20 February 2019

Blog by Dr Sohaib Imtiaz

I am a doctor on the NHS Clinical Entrepreneur programme who is very grateful to be granted a rotation working between public health and digital health due to the incredible support of Dr Liz Mear, chief executive of the Innovation Agency.

The Clinical Entrepreneur programme is a very enabling programme and opens you up to a large network of incredible people, inspires you to take action through the enigmatic Prof Tony Young but most importantly gives you the passport to ‘think outside the box’. This empowering approach coupled with organisations such as the AHSN Network and in particular enabling futuristic leaders such as Dr Liz Mear give an enthusiastic and young ‘pluripotent’ doctor the perfect opportunity to learn and gain experience in the ever advancing space of digital health.

Interestingly I proposed this placement when Prof Eric Topol had just published his interim report and am undertaking it as he launches his final report. I identified the increasing need to train the workforce in ‘digital health’ last year and having already undertaken a Masters in public health alongside spending a year at Imperial Business School as well as having a great interest in technology, this was something I really desired in order to put everything I was learning and learnt together.

I was recently certified in Lifestyle Medicine and have a particular interest in prevention, behaviour change and Artificial Intelligence. It has been refreshing interacting with the great team at the Innovation Agency and I have been exposed to a plethora of learning opportunities whilst learning about the innovation landscape in the NHS.

In particular I will focus on three meetings that I was able to attend due to Alan Davies who has taken me under his wing. Alan is the Innovation Agency’s Director of Digital Health.

I attended the Innovation Agency’s Digital Expert Group meeting where the centre of discussion was the NHS long term plan which had just been released alongside the NHS App. The meeting took place in the stunning Alder Hey Innovation Hub where I got to see the great work that was being done including 3-D printed anatomy, virtual reality engineering and various digital therapeutics.

The meeting brought together various stakeholders and we were able to discuss where the vision of the NHS aligns with the digital future and how we need to be prepared. The focus was on the launch and continuous development of the NHS App and how it will be a ‘front door’ for digital for patients acting as a gateway to empower the person and linking initiatives such as the NHS Apps Library and social prescribing.

I envision that we will see the NHS App as a great tool for personalised medicine, data visualisation, health promotion and behaviour change as well as seamlessly prescribing digital therapeutics and virtual medical consultations. However, in order for this to happen we must ensure it is interoperable and that we can integrate the best third party solutions into the app so it can be accessed by patients. 

The AHSN Network AI workshop was a great ‘think tank’ experience where people from across the 15 AHSNs were in one room to discuss artificial intelligence. The discussion was fascinating and there was a breadth of takeaways. The day began with an oversight into the vast amount of data that is currently being generated and the advancements in deep learning and neural networks is making it easier to decipher all this information and discover trends which weren’t evident previously.

With new AI solutions becoming available at an increasing rate and AI being a big area of investment globally, we need to be in a position to make decisions on how we will leverage these technologies for the NHS. We discussed the best use cases for AI and where the AHSNs should position themselves in the ecosystem. The consensus was that AI solutions need to be regulated ad validated but these processes need to not stifle innovation or significantly decrease the scale and speed of adoption which could mean patients missing out on the benefits. It was agreed it is best for the AHSNs to leave regulation to another body and help navigate the space at a national level with a core objective of adopting medical innovation.

The emerging artificial intelligence technologies present numerous challenges including inherent biases in data sets which may disadvantage certain groups as well as machine learning and black box algorithms that are continuously changing and learning. Would this mean we need continuous assessment and how do we ensure bias and harm are minimised?

Often, companies don’t disclose the middle layers or their algorithms and that poses a  challenge on the depth of assessment for these innovations. We also discussed how randomised control trials might be difficult to conduct for these technologies and it would probably be best to have ongoing assessment. If patients are already using some of these technologies then should we help democratize them and make them available to the wider population or do we need lengthy assessments before endorsing them?

The growth in the AI sector is occurring faster than the regulatory environment but NICE has conducted research on how to validate apps. If the public loses trust in data privacy and AI is met with reserve then it will hinder the adoption so it was emphasised that the messaging needs to be right and conveyed correctly to help adoption. The overall takeaways were on prioritising safety, data security, bias, ethics, updating ways of assessment and being more flexible. It is important to assess potential health solutions on a case-by-case basis, ensuring safety but also allowing it to reach those who need it as quickly as possible. Artificial Intelligence is helping in quicker and more accurate diagnosis in many cases and augmenting human professionals - therefore making it essential in our future.

I had been eagerly awaiting the launch of the Topol Review which was commissioned by the NHS to plan for the next 20 years. Taking place at the Royal Society of Medicine it brought together the senior leaders in the NHS and Health Secretary Matt Hancock. Matt Hancock reiterated his vision for the NHS to lead in digital, emphasise prevention, focus on genomics and train a digital health workforce.

Prof Eric Topol is an eminent professor of cardiology, geneticist and digital medicine expert. He first highlighted the advances in computing, machine intelligence and wearable sensors. The explosion in such technologies has bolstered the notion of putting patients at the centre of their health. It was particularly interesting seeing how our health is made up of multiple layers - exposome, genome, transcriptome, microbiome, proteome etc and how all this data can help make more informed decisions with the possibility of a future ‘virtual health’ assessment.

However, Prof Topol maintained these advances will help clinicians by freeing up time and allowing them to focus on the ‘care’ aspect of healthcare. The stethoscope now being quite outdated but still proudly worn around the necks of doctors is a symbol of where healthcare currently stands: way behind the curve of technology.

In parallel to other industries, health is quite behind with the use of fax machines and pagers. With smartphones enabling virtual appointments, the ability for remote patient health tracking and the rise of personalised medicine we must change the mindset. The focus of Prof Topol’s talk came back to the patient and training the future workforce in digital technologies to enable this transformation, because as great as the technology is, it is of no use unless the people on the front-line embrace it.

There was also discussion on how medical training needs to change and be fit for the 21st century. There were many recommendations produced as a result of the review and I hope they can be implemented.

The range of meetings and learning experiences I have been involved in have been really invigorating and has helped me join the dots and see how the greatest impact in health can be made and how the NHS is placed to really accelerate change. From my experience the Innovation Agency remains central to this change and is an example of a great functioning organisation which is making a big impact and should be a model for other NHS organisations to emulate.

The disparity between organisations has been quite evident and the Innovation Agency has both stimulated learning and been an amazing growth environment for myself as a doctor. 

I am delighted that everything is coming together on a national level and this was reiterated at the CVD public health conference I attended in Manchester where there were workshops on behaviour change with prevention and digital health being the primary discussion points.

Meetings with start-ups and SMEs have revealed the passion that exists for health innovation. Companies such as Babylon have very sophisticated technology which can make the role of a physician easier, use facial resignation to work out patient expression and allow the patient to access care and medicines more easily.

Overall, I feel enriched with all that I am learning and believe digital health needs to become a specialty in its own right, incorporating prevention, population health, digital technologies, behaviour change and genomics.

I am grateful to be a part of the enthusiasm at the Innovation Agency and appreciate everyone who is always willing to go out of their way to help me.










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