THE NHS does not have the best track record for delivering on large-scale digital projects – just consider the 2016 decision to finally abandon the care.data programme, having already cost the UK taxpayer in the region of £7.5 million. So it was no doubt with some trepidation that the Government recently announced the launch of a free NHS app allowing patients in England to access their GP record and book appointments, among other services.
Former Health and Social Care Secretary Jeremy Hunt said: "Technology has transformed everyday life when it comes to banking, travel and shopping. Health matters much more to all of us, and the prize of that same digital revolution in healthcare isn’t just convenience but lives improved, extended and saved."
The Government has high hopes that technological development will help address a host of growing healthcare challenges, including ever-increasing patient demand in an era of funding and workforce shortages. This was made even clearer in the recent cabinet reshuffle which saw the appointment of Matt Hancock as the new Health and Social Care Secretary – a self-proclaimed tech evangelist who has promised investment of over £487m in developing "revolutionary" technologies in the NHS.
Mr Hancock said: "I came from a tech background before I went into politics, and I love using modern technology myself. Not only do I have my own app for communicating with my constituents here in West Suffolk, but as you may have heard I use an app for my GP."
So it was he stepped instantly into his first controversy – the app referred to being GP at Hand, developed by the digital healthcare firm Babylon. GP at Hand is provided through a London practice to registered patients but is also available to out-of-area patients who are required to move from their existing practice. The app, which is accessible via smartphone and other devices, incorporates a triage system based on digital algorithms, offering patients healthcare advice or the option to book a video consultation with a GP 24/7 – usually within two hours. Patients needing a face-to-face consultation have a choice of clinics in the London area.
The service restricts registrations from some patients with complex needs or those with some long-term conditions. This prompted the Royal College of General Practitioners to accuse Babylon of "cherry-picking" younger, healthier patients, leaving traditional GP services to deal with more complex cases and without sufficient resources.
RCGP Chair Professor Helen Stokes- Lampard, speaking at a King’s Fund conference in London, called GP at Hand "disruptive innovation at its most disruptive at the moment" but also "phenomenal technology" that the NHS would do well to learn from.
"New technology needs to be expanded," she said. "We need equitable access to innovation technology across the NHS."
Babylon is certainly confident in the power of its AI technology, recently claiming it outperforms average candidates in MRCGP assessments. In tests using elements from both the AKT and CSA exams relating to diagnostics the AI system achieved a score of 81 per cent on its first attempt, according to Babylon’s medical director Dr Mobasher Butt. The average pass mark for both exams was 72 per cent over a five-year period.
Another test involved 100 scenarios or 'vignettes' in which the AI system was tested against 12 experienced GPs with no connection to Babylon. The correct diagnosis rate for the doctors averaged 80 per cent, which Babylon’s AI system equalled. Assessed against conditions seen most often in primary care, diagnostic accuracy among the GPs ranged from 52 per cent to 99 per cent and Babylon’s AI accuracy was 98 per cent.
RCGP vice chair Professor Martin Marshall commented on the findings: "The potential of technology to support doctors to deliver the best possible patient care is fantastic, but at the end of the day, computers are computers, and GPs are highly-trained medical professionals: the two can’t be compared and the former may support but will never replace the latter.
"An app might be able to pass an automated clinical knowledge test but the answer to a clinical scenario isn’t always cut and dried, there are many factors to take into account, a great deal of risk to manage, and the emotional impact a diagnosis might have on a patient to consider."
One point on which there appears to be a clear consensus is the need for digital health products to meet the same rigorous standards of evidence expected of traditional medical products. Recently the Government commissioned an independent technology review as part of an NHS workforce development strategy. It is being led by cardiologist and digital medicine researcher, Dr Eric Topol.
He recently told the Health Service Journal that in regard to digital innovation: "There should be no exceptionalism."
"The priority is getting the evidence base before going forward, putting in the resources to nail it. It’s so important."
Jim Killgore is managing editor of MDDUS Insight magazine