Can AI and other frontier technologies save the National Health Service?
On the 28th of February 2018, I had the privilege of being an invited panellist discussing the advances of AI and its potential in eradicating issues our current healthcare system faces. Myself, Eleonora Harwich, Omar Fogliadini and Dr Rabia Khan are like-minded in our vision to optimise healthcare using data-driven health platforms.
Optimising healthcare has always been the driving force for my involvement in a data-driven health community. As a front-line clinician who has worked in both primary and secondary care, it cannot be ignored that the NHS is facing unprecedented challenges.
Over the next 15 years or so, the population in England alone is expected to grow by an additional 8 million to over 61 million. The patient population is getting older with life expectancy increasing by four years to an average of 83 years for males by 2030. Each patient has greater co-morbidities because of the ageing population. They survive health conditions that might have killed them in the past, but as a result we now have to deal with health complications arising from this. Each patient now requires more resources and places a greater burden on the system than ever before. Moreover, there has been an increase in risk aversion from clinicians, who rely more on investigations and tests for risk stratification and management, all of which places a burden on resources through tests and referrals. In summary — these dual forces result in much greater demands being placed upon the health system than can be adequately supported by the current workload and resources allocated.
It is inspiring to be surrounded by other technology experts that see the future possibilities of AI in helping us treat complex diseases. Another member of the panel who fits such criteria was Dr Rabia Khan, an exploratory scientist at Benevolent Healthcare. Benevolent Healthcare is a company that uses AI in clinical discovery with a goal to treat all diseases as though they are one; this is to be done through the medium of personalised medicine.
What is a blockchain?
“What is a blockchain?” was one of the more prominent questions in the discussion that led to an open-ended conversation about Medicalchain and other relevant blockchain based digital health platforms. The way I described blockchain was that it is a continuously growing list of records, called blocks, stored in a digital ledger. The blocks are linked and secured using cryptography. Importantly, it allows for peer-to-peer transfer of data and prevents previous data within the chain from being altered. It is similar to a normal database that stores information in a central repository, with the main difference being that the data is instead stored on an number of different computers called nodes. Moreover, central entity controls the data, changes are only made to the data by consensus of the nodes. As a result, blockchains have a number of properties, such as auditability and immutability, which are highly applicable to the recording of events, storage and usage of medical records, and other records management activities, such as identity, transactions, documenting provenance, etc.
Fundamentally this is a very important thing. Any processes in healthcare that rely on trust, and that’s a lot of them, could use blockchain technology. For example, you could record the results of clinical trial results as they come in so that other parties know that your data has integrity. They don’t have to rely on you or your institution to tell them it’s correct, they know it’s correct because you have the records on the blockchain to prove it.
Today healthcare professionals are limited in the level of care they can deliver to patients due to the inability to see accurate and complete health records.
Patient’s records are spread across many fragmented sources of data with many gatekeepers — GPs, occupational health at your employers, hospitals, specialist care centres, — which all have their own data for the patient. These different sources of data may be incomplete or overlapping as well.
Throughout my time in medicine I have encountered many circumstances where paper-based medical records and decades-old electronic health records have prevented effective delivery of healthcare due to incomplete or incorrect information. In turn this leads to duplicated investigations or worse, medical errors.
Imagine a patient from London who has a chronic lung problem and goes on holiday to another city and is hospitalized. The admitting doctor has no access to their health records despite the sizeable medical notes from their local hospital that they likely have. To get that information, often the doctor will have to phone the request through to someone on the other side for them to read out the data. Alternatively, it might be faxed. Regardless, these processes are not efficient, and delay optimal treatment.
Blockchain technology has the potential to help deliver a better system that overcomes these issues, by providing a platform that empowers people with full access and control over their personal health records, in a single-version-of the truth. A fundamental problem with today’s medical record system is that patients lack knowledge and control. Access to their healthcare data can bestow both.
A personal health record powered by blockchain technology would also shift the ownership of health data from the data silos to the individual. Unlike today’s model, an individual would have access to a copy of their personal health information and would be able to authorise who can see it, and in what form.
Digital transformation will improve transparency and healthcare equality for all stakeholders; at the same time, it will give everyone the freedom to share their medical information with anyone they choose, be it a doctor, carer, or family member.
A common issue with blockchain was the question of how we manage identity and duplicate records. While we understand that there are issues that are yet to be eradicated within the framework, blockchain provides a better solution than what currently exists. The framework is still being navigated closely with full testing, vetting, and information governance to facilitate our efforts to follow data privacy legislation closely. Having a system that is built from the ground up in a GDPR compliant way is not something that a lot of systems can boast at this time. We are problems as we face them.
An audience member asked whether novel technology can help patients better self-manage their own conditions to reduce the NHS’s funding problems.
Medicalchain is a platform that helps empower patients in having access to their personal health data. This can give them better ability to monitor their well being, which in turn will help with self-management of their health conditions and be more concordant to lifestyle changes. Medicalchain can also be used to share health records with primary care physicians, giving them the ability to track and measure a patient’s lifestyle changes on the platform and show where improvements can be made. In the longer term, the NHS need reliance on patients that can self-care better, to off-set the greater demands placed upon the system.
The NHS was born out of a long-held ideal that good healthcare should be available to all, irrespective of an individual’s background. Moreover, the NHS sets the global standard for optimising patient centered care. It is our duty as clinicians and scientists to maintain that standard; if not improve it — in the face of these challenges listed. Blockchain powered personal health records is one spoke in the wheel that will help with the future of the NHS.
Dr Philip Xiu — Lead Medical Officer of Medicalchain
