The 4 NHS Digital foundations enabling today’s innovative health care.
The UK’s National Health Service is helping health providers use machine learning and automation to detect skin cancer using a mobile app. But the emerging tech being used today required a strong digital foundation, years in the making and built on the scrapheap of a failed $11 billion IT programme.
Dutch company Skin Vision uses a mobile app to capture images of moles and analyse them using cloud computing within 30 seconds for the risk of skin cancer. Images are checked by a dermatologists and high risk patients receive follow up advice within 48 hours.
Images are also added to a library of around 3 million images, helping train the machine learning models used for detection. Currently accuracy is above 90 per cent, according to the company.
The company joined the NHS Innovation Accelerator earlier this year and is being spread across the broader system over the next three years with a possibility that NHS groups could licence the app.
Integrating this level of technology with the NHS requires a solid digital foundation, according to Angus McAllister, an Amazon Web Services solutions architect previously involved with NHS architecture.
Today in Canberra, McAllister detailed some of the roadmap which had allowed the NHS to help deliver new digital services like Skin Vision.
Speaking at the AWS Public Sector Summit, McAllister said the NHS had learnt valuable lessons from the UK’s failed National Programme for IT, which began in 2002 as a way of digitising the NHS.
The £6.2 billion top down programme, the largest civil IT programme ever at the time, was scrapped by 2011 after failing to win over doctors or patients.
McAllister said the “well intentioned” but ultimately unsuccessful initiative provided a valuable lesson about user outcomes and buy-in.
“It was one of those things, which was not necessarily focused on user need. It was very much policy led … Where the various actual medical record systems were introduced into hospitals and other organisations they didn’t necessarily fit well with their clinical processes.”
McAllister said the lack of trust and a poor incentive scheme, combined with the lack of focus on user needs, stifled uptake.
“There is one of the dangers of introducing technology in service or digitalisation is leaving people behind, not actually focusing on user needs. That’s why having that as a priority will help avoid that danger [in the future].”
Today, the NHS is still undergoing a digitisation and is now much more critical of the technology choices it makes, according to McAllister.
He told attendees, which included sevral leaders from Australia’s digital health sector, that for technology to be considered effective in the NHS it must now satisfy the following four criteria: Meet user needs, ensure privacy and security, be open and interoperable, and be inclusive.
Usability, while seemingly obvious, was not always adhered to, with many NHS technology plays being about fitting “a square peg in a round hole”, McAllister said, ultimately stymying adoption and outcomes.
“Having that as a foundational principle for the use of technology in the digitalisation of healthcare is absolutely essential,” McAllister said. “So I was very gratified to see that that is an important thing now.”
Interoperability, allowing data flow and system integration, is critical in any architecture but especially so in the case of the NHS, McAllister said. Because, as a security measure, the national scheme uses a series of data registers connected via APIs rather than a single large repository of health data.
Hooking those data sets up gives both clinicians and patients a richer view of health records and increases engagement in treatments, McAllister said.
Healthcare technology must also be inclusive, McAllister explained.
“The temptation when designing healthcare technology is to make it appealing to millennials … We need to recognise that there’s a full spectrum of people in terms of not only their access to digital technologies, but also their capability to make use of them.
“And so the NHS is very, very strongly emphasising not leaving anybody behind in this respect.”
All NHS technology must also meet strict privacy and security standards, to help foster user trust and adoption, McAllister said.
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