UK health minister sets out tech-first vision for future care provision

The United Kingdom is still quite new in the post-health minister, Matt Hancock, quickly turned technology into one of his declared priorities. And today has put more into the bones of his thinking, establishing a vision for transformation, root and branch, how the National Health Service of the country works to accommodate "healthtech" applications and services, to support technology enabled " The preventive, predictive and personalized attention ".

How that would be paid for such an important IT update program is not clearly stated in the policy document. But the government writes that it is "committed to working with partners" to fulfill its great vision.

"Our ultimate goal is to provide better care and better health outcomes for people in England," Hancock writes in The Future Health Policy document. "But this can not be done without a clear focus on improving the technology used by the 1.4 million NHS employees, 1.5 million social assistance employees and those many different groups that provide and plan health and care services for the public".

The minister is proposing that NHS digital services and IT systems must meet "a clear set of open standards" to ensure interoperability and updating.

Which means that existing systems that do not meet the incoming standards should do so. It will be gradually removed and will tear with time.

The technology itself that NHS trusts and clinical commissioners can choose to buy will not be imposed on them from above. Rather, the stated intention is to encourage "competition in the user experience and better tools for all," says Hancock.

In a statement, the secretary of health and welfare said: "The technological revolution is coming to the NHS, these strong standards will ensure that each part of the NHS can use the best technology to improve patient safety, reduce delays and speed up appointments.

"A modern technical architecture for the health and care service has great potential to provide better services and services. To unlock our innovations. "We want this approach to empower the best innovators in the country, inside and outside the NHS, and we want to listen to staff, experts and suppliers to ensure that our standards provide the most advanced health and care service in the world."

The four priorities indicated for achieving the planned transformation are infrastructure (mainly, but not only in relation to patient records); digital services; innovation; and skills and culture:

"Our technological infrastructure must allow systems to communicate with each other in a secure manner, using open standards for data and interoperability so that people have confidence that their data is up to date and in the the right place., and health and care professionals have access to the information they need to provide care, "says the document.

The vision of" technology for health ", which lacks any type of time frame, is repeated in a variety of technology-based case studies, from AI application for faster diagnoses (as DeepMind has tried) to Amazon Alexa Alexa being used as a memory aid for social assistance And foresees, as a future indicator of success, that " a healthy person can stay healthy and active (using wearables, diet tracking applications) and can coordinate with your primary care physician or other health professional about directed preventive care "[19459007

The & # 39; technology & # 39; The vision is not surprising, given that Hancock was previously the UK's digital minister and has not hidden his love for applications. Even having a proprietary application developed to connect with their constituents (also known as Matt Hancock's eponymous application, even if he encounters some controversy due to problems with the application's privacy policy).

Hancock has also been a strong supporter of (and a user of the new London-based digital health company Babylon Health, whose application initially included an AI diagnostic chatbot, in addition to offering video and text consultations with physicians and specialists (humans).

The company has partnered with the NHS to obtain a classification.

However, the application has also received criticism from health professionals.The AI ​​chatbot component has specifically been attacked by Doctors for offering incorrect and potentially dangerous diagnostic advice to patients This summer, Babylon removed the artificial intelligence element from the application, leaving the bot to lend unintelligent classification advice, for example, suggesting that people go directly to A & E even with a headache. (In this way, critics said, putting pressure on hospital services NHS already overloaded.)

All that underlines some of the pitfalls of fighting too fast to crush innovation and medical care.

The demographic cherrypicking that can come This intrinsic critique of some of these modern and brilliant services, along with the digital health care applications that are more likely to attract younger users (who have fewer complex health problems), has the argument that affects the non-digital primary care services of the NHS. saddle the bricks and mortar bits with more elderly and sicker patients to care for while the applications deviate (and monetize) mainly young people well and with technology skills.

Hancock's technical vision to improve the health service of the UK No I am not really committed to that criticism that modern technology services have a potentially uneven impact on a free health service funded by taxpayers at the point of use.

Rather, in a section on "inc. lusion ", the vision document speaks of the need for" design for, and with, people with different physical, mental health, social, cultural and learning needs, and for people with low levels of digital literacy or who have less ability to access technology. "But without saying exactly how that could be achieved, given the global push to reconfigure the NHS to be the first on mobile devices, technology-enabled and powered by technology."

"Different people may need different services and some people will never use digital services directly, but will benefit from others who use digital services and free resources to help them, "the pattern runs." We must recognize that those with the greatest health needs also have the more risk of staying behind and building digital services with this in mind, ensuring the highest levels of accessibility whenever possible. "

So, the risk is being recognized, but in a way and context that suggests that it is being discarded, or being removed from the road, simultaneously, in the momentum of technological progress enabled.

Hancock tam he also seems willing to tolerate some iterative errors of technology, again towards a & # 39; greater benefit of modernizing the technology used to provide NHS services so that it can continuously respond to the needs of users, through modular updates and complements, all greased by the patient data that is available in a reliable way through the transformation planned.

Although there is a bit of a cautionary warning for new healthcare companies like Babylon as well. At least if they make real clinical claims with the document stating that: "We must be careful to ensure that we follow clinical trials in which the new technology is clinical, but also to ensure that we have adequate safety processes that recognize Innovation can be adopted faster, we must learn to adopt, iterate and continuously improve innovations, and support those who work in this way. "

Another more obvious contradiction is Hancock's claim that "privacy and security" is one of the four guiding principles for vision. (along with "user need, interoperability and openness, and inclusion"), however, this is bordering on active commitment to the idea that confidential social care data be processed and hosted by a retail giant commercial electronic like Amazon, for example.

However, the patient's need for trust and purchase becomes more than transient. And there is a commitment to introduce "a healthtech regulatory sandbox working with ICO, National Data Guardian, NICE and other regulators" to provide support and an easier route of entry for developers who want to create health applications to sell to the NHS, and the government has also said it will take other measures to "simplify the landscape for innovators."

"For data to be used effectively to support better health and care outcomes, it is essential that the public" Trust and trust us and see robust data governance, strong safeguards and strict sanctions established for misuse, "says the policy document.

However, balancing support for data-driven digital innovation, even in regards to data-hungry technologies like AI , with respect for the privacy of people's highly sensitive health data will be a difficult act for the government.Perhaps, especially given that Hancock is so hastily to embrace the market.

"We need to build National level only those few services that the market can not provide and that must be done once and for all, such as a secure login and granular access to the date ", executes the minis line "This may mean that some programs must stop."

Although he also writes that there is a "big role" for the NHS, care providers and commissioners to "develop solutions and create them jointly with the industry".

" Some of the needs of our users are unique, such as caregivers in a particular geographic location or patients who use assistive technologies, or sometimes we can gain something from the market because we know what we need and are motivated to solve the problem first.

"In those circumstances in which the industry does not see the economies of scale they need to invest, we must be empowered to build our own digital services, which often run on our data and networks. We will do it according to the government's Digital Service Standard, and within the minimum rules we set for our infrastructure. "

" We also want to reassure those who are currently building products that we have no intention or the desire to close the market: in fact, we want the exact opposite, "says the document as well." We want to support innovations that can improve our health and care system, wherever they may be found, and we know that some of the best Innovations are being driven by physicians and staff across the country. "

Among commercial entities that currently build products targeting the NHS is DeepMind, owned by Google that was involved in a privacy controversy related to a failure in data management by the NHS Trust with which he worked to jointly develop an application ication for the early detection of kidney disease.

DeepMind's health data ambitions expand beyond the creation of alert applications or even the creation of diagnostic AI to also want to build and own a health care application distribution infrastructure (also known as as FHIR). The project mentioned above was included in the application contract with Royal Free NHS Trust, which prevented him from sending data to the DeepMind servers by prohibiting him from connecting to other FHIRs. So it's not at all a model vision of interoperability.

Earlier this year, DeepMind's own panel of independent reviewers warned that there was a risk that the company would gain excessive monopoly power. And Hancock's vision for health technology seems to be proposing to ban such contractual blockades. Although it remains to be seen if the guiding principle will face the inexorable lobbying of the technology industry.

" We will establish open national standards for data, interoperability, privacy and confidentiality, access to real-time data, cybersecurity and access rules", the vision greatly contemplates.

" Open standards are not an abstract technical objective, they allow interoperability between different regions and systems, but also, crucially, they allow a modular approach to IT in the NHS, where the tools can be extracted and replace with better alternatives as suppliers develop better products.This, in turn, will help produce the market conditions that drive innovation, in an ecosystem where developers and suppliers continuously compete in quality to fill each niche, instead to capture users. "

Responding to Hancock's health technology plan, Sam Smith, coordinator of the medConfidential patient data privacy advocacy group, told us:" There are not many details here. It is not so much "jam tomorrow ", as "jam … ever" – there is not a timeline, and the traffic jam becomes quite stale after not much. He says that "these are standards", but they are only a vision by standards: all the hard work remains to be done. "

On the front of privacy plus AI, Smith also takes up Hancock's vision, including suggestive support to establish "data trusts to facilitate the ethical exchange of data between organizations," with the document reiterating the government's plan to launch a pilot later this year.

"Hancock says that" we support "stripping the NHS of its role in overseeing the commercial exploitation of the data. Who is the "we" in that, since it should be cause for widespread concern. If Matt thinks the NHS will never get the correct data, what does he know the public does not know? ", Smith said about it.

He also notes that in previous large scheme attempts to review NHS IT, in particular the NHS incomplete The National Program for IT, which in the early 2000s tried and failed to deliver a digitization Descending service: It took a decade and billions went down in the process.

"The National Program for IT, widely criticized, also started with similar programs. High vision, "he said. "This is another political piece that says what looks" good ", but none of the success criteria refers to patients receiving better NHS care, for which, better technology must be delivered in a ward, and in a GP surgery, and in the many other places that the NHS and social care provide.The reform of purchases and standards does matter, and will help, but it helps in the same way that a good accountant helps, and that it's not because you have a vision of better accounting. "

At the time of the vision, a spokesman for the Health Department told us: "Today marks the beginning of a conversation between technology experts in the NHS, regulatory bodies and the industry as we refine the standards and consider the terms and details. The document of iterated standards will be published in December, once we receive comments and the mandate will be gradually implemented.

"We have made it clear that we will eliminate any system that does not comply with these standards, we will not seek systems that do, it does not comply and will seek to terminate contracts with suppliers that do not comply with the standards."