England's NHS Begins Independent Review Into Cutting-Edge Healthcare Technologies

Tim Locke

April 30, 2018

England's National Health Service (NHS) has begun an independent expert review of future technologies to help transform healthcare through genomics, artificial intelligence (AI), and improvements in connecting patients to their physicians through their smartphones.

The review is being led by the US academic, geneticist, and cardiologist Eric Topol, MD, who is also editor-in-chief of Medscape. The review team includes experts in AI, digital medicine, genomics, education, and health economics. It is being facilitated by Health Education England (HEE). An interim report will be delivered to Health and Social Care Secretary Jeremy Hunt this summer, with a final report due by the end of the year.

Hunt wants to make sure the NHS and its staff are "digital ready." In a news release, he said: "Every week we hear about exciting new developments surfacing in the NHS which could help provide answers to some of our greatest challenges, such as cancer or chronic illness.

"These give us a glimpse of what the future of the whole NHS could be, which is why in the year of the NHS' 70th birthday I want to empower staff to offer patients modern healthcare more widely and more quickly. I'm delighted that Dr Topol is kicking off this review — ensuring the NHS is at the forefront of lifesaving, life-changing care across the globe for decades to come."

"Transformative"

"There's these new technologies — genomics, digital medicine, AI — really coming all together online, and it's really transformative," Topol told Medscape News UK. "So we have two major things. One is that the patient at the center of all this will derive considerable benefit to help empowerment, and being able to have much more charge of their care, and most importantly, restoring the patient-doctor relationship by the gift of time from this enhanced productivity.

"The second, of course, is to use these technologies to truly harness their potential — using the productivity, accuracy, the machine aspect of all these things to really rev up the way we do medicine and handle all these data, handle the tasks that are far better done by machines than by humans," Topol said.

Last year, a report by an independent health think tank, the Nuffield Trust, concluded: "Despite the fact there is good understanding of the issues obstructing innovation in the NHS, it is still slow to adopt new technological ideas." However, Topol believes the NHS is receptive to change: "What's distinguished the NHS vs anywhere else in the world is that no one has done this, no one has brought in all these experts in all these areas, and they include not just the AI, digital, genomics but [also] the ethicists, the economists, the educators, the futurists, all together for multiple days and to start this process.

"This has never been done before. So it's a start. The fact that the NHS has organized this tells you a lot about the progressive nature. It really is an impressive organization to have this vision that I'm just helping to pull together."

So has the NHS welcomed an outsider from the United States, where the healthcare system is organized and funded much differently? "Absolutely. We'll see with the final report, but right now, it's a very warm welcome," Topol said.

Case Studies

The review team will look at current examples of technology that demonstrate improved patient outcomes. These include the following:

  • Smartphone video consultations and virtual clinics to avoid some face-to-face appointments

  • Robotic-assisted surgery that offers greater precision

  • The 100,000 Genomes Project, which provides insights into genetic diseases

  • Stem cell treatment that is helping to restore sight in patients who have wet age-related macular degeneration

  • A smartphone app linked to a Bluetooth-enabled blood glucose meter to help women self-manage gestational diabetes and reduce clinic appointments

  • Continuous glucose monitoring systems linked to insulin pumps for better diabetes management and to avoid insulin injections

  • The Google-backed DeepMind AI and machine learning deployed at Moorfields Eye Hospital, London, England, to accurately detect eye diseases through optical coherence tomography and to reduce delays in diagnosis

  • A robotics company based in Bristol, England, that has developed 3D-printed artificial arms and bionics for amputees

  • Digital otoscopes deployed in general practice to take videos and images inside patients' ears, which can then be sent to ear-nose-throat consultants for review

  • A smartphone app and sensor to identify atrial fibrillation

The review comes nearly 12 months after a ransomware cyber-attack caused some UK hospitals to cancel appointments and operations and that exposed weaknesses in computer systems and pockets of outdated systems. So is the NHS ready for technologic change?

"I think that this is different," Topol said. "There's so much happening simultaneously, and they're interdependent. They're all data-driven stories — to sequence, microbiome, genomics, apps and sensors, and telemedicine, and then you have AI, data analytics, robotics — it's all happening at the same time. You can't turn your back on this. This is just extraordinary. The fact that these are all happening in parallel, there's never been any time like this in the history of medicine or healthcare."

There's never been any time like this in the history of medicine or healthcare. Dr Eric Topol

The review group acknowledges that already, pockets of innovation are being driven locally. Topol said the review will look at technologies used by patients themselves as well as by healthcare professionals and others: "And that means all different types [of providers] — the GPs, the specialists, the nurses, the pharmacists — all the way through, and includes the nonclinical staff like the administrative people, and the coders, and people working in back office functions. And then, of course, the future of education — the medical students and all the other healthcare trainees.

"And then lastly, it's the health system and hospitals, it's trying these same tools in the hospital setting," Topol said, "whether it's to reduce the need for hospitals per se or to make them far more error-free, and improving the workflow with things like machine vision. We've got so many different things we can improve with these tools."

No review of the future of the NHS can take place without addressing the question of funding, and the review group includes a health economist. Can the NHS afford new technology, given that some areas of basic care are currently underfunded?

"I think that's being pursued independent of this," Topol explained. "There is a lot of work going on, as I understand it, to secure funding for the next decade for the NHS and its expansion. But I also think this represents a very special opportunity. In the past, new technology always was correlated with higher costs. Now we're talking about technology which is actually cheap overall. AI is software. Sensors are chips that are cheap. Genomics is getting less expensive every day. These are not like the big-ticket items of the past. This is like Moore's law coming to medicine. The hope is you can actually improve the economic landscape with technology, and that's somewhat different than the experience of the past."

An HEE news release that announced the launch of the review states that "tens of thousands of NHS staff will be trained to use robotics and artificial intelligence." Topol has a reassuring message for clinicians nervous about the pace of change: "I don't think that robotics is going to apply to many apart from assisting surgeons at this point. So it's limited.

"Doctors are always resistant to change, perhaps more so here than some other places. But we'll emphasize in our report the validation requirement, the evidence, whether from randomized trials or real-world, strong, compelling evidence. So we don't recommend these things until that evidence basis is established. By the time we get there...then I think the clinicians will move forward and be willing, embrace, adapt, and implement."

Dr Topol is editor-in-chief of Medscape.

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