The health revolution

13 Feb 2019 Nick Garbutt    Last updated: 13 Feb 2019

Medicine is at the dawn of a new era. A whole range of new digital technologies, significant steps in developing artificial intelligence and rapid developments on genomics will together transform healthcare forever.

This week we got an insight into how that is likely to unfold over the next two decades, what it will mean for patients and NHS staff and the challenges that need to be overcome to make it a reality.

The dull -as-ditch water sounding “Preparing the healthcare workforce to deliver the digital future” is an important and exciting landmark.

It marks the first time anywhere that clinicians, ethicists, computer scientists, engineers, economists and educators have been brought together to study the impacts of new health technology on a country-wide basis.

Even more exciting is the fact that nearly all of the technologies cited are already in use. Less so is the fact that in several respects Northern Ireland is not yet at the starting grid.

Much of the report concerns the impact these technologies will have on health care staff, the new skills that they will have to learn and the “gift of time” they will provide. By this the authors mean the amount of time technology will free up for them to provide high quality care for patients.

It concludes that health outcomes will improve across the board and that patients will be empowered to be fully involved in their own care. Yet it also states: “within 20 years 90% of all jobs in the NHS will require some element of digital skills. Staff will need to be able to navigate a data-rich healthcare environment. All staff will need digital and genomics literacy.”

And that points to a revolution in the training of all healthcare professionals, starting immediately.

The Genomics Revolution

A genome is an organism's complete set of DNA, including all of its genes. Last Autumn the NHS became the first health service in the world to routinely offer genomic medicine. Specialist centres can analyse patient DNA to identify disease and match them with appropriate treatments.  It is expected that five million of these tests will take place over the next five years.

It is expected that as the science develops it will enable the very early identification of conditions like cancer and also help tackle outbreaks of infectious disease. The service is not currently available in Northern Ireland.

This will inevitably lead to everyone having information from their genome sequence attached to their medical records. This will be good for our healthcare. But it also leads to troubling ethical questions. What happens to health insurance if my sequence shows I’m predisposed to a terminal illness? Will my partner or employer get to see it? And how will my privacy be protected and the information kept safe?

These are important, urgent issues that need to be debated and resolved so that we can all feel confident about this new and exciting science.

There are important issues for staff as well. To date genomics has been confined to a small number of highly specialised fields. Yet the science has relevance for all professionals, many of whom currently know little or nothing about it. Therefore all need to be trained so that they understand the basic science, the benefits and the ethical considerations.  

 

Digital Medicine

This is another area where progress is being made. Last month saw the launch of the new NHS app. In its first phase of development it allows patients to book appointments, order prescriptions and view their medical records. Within two years it will allow people to upload data from wearable and lifestyle apps which can be linked to their medical records. The app was developed by Belfast company Kainos. However it is currently only available in England.

The 111  service is also not available here. It helps to ensure that patients get the care they need and diverts them away from Emergency departments if they don’t need that service. You can either type symptoms onto a web page or else speak to an operator who will then advise you what to do. It had been proposed for Northern Ireland back in 2012 but the BMA locally objected saying it would cause chaos and it was never introduced.

There are some extremely promising localised initiatives well. For example a hospital in the South Tees area has introduced speech recognition for note taking in A&E. Trials show that it saves three minute per patient. If this technique were to be taken up across the whole system it would save hundreds of thousands of hours for healthcare staff.

Just as exciting is the Airedale Digital Hub. This provides teleconsultations between care homes and clinicians 24/7. To date those homes using the service have seen a 40% drop in A&E admissions for their residents with consequent savings in both ambulance  times and for hospital staff.  

Similar initiatives are springing up across the UK. It therefore follows that the workforce delivering care will need to know for whom, where, when and how digital technologies are able to improve health outcomes. They will also need to be aware of any ethical implications.

AI and Robotics

AI has enormous potential to transform both the quality of healthcare and how it is delivered. Healthcare contains huge volumes of data and complex categories  and meanings. AI’s ability to analyse complex data and to make predictions from it will make a significant  contribution.

Another important contribution will be through speech recognition. Smart speakers and voice assistants like Alexa, Cortana and Google Assistant can interpret human speech and respond through synthesised voices. To date its uptake in healthcare has been slow because early trials showed up clinically unacceptable error rates. But the technology is improving all the time and we will soon see it being deployed.

Robots are already being used in surgery. Snake robots have been developed for reaching peripheral areas of the lungs and for gastrointestinal surgery. There are even examples of wearable robots to help people with physical disability. The report cites the example of a bionic arm which was manufactured by 3D printing and fitted to a patient.

But robots and A1 will not replace humans in the system. The report envisages that the mix of human and artificial intelligence will together create a greater collective intelligence.

The report puts it thus: “We need to prepare the current and future healthcare workforce for the AI-enabled health system of the future by bringing humanity to the machine-patient interface. This includes focusing on the essential human skills that AI and computers cannot achieve, such as collaboration, leadership, reflection, compassion and empathy.”

This is critical. The whole idea is not to dehumanise care, but to improve outcomes for patients. This will also save time which will mean that health staff will be able to spend more time doing what they are best at: caring for people.

What needs to happen now, according to the report is an ambitious drive “towards the NHS becoming the world’s largest learning organisation”. That means a cultural shift towards a system that understands and works with technology. It concludes: “There is no time to waste.”

This report was commissioned by the government and is consistent with its stated aims of making the NHS the most technologically advanced health care system in the world. The problem, as always, will be cash. The training envisaged will not come cheap, the new technology will require significant investment, and although there will be a payback it will not be immediate.

In Northern Ireland we’ll be well off the pace. This is not always a bad thing when it comes to adopting new technology and practices because there’s an opportunity to learn from mistakes and teething problems elsewhere. But it still has to be done.

 

 

 

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