HOW ARTIFICIAL INTELLIGENCE & DATA ANALYTICS ARE TRANSFORMING HEALTH & CARE ONE LONDON LOCAL HEALTH & CARE RECORD 12 th March 2019
INTEGRATED CARE & POPULATION HEALTH MANAGEMENT: SHARING DATA
LEADERSHIP – A LEARNING HEALTH SYSTEM FOR LONDON What Do You Do With An Idea? ….strive to become learning health systems Kobi Yamanda by making clinical data research grade and The story of one brilliant idea and the child who lowering the cost of data acquisition and helps to bring it into the world. As the child's knowledge generation confidence grows, so does the idea itself. And then, one day, something amazing happens. Victor Dzau. Transforming Academic Health Centres for an This is a story for anyone, at any age, who's Uncertain Future (2013) ever had an idea that seemed a little too big, too odd, too difficult. Every consenting patient’s characteristics and experience is available to learn from Best practice immediately available Improvement is continuous This happens routinely and efficiently This is part of a culture Charles Friedman. Toward Complete & Sustainable Learning Systems (2014)
ONE LONDON ENTERPRISE LAYERS 1. Extend and build upon a single approach to record sharing via federated exchange Minimum Required mechanisms both within STP footprints and pan London 2. Data service for 9M registered people in London in full, plus those outside London where treatment is delivered via London providers in part. 3. Exploit significant opportunities to enable active patient participation by linking them to their data 4. Support for utilities that sit on top of the data service to provide population health Optional and business intelligence (information service). 5. To develop London-wide governance of trusted clinical improvement methodology 6. To provide a single data resource for research pan London
ONE LONDON STRATEGY – NEW MODELS OF CARE We need to ensure that each provider of care has in place secure, reliable, user-friendly and inter-operable technology systems (and Robust digital operations 0 Unscheduled care | Planned care | Population Health Management in each organisation operational processes) to capture the right information at the right New models of high quality, sustainable and integrated care time, making the right thing to do the easy thing to do We need to ensure that providers of care are able to work together as an integrated system of care, with all relevant information about a Ubiquitous viewing of 1 person being held in a way that it can be viewed so that vital records across care organisation information is available to view (according to staff role) and so that people don’t need to tell their story over and over again We need to ensure that integrated care systems can move from Normalised data service providing mainly reactive care, to a position where it is possible to for proactive care and analyse clinical information across a population in order to spot 2 population health people with high need, complexity or deterioration, and to offer management targeted support to them We need to ensure that people really are empowered to be at the centre of care, developing systems that allow people to access their Patient access 3 own information, to add to that record, to register preferences, and to and control use new technology to self-manage, to plan their care, and where appropriate to consume care services We need to ensure that integrated care systems have in place the De-identified 4 infrastructure and applications to allow information about the whole information for population to be used to understand patterns of need and service system planning & 6 utilisation, to predict demand and flow and to improve quality, as part research of functioning ICSs and learning health systems
ONE LONDON TECHNICAL ARCHITECTURE
ENTERPRISE LEVEL 1 – LONDON PATIENT RECORD 400,000 November 18
ENTERPRISE LEVEL 2 – FRAILTY FLAG (NHS 111 API) “As a London Ambulance Service (LAS) clinician who provides clinical expertise for NHS 111 … I want to obtain access to the local … information within the Discovery Dataset to determine whether the caller is potentially seriously frail.” Since the API went live on 27 th November 2018, the Discovery Data Service has: handled 317,314 API requests ➢ matched 133,785 patients ➢ flagged 6,195 potentially frail patients ➢ as at 6 th March 2019
AI? Accelerating Artificial Intelligence in health and care: results from a state of the nation survey • By mapping some of the methods employed by survey respondents against Professor Jeremy Wyatt’s complexity scale (see previous section), it can be seen that many of the current solutions are using ‘lowest complexity’ advanced statistical techniques rather than more complex AI applications. Autumn 2018 https://www.ahsnnetwork.com/wp-content/uploads/2014/12/AHSN-Network-AI-Report.pdf Code of conduct for data-driven health and care technology • respect for persons • respect for human rights • participation • accounting for decisions September 2018, updated February 2019 https://www.gov.uk/government/publications/code-of-conduct-for-data-driven-health-and-care-technology/initial-code-of-conduct-for-data-driven-health-and-care-technology
RECENT LHCRE-RELEVANT ARTICLES Quoting Dame Fiona Caldicott: “ Dialogue with the public about data use has not grown at the same speed as the capacity of technology …Where there “[Public involvement is] not necessarily a trade -off is a gap between expectations and reality, anxiety may grow” between empowerment and equality. You get better decisions for the whole community and you hear “ Arguments for and against selling (or giving voices you don’t hear in our current structures .” away) NHS patient data are complex and fraught . “if the NHS actively asked [the public] to make Is it exploiting confidential patient records for private balanced decisions designed to “to help each other” profits or a public resource that, with the proper safeguards, can be used to save lives?.” rather than simply to meet their own needs it might be pleasantly surprised .” “Senior NHS officials [have] insisted LHCREs will not be used to create a national patient “data lake” for “…it’s not for senior managers in the NHS to tell me what is going on [so I can] tell everybody else. My job researchers [but] NHS Digital told suppliers in October last year that the LHCREs will feed data directly into is to create a platform on which a constructive its central platform.” “… some local LHCRE [have conversation can happen about the kind of healthcare we need.” said] it wasn’t what they’d ‘signed up for ’” Stella Creasy | London MP (Walthamstow) Ben Heather| The Download Column Links: https://www.hsj.co.uk/comment/the-bedpan-its-difficult-for-people-to-imagine-different-could-be-good/7024439.article https://www.hsj.co.uk/expert-briefings/the-download-selling-patient-data/7024573.article
BUILDING PUBLIC TRUST In all cases though, we must take the public with us … and avoid a complacency about the desire for digital and information sharing Low levels of awareness, High levels of awareness, understanding and active understanding and active support support
LESSONS 1. Partnership working is hard (agreement first) 2. Expectation runs faster than delivery (at all levels-scope creep) 3. Public trust is critical (deliberative processes) 4. End point maturity is very variable (time to UPnP) 5. Technical Standards must prevail (FHIR API) 6. Some of what we are doing has not been done (invention vs procurement) 7. Align incentives and levers at all levels (hard & soft) 8. National data research approach must be aligned (DiH) 9. Land grab for data! (public vs commercial)
LEADERSHIP IN COLLABORATION (1)
LEADERSHIP IN COLLABORATION (2)
LEADERSHIP IN COLLABORATION (3)
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