DeepMind Health, the fraction of the Google-owned AI company thats applying machine learning to medical data in the hopes of profiting from diagnostic gain, has inked another services agreement with the U.K.s National Health Service expanding the deployment of an alertings, messaging and task control app, Streams, to a infirmary in Taunton& Somerset.
This expansion derives despite ongoing controversy over the companys first NHS data-sharing agreement. The sharing of 1.6 million cases medical records with DeepMind by the Royal Free NHS Trust during the development of Streams remains under investigation by the U.K.s data protection guardian, the ICO.
Patients were not informed nor their consent attempted. Yet the Streams app had now been play an active role in deployed in the Royal Frees hospitals. And DeepMind is now forging ahead significantly, by inking a commercial agreement with a third NHS Trust to positioned the task conduct app, following an agreement with Imperial College Healthcare NHS Trust last December.
Announcing the latest Streams app agreement on its blog, DeepMind induces no mention of the ongoing data-sharing approval discussion is connected to the apps development.
At Musgrove Park Hospital, part of Taunton and Somerset NHS Foundation Trust,[ Streams] boasts will alert doctors and wet-nurses to a potential slump in their patients vital sign that could indicate a serious problem, it writes. We believe that by making it as rapid and easy as possible for clinicians to intervene if something is wrong, well be able to improve patient safe across the hospital.
DeepMind would not remark when asked to comment on the ethics of expanding a commercial rollout when incredulity has been given over the legal basis under which cases data was find and used during the development chapter of the app.
DeepMind and the Royal Free previously retained “there werent” need for them to obtain patient permit for the sharing of medical records as the Streams app would be used for so-called direct patient care. However, thisMay a review of the arrangement by the U.K.s case data refuge advisory organization, the National Data Guardian( NDG ), resulted in Dame Fiona Caldicott taking a very different view.
My considered opinion hence remains that it has not been able to ought to have within the reasonable apprehension of cases that their records would have been shared for this purpose, wrote Caldicott in a letter sent to DeepMind and the Trust in question on February 20.
The NDG has been liaising with the ICO as part of its investigation into the data sharing.
Asked whether it has had any specific concerns relating to the arguing encircling Streams, the Trusts deputy united states president Peter Lewis told us: Clearly we are taking the information governance issues around this very seriously. And weve looked at exactly what we are doing with that app, and will be doing with DeepMind. Clearly weve taken the appropriate advice on that. So were quite clear in terms of what weve done and that its legal, exactly what we doing.
There is not yet a conglomerate appointment for launching of Streams within Musgrove Park Hospital, whose website states it plows more than 450,000 cases yearly. Were starting on the planning stage just now, Andrew Forrest, CIO, told us. Well has been extremely open about when were going to start using it as a captain once we know.
The Trust also said it does not yet know how many cases medical record will be shared under the arrangement because work has not been able to inaugurated and no data has started flowing.
In astatement about the forthcoming deployment of the Streams app at Musgrove Park Hospital, the Trust saysthe app will be available at the bedside to notify doctors and wet-nurses to any patients needing immediate analysi, and used to help rapidly deciding whether the patient has other serious conditions such as acute kidney injury.
What were doing with DeepMind is not inconsistent around the roadmap we had with digital regardless, addedLewis, in an interview with TechCrunch. In words of thinking about how do we need to run a hospital if we were able to take advantage of what we can do digitally what will make a big difference?
Data torrents under review
DeepMind co-developed Streams between descend 2015 and 2016 with the Royal Free NHS Trust. The app calls an existing NHS algorithm to push alertings to attend staff when individual patients might be at risk of a condition called Acute Kidney Injury.
However, after it rose how much patient-identifiable data was being shared under the original arrangement, and how regulators had not been pro-actively informed of the project, the ICO established a probe.
DeepMind and the Royal Free subsequently went on to reboot the project viaa brand-new contractin fall last year. Yet underlying data governance contentions remain.
The new works agreement, withTaunton& Somerset NHS Trust, sees, at first glance, to be more a robustly defined entity than the original information sharing agreement( ISA) inked with the Royal Free NHS Trust.
A redacted edition of the services agreement between DeepMind and Somerset has been uploaded onto DeepMindswebsite. Various portions have been entirely redacted such as a division registering subcontractors on development projects, and a representation testifying a data spurt map.
Notably, though, theres a narrowing of the types of data that are being shared to specify the Somerset Trust shall not provide DeepMind with access to the personal data of patients who are not active patients.
This compares favorably with the first Royal Free ISA, which included sharing historical medical records from cases dating back five years old, for example, many of whom is no longer able be actively undergoing therapy at the hospital or ever likely to return.
There also is a limit on DeepMinds processing of Trust patients personal data so it cannot be used to develop software outside the remit of the agreement.
And there are what look like expressions to purpose-limit how DeepMind can exploit any IP that emerges as a result of the collaboration i.e. revelations that can be deduced from the data, and/ or extracted as a result of the company being in a position to see how NHS detection moves through to treatment, for example.
Again, IPR restraint were missing from the first Royal Free ISA.
Heres the related paragraph from the Somerset agreement 😛 TAGEND
The Trusts Lewis told us: Two things are really important that we have been very clear about: one is that were not employing any patient data for measuring. We will use dummy the necessary data for test the app now. And the authorities concerned will then, as we go it out, we will be using live data and it will only be our clinical staff who are accessing that live data to treat the patients when we do it.
The second important consideration was the amount of data that is transferred so that were only conveying data that relates to active patients who are under our upkeep So its clearly articulated therefore what patients are active and only carrying data relating to them.
He added that active patients makes patient who are on an open care pathway with us, and patients admitted in emergencies in some circumstances given there may also be a risk of A& E admissions developing AKI.
What weve too done is written to the National Data Guardian delineating such an approach not only to seek advice if we are taking the erroneous approaching but to confirm that we are doing job which is safe and which is legal, added Forrest. We havent started the results of this work hitherto this is our meant approach.
Giving an early take on the latest Streams agreement, prof Eerke Boiten, who attends research in data privacy and morals, were of the view that lots of lessons have been learned by DeepMind after its Royal Free cooperation ran into trouble indicating, for example, that the Somerset agreement includes an definite evidence that data will not be linked.
Concerns had already been been raised about what else the Google-owned company might do with Royal Free cases data as a result of a lack of clearly defined limits in the contract.
Digitizing health data and delivering apps
Streams “ve never” exploited anyof DeepMinds AI expertise or its own machine learning algorithm. Although a memorandum of understanding between the company and the Royal Free lay out DeepMinds hope to gain data for machine learning investigate as part of the wider, multi-year the cooperation between the pair.
There is no similar MoU with the Taunton& Somerset NHS, according to Lewis. Nor is there any mention of applying AI or DeepMind machine learning algorithms to its patients data the focus is on text messaging and clinical assignment management.
This is specifically about the Streams application. We dont have any other agreement an MoU or a formal contract with DeepMind. Just this one, he demonstrated, adding that the Trust has no interest in applying AI to patient data at this time.
The five-year works agreement with the Taunton& Somerset NHS Trust, which was signed on May 10 this year, extends both its implementation of the Streams app and an underlying case data API infrastructure whats known as an FHIR API which DeepMind fleshed out in more detail last year.
While the company began its health tech approach by working on a single app( Streams ), it had now been bolted that to this underlying app bringing infrastructure thereby potentially sentiment itself to be a agent for other app developers wanting to push their own apps to NHS Trusts in the future.
On this possibility the Trust announced upbeat.
The entire station of the FHIR development is its open and standardized so that there are alternatives which become available. I recall the FHIR standard will become the defacto guideline in the various regions of the NHS wholly, saidForrest.
While the services agreement is tied to Streams, the Trust also is evidently hoping to be able to apply a same exercise management app approach to added conditions in the future with such arrangements talking about additional modules that might be developed for the app, i.e. to expand out from precisely acting as an earlier sensing early warning system for AKI.
Lewis explained the aim is to digitize other prevailing paper-based process although it was has still not been clear accurately which added condition alerts might be bolted on to its deployment of Streams in the future.
This is really based on individual patients, so that what weve came in there is data about the patient and about whats happening to the patient while theyre now with us as an in-patient that can help us relate when there are potential difficulties, mentioned Lewis.
So whether the government has about AKI or whether the government has about sepsis, for instance, we will know when things are happening with that patient that we need to react to. And all of that happens at the moment the problem is a lot of it is recorded manually on paper, and staff members have to do specific estimates to calculate whats called acts like early warning orchestrates, which means we need to react. So whilst that works well on paper youll appreciate its much better to digitize that and have it done much more in real age, and then the alerts and so on are automated.
Thats how “weve been” will drive safer patient care through doing this, he added.
Commercial question marks
Lewis confirmed to TechCrunch that the Trust did not put out a tender for the development of what it greenbacks as a patient-focused portable app.
Rather, the agreement with DeepMind came out of a series of conversations with the company. He noted that the Trust was last year one of a handful specified as a global digital exemplar, which led it to numerous the talks with suppliers aimed at delivering on a digital roadmap.
We were having a dialogue with different suppliers, including DeepMind, and this agreement has come out of that, he told us.I cant retain exactly when the initial contact happened but there was quite an informal contact between ourselves and DeepMind and this just thrived out of a conversation that was happening It wasnt something that we deliberately went and said this is what we need to do.
What we havent done, and havent needed to do, because weve got legal advice for this, is leave out to a full competitive tender process .
Is that standard practice for the Trusts procurement of services that are? It depends on exactly what we are doing and how we are testing those options. So we didnt just say DeepMinds the only option and thats what were going to do weve been looking at alternatives. What we havent done, and havent needed to do, because weve got legal advice for this, is start out to a full competitive affectionate process.
He also confirmed there are no wider arrangements with the company such as the Royal Frees MoU.But he declined to disclose anything about the commercial grouping with DeepMind.
Were not at liberty to discuss the commercial-grade detail of the contract, answered Lewis.
Commercial expressions have been redacted from the ISA uploaded to DeepMinds website 😛 TAGEND
Regarding the business model, under our agreement the Trust will pay DeepMind only a limited service fee if DeepMind incur support costs when providing the services. As with our other agreements, we dont believe in blaming the NHS for yet-to-be-proven answers, she added.
Only when we can prove that we have improved outcomes will we be paid accordingly within IT supplier market proportions. Were not driven by a desire to maximize revenue, but rather to create a mutually sustainable business simulation so that we can continue to grow our squad, work with more hospices and, eventually, facilitate more patients.
The ongoing scarcity of any business information for the pricing of the Streams service is significant given that this is a service being sold to the public sector. And if NHS Trusts are inking are dealing here with a tech monstrou without put forward by open affectionates, there could be legal issues to consider such as compliance with procurement regulates, and even concerns relating to possible anticompetitive behavior.
Although, obviously, Lewis is confident that the Relies own legal advice on the procurement pitch is sound i.e. that it didnt need to run an open, competitive procurement in this case.
Another consideration: The BBCreported earlier that NHS patients are not being offered an opt-out for their medical record to be shared with the Google-owned company.
Asked about this, Lewis said their aim is to engage with patients so they understand the app and its implications.
We need to work this through. Clearly theres checks and balances now were trying to be very open about exactly what we doing and therefore we have a process in place from here on about how were locking with cases to work through exactly how we do that. But this is built on the premise that we are using the information about these patients in this way to improve their care and reach them more safe so that particularly were heightening languishing cases much earlier and we can therefore has responded to that, he said.
Thats the whole proposition on which were doing this but we are going to go through that engagement process with cases one so they can understand exactly what were doing, and two so that we can understand the same concerns and look at how it is possible to relieve them.
The Trust will be holding shops, presentations and open day events with staff and the public over the course of the next dates and weeks, so that people can see how the app operates, what it will mean for patients and how it might be developed in future, as it situates it.
The first of these events will take place on July 17, with knowledge slated to be displayed in the public foyer of the hospital.
The Trust also has indicated it intends to publish its Privacy Impact Assessment of the agreement with DeepMind though at the time of writing, the purposes of this report has not yet surfaced.
In a statement about its ongoing investigation into the original data-sharing administer between DeepMind and the Royal Free, an ICO spokesperson told us: The ICO continues to investigate the sharing of 1.6 million patient items by the Royal Free NHS Foundation Trust with Google DeepMind in support of the testing and development of an notify, diagnosis and spotting plan for acute kidney hurt. We hope to conclude that work shortly.
We will also speak with Taunton and Somerset NHS Foundation Trust to furnish our advice on the laws and regulations, the spokesman added.
Chastening: This announce originally was also pointed out that DeepMinds Somerset business agreement is another agreement it has inked with an NHS Trust to roll out the Streams app; in fact it is the third. The previous agreement are with the Royal Free NHS Trust and Imperial College Healthcare NHS Trust .