NHS’ COVID contact tracing service started today–but where’s the app? Australia? (with comments)

To paraphrase the burger chain Wendy’s long-past spokeswoman, Clara Peller, ‘Where’s The App?’. The NHS debuted a contact tracing scheme for COVID, but it is a manual system dependent upon–people. If you test positive for the virus, you will receive a call from the NHS’ test and trace system. The person will ask for information about your recent contacts with others, and then asked to self-isolate for 14 days. Those names you provide will be contacted as well.

The NHSX-developed Bluetooth LE app remains in beta test on the Isle of Wight, which started on 5 May [TTA 5 May]. Reportedly there were 52,000 downloads in week one, which for an island with only 80,000 households is pretty impressive. 

The original rollout date set by Health Secretary Matt Hancock and NHSX chief Matthew Gould to the House of Commons’ science committee was mid-May, which has come and gone. The new date is now sometime in June. However, Baroness Dido Harding, the new director of NHS’s Test and Trace program, would not confirm that date–as we’d say, tap dancing quite hard. Digitalhealth.net, Telegraph

The US has been hiring contact tracers by state from Alaska to New York. A recent study in preprint in MedRxiv (PDF) by Farzid Mostashari of ACO management company Aledade and others found that in order to reduce the transmission rate by 10 percent, a contact tracing team would have to detect at least half of new symptomatic cases, and reach at least half the people with whom they were in close contact. MIT Technology Review 

Apps have been deployed in Australia (COVIDSafe) and Singapore (TraceTogether) and are in development in Switzerland and Germany. Most use BTE, but South Korea, India, Iceland, and some US states including North Dakota and Utah are using GPS phone location. China has been the most ruthless in using GPS data to monitor citizen locations and activity, to restrict their movements. Previously mentioned here [TTA 19 May] are UnitedHealth Group and Microsoft’s ProtectWell, PWC’s homegrown app–and Google and Apple announced in April a BTE app which hasn’t debuted yet. The Verge

Reflections of a TechForce19 Participant

Ever wonder what it’s like to successfully apply for, and then to deploy your program, as part of a high-stakes challenge? Reader Adrian Scaife, Business Development Manager of Alcuris Ltd., has been on an eight-week merry-go-round on hyperdrive (to mix a few metaphors). We invited him to tell us what it was like after the reports were handed in, and his impressions follow. Thank you, Adrian!

Now the Rapid Feasibility stage has been completed and outcome reports submitted, it’s a good time to sit back and take stock of the last 8 weeks.

It all started in late March when Matt Hancock asked for innovative tech companies to support vulnerable people during the Covid crisis around three themes, Optimising Staffing in Care and Volunteering Sectors, Mental Health and Remote Care. The funding available totalled £500,000 and was planned to be shared across 20 companies.

Even at the start the ambition, the scale and the pace of the initiative were very clear.

Looking back, it is apparent that the initiative has become a brand–TechForce19 – a great name, logo and its own website. The benefit to all is a set of unifying objectives, direction, urgency, and something that people and organisation can come together to support.

The sheer number of organisations involved in the initiative was breath-taking. Funding was from the Department of Health and Social Care along with the Ministry of Housing, Communities and Local Government. It was run by NHSX supported by Public Ltd., the Academic Health Science Networks including the Health Innovation Network in London and other experts from a variety of organisations.

The application process was at speed with a launch date of 24th March and application submission by noon 1st April (and that was the extended deadline!). The application form was thorough in the questions asked particularly around how you would conduct a two-week test to demonstrate that you can solve the challenge(s). We also knew it was going to be scored based on Solution feasibility, Company credibility, Impact, and Digital maturity.

The selection process was equally fast with feedback on the next stage due Friday 4th April. Friday came and went, and we feared the worst. Little did we know at the time that over 1,600 applications had been received. Just before midnight on Saturday an email was received announcing we were through to the interview stage and ours was on Monday. 60 interviews were completed over the next few days.

Just over a week later, confirmation that our proposal had been accepted, one of just 18 participants. Time to deliver on our plan. Just 10 days to plan the project in detail, provide partner training, deliver the hardware, for our partners to collect their referrals and then to deploy the Memo Connected Care Suite. Two weeks of live running. Evaluation and an outcomes report to be submitted by the 18th May.

I must give enormous praise and thanks to our partners for their commitment to deliver when all around them the pressures on their services due to Covid were unbelievable.

So now the Feasibility and Outcomes report has been submitted. We have received some terrific feedback both from families and Social Care staff. Did the project go according to plan? Well not entirely but when do they ever, especially during a national crisis.

One surprise that I shall never forget is Nasdaq, the American stock exchange, wanted to applaud digital innovators globally who were supporting the Covid fight. They promoted the work of TechForce19 on their seven storey Nasdaq Tower in Times Square, New York by highlighting each of the 18 participants.

TechForce19 is an NHSX Covid-19 response initiative, supported by PUBLIC and the AHSN Network. The views expressed in this article are those of the author and not necessarily those of NHSX or its partners.

PUBLIC’s website has profiles on the 17 other TechForce19 participants, including many names familiar to our Readers, such as Just Checking and Buddi. Our earlier article is hereHat tip to Reader Alistair Appleby.

 

 

NHSX announces TechForce19 challenge awards (updated), COVID-19 contact tracing app in test for mid-May launch (UK)

NHSX, the group within the NHS responsible for digital technology and data/data sharing, made two significant announcements yesterday.

TechForce19 Challenge Awarded

NHSX, with the Department of Health and Social Care (DHSC) and the Ministry for Housing Communities and Local Government (MHCLG), yesterday announced the 18 finalists in the TechForce19 challenge. This challenge was set up quickly to support the problem of vulnerable, elderly, and self-isolating people during this COVID-19 quarantine to reduce actual and feelings of loneliness and lack of safety.

Like most everything around coronavirus, this was fast tracked: the challenge announcement in late March, submissions closing on 1 April, and the selection announced on 24 April. Each finalist is being awarded up to £25,000 for further development of their technology systems.

The 18 finalists include a number of familiar names to our Readers (who also may be part of these organizations): Feebris, Neurolove, Peppy, Vinehealth, Beam, TeamKinetic, Alcuris MemoHub, Ampersand Health, Aparido, Birdie, Buddi Connect, Just Checking, Peopletoo/Novoville, RIX Research & Media (University of East London), SimplyDo, SureCert, VideoVisit, and Virti. Their systems include checking for the most vulnerable, volunteering apps, mental health support, remote monitoring, home care management, and in-home sensor-based behavioral tracking. Details on each are in the NHSX release on their website. NHSX partners with PUBLIC and the AHSN Network (15 academic health science networks). Hat tip to reader Adrian Scaife

Updated 29 April. Adrian was also kind enough to forward additional information to Readers on Alcuris MemoHub (left) as a finalist in the remote care category. Partners in the test are Clackmannanshire and Stirling Health and Social Care Partnership (HSCP), East Lothian HSCP, South Tyneside Council, and Stockton on Tees Borough Council and last for about two to three weeks. Release

COVID-19 contact tracing

NHSX announced the release, in coming weeks, of a contact tracing app to track your movements around people and if you become positive for coronavirus, “you can choose to allow the app to inform the NHS which, subject to sophisticated risk analysis, will trigger an anonymous alert to those other app users with whom you came into significant contact over the previous few days.” The app is being tested in ‘early alpha’ at RAF Leeming (Computer Weekly). The app will tell users that they are OK or if they need to self-isolate. Far more controversial, if one cares about privacy, despite all the caveats. Based on the articles, NHSX is targeting a release of the app by mid-May according to the BBC, which also broke the RAF test. It will presumably acquire a snappy name before then. ComputerWeekly 24 April (may require free business registration), Matt Hancock Commons statement 22 April

Babylon Health fires back at critic @DrMurphy11; Dr. Watkins–and Newsnight–return fire (UK)

Last month, this Editor took note of the Twitterstorm around Babylon Health on the issues raised surrounding diagnosis of women’s cardiac symptoms. @DrMurphy11, who has been raising performance issues with the Babylon chatbot for the past three years, ran a test on the app. First using a male patient, then a woman, with identical cardiac symptoms, the app returned two different diagnoses: the man was advised to go to an ED on an emergency basis and given information on a heart attack, the woman to her GP in six hours and given information on a panic attack.

@DrMurphy11 came out earlier this week to BBC Two’s Newsnight’s Emma Barnett on a profile of ‘healthcare juggernaut’ Babylon as Dr. David Watkins, a consultant oncologist. You can see him on YouTube here (at the 1 minute and 3 min. 30 mark). He demonstrates the response of the chatbot, using as the patient an older male smoker with chest pains. The chatbot advises him that he might have either gastritis or ‘sickle cell crisis in chest’–and to go to his GP in 6 hours. What is far more likely than sickle cell with this history is, of course, a heart attack, as a consultant cardiologist, Dr. Amitava Banerjee confirmed on the program. Dr. Banerjee has also been critical of Babylon’s chatbot on cardiac diagnosis and Health Secretary Matt Hancock in his visible advocacy of Babylon in the NHS alone (at 6 min.) According to Dr. Watkins, he has been documenting chatbot problems to the MHRA and the CQC since 2017, and the problems haven’t been fixed.

Timed with the Newsnight piece, Babylon fired back with a press release labeling Dr. Watkins a “troll” and stating that only 100 of his 2,400 tests demonstrated any concerns with the chatbot. According to the release, Babylon’s staff “have attempted to start a positive conversation with this anonymous person. We have invited him in to start a dialogue, to test our AI, and to meet with the senior doctors who build our products” without response. Babylon has also cited that all of Dr. Watkins’ trials were theoretical tests and cites millions of real uses without a single report of harm, that it meets regulatory standards in five countries including use in the NHS, and that its real life users are highly satisfied (85 percent at 5 stars).

At 6:48 to 12:40 in the video, Newsnight’s Emily Maitlis grills both Babylon’s Dr. Keith Grimes and Dr. Watkins. She brings up that Babylon’s former head of regulatory affairs, Hugh Harvey, had stated that no one has assessed how well the app works. Dr. Watkins also counters Babylon’s non-contact claim that he contacted one of the Babylon leadership members back in 2018 on chatbot problems. Dr. Grimes responded to Ms. Maitlis’ remark that founder Ali Parsa is not a doctor that over 600 doctors work for Babylon. This Editor will leave it to Readers to decide what side won, or if it was a draw. Also Mobihealthnews global edition. (For US Readers, Newsnight and Ms. Maitlis conducted the exclusive, disastrous–for Prince Andrew–interview on his relationship with the late Jeffrey Epstein.)

News roundup: docs dim on AI without purpose, ‘medtail’ a mall trend, CVS goes SDH, Kvedar to ATA, Biden ‘moonshot’ shorts out, and Short Takes

Docs not crazy about AI. And Dog Bites Man. In Medscape‘s survey of 1,500 doctors in the US, Europe, and Latin America, they are skeptical (49 percent-US) and uncomfortable (35 percent-Europe, 30 percent-Latin America). Only 20 percent fess up to actually using an AI application, and aren’t crazy about voice tech even at home. Two-thirds are willing to take a look at AI-powered tech if it proves to be better than humans at diagnosis, but only 44 percent actually believe that will happen. FierceHealthcare

This dim view, in the estimation of a chief analytics and information officer in healthcare, Vikas Chowdhry, is not the fault of AI nor of the doctors. There’s a disconnect between the tech and the larger purpose. “Without a national urgency to focus on health instead of medical care, and without scalable patient person-centered reforms, no technology will make a meaningful impact, especially in a hybrid public goods area like health.” The analogy is to power of computing–that somehow when we focused behind a goal, we were able to have multiple moon missions with computing equivalent to a really old smartphone, but now we send out funny cat videos instead of being on Mars. (And this Editor growing up in NJ thought the space program was there to market Tang orange drink.) HIStalk.

Those vacant stores at malls? Fill ’em with healthcare clinics! And go out for Jamba Juice after! CNN finally caught up with the trend, apparent on suburbia’s Boulevards and Main Streets, that clinics can fill those mall spots which have been vacated by retail. No longer confined to ‘medical buildings’, outpatient care is popping up everywhere. In your Editor’s metro area, you see CityMDs next to Walmarts, Northwell Health next to a burger spot, a Kessler Health rehab clinic replacing a dance studio, and so on. The clever name for it is ‘medtail’, and landlords love them because they sign long leases and pay for premium spots, brighten up dim concourses, and perhaps stimulate food court and other shopping traffic. Of course, CVS and Aetna spotted this about years ago in their merger but are working expansion in the other direction with expanding CVS locations and on the healthcare side, testing the addition of social determinants of health (SDH) services via a pilot partnership, Destination: Health with non-profit Unite Us to connect better with community services. This is in addition to previous affordable housing investments and a five-year community health initiative. Forbes, Mobihealthnews

ATA announces Joseph Kvedar, MD, as President-Elect. Dr. Kvedar was previously president in 2004-5 and replaces John Glaser, PhD, Executive Senior Advisor, Cerner. He will remain as Vice President of Connected Health at Partners HealthCare and Professor of Dermatology at Harvard Medical School. A question mark for those of us in the industry is his extensive engagement with October’s Connected Health Conference in Boston, one of the earliest and now a HIMSS event. ATA’s next event is ATA2020 3-5 May 2020 in Phoenix–apparently no Fall Forum this year.

The Biden Cancer Initiative has shut down after two years in operation. This spinoff of the White House-sponsored ‘moonshot’ initiative was founded after the death of Beau Biden, son of Democrat presidential candidate Joe Biden. Both Mr. Biden and wife Jill Biden withdrew due to ethics concerns in April. According to Fortune, the nonprofit had trouble maintaining momentum without their presence. However, the setup invited conflict of interest concerns. The Initiative engaged and was funded by pharmas and other health tech companies, directly for Initiative support but mainly for indirect pledges to fund research. Most of these organizations do business with Federal, state and local governments. Shortly after the formal announcement, Mr. Biden the Candidate announced a rural health plan to expand a federal grant program to include rural telehealth for mental health and specialized services. Politico   But isn’t that already underway with the FCC’s Connected Care Pilot Program, coming to a vote soon? [TTA 20 June]

And…Short Takes

  • Philips Healthcare bought Boston-based patient engagement/management start-up Medumo. Terms not disclosed. CNBC
  • London’s Medopad launched with Royal Wolverhampton NHS Trust (RWT) in a three-year RPM deal. DigitalHealthNews
  • Parks Associates’ Connected Health Summit will be again in San Diego 27-29 August with an outstanding lineup of speakers. More information and registration here.

And in other news, Matt Hancock holds tight to his portfolio as UK Secretary of State for Health and Social Care in the newly formed Government under new PM Boris Johnson. Luckier than the other 50 percent!

 

 

‘Ask Alexa’ if you’re sick, says the NHS

The latest in the NHS’ ‘digital first’ effort in the Long Term Plan is to add Amazon Alexa’s voice search capability to the NHS’ online advice service. Using Amazon’s search algorithm, UK users will be able to ask Alexa about their scratchy throat, sneezing, flu symptoms, or headache with information sourced from the NHS website. In the announcement, Secretary of State for Health and Social Care Matt Hancock said that “We want to empower every patient to take better control of their healthcare and technology like this is a great example of how people can access reliable, world-leading NHS advice from the comfort of their home, reducing the pressure on our hardworking GPs and pharmacists.” 50 million GP consultations each year are estimated to be unnecessary; the NHS is actively campaigning for patient awareness on self-care to reduce the patient load on practices (GP). NHSX is also planning of making more NHS services available to all patients through digital technology. 

Physicians have expressed concern that what seems to be a minor symptom could be the start of something big, like an underlying illness. For instance, heart rate monitors which are present in smartwatches and gym equipment have driven many to their doctor because of normal heart rate fluctuations, but that visit could be also picking up the early symptoms of atrial fibrillation.

The Alexa voice assistant adoption by the NHS makes search information more accessible for those with limited mobility or sight, which can help them feel more connected and enhance safety. It also assumes that internet is both available, affordable, and understandable by these users.

This Editor wonders if Alexa will have an emergency feature which calls for assistance or to a GP if the user indicates a worsening condition or is in distress. Voice recognition, as Readers know, is imperfect; Alexa may be puzzled by regional accents, phrasing, or speech impediments.

Current estimates on voice search fluctuate. The oft-repeated ’50 percent by 2020′ assumes an accuracy in digital voice recognition and Alexa/Echo/Android/Siri usage and sales that at this stage are simply not there. An excellent discussion of the voice search market that cuts through the hyped-up predictions is by Rebecca Sentance on the eConsultancy website.

More on NHS and Alexa: Telegraph, Wired UK

Events, dear friends, events in London from painting to leadership

‘Framing the Future’, Paintings in Hospitals 60th Anniversary. Monday 13 May at 6pm, Royal College of Physicians

What is the past, present and future role of arts in health? Considering the past pioneers and future innovations of visual arts in health and social care is a panel including Edmund de Waal OBE (artist and author), Dr Errol Francis (CEO of Culture&), Dr Val Huet (CEO of the British Association of Art Therapists), Prof. Victoria Tischler (Professor of Arts and Health at the University of West London) and Ed Vaizey MP (Chair of the All-Party Parliamentary Group on Arts, Health and Wellbeing). This event is waitlisted, but was fascinating enough to warrant a mention.

HealthChat with Ruth May, Chief Nursing Officer for England, Thursday 23 May at 5.30pm, The King’s Fund

Organized by UK Health Gateway, this evening with Ms. May will delve into issues such as workforce, her priorities, and how she will unite nurses in planning for the future? Tickets through Eventbrite are £19.95 – £39.95.

HealthChat with Rashik Parmar MBE. Monday 10 June at 5.30pm, The King’s Fund

Organized by UK Health Gateway, this evening with Mr. Parmar who is a Fellow of IBM, the leader of IBM’s European technical community and an IBM Distinguished Engineer will be about technology, data mapping, and AI. Tickets through Eventbrite are  £19.95 – £39.95.

Hat tip to Roy Lilley and his NHSManagers.net newsletter for the above three events

Ninth annual leadership and management summit. Wednesday 10 July starting 8am for the full day. The King’s Fund

The King’s Fund’s annual leadership event is for senior leaders in health and care organizations across the public, private and third sectors. Topics will be centered on leadership capabilities and cultures that enable teams to deliver better patient care and value for money, while also delivering continuous improvements to population health. Speakers include the Rt Hon Matt Hancock MP and Simon Stevens, CEO of NHS England. More information and registration here.

 

RSM’s Medical apps: mainstreaming innovation with Matt Hancock

This event on 4 April run by the Royal Society of Medicine’s Digital Health Section continues the successful series started by this editor (now no longer involved) seven years ago. It will examine the growing role that apps are playing in healthcare delivery.

Join colleagues to hear renowned speakers, including the Secretary of State for Health and Social Care, Matt Hancock, discuss the current and future part apps can play in the NHS and broader healthcare industry. We will hear Wendy Clarke, executive director at NHS Digital talk about the new NHS app. As apps move from concept to pilot to practice, demonstrating efficacy becomes increasingly important, so will be looking at how we can best assess clinical effectiveness. It is well recognised that poorly designed software can hamper rather than enhance healthcare. Matt Edgar Head of design for NHS Digital will talk of the importance of good design in medical apps, and how it can improve patient and clinician experience. The use of cutting edge technology in healthcare necessarily opens new regulatory and legal issues. We are pleased to have our legal counsel, Julian Hitchcock back to share his experience with this, with a particular focus on the use of artificial intelligence in healthcare. We will also be examining the importance of interoperability, as medical apps become more mainstream, and how to make this happen. We have some presentations, too, from new and established medical start-ups, showcasing the transformative effects these new technologies can have. Finally, we will take a look at what the future may hold with futurologist Lewis Richards, Chief Digital Officer of Servest.

Aims:

This meeting aims to: 

  • Encourage clinicians to consider medical apps when deciding on an appropriate intervention
  • Aid understanding of the medicolegal issues around medical app use
  • Reduce the fear, uncertainty and doubt about the use of medical apps

Objectives:

By the end of this meeting, delegates will be able to,

  • Have an understanding of the current state of the art of medical apps
  • Explain the latest position on regulation and endorsement of medical apps
  • Have an appreciation of how to assess the clinical effectiveness of medical apps. 

Book here – best to book soon too, as currently the RSM has not allocated the largest lecture theatre to the event so it will almost certainly sell out.

First they came for the fax machines….now NHS is coming for the pagers

Bloop, Bleep. The NHS has officially announced the phasing out of pagers in hospitals by the end of 2021, with all hospitals required to have their plans and infrastructure in place by September 2020. Replacing pagers will be mobile phones, and smartphones with health communication apps, which facilitate two-way communications and coverage.

According to Digital Health, the pager-less pilot was at West Suffolk NHS Foundation Trust (WSFT), which is one of the Global Digital Exemplar (GDE) sites. The 2017 test resulted in junior doctors saving 48 minutes per shift and nurses 21 minutes on average. The platform  used was Medic Bleep, which integrates audio, text, image and file sharing on web, iOS, and Android. 

NHS is estimated to use about 10 percent of all pagers in use worldwide. The cost, according to this report in Bloomberg, is also stunning. Its 130,000 pagers cost £6.6 million ($8.6 million). A single device can cost as much as £400 pounds, which came as a great surprise to this Editor. Only one UK company, Capita Plc’s PageOne, even supports pagers. So this ‘War On Pagers’ as Digital Health dubs it, has some rationale. Supposedly, the NHS can keep some pagers for emergencies, when Wi-Fi fails or when other forms of communication are unavailable, but even that is doubtful as PageOne will likely go out of the pager business by then.

Mr. Hancock is quoted extensively in both reports. “We have to get the basics right, like having computers that work and getting rid of archaic technology like pagers and fax machines. Email and mobile phones are a more secure, quicker and cheaper way to communicate which allow doctors and nurses to spend more time caring for patients rather than having to work round outdated kit.”

In the US, pagers have largely been replaced by smartphones with advanced communication and file sharing/monitoring except in one specialty–psychiatry. Many psychiatrists in private practice retain their pagers and answering services as a needed triage between themselves and patients. (Over 55 percent of psychiatrists are also aged 55+.)

The King’s Fund Digital Health and Care Conference announces Matt Hancock as Day 2 keynoter

The latest word is that the Rt Hon Matt Hancock MP, Secretary of State for Health and Social Care, will be giving the keynote address on the second day (23 May) of The King’s Fund’s annual Digital Health and Care Congress. If you are UK-based or do business there, and you haven’t signed up…what are you waiting for? This link here or on the right sidebar will take you straight to the program site. When you’re there to register, don’t forget to use the code Telehealth_10 to get an exclusive 10 percent discount for our Readers. TTA is pleased to be again an official supporter of the Digital Health and Care Congress.

Roy Lilley’s tart-to-the-max view of The Topol Review on the digital future of the NHS

Well, it’s a blockbuster–at least in length. Over 100 pages long, and in the PDF form double-paged, which will be a tough slog for laptop and tablet readers. It’s Eric Topol’s view of the digital future of the NHS and it’s…expansive. In fact, you may not recognize it as the healthcare world you deal with every day.

Our UK readers may not be so familiar with Dr. Topol, but here you can get a good strong dose of his vision for the NHS’ future as delivered (electronic thunk) to Secretary Hancock. I haven’t read this, but Roy Lilley has. You should read his 12 February e-letter if you haven’t already.

Here is a choice quote: It’s a mixture of science faction, future-now-ism and away-with-the fairies.

Here’s some background. The Vision’s been around for awhile. Dr. Topol thinks and talks Big Picture, in Meta and MegaTrends. His view is patient-driven, self-managed, with their genomic sequenced and at their fingertips, with the doctor empowered by their records, his/her own digital tools for physical examination, with AI to scan the records and empower a partnership model of decision-making.

Topol In Person is quite compelling. This Editor’s in-person take from the 2014 NY eHealth Collaborative meeting is a review of vintage Topol. His expansive, hopeful view was in contrast to the almost totalitarian view (and it is fully meant) of Ezekiel Emanuel, with his vision of the perfectly compliant, low choice patient, and squeezed like a lemon medical system. At that time, I concluded:

One must be wary of presenters and ‘big thinkers’–and these doctors define the latter, especially Dr Emanuel who looks in the mirror and sees an iconoclast staring back. Fitting evidence selectively into a Weltanschauung is an occupational hazard and we in the field are often taken with ‘big pictures’ at the expense of what can and needs to be done now. Both Drs Topol and Emanuel, in this Editor’s view, have gaps in vision.

A year later, I reviewed his article The Future of Medicine Is in Your Smartphone which came out at the time of ‘The Patient Is In.’ which was quite the succès d’estime among us health tech types. “The article is at once optimistic–yes, we love the picture–yet somewhat unreal.” It seemed to fly in the face of the 2015 reality of accelerating government control of medicine (Obamacare), of payments, outcomes-based medicine which is gated and can be formulaic, and in the Editor’s view, a complete miss on the complexities of mental health and psychiatry.

Back to Roy Lilley:

There is an etherial quality to this report, spiritual, dainty. The advisory panel is 70 strong.

Studies and citations galore, from the world’s top research organizations. The advisory board–I believe well over 70–there’s not a soul down in the trenches running a hospital. Government, academics, and a few vendors (Babylon Health, natch). A lot of emphasis on AI, genomics, and training for ‘collective intelligence’. After reading but a few dizzying, dense pages, I admire the vision as before, but wonder again how we get from here to there.

Roy’s essay is a must read to bring you back to reality. 

Just the Fax. Or Matt Hancock versus the Fax Machines (UK) (Updated)

Updated. Add fax machines to the Endangered Device list. The news that Health Secretary Matt Hancock has banned the NHS from purchasing new fax machines starting in January 2019, with a full phaseout of use by 31 March 2020, was this past weekend’s Big News in the UK health sector. This is to help force adoption of paperless methods such as apps and email, which is a noble intention indeed.

The remaining prevalence of fax machines in the NHS became a cause célèbre after the Royal College of Surgeons in July estimated that over 8,000 fax machines were still in use. The RCS takes credit for nudging trusts to ‘Ax The Fax’. Guardian

This Editor presumes that Secretary Hancock does not possess a printer, or find the need to print his records even for convenience–or posterity. (One wonders what he’s carrying in that folder or brief…) I also presume that he has never heard of electrical outages, data breaches, malware or ransomware which may make print records suddenly quite needed.

The Road to Perdition is Paved With Good Intentions. A wonderfully tart take on Mr. Hancock’s Fax Obsession is contained in Monday’s NHSManagers.net newsletter from Roy Lilley. He looks at why NHS offices and practices have stayed with fax machines–and the absurdity of such a ban when trusts and practices are attempting to squeeze every penny in a cash-strapped, failing environment:

  • It’s point to point and legally binding not only in medicine, but in law and finance–even in the US
  • They are on the desk, easy to use–requiring only plug in to power and a phone line, fax toner, and paper
  • They don’t need IT support
  • Compared to computers, printers, and internet service, they are wonderfully cheap

And paper-free isn’t a reality even in the US with EHR, tablets and smartphones widely used. Even HHS and CMS in the US require some paper records. Confidentiality and hacking–especially when tied to computer networks–are problems with fax, but the same can be said for computer networksOh, and if your systems are attacked by ransomware, it’s awfully handy to refer back to printed records and to be able to communicate outside of computer networks.

Mr. Lilley also points out that ‘No 18’, as he dubs the Secretary of State for Health, actually has no power to enforce his edict with trusts or GPs.

This Editor predicts a thriving market in used and bootleg fax machines–“check it out”, as the street hustlers say!

Other articles on this: Fortune, Forbes

AI promises, promises! Babylon Health to spend $100m, hire 1,000 to develop leading AI platform

Babylon Health’s CEO Ali Parsa announced at their headquarters last week that the company would be spending $100 million to develop the ‘world’s leading AI healthcare platform’. In the company of Health Secretary Matt Hancock, an admitted GP at hand fan (nothing goes better after poring over your red boxes), Mr. Parsa confirmed that the 1,000 data scientists, programmers, and clinicians would be based in London after a global search of suitable cities. They will be helping to design the next generation of health AI for diagnosis and to support patients with long-term conditions. 

The report in Digital Health noted that the audience included key figures such as Malcolm Grant, chairman of NHS England; Dr Simon Eccles, NHS England CCIO; and Juliette Bauer, head of digital experience. This is despite Babylon challenging the Care Quality Commission (CQC) over an unfavorable report [TTA 11 Dec] and being put on hold by Birmingham as well as Hammersmith and Fulham CCGs [TTA 23 Aug].

Babylon is well able to afford this as Prudential Asia (Prudential plc) has licensed Babylon’s software for its own apps across 12 countries in Asia for an estimated $100 million over several years. Forbes  It also inked a deal in June to provide insurer Bupa’s Instant GP to corporate clients [TTA 21 June]. Will this include a foray into the US? No clues so far!

Despite recruiting, Babylon Health’s GP at hand still on hold in Birmingham (UK); CEO steps down at rival Push Doctor

GP at hand, Babylon Health’s NHS app and service for scheduling patients with local GPs, was expected to roll out in Birmingham, but the Hammersmith and Fulham CCG, from which Babylon operates, continues to halt its the expansion since the beginning of this month on patient safety concerns.

The app, which schedules patients with GPs and requires registration that effectively changes what we in the US call ‘attribution’, was set to add GP surgeries in Birmingham starting this month and was setting up an HQ at Badger House, an out-of-hours GP services provider based in Birmingham’s inner city. GP recruitment had started, according to Pulse, in late July. Patients would register in Babylon’s host practice Dr. Jefferies and Partner in southwest London through NHS’ out-of-area registration scheme.

The objections to Babylon’s expansion came initially from Paul Jennings, the chief executive of Birmingham and Solihull CCG. According to Digital Health, “he wrote to Hammersmith and Fulham to lodge a formal objection to the expansion. He argued the digital service was “not yet robust or tested for a national service to be delivered from a single practice outside of Birmingham”. Hammersmith and Fulham then stated that “further information is required to provide assurance on the safety of patients” before the Birmingham roll-out could be approved. 

This is despite the release of a equality impact assessment by Verve Communications on behalf of Hammersmith and Fulham finding mainly positive results, such as GP at hand “more likely to address most barriers than traditional GP services” in 10 out of 11 protected groups” and that “carers may benefit from [the] use of GP at Hand as this will allow them to consult a primary care practitioner whilst continuing with their care responsibilities.” The new Health Secretary Matt Hancock, a major advocate of technology in care, is himself registered with Babylon. Mobihealthnews

(If you are in the UK, you can hear it straight from Babylon’s CEO Ali Parsa, interviewed by Roy Lilley of nhsmanagers.net, on 10 September at the RSM.)

Rival telemedicine service Push Doctor is also undergoing changes with CEO and co-founder Eren Ozagir’s departure. It appears that he and the board had a difference around company direction, with the board recommending a cut of 40 jobs (Sunday Times). Their COO, Wais Shaifta, became acting CEO in July. In June 2017, a report by the Care Quality Commission (CQC) found the service to be delivering unsafe care via antidepressant and blood thinner prescriptions being given without requisite blood tests and monitoring. Digital Health

Will Matt Hancock be a refreshing change for NHS? Or another promise unfulfilled? (updated)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2018/07/matt-in-a-binder.jpg” thumb_width=”200″ /]Matt In A Binder? With the sudden departure of Jeremy Hunt from the Department of Health and Social Care in the Cabinet’s ‘change partners and dance’, the new Secretary of State Matt Hancock comes over from heading Digital, Culture, Media and Sport. A couple of weeks in, it can be determined that he is a big advocate of technology and looking forward, not back (which Mr. Hunt spent a great deal of time doing):

Technology has a proven ability to radically change the world for the better – be it in finance, in education and in transport. But nowhere does technology have greater potential to improve lives than in healthcare. (Statement on Gov.UK/Health Service Journal 12 July )

And he glows again about increasing the use of apps within the NHS, though Digital Health goes a little overboard in calling the Rt Hon Mr. Hancock ‘app-happy’ even though he’s built his own this year so that his West Suffolk constituents can keep track of his activities. 

In his maiden speech, Mr. Hancock promoted a drive to replace pagers with smartphone apps as part of a £487 million funding package and connecting Amazon Echo with the NHS Choices website. It was overshadowed by a seeming walking back of the 95 percent four-hour A&E treatment target. Telegraph

Much of the criticism comes from those who see his appointment as yet another step in the privatization and regional devolution of the NHS due to campaign donations from the chair of pro-market group the Institute of Economic Affairs (IEA). However, Mr. Hunt faced the realization that NHS trusts are $1.2bn in debt and sought workarounds such as adoption of an ACO-type model (which in the US has a strong element of public incentive) and increased use of private health insurance to cost-shift. He wasn’t a technophobe, having inked a deal with the UK Space Agency to repurpose space tech for health tech and funding innovators in this conversion up to £4 million–which can be said to be ‘out there’.

Mr. Hancock also announced this week the £37.5 million funding of three and five ‘Digital Innovation Hubs’ over the next three years. These will connect regional healthcare data with genetic and biomedical information for R&D purposes.

Will he last? Will there be positive changed fueled by technology? Will the May Government last? Only time will tell.

What are your thoughts? (If you’d like to post anonymously, write Editor Donna in confidence)

Here’s select opinion from across the spectrum:

Don’t be fooled, Matt Hancock will be no better for the NHS than Jeremy Hunt was (The Independent)

New health secretary Matt Hancock received £32,000 in donations from chair of think tank that wants NHS ‘abolished’ (The Independent)

Roy Lilley’s always tart take on things NHS extends to the new Secretary dubbed ‘No18’. A deft wielding of Occam’s Razor and a saber on reflexive phraseology such as ‘driving culture change’ (it can be cultivated not driven–this Editor agrees but the tone and structure need to be set from the top), dealing with suppliers, and the danger of creating an electronic Tower of Babel due to lack of interoperability. (Does this resonate in the US? You bet!) (See NHSManagers.net if the link does not work.)

Margaret McCartney: Health technology and the modern inverse care law (BMJ) — to paraphrase, that the greatest need for healthcare is by those least likely to have the right care at the right time available. She points to Babylon Health, which counts Mr. Hancock as a member, as not only unproven, but also not needed by those able to afford other options. (But didn’t we know that already?)