facebook.com/Egplearning/👍🏼
🐦 Twitter - https://twitter.com/egplearning 🐦
🐦 Twitter - https://twitter.com/drgandalf52 🐦
🖥 Website - https://egplearning.co.uk/ 🖥️

💷 Support: https://patreon.com/egplearning 💷

Some links may contain affiliate links to help support eGPlearning see our disclaimer at https://egplearning.co.uk/contact/disclaimer/

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

Do let us know what you think?

Click here for your certificate of engagement

Do not forget to subscribe on your platform of choice: iTunes, Podbean, Spotify or YouTube. 

Thanks for listening...

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