This is a longer version of an article published in Contrast, the quarterly magazine published by NHS EMRAD on 24 September 2020 available at https://emrad.nhs.uk/news-alias/670-autumn-2020

“Does this mean a "robot" reads them [mammograms]?  Not sure I like that idea much.”
When TaoHealth researchers asked women in the East Midlands earlier this year how they felt about using artificial intelligence in breast screening, this was, not surprisingly, a common response.

Very few of us really know what artificial intelligence is and the part it can play in healthcare if it proves to be effective and safe. As one of the participants in a recent focus group said;
“A lot of my understanding is from movies where robots take over the world.”
 
And yet it is increasingly embedded in our everyday lives in the search engines like Google, virtual assistants like Siri, entertainment platforms like Netflix and email platforms like Microsoft Outlook that we use constantly.
 
So, what is artificial intelligence? The UK government use the definition “Technologies with the ability to perform tasks that would otherwise require human intelligence, such as visual perception, speech recognition, and language translation… and learn and adapt to new experiences”. In plain English, you could think of artificial intelligence (AI) as computers and robots understanding patterns, pictures, speech and language. They can learn from their understanding and make decisions. The BBC has a short video that is a helpful start https://www.bbc.co.uk/news/av/technology-34224406/what-is-artificial-intelligence
 
NHS EMRAD is working with UK-based AI companies to test how their technology can be used safely in the NHS breast screening programme. As part of the evaluation of this project we are talking to women of all ages to understand what they think about using AI.
 
What worries many of us about AI is the idea that machines will start making decisions without human input, the machines will ‘take over’ and potentially put many of us out of a job.
 
There are two ways in which we, as a society, are working to ensure that does not happen, specifically in breast screening but this applies in many situations where AI is being used.
 
A lot of work is being done at the moment by governments, academics and regulators to establish how AI will be developed, tested and regulated in the real world in ways that make sure it is trust-worthy, understandable, un-biased, protects our privacy, doesn’t exclude anyone and allows us to have control over who and what we share our data with. This project is working closely with the UK government and regulators to shape the approach that will be taken to regulating AI in healthcare to make sure it is ethical as well as safe and effective.
 
We know that health professionals are in short supply in the UK and across the world and radiology as a specialty is possibly more affected that some other professions. Introducing AI to support professionals with the human retaining ownership of the decision is broadly acceptable to the women we talked to. This would free up professionals to do other work, like seeing women referred by the GPs with breast lumps or other symptoms they worried about, and speed up the time women have to wait for these appointments, where the wait can be agonising.
 
As one woman I talked to put it:
 “If it can free up more human time to then spend more time on the complex cases or actually just to be able to process things more quickly, I think that's got to be a positive. To get the confidence of the woman, [there] has there been a human involvement, I think it’s a partner in medicine not a replacement.”

As an advocate of evidence-informed practice, I have seen fashions come and go in an effort to get governments, non-profit and commercial organisations value the contribution of research and evaluation to the success of innovation.
The latest is the use of terms such as ‘scientific method’, ‘experimentation’ and ‘A/B testing’ which has gained currency amongst the tech start-up community and is now seeping into public policy and charity organisations. If you have been involved in user testing, how informed were you about the purpose of the testing? Did you get any feedback on the outcome?
There is no doubt that....

I have been in the health technology bubble for the last 18 months, reading, listening and debating with others in the bubble, about the impact that AI and machine learning will have on healthcare. It is tremendously exciting stuff and very hard not to get carried away when you see some of the work that is being done around the world in this space.
But like many of you, I have an existence outside of this rarefied atmosphere, in the real world of health and care delivery where timely access to the right safe, high quality care in the right place from professionals who have the time and space to really listen is becoming harder to find.
When these two worlds collide, cynicism and frustration are not infrequent responses. Cynicism from health professionals who have been promised “game-changing” innovations to make their lives easier before, and frustration from technology advocates who struggle to be heard in a pressured and noisy system.

This article is a repost and first appeared on the Optimity Advisors website in May 2018.  The IC landscape in Europe is highly diverse, and different health systems are clearly at different stages of their integrated care implementation journeys. Context-sensitivity is fundamental when trying to understand the advancement of integrated care across the continent, from a design and implementation perspective.

This article is a repost and first appeared on the Optimity Advisors website in May 2018.  In this blog, we explain some of the health system characteristics that have shaped different models of integrated care. The heterogeneity and diversity of models and programmes in the implementation of integrated care reflects the values, principles and organisation of their health systems.

This article is a repost and first appeared on the Optimity Advisors website in May 2018.  In previous blogs we saw how integrated care is moving from being a stated goal to delivered in practice in many different ways across Europe. These differences reflect the different political, economic, social, legal and technical contexts in which integrated care models evolve.

By Niamh Lennox-Chhugani and Malcolm Bray 
This article is a repost and first appeared on the Optimity Advisors website in November 2018.  The first question to consider is why would we want to introduce social prescribing into local health care systems in the first place? On the face of it there appears to be a simple answer - of course we should mainstream social prescribing (or non-medical referrals by General Practitioners that support health and well-being). It provides patients with a more holistic offer by combining traditional health care services with services that can help people with a wide range of social issues. The evidence tells us if these are not tackled they can contribute to poor health and wellbeing. There is a compelling case for primary care to invest in social prescribing as around 20% of patients see their GP for a social rather than medical problem. NHS England has published their ten high impact change recommendations; one of which is social prescribing.
So why has the development of social prescribing been so challenging?

This article is a repost and first appeared on the Optimity Advisors website in March 2018.  Amazon, JPMorgan Chase and Berkshire Hathaway caused ructions in healthcare insurance markets recently following the announcement of their intention to work together to launch a not-for-profit health insurance company for their U.S. employees. Whilst concrete details of the collaboration have yet to be released, the markets illustrated their concerns at the entry of a new potentially powerful competitor with shares in CVS dropping 4%, United Health dropping 11% and Cigna dropping 7% following the announcement.

This article is a repost and first appeared on the Optimity Advisors website in December 2016.  One of the biggest challenges in any sector is turning strategy into action and impact, knowing where to focus effort and in what order. Specialist commissioning in England is trying to reposition itself in the context of exponential development and innovation in precision medicine, health technology and novel therapies for rare diseases, the main focus of specialised commissioning as well as a system shift to population health risk management. Providers of specialist services are starting to respond to this challenge by designing new models of integrated care. One example is the Accountable Cancer Network involving The Christie, the Royal Marsden and University College London Hospitals. Earlier detection is a key aim of such models but even these innovators recognise the current provider networks need to be expanded, potentially beyond the health system, to do this really effectively.

This article is a repost and first appeared on the Optimity Advisors website in November 2016.  One of the biggest challenges in any sector is turning strategy into action and impact, knowing where to focus effort and in what order. Specialist commissioning in England is trying to reposition itself in the context of exponential development and innovation in precision medicine, health technology and novel therapies for rare diseases, the main focus of specialised commissioning as well as a system shift to population health risk management.