DeepMind Health inks new deal with UKs NHS to deploy Streams app in early 2017

DeepMind Health, the division of the Google-owned AI company thats focused on buildinglinks to healthcare providers to drive the application of machine learning algorithms for preventative medicine, has inked a fresh data-sharing agreement with the NHS Royal Free Hospital Trust in London.

Its the second agreement signed between the pair and it supersedes theiroriginal agreement inked last year, which ran into controversy after a freedom of information request by New Scientist revealed the volume of patient identifiable medical data (PID) flowing from the Royal Free to DeepMind, and raised questions about whetherNHSinformation governance principles were being correctly followed. The data in question wasbeing used to power an app called Streams, built by DeepMind but using an NHS algorithm togenerate alerts on patients at risk of Acute Kidney Injury (AKI).

At the time the collaborationwas made public,last February, no details wereprovided about how much PIDwas being shared between DeepMind and the NHS leading to huge consternation when the scope of the arrangement emerged.

The U.K.s data watchdog, the ICO, began investigating complaints aboutthe data-sharing agreement. The Streams app also ran into trouble when it was revealedDeepMind and the Royal Free had not registered it as a medical device with the oversight body, the MHRA, despite piloting the appin the Royal Frees hospitals. The MHRA had not been approached prior to starting tests of the app.

The pair subsequently suspended use of Streams in the hospitals. But theyre now announcing plans to restart the project and, evidently, to try to reset it onto a firmer information governance footing. Above all this is an attempt toimprove the tarnishedpublic image ofDeepMinds inaugural push intopreventative healthcare by trying to securepatient trust to, ultimately, grease the future funnel for moredata flows from the NHS to DeepMind.

The point is, healthcare-related AI needs very high-quality data sets to nurture the kind of smarts DeepMind is hoping to be able to build. And the publicly funded NHS has both awealth of such data and a pressing need to reduce costs incentivizing it to accept the offer of free development workand wide-ranging partnerships with DeepMind (which has several other projects on the go with other NHS Trusts).

DeepMind and the Royal Free confirmed today thatthe Streams app has now been registered as a medical device with the MHRA, and saidit is readytobe deployed in the Royal Frees hospitals fromearly next year.

Following prototype testing, as well as registration with the Medicines and Healthcare products Regulatory Agency (MHRA), this first version of Streams is ready to be deployed to clinicians across the Royal Free hospital sites early in 2017. It is expected to result in an immediate improvement in AKI-related patient safety and outcomes, they write in a press release about what they describeas the next phase of their collaboration.

There also looks to be a broadening of the scope, with the PR talking about expanding the apps remit to cover early detection of sepsis and organ failure, as well as AKI.

The ultimate version of the Streams app willalert doctors and nurses to patients who need their attention in seconds rather than hours, reducing the number of patients who deteriorate in hospital without a clinician being aware, they write, adding:Streams will be extended beyond AKI to help care for patients with other serious conditions including sepsis and organ failure. At leastten thousand people a year die in UK hospitals through entirely preventable causes, and some 40% of patients could avoid being admitted to intensive care, if the right clinician was able to take the right action sooner.

On the information governance front, among thenoteworthy developments are:

  • Acommitment from DeepMind/Royal Free to publish the key agreements underpinning this partnership, including themaster services agreement (covering the partnership as a whole) and information processing agreement (covering how patient data is processed) although they do not statewhen these documents will be published.
  • Astatement that DeepMinds software and data centers will undergo what they describe as deep technical audits by experts commissioned by [DeepMinds]Independent Reviewers (a list of the reviewers can be found here).
  • The introduction of what they describe as an unprecedented level of data security and audit pertaining to the data being shared under the arrangement, with data access logged, and subject to review by the Royal Free as well as DeepMind Healths nine Independent Reviewers
  • An intention todevelop what they describe as an unprecedented new infrastructure that will enable ongoing audit by the Royal Free, allowing administrators to easily and continually verify exactly when, where, by whom and for what purpose patient information is accessed. This is being built by Ben Laurie, co-founder of the OpenSSL project.
  • Acommitment that theinfrastructure that powers Streams is being builton state-of-the-art open and interoperable standards, which they specify will enablethe Royal Free to have other developers build new services that integrate more easily with their systems. This will dramatically reduce the barrier to entry for developers who want to build for the NHS, opening up a wave of innovation including the potential for the first artificial intelligence-enabled tools, whether developed by DeepMind or others, they add.
  • They also describethe types of data being shared under the new agreement as similar to those being shared in the original agreement suggesting there has been some rethinking of which types ofdata are appropriate to share for the AKI use-case (a key criticism of the original arrangement); although its not yet clear what those differences are. Weve asked DeepMind for clarification and will update this story with any response.
  • Commenting in a statement, DeepMind co-founder Mustafa Suleyman said: Privacy and trust are paramount, and were holding ourselves to an unprecedented level of oversight by publishing our agreements publicly and engaging nine respected public figures to scrutinise our work in the public interest.

    Despite what is clearly a lot of re-engineering of the presentation and some changes in the structure of DeepMinds collaboration with a publicly funded and much-beloved National Health Service, many questions remain unanswered not least the core criticism that the volume of PID being shared without patient consent is questionable, given the pair have always relied on claiming they do not need to obtain patient consent forsharing thedata because they say it is being used for whats termed direct patient care.

    However, direct patient care refers to a direct care relationship between an individual patient and their clinician(s) whereas some of the patients whosedata is being shared under theStreams arrangement, so at least initially for the purposes of detecting AKI, will never be in the relevant direct care relationship because they will neverdevelop AKI.

    Safe to say, the push toward preventative healthcare looks to be puttinga lot of pressure on the NHStraditional information government processes which are not set up for an era of big-data mining andmachine learning-driven future potential promises. Itremains to be seen whether the U.K.s National Data Guardian willseek to provide some guidancehere(following controversy generated by the original DeepMind/Royal Free data-sharing data, Caldicotthas been looking intohow data was shared between the pair).

    But as private sector giants likeDeepMind make early bids for valuable publichealth data sets for thestated aim of building future healthcare services to sell back in to the NHS etc. governments and regulators have an equally pressing need to get theirheads around the new reality of health data as both a highly sensitiveand personal resourceand a commercial-accelerant-in-waiting that could enable the creation of a new generation of digital healthcare products. One thing is certain: Gaining and sustainingpatient trust in any such systems will be essential.

    At the time of writing DeepMind had not responded to requests for an interview.

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