#AI – Diagnosis on demand – and disappointment

Thursday evening’s Horizon, subtitled ‘The Computer will see you now’ is the latest in a lengthening line of programmes and books that purport to critique today’s medical zeitgeist: Artificial Intelligence in healthcare. It was entertaining. I understand. Who would have watched a programme called ‘Using statistics on huge datasets might one day help with diagnosing illness’? And to be clear about my stance – I am a Tech Believer! I first used Babylon in March 2015. (Ok, it missed my appendicitis, but then so did the colorectal surgeon I spoke to. Online forums gave me all the insight needed, so I picked up my overnight bag, went to A&E, home after 24 hours minus my appendix. All’s well.) Vision testing software transformed my home-visiting optometry practice back in 2004; 2020health’s team have produced many reports on the potential of digital health and Dan’s story during Horizon was a perfect example of tele-consulting a GP, with the double win of Dan’s reassurance and NHS saving money. I think Ali Parsa of Babylon is a genius and I am really excited about the possibilities with digital health interventions.

Yet I found myself from the start of Horizon scribbling notes and snapping at the screen, including right at the start when the initial framing was evil private tech industry and profits, versus good old, familiar, fax-dependent, public NHS. Sprinkled throughout were Halloween appropriate claims of computers ‘thinking’ and ‘understanding’ and ‘beating’. I kept wondering when we were going to get to the nub, stated at the beginning, of asking ‘Not what could but what should we be using #AI for in health‘?

This programme had the opportunity to demystify, question and critique: what do AI, machine learning, algorithms really mean? What is the difference between symptom checking, guidance, recommendations, diagnosis and treatment, and why CAN’T chatbots diagnose (cue MHRA)? Why is digital health, in the view of leading experts such as Prof Ann Blandford*, currently like the ‘Wild West’? Why didn’t politicians think through the disruption to GP funding and potential destabilisation of services, and mitigate it before launching GPatHand? What are the government’s plans now, both on GP financial flows and public understanding? What do Rwandans think of their government describing them as ‘a laboratory to try things out’? How do we build trust and confidence – the impressive Kheiron seems to have done it? Is Deep Learning an either-or?, or a both-and? And as Dr Liz O’Riordan asked (I paraphrase) ‘Is this what patients want’? And yes, we could have still had the central Babylon narrative of man versus machine, but I’d have added questions on why they seem to employ so few women, and why call it Babylon – it didn’t work out so well the first time!

Other much smarter folk have already critiqued the Babylon research findings  but what would have been really interesting would have been having answers to Ali Parsa’s correct assertion that RCT’s are not fit for purpose in digital health. We all know they are not, allowing no provision for iteration and qualitative insight. So what shall we do to progress tech but keep it safe? IMHO, this programme was a real missed opportunity. There were some stellar participants, the producers could have provided infotainment AND detailed the global demographic challenge AND burst the hyperbole bubble on battles of the consciousness AND asked how the NHS monetises its enormously valuable databanks. But it didn’t. There’s an opportunity there…

*(Disclaimer – I am a student in the same UCLIC department – but my bias is evidence based!)

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Tackling obesity – What the UK can learn from other countries

This week 2020health is producing its third report on obesity: Tackling obesity – What the UK can learn from other countries. The prevalence of overweight and obesity among adults and children has never been higher in the UK, so what the country has spent and implemented to date is clearly not enough.

What we know 

In our first report on obesity, Careless Eating Costs Lives (2014), we made 17 recommendations that required at least as many agencies, local and national government departments, national health and clinical institutions to be involved in the delivery of a cross-cutting strategy. Our second report Fat Chance? in 2016 looked at the evidence for who becomes, and is most likely to become, obese. One revelation in the socio-economic context was that both upwardly and downwardly mobile groups are correlated with higher rates of obesity than the stable rich or middle classes, while upwardly mobile groups have the same obesity rates as the stable poor; uncertainty seems to be a significant factor for weight gain.

Where we are

In 2017 we began a review of countries we had researched four years previously to discover where they had got to with their obesity programmes. We case-studied policies implemented at the country, region, city and town level to inform a discussion on potential insights and transferable learning for the UK.

Key findings in our latest report Tackling obesity – What the UK can learn from other countries include:

  • National Interventions – Top level leadership needs to convey the importance of obesity prevention through stronger accountability structures, intelligent taxation, and mandatory school-based education on health and wellbeing
  • Regional Interventions – Coordinated, cross-sector local programming is essential across multiple environments, with consideration of public-private partnerships
  • City/town Interventions – A detailed understanding of the social determinants of obesity within the locality are vital to the implementation of relevant and targeted initiatives
  • 0-12 years – Multi-stakeholder, community-based programmes for school-aged children (across multiple environments) are more effective than school-based programmes; interventions need to consider improving access to drinking water in schools, public (parent) health literacy and the built environment

Obstacles to progress included a lack of evaluation of obesity programmes, preventing shared learning and buy-in; the widening price gap between junk food and healthier options; and obesity prevention with a school-only focus, which often shows no effect in the long term, leading to stakeholder discouragement and possible disinclination to pursue further strategies.

What we can do next

Strong and mandated central policy, supporting bold, holistic local action, is needed to impact what is arguably the greatest health challenge of the 21st century. The UK government has rightly placed principal focus on children, but a health-in-all-policies approach has yet to be realised.

In the light of our three reports we therefore urge the government:

  • to help finance Local Authority pilots of EPODE (‘Ensemble Prévenons l’ObésitéDes Enfants’: EPODE, Together Let’s Prevent Childhood Obesity), or similar community-based programming, in a range of communities around the UK, supported by robust academic evaluation to enable learning and effective dissemination
  • to support healthier food choices among the poorest families by extending the healthy start voucher scheme
  • to introduce a compulsory Ofsted rating scheme of school policy and action on physical and mental health – in both primary and secondary schools
  • to ‘obesity check’ all new policies to spot potential unintended consequences

While local, whole-systems approaches to obesity need to be explored (as being trialled in the London Borough of Lewisham), children require special focus. If the UK fails to implement joined-up, multi-sectoral obesity prevention strategies for children and their families across a range of local contexts, it has little hope in ever reversing the obesity epidemic among the wider population.

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Managing Mental Well-being in the Workplace: Can Health Tech Help? #2: Awareness

This is the second in our series of articles on Mental Health Wellbeing in the Workplace, following on from the AXA Health Tech & You Round-Table discussion hosted by 2020health in January.  Our first article highlighted some of the headline figures of the AXA HTY digital health ‘State of the Nation’ survey by YouGov.

This second picks up on one the key themes that emerged from the Round-Table discussion; changing attitudes and increasing awareness across our society about the prevalence of mental distress and its effect on peoples’ lives; and about the importance of mental wellbeing and early intervention and prevention.  Reflecting on the many changes over my working life; starting in the City as a trainee accountant, when computers were the size of a room and lowly auditors worked with Tipp-Ex and calculators; I recalled some lines of poetry by T.S. Elliot, about the despairing death-like crowd flowing over London Bridge in a foggy winter dawn, as I commuted into work each morning and grappled with the strangeness and challenge of this new grown up working life. A bit melodramatic, but I was an idealistic English Literature Graduate, adapting to corporate life in a traditional, stiff upper lip environment, where admitting to stress was not an option!

Thankfully, things have moved on and there is greater awareness of the incidence of mental illness in our society, and an acknowledgement that it needs to be addressed, just as much as physical illness. Alongside the mental health charities, including MIND who were represented on our Roundtable panel; public figures such as the younger members of Royal Family, are raising the public profile and seeking to eliminate stigma around mental health with their Heads Together Charity.

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The current received wisdom is that ‘at any one time’ , “around 1 in 4 people will experience a mental health problem”.  Drawing on the results of the AXA HTY YouGov poll, Round-Table chair Julia Manning observed, it is more likely that “we’re getting on for half the population who have experienced some sort of mental health distress” at some point in their lives.  Significantly, this is being reflected in government health policy and corporate HR policies; highlighted by the recent government commissioned Farmer Stevenson Report, Thriving At Work . A key recommendation being that, “all employers, regardless of size or industry, should adopt 6 ‘mental health core standards’ that lay basic foundations for an approach to workplace mental health”. Eve Critchley of MIND shared their experience of implementing the Work Place Wellbeing Index as the benchmark, “we’re taking this seriously and we’re willing to share some of our results, and data as well, so we can benchmark how we’re doing and set a target for improvement”.

Alongside the anguish of mental illness for sufferers and their families, the Roundtable reflected on societal and commercial impacts of mental illness on this scale. The YouGov survey showed that of the 41% respondents taking days off work as a result of mental illness, 18% took 21 days or more. The Thriving At Work report suggests that untreated mental health costs employers between £33 billion and £42 billion each year. The commercial good sense of supporting mental wellbeing in the workplace was underlined by reflections from panellist, Chris Tomkins . He shared analysis by Professor Alex Edmunds, of companies with wellbeing programmes, and those without , showing that companies with wellbeing programmes grew, on average, between 2.3% and 3.8% faster than those without. As Chris reflected, “Certainly, any large corporate’s going to be impressed by 4% growth. That’s a major impact”.

Kathy Mason, March 2018

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An edited version of this article was published by The Huffington Post on 23/02/2018

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Managing Mental Well-being in the Workplace: Can Health Tech Help? #1

AXA Health Tech and You 2018 is a series of events, competitions and awards for digital health innovation, now in it’s fourth year.

Each year AXA HTY have run a digital health ‘State of the Nation’ survey with YouGov to discover the latest public opinion on digital health. This year the questions included some specifics on mental health in the workplace, and the findings were discussed at a Round-Table discussion hosted by 2020health and held at Runway East.

In the first of several blogs on the subject, here are some of the findings of the survey.Vessi Ves

  1. About a third of people willing to buy and wear a device that would be an ‘early warning’ system’ for decline in mental health, though over 55s were less likely at 24%. This rises to just over 50% doing so if the employer supplies it, though youngest (18-24s) were most keen at 73%.

[Interestingly very similar figures to question on general health tracker in 2017 AXA HTY Year 3 survey, apart from willingness to engage was higher for general health where employer provided device at 63%.]

It’s possible that this shows lack of value in illness prevention, shown by increase in willingness to monitor if individual not having to pay. Half of population not yet willing to engage (for whatever reason).

Vessi Ves

 

  1. If given the option given of wearing a device, still only about half of respondents were willing to wear it, and less so if they had to pay for it.Vessi Ves
  2. In terms of sharing information if someone was prepared to wear a device, across the age groups half of respondents were happy to share data.

[Slightly less than general health tracker in AXA HTY Year 3 survey].

  1. Of those who did not want to share data, the fears were around discrimination, privacy and trust. Sharing of information with third parties was a particular concern of older workers, whilst not wanting the employer to know about their lifestyle was the biggest concern of  78% of 18-24 year olds!
  2. Interestingly, if the data was anonymized, whilst younger people were more likely to share data (76%), those in older age-groups were slightly less likely to share anonymized data. This could imply that even if anonymized data shared, older workers think it wouldn’t make a difference, or could take too long to see the benefits in the workplace, or personally, from data collection? Vessi Ves
  3. Where a financial incentive was given to wear a tracker, just over half said they would be more likely to wear one. Given that just over half would wear one anyway if the employer supplied it, there was no real difference between the employer supply of a tracker and the employer incentivizing wearing of a tracker.
  4. The figure we are given generally is that one in four people at any one time can be experiencing mental illness. Those questioned revealed that about half (41% and we’ve included don’t knows and no comments) the working population have experienced mental illness at some point (and had had time off work), and nearly half of these had NOT shared tVessi Vesheir symptoms with their employer.
  5. However, what was really encouraging was that of those who had spoken to their employer about their illness, nearly three-quarters had had a helpful, supportive response, although 42% (nearly half) of 18-24 year olds said they hadn’t been supported.
  6. Of those who had taken time off, 18% had taken more than 21 days (none of these were under 24)Vessi Ves

 

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Fabulous Night at the Museum!

Finalists and judges joined AXA PPP Healthcare and 2020Health at the Design Museum last night to celebrate innovation and present their joint 3rd Annual Health Tech and You Awards. Congratulations to all the winners and to all the finalists. Thank you to everyone who entered and made it possible.

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HT&Y The WOW! Award Shortlist: Mable Care

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MABLE is a personalised Care Management System for older adults and their family to improve their Quality of Life: monitoring loneliness depression anxiety and safety.

MABLE offers communication technology understanding the language used to build positive relationships. Ideal in extending independent living for those with early stages of Dementia. Carers number more than 6.5 million in the UK. Dementia is one of the costliest health conditions to the national economy providing formal and informal care is estimated at 26.3 Billion per annum.

MABLE Care is a mobile App (phone tablet and smart watch) that monitors ambient observations (text speech video and eye tracking). Natural Language Processing using Machine Learning algorithms indicates emotional behavioural and cognitive trends. Personalised feedback helps carers to engage positively communicate regularly and reduce isolation.

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Judges Comments:

“A positive way of communicating with family members who may be elderly and improving their lives through independent living”

“Can reduce stress and anxiety of the users making living alone simple, but they have a communication stream when needed”

“Adaptable by learning the user’s traits makes the technology more personable”

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HT&Y The WOW! Award Shortlist: Inspair

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Inspair a compact add-on turning traditional inhalers into smart medical devices. People living with respiratory disease have been using inhalers for decades. Unfortunately inhalers misuse is far too common (86%). As a result asthma control was suboptimal in 56.5 % of patients and it was associated with poorer asthma-related quality of life higher risk of exacerbations and greater consumption of healthcare resources.

To overcome these challenges Biocorp designed Inspair – a smart solution collecting data related to treatment adherence and inhalation techniques. In addition to reconnect patients and doctors Inspair functionalities fosters better self-care therapy. Inspair consists of a smart sensor that can be attached to any pMDI. Connected with a dedicated mobile app via Bluetooth the smart solution embeds an inhalation tracking system an active feedback system as well as digital features allowing treatment monitoring.

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Judges Comments:

“Universal in shape meaning it can be used on all types on inhaler and can be used multiple times”

“The idea behind being able to help people in using an inhaler correctly is a great idea as those who may not always need an inhaler are not sure how to put it to the right use”

“Currently in the process of making this item it has a bright future”

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