Digital Health Section Podcast- Royal Society of Medicine

This episode features a conversation with Sara Nelson- Programme Director at DigitalHealth.London focussing on how to pitch healthtech to the NHS.

Sara shares pitching tips based on her experience working within a NHS healthtech accelerator and as deputy CNIO at NHSX

Topics include:

- Navigating the NHS procurement landscape

- Identifying budget holders- why the CEO may not be the best person to pitch to

- Why being too flexible can put buyers off

- The power of effective follow up

- The risk of offering a free pilot

This episode features a conversation with Dr. Bob Wachter, a prominent physician and academic known for his significant contributions to the field of healthcare and technology.

Dr Wachter has authored several influential books including the brilliant "The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age" (2015)

In 2016, Dr. Robert Wachter was commissioned by the UK government to deliver Wachter Review aimed to assess the state of health information technology (IT) in the National Health Service (NHS) and provide recommendations for its improvement. 

As we mark seven years since the Wachter Review, Dr Wachter joins me to reflect on the progress made, future potential, and address the persistent challenges facing the NHS.

The conversation explores the journey that the NHS has come on since 2016 including the widespread introduction of electronic health records, patient health record access and development of NHS CCIOs. It also explores the future of AI enabled healthcare, the challenge of the so-called productivity paradox and whether AI is likely to result tin evolution or revolution of care delivery.

This episode features a conversation with Jeanette Kusel- Director for Scientific advice at NICE the national institute of health and care excellence, and addresses the role that NICE  has to play with regards to digital health technologies

Discussion topics include:

• The difference between the evaluation required for regulatory approval (CE/UKCA marking) and NICE approval
• Innovative new approaches to assessing healthtech innovations including:
• The NICE META tool
• Early value assessments
• The AI and digital regulations service
• NICE Evidence Standards Framework
• What is involved in a NICE approval process for digital health technologies 
• Common mistakes that companies make when evaluating their products and how these can be avoided

Links:

META tool: https://meta.nice.org.uk/

Early value assessments: https://www.nice.org.uk/about/what-we-do/eva-for-medtech

AI and digital regulations service: https://transform.england.nhs.uk/ai-lab/ai-lab-programmes/regulating-the-ai-ecosystem/the-ai-and-digital-regulations-service/

NICE evidence standards framework: https://www.nice.org.uk/about/what-we-do/our-programmes/evidence-standards-framework-for-digital-health-technologies

NICE Real World Evidence framework: https://www.nice.org.uk/corporate/ecd9/chapter/overview

Max Jaderberg, Director of Machine learning at Isomorphic labs, shares the Isomorphic approach to drug discovery in one of their first interviews as they emerge from shadow mode.

In 2020 Google DeepMind made history when they took on the grand challenge of biology- the protein folding problem- with their algorithm AlphaFold2.  Their success prompted the creation of a sister company, Isomorphic Labs. Our conversation topics include:   - The concept of “Digital Biology”- How AI can be used model the biological world 

- Bottlenecks in the drug discovery process and how AI could circumvent them

- How AI may unlock 'undraggable targets' to find treatments for incurable diseases  Links:

Isomorphic labs website: https://www.isomorphiclabs.com/

AlphaMissence: https://www.deepmind.com/blog/alphamissense-catalogue-of-genetic-mutations-to-help-pinpoint-the-cause-of-diseases

This episode focuses on the topic of AI education and workforce transformation with Dr Hatim Abdulhussein, National Clinical Lead for AI and Digital Workforce at NHS England

Key discussion topics include:

- The NHS England strategy for AI education for the healthcare workforce

- 5 healthcare workforce AI archetypes: Shapers, Drivers, Creators, Embedders and Users

- The role of workforce transformation from AI MDT teams to the professionalisation of the digital and data professionals and the creation of new leadership roles in technology and AI. 

Developing healthcare workers' confidence in AI: https://digital-transformation.hee.nhs.uk/building-a-digital-workforce/dart-ed/horizon-scanning/developing-healthcare-workers-confidence-in-ai

Artificial Intelligence (AI) and Digital Healthcare Technologies Capability framework: https://digital-transformation.hee.nhs.uk/building-a-digital-workforce/dart-ed/horizon-scanning/ai-and-digital-healthcare-technologies?

This episode features a conversation with Eric Topol, a renowned cardiologist scientist, and author. He is the founder and director of the Scripps Research Translational Institute where he is a professor of Molecular Medicine . He is editor-in-chief of Medscape and He has published three bestselling books including the highly influential  Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again . 

In 2019 he led the Topol review a report focussed on planning for the NHS future workforce, integrating genomics, digital medicine, and artificial intelligence.

Our discussion topics include: 

• How LLMs could make doctors more empathetic
• The potential for ‘keyboard liberation’ using LLMs to repair the damage that EHRs have inflicted on the doctor-patient relationship
• The ‘silicon-vallydation’ issue and the need for high quality evidence generation for AI
• Hallucinations and the ‘frequently wrong never in doubt’ issue

This episode features a discussion with Mohammad AI-Ubaydli- CEO and Founder of Patients Know Best on personal health records.

Key discussion points include

- Do patients really know best?

- How personal health records are driving clinicians to rethink the way they write their clinical notes

- Changes that are needed within clinical training to better prepare the workforce for treating patients using personal health records

This episode focusses on the topic of confidence in healthcare AI technologies. My guest is Dr Mike Nix, Lead AI Clinical Scientist at Leeds NHS trust.

Discussion topics include:

• How AI errors and human errors are fundamentally different, and why that’s so important in the context of healthcare AI 
• The concept of explainable AI and its potential limitations in the context of human cognitive biases and decision making 
• The role of regulation in supporting AI confidence 

Link to reports on Healthcare workers' confidence in AI:

https://digital-transformation.hee.nhs.uk/building-a-digital-workforce/dart-ed/horizon-scanning/understanding-healthcare-workers-confidence-in-ai

https://digital-transformation.hee.nhs.uk/building-a-digital-workforce/dart-ed/horizon-scanning/developing-healthcare-workers-confidence-in-ai

This episode centres on the evaluation of digital health solutions. It features a conversation with Dr Saira Ghafur, Consultant in Respiratory medicine and co-founder of Prova Health.

Discussion topics include

- The different types of evidence required at different stages of product development

- The use of innovative approaches such as simulation to produce evidence for digital health technologies

- The importance of linking evidence and reimbursement and different international approaches that are being implemented to tackle this

This episode focusses on PIFU (patient initiated follow up) and how technology is helping to reimagine outpatient care pathways. It features a conversation with Tom Whicher, CEO and co-founder of DrDoctor Discussion topics include: - How technology enabled patient initiated follow up pathways are helping patients, clinicians and the healthcare system  - How data from appointment bookings is enabling a personalised approach to patient appointment booking and outpatient care  - How PIFU technology can help to even out the variability in care experienced in the NHS

In this episode Giuseppe Sollazzo shares his insights from the NHS AI lab skunkworks programme - an initiative to find new ways to use AI for driving forward the early adoption of technology in the NHS.

Discussion topics include:

- The value of an open-source approach to AI development in the public sector

- The importance of being transparent about both successes and failures

- The role of MDT AI teams in the NHS and upskilling the workforce in relation to AI

More information about the skunkworks projects here: https://transform.england.nhs.uk/ai-lab/ai-lab-programmes/skunkworks/

This episode features a conversation with Dr Saddif Ahmed- Director of Clinical Safety and Accuracy at Flo Health, uncovering how femtech products are providing novel insights into women's health. Discussion topics include: - How period tracking apps are leading to earlier diagnosis of women's health disorders - How femtech data is challenging conventional medical wisdom and offering novel insights into how sleep, mood and exercise vary of their menstrual cycle - The potential for future research in the field using data collected at scale from apps and wearables

In this episode, we delve into the realm of AI regulation and its impact on the future of medical AI innovation in UK. Joining me is the esteemed Professor Stephen Gilbert, a medical device regulatory science academic.

During our discussion, we explore:

• The necessity for innovative regulatory approaches in the AI domain
• The diverging paths of EU and US regulatory strategies
• Challenges posed by the EU MDR approach and its horizontal regulatory system
• Pioneering approaches to regulation, emphasising system rather than product-level oversight

Relevant publicatons:

https://www.jmir.org/2023/1/e43682

https://www.nature.com/articles/s41591-023-02412-6
https://www.sciencedirect.com/science/article/pii/S2949761223000421

This episode features a conversation with Dr Azeem Alam, member of the RSM Digital Health Council and co-founder of Bitemedicine, the creators of Bitelabs, a healthtech and innovation fellowship for clinicians  Discussion points include: - The bitelabs fellowship - Ways clinicians can gain experience in digital health - How you can combine tech experience with clinical training  - Roles for clinicians within healthtech companies Resources/opportunities discussed during the podcast: Bitelabs: @BiteLabsHealth https://bitelabs.io Fellowships/programmes: - Topol Digital fellowships:⁠ ⁠⁠Topol Digital FellowshipsHealth Education Englandhttps://topol.hee.nhs.uk › digital-fellowships⁠Fellowships in Clinical Artificial Intelligence : https://www.aicentre.co.uk/fellowships - National medical director's clinical fellow scheme (digital roles available): https://www.fmlm.ac.uk/programme-services/individual-support/national-medical-directors-clinical-fellow-scheme - Royal College of Physicians Flexible portfolio training (clinical informatics stream): https://www.rcplondon.ac.uk/projects/flexible-portfolio-training - Clinical entrepreneur programme: https://www.england.nhs.uk/aac/what-we-do/how-can-the-aac-help-me/clinical-entrepreneur-programme - Digital health leadership programme https://digital-transformation.hee.nhs.uk/digital-academy/programmes/digital-health-leadership-programme - Harvard health tech fellowship https://projects.iq.harvard.edu/healthtechfellowship/fellowship-overview - Stanford biodesign innovation fellowship:https://biodesign.stanford.edu/programs/fellowships/innovation-fellowships.html - Faculty fellowship: https://faculty.ai/fellowship-fellows/ - Entrepreneur First: https://www.joinef.com/ Events: - Royal Society of Medicine Digital health council events - HETT - Digital health Rewired - SomX events - Intelligent Health  - Med-tech World Blog article about different roles for clinician in digital health: https://medium.com/@annabellepainter/what-is-a-digital-doctor-db14522ec398 Range- Generalism book: https://davidepstein.com/the-range/

This episode features a conversation with Dr Satya Raghuvanshi- VP at Accurx exploring the development of healthtech communication tools in the NHS. Discussion points include - How Accurx is solving entrenched communication problems in primary & secondary care - Accurx’s approach to product development and market entry that have contributed to its success - How Accurx is now tackling elective recovery

This episode features a conversation with Professor Colin Espie Professor of Sleep Medicine at the University of Oxford and co-founder and Chief Scientist at Big Health. It focusses on the topic evidence generation for digital therapeutics

Discussion topics include:

- Why evidence generation is so important for digital therapeutics

- The distinction between evidence-informed and evidence-based therapies

- The challenge of designing placebo controlled trials for digital therapies

Links to papers:

https://www.healthaffairs.org/do/10.1377/forefront.20220223.739329/

https://www.jmir.org/2023/1/e43682

This episode features a conversation with Dr Hugh Harvey- Managing Director at Hardian Health exploring the regulatory, ethical and logistical challenges involved in developing Large Language Models (LLMs) as medical devices.

Discussion topics include:

- A step-by-step guide to the regulatory approval process for LLM medical devices

- Should users be allowed to ask general purpose LLMs (like chatGPT) medical questions?

- What needs to change in current regulation in order for it to keep pace with recent AI developments

Blog posts mentioned in podcast:

Hardian Health blog by Hugh Harvey: https://www.hardianhealth.com/blog/how-to-get-regulatory-approval-for-medical-large-language-models

MHRA LLM blog post: https://medregs.blog.gov.uk/2023/03/03/large-language-models-and-software-as-a-medical-device/

RSM Ethics and Regulation for AI in health event: https://www.rsm.ac.uk/events/digital-health/2022-23/ter04/

This episode features a conversation with Dr Murray Ellender- CEO of eConsult. It explores how innovative digital triage tools are catalysing new ways of working and improving system efficiency within the NHS.

Discussion points include:

- Digital triage enabled primary & secondary care

- The concept of one unified 'digital door' across NHS services

- The future of AI-enabled triage

Exploring Google's consumer mental health efforts with Megan Jones Bell, Clinical Director- Consumer and Mental Health at Google & ex-Chief Strategy and Science Officer at Headspace.

This episode is themed on mental health to accompany the upcoming Digital Health section event 'Digital mental health in adults and older people' https://www.rsm.ac.uk/events/digital-health/2022-23/ter52/

Find out more about Google's consumer mental health efforts here: https://blog.google/technology/health/mental-health-month-2022/