Accelerating Artificial Intelligence in health and care: results from a state of the nation survey - AUTUMN 2018 - KSS AHSN

Page created by Ana Robertson
Accelerating Artificial Intelligence in health and care: results from a state of the nation survey - AUTUMN 2018 - KSS AHSN
Artificial Intelligence
in health and care:
results from a state
of the nation survey
Accelerating Artificial Intelligence in health and care: results from a state of the nation survey - AUTUMN 2018 - KSS AHSN
Accelerating Artificial Intelligence in health and care:
                                         results from a state of the nation survey    3

4:   Foreword

6:   Introduction

8:   Executive summary

10: What do we mean by AI in health and care?

14: Results of the national survey about AI
    technologies in health and care

22: Real world analysis: feasibility and

38: Summary and next steps

44: Appendix 1: Case studies

48: Appendix 2: Further reading

52: Appendix 3: Glossary

59: Acknowledgements

62: About The AHSN Network AI Initiative
4     Accelerating Artificial Intelligence in health and care:
      results from a state of the nation survey
                                                                                                                                                                                        Accelerating Artificial Intelligence in health and care:
                                                                                                                                                                                                      results from a state of the nation survey               5

New technologies that harness                 envisions what can be achieved         As it stands, the NHS is primed to   We have already made some               industry, academia, innovators            By working together we will
the power of data, like artificial            when the vast potential of AI is       use AI to improve its efficiency,    important steps forward in              and commissioners we will                 be able to explore all potential
intelligence (AI), present huge               unlocked. The report is based          deliver better outcomes and          this area. These include the            continuously iterate the principles       avenues of opportunity, and risk,
opportunities to transform                    on a survey conducted by NHS           prevent ill health. However,         introduction of a new national          and guidance contained in the             and to make sure that none are
healthcare, improve the quality               England and the AHSN Network           we must be realistic about the       data opt-out and by the Bill,           Code. Together, we will work to           missed. We hope that, based on
of people’s lives, and to make the            AI Initiative, and it underlines the   challenges. First and foremost,      currently before Parliament, to         ensure that the NHS gets the              this reassurance and reflecting on
job of working within the health              potential for AI to contribute to      the public must have confidence      put the National Data Guardian          maximum possible benefits from            the information presented in this
and care system more rewarding.               improved care: 94% of the UK’s AI      that AI (and the health data which   on a statutory footing. At the end      these partnerships, both for              enlightening report, you are left
We are determined to harness                  thought-leaders cite AI as being       fuels the development of new         of this report we point to, for the     existing use cases of AI and those        feeling as optimistic as we are
this potential.                               extremely important or very            algorithms) is being used safely,    first time, a Code of Conduct for       that appear in the future. And, of        about the ability of technology,
                                              important for diagnostics; 89%         legally and ethically, and that      Digital Health Innovations and          course, these developments all            and AI in particular, to transform
While these opportunities are
                                              support this view for operational      the benefits of the partnerships     Intelligence Algorithms, which is       take place in the context of our          health and care.
available to every country, the
                                              and administrative goals; and,         between AI companies and the         designed to provide a national          review of the current regulatory
UK is well-placed to take a global
                                              79% have this opinion in regard to     NHS are being shared fairly. As      set of ‘rules of engagement’ for        framework and analysis of the
advantage in this field. By virtue
                                              the benefits for health promotion      a consequence, realising the         any NHS organisation entering           future needs of the health and
of our universal single-payer
                                              and preventative health. The           potential of AI in health and        into a partnership with an AI           care workforce.
system, the complete longitudinal
                                              report cites many exciting             care requires changes to data        developer.
datasets the NHS holds on every
                                              examples of pilot schemes and          infrastructure, organisational                                               A collaborative approach is
citizen’s health and care, and
                                              more developed programmes              structures, commercial               Inevitably, there is still more to do   important; no single partner in
our world-leading AI and tech
                                              that are already delivering better     arrangements, and models             to seize the opportunities ahead.       this endeavour has a monopoly
industries, our goal should be to
                                              healthcare for British patients.       of consent.                          By working collaboratively with         on wisdom about what will work.
bring the transformative power of
AI to every corner of the NHS.
For that reason, we are delighted
to introduce this ‘state of the
nation’ report, which looks to the
future of health and care and

                                                                                                                                                                            Matt Hancock                               Lord O’Shaughnessy
                                                                                                                                                                          Secretary of State                           Parliamentary Under
                                                                                                                                                                                                                        Secretary of State
                                                                                                                                                                        Department of Health
                                                                                                                                                                          and Social Care                             Department of Health
                                                                                                                                                                                                                        and Social Care

                                                                                                                                                                                                               Photo attribution: Chris McAndrew [CC BY 3.0 (https://
                                                                                                                                                                                           ], via Wikimedia Commons
6     Accelerating Artificial Intelligence in health and care:
      results from a state of the nation survey
                                                                                                    Accelerating Artificial Intelligence in health and care:
                                                                                                                  results from a state of the nation survey    7

                                                                                     The report is split into
In recent years there have been a
number of policy reports published
                                              intelligent technology is being
                                              realised. This survey went live to
                                                                                     four main sections:
on the potential for artificial               the nation at the start of 2018 and
intelligence in healthcare. In this           we have captured throughout this            What do we mean by AI in health
report we are not attempting to               report the initial findings from the    1   and care? This section describes
recreate that content but rather              131 responses.                              how AI is broadly defined and shows
to address some of the concerns                                                           how, as AI evolves, it is becoming an
                                              In order to present a rich picture
raised and outline some of the                                                            increasingly complex landscape.
                                              of the nation’s ecosystem and
emerging policy in this arena within
                                              bring to life the complex and
the UK.
                                              multifaceted aspects of the
                                                                                          Results of the 2018 national survey
We developed a survey in                      industry, the report also highlights
collaboration with industry,                  a number of case studies that set
                                                                                      2   of AI technology in health and care,
                                                                                          and the defining characteristics of
academia and policy makers in an              the scene for the work needed to
                                                                                          the first 131 solutions that were
attempt to capture the reality of             scale up evidence-based solutions
what technology is actually being             that are safe, effective and offer
developed within the UK health                value going forward.
and care sector, and to understand                                                        Real world analysis of feasibility
what complexity of artificial                                                         3   and implementation based on
                                                                                          evidence from over 100 leaders
                                                                                          and pioneers working in the field.
                                                                                          This highlights the top barriers and
                                                                                          enablers for catalysing an ethical,
                                                                                          evidence-based market for AI-
                                                                                          enabled solutions in health and care,
                                                                                          and defines the issues that will set
                                                                                          the agenda for the sector over the
                                                                                          coming months and years.

                                                                                          A summary of proposed next steps.
                                                                                      4   This includes the key themes for
                                                                                          policy makers to develop a ‘Code
                                                                                          of Conduct’ for an AI-enabled
                                                                                          digital health and care market
                                                                                          going forward, and the regulatory
                                                                                          challenges that need to be
8   Accelerating Artificial Intelligence in health and care:
        results from a state of the nation survey
                                                                                                                                                                                                                 Accelerating Artificial Intelligence in health and care:
                                                                                                                                                                                                                               results from a state of the nation survey    9

Over the last few years numerous                 The survey                                        The results shows that AI has                     •   ground AI solutions in real      Showcase                                  Code of conduct
reports have been written about                                                                    huge potential to transform                           ‘problems’ as expressed
                                                 The survey was developed with                     whole the health and care                             by the users of the health       To show what can be achieved as           To address these challenges, a
the opportunities and benefits
                                                 the input of the AHSN Network                     system. Unlocking value in data/                      system;                          AI is embraced across health and          number of workstreams have
artificial intelligence (AI) can
                                                 AI Initiative Core Advisory Group                 analytics was the top category                                                         care, this report showcases some          already been initiated across
offer for healthcare. These have                 (individual members are listed                                                                      •   engage healthcare
                                                                                                   (75%) addressed by solutions                                                           of the emerging examples of               the UK health and care sector.
ranged from the Reform report1                   in Acknowledgements) and sent                                                                           professionals and create an
                                                                                                   submitted for the survey,                                                              more complex AI methodologies             These include the Topol review
illustrating the areas where AI                  out nationally via the AHSN                                                                             ethical framework to enhance
                                                                                                   followed by condition recognition                                                      currently being used and which            on workforce; a set of principles
could help the NHS become                        Network and a number of AI and                                                                          and preserve trust and
                                                                                                   (60%) and organisational                                                               hold significant potential to             and guidelines summarised in
more efficient to the report by                  innovation networks including                                                                           transparency;
                                                                                                   processes (50%).                                                                       deliver impact at scale in NHS,           a Code of Conduct for digital
Future Advocacy2 which reviews                   the AI community run by NHS                                                                         •   build capacity and capability;   social care and, importantly,             health innovations incorporating
the ethical, social and political                Horizons. The survey results are                  Whilst impressive, the survey                     •   ensure the regulatory            in preventative health. As the            intelligent algorithms; and
implications of AI in health and                 self-reported and were compiled                   shows that many solutions are                         framework is fit for purpose;    complexity and capabilities of            a number of initiatives to
                                                 and analysed by a team at Kent                    primarily in their infancy and have                                                    these projects increase, it is vital      understand and unlock the value
medical research.                                                                                                                                    •   explore innovative new
                                                 Surrey Sussex Academic Health                     a long way to go before the true                                                       that the policy and organisational        of data to provide maximum
                                                                                                                                                         funding and commercial
While acknowledging these                        Science Network, supported by                     potential of AI for health and care                                                    contexts, processes and                   benefit to citizens and UK plc.
                                                                                                                                                         models; and
reports exist, we felt there was                 Health Education England Kent                     can be realised. As one survey                                                         regulation evolve to keep pace.
a need to understand what is                     Surrey Sussex. This report is a                   respondent commented ‘AI is                       •   focus on building a
                                                 collaboration between the AHSN                    still evolving... it won’t solve all                  sound data infrastructure
actually happening on the ground
                                                 Network, NHS England, NHS                         the problems healthcare faces at                      and high quality data
and what is being developed. We
                                                 Digital and the Department for                    the moment’ and we must avoid                         sets, underpinned by
also wanted to ask people within                                                                                                                         interoperability and sharing
                                                 Health and Social Care.                           the trap of ‘overhyping potential,
the health and care system who                                                                                                                           standards.
                                                 Survey respondents included                       unrealistic claims and poorly
use artificial intelligence (which
                                                 CEOs, senior managers and others                  thought out products.’
is summarily defined as a series                                                                                                                     Furthermore, momentum is
                                                 working across the AI ecosystem                   The survey revealed that realising
of advanced technologies that                                                                                                                        starting to build for unlocking
                                                 in England. They represented both                 the truly huge potential of AI                    open innovation through
                                                                                                                                                                                                    ‘Focus on building
enable machines to effectively                   large organisations with 250 staff
carry out complex tasks that                                                                       to transform health and care                      establishing open data
                                                 or more (32%) as well as micro                    services will require overcoming
would require intelligence if                                                                                                                        ecosystems across health and
                                                 organisations with less than 10
completed by a human) what
stage of deployment their work
                                                 staff (28%) across private, public
                                                 and charitable sectors as well as
                                                                                                   several key barriers, and
                                                                                                   working together across the
                                                                                                                                                                                                    a sound data
                                                                                                   AI ecosystem to:
has reached.                                     academia.
                                                                                                                                                                                                    infrastructure and
                                                                                                                                                                                                    high quality data
                                                                                                                                                                                                    sets, underpinned by
                                                                                                                                                                                                    interoperability and
 Harwich, S. and Laycock, K. (2018). Thinking on its own: AI in the NHS. Reform. Available at:

                                                                                                                                                                                                    sharing standards’

 Fenech, Matthew, Strukelj, Nika and Olly Buston (2018). Future Advocacy and Wellcome Trust. ‘Ethical, social and political challenges of
artificial intelligence in health’. Available at:
10   Accelerating Artificial Intelligence in health and care:
     results from a state of the nation survey
                                                                                                                                      Accelerating Artificial Intelligence in health and care:
                                                                                                                                                    results from a state of the nation survey    11

                                                                        There is no single, universally          better understand clients’              Thanks to advances in AI and
                                                                        agreed definition of AI, nor indeed      current and potential future            Big Data research, narrow AI
                                                                        of ‘intelligence’. Broadly speaking,     financial needs.                        technologies have the potential
                                                                        intelligence can be defined                                                      for wide application in health and

                                                                        as ‘problem-solving’, and ‘an          • Ambient (Intelligence) -                social care, bringing benefits to
                                                                        intelligent system’ as one which         the application of several              individuals, families, communities,
                                                                        takes the best possible action in        technologies (including                 and society as a whole. While
                                                                        a given situation.                       Artificial or Augmented                 early examples from our survey
                                                                                                                 Intelligence, but also sensor

                                                                                                                                                         illustrate that much of this work
                                                                        The ‘A’ of AI generally refers to        networks, user interfaces,              is at an early stage, current
                                                                        one of the following:                    home automation systems,                technologies support a more
                                                                        • Artificial (Intelligence) – makes      etc) to create proactive ‘smart’        general shift away from reactive

                                                                          it possible for ‘machines’ to                                                  care models to models that are
                                                                          learn from new experiences,                                                    more personalised and proactive.
                                                                                                               AI is generally classified into the
                                                                          adjust outputs and perform
                                                                                                               following types:                          But this is not without its
                                                                          human-like tasks. It can be
                                                                                                               • Narrow AI typically focuses on          challenges in health and social
                                                                          thought of as the simulation
                                                                                                                 a narrow task, or works within a        care and more widely – ensuring
                                                                          of human intelligence and
                                                                                                                 narrow set of parameters such           these technologies are fit for
                                                                          could include voice and visual
                                                                                                                 as reading radiology scans, or          purpose, ensuring outputs are
                                                                          recognition systems.
                                                                                                                                                         transparent and explainable, and
AI describes a set of advanced technologies that enable machines to     • Augmented (Intelligence)
                                                                                                                 optimising hospital workflows;
                                                                                                                                                         ensuring people are trained in the
carry out highly complex tasks effectively – tasks that would require     - outputs that complement            • Strong or general AI is a               use of these new technologies.
                                                                          human intelligence,                    hypothetical concept which
intelligence if a person were to perform them.                            emphasising AI’s                       can refer to an AI that can learn
                                                                          supplementary role. Examples           to perform several different
                                                                          include tools that support             types of task, or to a sentient
                                                                          radiologists in reviewing large        machine with consciousness
                                                                          numbers of scans, or that              and mind.
                                                                          support financial advisors to
12      Accelerating Artificial Intelligence in health and care:
        results from a state of the nation survey
                                                                                                                                                                                                            Accelerating Artificial Intelligence in health and care:
                                                                                                                                                                                                                          results from a state of the nation survey    13

                                                                                                                                                 Example of how simple components form modules
                                                                                                                                                     which then form a complex AI application

                                                                       There is a significant amount of effort being
                                                                       devoted in the research space to map machine
                                                                       learning and AI, but it has been challenging to

            scale in AI
                                                                       categorise them according to their ‘intelligence’.                                                             decision
                                                                       Thus far, attempts at categorisation have been                                                                 support                                                            Complex
                                                                       limited to looking at their generic ability to solve                                                           system                                                            application
                                                                       new problems, and at the speed with which they
                                                                       adapt to these problems.
                                                                       A more straightforward way of understanding AI
                                                                       is to classify AI systems by their complexity. A
                                                                       ‘Complexity Scale for AI’ can be seen in the boxed                                 Inference                                               User
                                                                                                                                                            engine                                              interface                                 Modules
                                                                       section and compared with methods and case
                                                                       studies revealed in our survey.
                                                                       A glossary of AI-related terms used within the
                                                                       Complexity Scale for AI can be found at Appendix 3
                                                                       on page 50.
                                                                                                                                           Algorithm derived                                                                                            of modules
                                                                                                                                                                      Link to EPR for         Interface widgets          Context-sensitive
                                                                                                                                              by ML from
                                                                                                                                                                       current case            & resource files                help
                                                                                                                                           historical dataset

  High complexity                   Middle complexity              Low complexity
  AI applications                   AI modules or                  AI reasoning methods
                                                                                                                                                 Devised by Jeremy Wyatt, Director and Professor of Digital Healthcare, Wessex Institute of Health Research,
                                    components                                                                                                    Clinical Advisor on New Technologies, Royal College of Physicians, Fellow of American College of Medical
                                                                                                                                                                              Informatics & UK Faculty of Clinical Informatics)
  •   Autonomous vehicle            •   Natural language           •    Deep learning module
  •   Machine translation tool          to SNOMED code             •    Ensemble methods (e.g. Random Forest Models)
                                        processing module
  •   Care companion robot                                         •    Neural networks
                                    •   Image processing
  •   Chat bot                                                     •    Object segmentation algorithm
  •   Surgical or pharmacy                                         •    Signal processing algorithm / filter                           The lowest level of the complexity        The above provides an example                 state that they use ‘AI’. We would
                                    •   Text to speech module
      robot                                                        •    Generative adversarial networks                                scale comprises single specific           of a complex AI application.                  also like to encourage those
                                    •   Knowledge based or
  •   Mammogram
                                        expert system module       •    Time series analysis                                           reasoning methods (e.g. neural                                                          investing in these technologies
      interpretation system                                                                                                                                                      Algorithms in healthcare are not
                                    •   Signal processing &        •    Graphical models                                               networks, pattern recognition                                                           to understand what type of AI is
  •   ECG interpreter                                                                                                                                                            a new phenomenon and have
                                        classification module      •    Decision trees, rule induction e.g. CART                       algorithms). When these                                                                 being developed, how complex it
  •   Diagnostic decision                                                                                                                                                        been deployed for decades.
                                    •   Recommender module         •    Clustering algorithm                                           reasoning methods are combined                                                          is, and indeed question what the
      support system                                                                                                                                                             What we have attempted to
                                                                   •    Classification algorithm                                       with other functions (e.g. a                                                            ‘A’ in AI truly represents.
  •   Speech driven radiology                                                                                                                                                    show here is how technology
      report tool with SNOMED                                      •    Regression – linear, multiple, logistic                        database or user interface), we
                                                                                                                                                                                 utilising intelligence within its
      coded output                                                 •    Inference engine for rules or frames                           get ‘modules’, which sit at the
                                                                                                                                                                                 algorithms can fall under many
                                                                   •    Argumentation, temporal or spatial reasoner e.g. QSIM          next level of complexity and are
                                                                                                                                                                                 different subsections and with
                                                                   •    Text generator using DCGs                                      the problem-solving components
                                                                                                                                                                                 varying degrees of complexity.
                                                                   •    Case-based reasoning algorithm                                 of a system. At the top level of
                                                                                                                                                                                 We encourage developers and
                                                                                                                                       complexity, we have applications
                                                                                                                                                                                 industry to be transparent as to
 Devised by Jeremy Wyatt, Director and Professor of Digital Healthcare, Wessex Institute of Health Research, Clinical Advisor on New   or packaged systems comprising
                                                                                                                                                                                 what complexity or methodology
Technologies, Royal College of Physicians, Fellow of American College of Medical Informatics & UK Faculty of Clinical Informatics)     two or more of these modules
                                                                                                                                                                                 they are utilising when they
                                                                                                                                       (e.g. an autonomous robot).
14   Accelerating Artificial Intelligence in health and care:
     results from a state of the nation survey
                                                                                                                                  Accelerating Artificial Intelligence in health and care:
                                                                                                                                                results from a state of the nation survey    15

                                                                         Complexity of
                                                                         current projects
                                                                       As part of the survey we asked     complexity scale (see previous               At the highest end of the
                                                                       respondents to list some of the    section), it can be seen that many           complexity scale, 8% of solutions
                                                                       AI methods employed in their       of the current solutions are using           employed machine translation
                                                                       solutions. This enabled them       ‘lowest complexity’ advanced                 methods. 20% of solutions
                                                                       to be categorised in a way that    statistical techniques rather than           indicated they used ‘other’ AI
                                                                       shows how solutions in the AI      more complex AI applications.                methods, including a range of

                                                                       space vary greatly in terms of     Classification and neural network            chat bot solutions (considered
                                                                       complexity.                        machine learning methods                     ‘highest complexity’ solutions).
                                                                                                          were by far the most popular
                                                                       By mapping some of the methods
                                                                                                          techniques, used by 60% and 51%

                                                                       employed by survey respondents
                                                                                                          of solutions, respectively.
                                                                       against Professor Jeremy Wyatt’s

                                                                                                                     The percentage of solutions
                                                                          Case studies                              reporting using a method of AI

                                                                                                                                                       Lowest complexity
                                                                          value now                                               Classification 60%
                                                                          A range of case studies                              Neural networks 51%

                                                                          identified through the                                 Decision trees 39%
                                                                          survey at various stages
                                                                                                                                     Clustering 36%
                                                                          of maturity (from those at
                                                                                                                           Time series analysis 33%
                                                                          research stage through to
                                                                          examples with regulatory                          Ensemble methods 25%

                                                                          approval and/or publicly                                  Regression 25%
                                                                          available) are listed in                            Graphical models 16%
                                                                          Appendix 1.                           Generative adversarial networks 11%

This section presents key findings from 131 self-reported entries in      These solutions are                 Knowledge based/expert systems 37%
                                                                          delivering value to the                            Image processing 33%
response to our survey that began in Spring 2018. The information         health and care sector in
has been used to create an online map that illustrates what sort of       the following areas:                                                         Middle complexity
                                                                          • Unlocking value in data/                              Text to speech 9%
problems are being solved currently, who some of the key players            analytics                              Natural language processing 38%
                                                                          • Leveraging skills and
are, and how we can group or categorise current projects to help our        capacity                                                                   Highest complexity
                                                                          • Organisational
understanding of the current reality of AI in health and care.                                                               Machine translation 8%
                                                                            processes                                     Other (please specify) 20%
                                                                          • Condition recognition.
                                                                                                                          Unsure/Not applicable 9%
16   Accelerating Artificial Intelligence in health and care:
     results from a state of the nation survey
                                                                                                                                                                  Accelerating Artificial Intelligence in health and care:
                                                                                                                                                                                results from a state of the nation survey    17

         Unlocking                                                                 Condition                                                                  With wide consensus that diagnostics presents
     value in data/                                                                recognition                                                                some of the strongest early AI use cases, we chose
                                                                                                                                                              to make it a special focus for this first AI map and
     analytics 75%                                                                 60%

                                                                                                                          in focus
                                                                                                                                                              Across the range of diagnostics categories, AI is
                                                                                                                                                              already offering opportunities to free up workforce
                                                                                                                                                              capacity and to dramatically increase diagnostic
                                                                                    The percentage of                                                         accuracy. Taking advantage of the convergence
                                                                                      solutions aiming                                                        across diagnostics, personalised medicine and
                                                                                                                                                              data science, some organisations on the map are
                                                                                      to address each                                                         already seeking to mine big data sets to enable
                                                                                    specified category                                                        identification of individuals at the earliest stage of
                                                                                                                                                              disease, when interventions have a higher likelihood
                                                                                                                                                              of success.
                                                                                                                                                              Overall, 66% of the initial solutions featured on
                                                                                                                                                              our map indicated they contained one or more
                                                                                                                                                              categories of diagnostics. As can be seen below,
                                                                                                                                                              many early solutions are in diagnostic imaging/
                                                                                                                                                              radiology (25%), where digital imaging has been
                                                                                                                                                              in widespread use for a number of years. This
                                                                                          skills and                                                          compares to far fewer solutions listed in pathology
                                                                                          capacity                                                            (9%) and endoscopy (3%), where the digital and AI
                                                                                          43%                                                                 solutions are only recently starting to emerge.

          processes                                                    Other
                 50%                                                   24%

         Key areas
                                                                We wanted greater insight into what types of
                                                                problems are being addressed across the range of
                                                                solutions. Survey respondents were able to select
                                                                                                                                Not applicable

          where AI                                                                                                      25%                               21%
                                                                multiple entries from a list of four categories.
                                                                Results can be seen below.
                                                                                                                                                                                                The percentage
                                                                Unlocking value in data/analytics was the top                                11%          Other
                                                                                                                                                                                                  of companies
        can deliver
                                                                category (75%) addressed by solutions submitted         Imaging/Radiology    Genetics
                                                                for the survey, followed by condition recognition
                                                                (60%). Organisational processes were addressed
                                                                                                                                             & Genomics                                          by category of
                                                                by half of the solutions, reflecting the increasing          9%                                                                     diagnostics

                                                                use of AI to automate routine clinical, managerial                                       Endoscopy
                                                                and back office tasks (e.g. document management,
                                                                paperwork and scheduling).
18   Accelerating Artificial Intelligence in health and care:
     results from a state of the nation survey
                                                                                                                                                   Accelerating Artificial Intelligence in health and care:
                                                                                                                                                                 results from a state of the nation survey    19

                            The percentage of solutions, which
                            indicated a point of care, delivering
                                  in each point of care site

                                                                                                          The percentage            Yes 57%
                                                                                                               of projects
                                                                                                          linked to smart
                                                                Patient’s own                                  connected
                                                                   home 49%
                                                                                              Other 13%
         Hospital 68%                                                     Residential care
                                                                          or nursing home,
                                                                          assisted living

                             Mobile, semi-mobile
                             units and other and                                  Personal/

                                                                                                          Point of
                                                                                                                             Another way that AI is enabling          (8%), vendor/supplier managed
                             ‘pop up’ style settings                              wearable
                                                                                                                             new models of care is by                 settings (19%) and mobile,
                             of no fixed abode 19%                              technology                                   using remote diagnostic and              semi-mobile units (19%), were

                                                                                                                             monitoring capabilities to               selected by the least number of
                                                                                                                             change where and how care is             respondents.
                                                                                                                             delivered. We asked solutions to
                                                                                                                                                                      Already, 57% of solutions within
                                                                                                                             indicate the points of care where
                                                                                                                                                                      the survey say they able to link
                                                                                                                             they deliver services (multiple
                                                            Vendor/supplier                                                                                           to smart connected devices (e.g.
                                                                                                                             selections were possible).
                                                                                                                                                                      Internet of Things). With super-
                                                            managed clinic                                                   Excluding those entries that did         fast 5G broadband networks
                                                             facilities 19%                                                  not indicate a point of care, the        being tested this year, it is likely
                                                                                          Medical                            majority of solutions reported           that the number of IoT-enabled
                                                                                         transport                           delivering services in hospitals         solutions offered in non-acute
                                                                                         vehicle 8%                          (68%), followed by a patient’s           points of care will increase over
Community or                                                                                                                 own home. Care settings such             the coming years as 5G networks
 primary care                                                                                                                as medical transport vehicles            are rolled out more widely.
    clinic 39%
20   Accelerating Artificial Intelligence in health and care:
     results from a state of the nation survey
                                                                                                                                                                                        Accelerating Artificial Intelligence in health and care:
                                                                                                                                                                                                      results from a state of the nation survey    21

                                            Regulation                                                                           Proprietary (closed source) 35%

                                             Our survey aimed to capture a             device. Devices meeting the
                                                                                                                                                    Unsure 19%
                                                                                                                                                                                                             The percentage of
                                             full range of AI activity across          requirements can place a CE                        Prefer not to say 16%
                                                                                                                                                                                                             solutions according
                                             the health and care ecosystem,            mark (or logo) on their product to                    Not applicable 14%
                                             ranging from ongoing research             show that the medical device has                Other (Please specify) 8%
                                                                                                                                                                                                             to type of licence
                                             projects to fully scaled                  met the requirements as set out
                                                                                                                                   GNU GLPv3 (open source) 4%                                                the computational
                                             commercial products and                   in the conformity assessment.
                                             services. With new solutions              The CE marking also means            Apache Licence 2.0 (open source) 3%                                              product has
                                             coming to market regularly, it is         that the product can be freely              MIT Licence (open source) 2%
                                             important for buyers (including           marketed anywhere in the EU.
                                             commissioners and consumers)              In the United States, the Food
                                             and users of AI to have                   and Drug Administration (FDA)
                                             mechanisms for distinguishing             provides medical device approval.
                                             which solutions have the
                                                                                       When we asked our respondents
                                             appropriate evidence base and
                                                                                       about regulatory status, only 18%

                                             are ready for ‘at scale’ adoption.                                                                                    Currently, 35% of solutions in          Proponents of open standards,
                                                                                       of solutions indicated they had
                                             In the UK, medical devices                secured approval in the UK/EU or                                            the survey have been developed          such as the Apperta Foundation,
                                             must demonstrate that they                abroad. A further 23% indicated                                             using proprietary (closed               a not-for-profit community
                                             meet the requirements set                 they were in the process of                                                 source) software, distributed           interest company supported by
                                             out in the Medical Devices                securing approval.                                                          under licensing agreement to            NHS England and NHS Digital,
                                             Directive by carrying out a                                                                                           named users who are given               maintain that liberating both data
                                             conformity assessment. The                                                                                            authorisation to modify, copy           and applications and making
                                             assessment route depends                                                                                              and republish applications. The         them portable and interoperable
                                             on the classification of the                                                                                          source code for this software is        eliminates lock-in, facilitates
                                                                                                                                                                   not shared publicly for anyone          innovation and competition,
                                                                                                                                                                   to look at or modify. Proprietary       and forces vendors to compete
                                                                                                                                                                   software developers often               on quality, value and service.
                                                                                                                                                                   pride themselves on product             A downside can include the
                                                                                                                                                                   ‘usability’ and providing a high        significant capacity and capability
                                                                                                                                                                   level of ongoing support for            required to run open platform
                                                                                                                                                                   maintenance, security, content          ecosystems.
                                                                                                                                                                   updates and training.
         The percentage of projects with regulatory approval                                                                                                                                               A further 19% are unsure what
                                                                                                                                                                   In contrast, only 9% of                 licence their computational
                                                                                                                                                                   respondents report using one of         product uses altogether, and this
                                                                                                                                                                   the following three open source         needs to be explored further to
                                                                                                                                                                   licences – GNU GLPv3, Apache            understand the reasons for this.
                                                                                                                                                                   Licence 2.0 and MIT Licence.
                                                                                                                                                                   Open platforms are vendor
             41%                                 23%                        18%                            18%                                                     and technology neutral and
                                                                                                                                                                   are based on open standards,
                                                                                                                                                                   meaning that any application
                                                                                                                                                                   built on an open platform will
                                                                                                                                                                   operate on an open platform.

       Not applicable                     In process of                           No                        Yes
                                        securing approval
22   Accelerating Artificial Intelligence in health and care:
     results from a state of the nation survey
                                                                                                                                Accelerating Artificial Intelligence in health and care:
                                                                                                                                              results from a state of the nation survey    23

                                                                                        Who responded?
                                                                                        Survey respondents included          Respondents cite a broad range
                                                                                        CEOs (42%), senior managers          of experience with AI, with many
                                                                                        (15%) and others working across      indicating that they wear multiple
                                                                                        the AI ecosystem in England.         hats when dealing with AI.
                                                                                        They represented both large
                                                                                        organisations with 250 staff or
                                                                                        more (32%), as well as micro
                                                                                        organisations with less than 10
                                                                                        staff (38%) across private, public
                                                                                        and charitable sectors, as well as

ANALYSIS ON                                                                                      Q: What describes your current
                                                                                                      experience with AI?                                                   I evaluate

                                                                                                                                                                            AI 43%

                                                                             I use AI
                                                                                                                    I procure AI


In order to inform government policy and the AHSN Network AI
Initiative offer, we conducted a survey of 106 thought leaders and AI
pioneers during May and June 2018. In this section we outline survey
results, highlighting top barriers and enablers for catalysing an ethical,                                                                                              I regulate
                                                                                                                                                                        AI 5%
evidence-based market for AI solutions in health and care.

                                                                                                                                                           I develop AI
                                                                                            Other                                                          51%
24     Accelerating Artificial Intelligence in health and care:
       results from a state of the nation survey
                                                                                                                                                                                       Accelerating Artificial Intelligence in health and care:
                                                                                                                                                                                                     results from a state of the nation survey    25

   Game-                                       The best AI-enabled solutions
                                               always solve a valuable problem
                                               or ‘use case’, as expressed by
                                                                                     Development in drug discovery
                                                                                     and medical research will also be
                                                                                     hugely aided by AI.
                                                                                                                                                      ‘80% of all
                                               users - citizens, carers and
                                                                                     Respondent views ranged from
                                               professionals. Working with
                                                                                     AI being ‘ubiquitous’, ‘pervasive’
                                               users to understand their needs
                                                                                     and ‘high impact’ that will ‘replace                            dermatology
use cases
                                               and then working with them to
                                                                                     front line tasks’ to rather less
                                               prototype and test solutions
                                               iteratively is key to refining the
                                                                                     optimistic predictions. Many see
                                                                                     AI as a tool to help doctors and all
                                                                                                                                                     diagnoses will be done
                                                                                                                                                     using AI within 3 years
                                               product’s value proposition and
                                                                                     healthcare professionals become
                                               ensuring successful uptake and
                                                                                     more efficient and deliver a
                                               adoption at scale.
                                               We asked respondents to identify
                                                                                     higher standard of care at less
                                                                                     cost to benefit patients. Most see                              - it will be better than
                                               the areas where the strongest         AI having a key role in helping to
                                               early use cases are.                  make decisions across the board
                                                                                     and in better planning for scarce
                                                                                                                                                     dermatologists at
                                               Overall, the views were clear that
                                               the main game-changing use
                                                                                     resources.                                                      diagnosing’.
                                               cases for AI will be in three key
                                               areas in the immediate period:                                                                        Respondent prediction
                                               • Diagnostics

                                               • Non-clinical (operational and
                                                 administrative efficiency)

                                               • Health promotion and
                                                 preventative health.

                                                                                                                            The top three use cases are         • ‘Translation into routine               processes (e.g. document
                                                                                                                            explored in more depth below.         practice, widespread use                management, paperwork and
                                                       Treatments                                                                                                 of clinical decision support            scheduling). Machine learning will
                                   Health                   and        Diagnostics     Non-clinical        Keeping          Diagnostics (accurate and
                                                                                                                                                                  tools for complex diagnostics,          increasingly be used to process
                               promotion and          interventions     (accurate       (e.g. save        up to date        early detection) was cited
                                                                                                                                                                  genomics and lifestyle advice’          images and texts.
                                preventative            (including      and early       time with        with medical       overwhelmingly as a strong
                                   health                surgery)       detection)    administration)      research         early AI use case, with 94% of                                                A reduction in administrative
                                                                                                                                                                •   ‘80% of all dermatology
                                                                                                                            respondents citing it as either         diagnoses will be done using          staff overheads is expected, and
                                                                                                                            extremely important or very                                                   a positive view on how AI will
     Extremely important           47%                   40%            80%              66%               35%              important. Some predictions from
                                                                                                                                                                    AI within 3 years - it will be
                                                                                                                                                                    better than dermatologists at         impact clinicians also emerged.
                                                                                                                            survey respondents include:             diagnosing’.                          • ‘AI and clinicians will work more
          Very important           31%                   28%            14%              23%               30%              • ‘Huge impact in radiology                                                     closely as one team’
                                                                                                                                                                Use cases for non-clinical
                                                                                                                              for assisted reporting and
                                                                                                                                                                applications, for instance saving
         Quite important           16%                   26%              5%               9%              21%                screening’
                                                                                                                                                                time with administration, were
                                                                                                                                                                                                          • ‘Supervised machine learning -
                                                                                                                                                                                                            Clinicians remain in control’.
                                                                                                                            • ‘Increased use in radiology and   seen as extremely important
 Somewhat important                 5%                     5%             1%               2%              10%                other imaging applications,       or very important by 89% of
                                                                                                                              particularly in prioritisation/   respondents. AI will increasingly
      Not at all important          1%                     2%             0%               0%               4%                triage of scans to ensure these   be used in the automation of
                                                                                                                                                                routine clinical and managerial
                                                                                                                              are brought to human attention
                                                                                                                              first’                            tasks and for back office
26    Accelerating Artificial Intelligence in health and care:
      results from a state of the nation survey
                                                                                                                                                                            Accelerating Artificial Intelligence in health and care:
                                                                                                                                                                                          results from a state of the nation survey    27

Some predictions include:
• ‘Significant improvements in
  workflow management and
                                              Comments from respondents
                                              • ‘Move towards using AI as
                                                                                   • ‘AI will be instrumental in
                                                                                     detecting minuscule changes
                                                                                     in individual’s records (data),
                                                                                                                                       Overall AI                        To gauge what factors might support the
                                                                                                                                                                         development of AI in health and care, we asked
                                                                                                                                                                         respondents to consider the extent to which the

                                                                                     making it possible to detect                                                        following actions or policies were important in
  data analysis coupled with the                a tool for early prevention
                                                                                     and catch problems even                                                             realising the potential of AI in health and care.
  emergence of intelligent clinical             and diagnosis using large
                                                                                     before they actually form. It will
  decision support systems’                     population level datasets i.e.                                                                                           The numbers below highlight actions or policies that
                                                                                     enable prevention in the most
                                                identifying individual risk. Use                                                                                         respondents viewed as very or extremely important:
• ‘AI will become a standard                                                         literate sense of the word’.
                                                of AI in demand management
  part of devices and image                     and predictive modelling’          For an excellent overview of
  management systems’.
                                                                                   AI use cases, refer to Future
                                              • ‘Better allocation of resources
Health promotion and                                                               Advocacy’s Ethical, Social and
                                                by earlier detection of patterns
preventative health was cited
as extremely important or very
                                                and thus disease, with
                                                                                   Political Challenges of Artificial
                                                                                   Intelligence in Health and Care
                                                                                                                              92%                 88%               87%                      82%                         81%
                                                better targeted preventative
important by 78% of respondents.                                                   (April 2018)3, a report produced
                                                strategies as a result’
Overall, respondents expect AI to                                                  with the Wellcome Trust.
be used in a more predictive way,             • ‘AI will take a large amount       3
facilitating the shift from reactive            of the early identification of
care to a more preventative                     disease, allowing clinicians                                               Engagement          Ethical frame-     Capacity and          Clarity around               Education of
health model in which people are                to focus on the complicated                                                of healthcare       work to build/     capability to         ownership of                  healthcare
more empowered to take care of                  cases’                                                                     professionals     preserve trust and   deliver scope              data                    professionals
their own health.                                                                                                                              transparency

                                                                                                                                AI enablers
                                                                                                                                                                         We then looked at the relative importance of factors
                                                                                                                                                                         impacting diagnostics, building on potential actions
                                                                                                                                                                         suggested by our AHSN Network AI Initiative core

                                                                                                                                 specific to
                                                                                                                                                                         advisory group members.
                                                      ‘Better allocation                                                                                                 The percentages below show the key factors that
                                                                                                                                                                         pioneers believe are very or extremely important
                                                      of resources by
                                                                                                                                                                         to address in order to realise the potential of AI in
                                                                                                                                                                         health and care:
                                                      earlier detection of
                                                      patterns and thus
                                                      disease, with better                                                    93%                 93%               85%                      82%                         78%
                                                      targeted preventative
                                                      strategies as a result’
                                                      Respondent feedback                                                 Data sharing for     Support the         Consistent             Reviewing                   Work with
                                                                                                                          medical imaging    spread of proven       labelling        governance models             commissioners
                                                                                                                           for AI training     innovations         methods for       (eg ST 11-7) in light           to help them
                                                                                                                                                                  imaging data       of machine learning           understand how
                                                                                                                                                                                         algorithms               to buy AI-enabled
                                                                                                                                                                                                                    products and
28    Accelerating Artificial Intelligence in health and care:
      results from a state of the nation survey
                                                                                                                                                                                         Accelerating Artificial Intelligence in health and care:
                                                                                                                                                                                                       results from a state of the nation survey    29

  Trust, privacy and ethics
                                                                                                                                                                               Education of
                                                                                                                                                                                healthcare                                 Education
                                                                                                                                                                               professionals                                of public

According to survey respondents,
the top two factors enabling the
                                              • ‘The speed at which AI will
                                                have an impact on healthcare
                                                                                    Educating healthcare
                                                                                    professionals and the public on
                                                                                                                                        Extremely important                         50%                                        37%
realisation of AI in health and care            will depend very much on the        the potential of AI in a balanced
are ‘engagement of healthcare                   public’s (and therefore the         way was also raised as a key                               Very important                       31%                                        28%
professionals’ and establishing                 government’s) trust in AI and       issue by survey respondents.
an ‘ethical framework to build/                 the company using patient           This is central to achieving                              Quite important                       17%                                        25%
preserve trust and transparency’.               data to develop AI. This will not   and maintaining trust in an
                                                impact all AI products but a        environment where there is much
Overall, respondents agreed with
                                                significant proportion’             negative media coverage on
                                                                                                                                       Somewhat important                             2%                                       10%
the need for a clear governance
                                                                                    the risks of AI and its potential
structure to guide decisions
and build trust. This needs
                                              • ‘There has to be first an
                                                enabling framework within the
                                                                                    impact on workforce. A narrative                     Not at all important                         0%                                        0%
                                                                                    around data sharing is needed.
to be underpinned by a clear                    NHS. This would include ethical     There is also the need to engage
ethical framework to address                    considerations, the right for       the public actively in order to help
such issues as transparency in                  human interpretation of the AI      define the problems that need
algorithm development.                          algorithms’                                                                Key comments include:                  Predictions for the future include:
                                                                                    solving and co-develop solutions
Comments from the respondents                                                       enabled by AI.                         • ‘We need a narrative around          • ‘Greater public support for AI
                                              • ‘We need transparency of
include:                                                                                                                     data sharing and trust …’              due to better understanding
                                                algorithm development’
• ‘There is a need for widespread                                                                                                                                   [of] how AI works’
                                              • ‘[the potential of AI] is based                                            • ‘We need public education
  understanding of augmented                                                                                                 and enabling regulatory              • ‘There will be a new cohort
  intelligence, predictive                      on the governance structure
                                                developed and ability to forge                                               frameworks’                            of healthcare professionals
  analytics, deep learning and                                                                                                                                      that will be educated to think
  machine learning’                             trust’.                                                                    • ‘It’s not enough to ‘educate’          how to empower their human
                                                                                                                             the public- we need active             abilities with AI driven tools’.
                                                                                                                             participation of patients and
                                                                                                                             other interested parties at all
                                                                                                                             stages of the development
                                                                 Engagement             Ethical framework to                 process’
                                                                 of healthcare          build/preserve trust               • ‘Much more needs to be
                                                                 professionals           and transparency                    done to educate healthcare
                                                                                                                             professionals, listen to/
              Extremely important                                   58%                           61%                        understand their concerns,
                                                                                                                             and get their buy in. At the

                       Very important                               33%                           26%
                                                                                                                             moment the conversation is too
                                                                                                                             polarised between naysayers
                                                                                                                                                                                                 ‘We need a
                                                                                                                             who say, “AI will never change
                                                                                                                                                                                                 narrative around
                      Quite important                                8%                            9%                        healthcare significantly” and
                                                                                                                             techno-utopians who say, “AI
                                                                                                                             will replace all doctors and                                        data sharing
             Somewhat important                                      0%                            3%                        nurses” - the reality is of course
                                                                                                                             much more nuanced than that.’                                       and trust …’
                Not at all important                                 1%                            0%
                                                                                                                                                                                                 Respondent feedback
30    Accelerating Artificial Intelligence in health and care:
      results from a state of the nation survey
                                                                                                                                                                                        Accelerating Artificial Intelligence in health and care:
                                                                                                                                                                                                      results from a state of the nation survey    31

     Workforce                                                                                                                   Evidence of effectiveness
     knowledge of AI                                                                                                             and regulation
Workforce opportunities will be               in the new era of AI will also be      • ‘Ability for enough people to         Linking strongly with the theme      78% of respondents felt that             • ‘Regulation needs to be
addressed in detail in the Topol              essential, along with training in        understand the back end of            of trust, the requirement for        regulation was extremely                   light touch, to allow patient
Review (being led by Dr Eric                  technical and legal aspects of AI.       AI, and even perhaps learn the        evidence of effectiveness of         important or very important                confidentiality but at the same
Topol and facilitated by Health                                                        coding within hospitals to help       the digital health innovations       in realising the potential of              time allowing the industry to
                                              Above all, securing clinical
Education England), but it is                 understanding, engagement                internal management’                  and intelligent clinical decision    AI in health and care. Gaps in             flourish so we can achieve
important to note that at a high              and buy-in to the co-design                                                    support (algorithms) was a topic     regulating AI-enabled products             efficiencies in the fast time
level, education has come out as                                                     • ‘We need to understand and
                                              and use of AI will be important                                                that ran throughout respondents’     and services, and uncertainty              possible’
a clear enabler.                                                                       design the human computer
                                              to leverage the potential of the                                               comments.                            about the roles of the various
                                                                                       interaction and how algorithms                                                                                      • ‘Regulation is important, but it
87% of respondents indicated                  technology. This will not only                                                                                      regulators and when a product,
                                                                                       are used in practice’                 A number of respondents called                                                  would be better to find a global
that building capacity and                    assuage clinicians’ fears and                                                                                       service or algorithm should
                                                                                                                             for the ability to explain the                                                  solution rather than country by
capability is extremely important             concerns, but will ensure that the     • ‘Understanding financial and                                               be subject to regulation were
                                                                                                                             algorithm and providing enough                                                  country. Particularly concerned
or very important to achieving                AI algorithms developed augment          clinical pathways in more detail                                           also strong themes. There is a
                                                                                                                             information to allow regulators to                                              if the UK decides to go its own
AI’s potential. This includes basic           (rather than replace) and increase       will be important…’                                                        clear need for a new regulatory
                                                                                                                             independently replicate results                                                 way post-Brexit, as the NHS
education on AI and its potential             the accuracy of human clinical                                                                                      framework to keep up with
                                                                                     • ‘Helping to build interdisciplinary   on a similar set of data, ensuring                                              market isn’t large enough to
applications for senior managers              decision making. Helping senior                                                                                     advances in AI.
                                                                                       teams so that clinicians with         algorithms are safe and unbiased.                                               be worth separate certification
and directors in clinical,                    decision-makers to understand
                                                                                       good ideas can have these             Representative comments              Comments included:                         beyond FDA [United States] &
management, commercial and                    and have realistic expectations
                                              of what AI has to offer will also be     realised by people with               include:                                                                        CE [EU]’.
procurement roles. Training in                                                                                                                                    • ‘Legacy regulations will
                                              important.                               computer programming skills’          • ‘Many AI-based tools will            limit widespread adoption
areas such as user-driven design,
change management, ethics and                 Key points to consider from our        • ‘Having highly skilled data             struggle to get used through         of diagnostics and health
having difficult conversations                survey participants include:             scientists involved is crucial’.        lack of evidence and/or clinical     prevention applications’
                                                                                                                               conservative behaviour’
                                                                                                                                                                  • ‘[Government should] address
                                                                                                                             • ‘Clinical support should be          barrier of regulation and
                                                                                                                               gained by discussion of the          the ability to rapidly iterate,
      Somewhat                                                                                     Extremely                   scientific case and justifying       prototype, and validate
       important                                                                                   important                   the technology. Just offering        prospectively’
                                                                                                   46%                         an algorithm lacks scientific

                                                                                                                                                                                      Regulation of AI
       Not at all
      important                                     Capacity and                                                                                                          Extremely important                                 44%
             1%                                      capability                                                                                                                  Very important                               34%
                                                     to deliver
          Quite                                        scope                                                                                                                    Quite important                               17%
      important                                                                                       Very
           12%                                                                                        important                                                           Somewhat important                                   5%
                                                                                                                                                                            Not at all important                               0%
32    Accelerating Artificial Intelligence in health and care:
      results from a state of the nation survey
                                                                                                                                                               Accelerating Artificial Intelligence in health and care:
                                                                                                                                                                             results from a state of the nation survey    33

     Funding and
                                                                                                                   Given AI’s potential for system
                                                                                                                   wide impact, with funding
                                                                                                                   flows and incentives crossing

     commercial models
                                                                                                                   organisational boundaries
                                                                                                                   and hierarchies, some
                                                                                                                   respondents also commented
                                                                                                                   on the opportunity to reimagine              ‘value’ of public/
                                                                                                                   commercial models in the new
Despite the financial challenges
experienced in the NHS, ‘funding
                                              models for AI development and
                                              deployment’, which came in at
                                                                                 92% of respondents said
                                                                                 they believed ‘supporting the
                                                                                                                   era of AI:                                   NHS data and how
and budget restraints’ featured
only tenth on the list of thirteen
                                              12th and 13th (last) on the list
                                                                                 spread of proven innovations’
                                                                                 is extremely important or very
                                                                                                                   • ‘Understand ‘value’ of public/
                                                                                                                     NHS data and how this can be               this can be sold
factors affecting the potential of                                               important to realising the          sold to developers or used to
AI in health and care, with 68%
of respondents indicating that
                                              This result could be reflective
                                              of the early stage of the
                                                                                 potential of AI in diagnostics.     generate additional income’                to developers or
funding was extremely important
or very important. Featuring even
                                              development of the AI market
                                              in health and care. In contrast,
                                                                                                                   • ‘Evaluate cross department
                                                                                                                     business models - who                      used to generate
                                              in diagnostics, where the early
                                                                                                                                                                additional income.’
                                                                                                                     owns hospital-wide clinical
lower on the overall list of key
                                              AI use cases are strongest and                                         efficiency? For example,
factors were ‘NHS internal market
                                              where we are already starting to                                       will radiology purchase an
and procurement’ and ‘lack of
                                              see products come to market,
clarity over appropriate business
                                                                                                                     AI product whose benefit is                Respondent feedback
                                                                                                                     realised by reduced drug cost
                                                                                                                     in neurology? How do those
                                                                                                                     dots get joined up?’.

                                                                          Lack of
                                                                        clarity over
                                                                       models for AI           NHS internal
                                             Funding/budget            development              market and
                                                restraints            and deployment           procurement
                                                                                                                         Not at all
                                                                                                                     important 1%
     Extremely important                              45%                   34%                    29%
             Very important                           23%                   25%                    34%                                                    Support
           Quite important                            27%                   33%                    21%                                                  the spread
                                                                                                                     important 2%                        of proven
     Somewhat important                                4%                    8%                    13%                                                innovations in
      Not at all important                             1%                    0%                     3%                    Quite                        diagnostics                                     Very
                                                                                                                      important                                                                        important
                                                                                                                            5%                                                                         42%
34    Accelerating Artificial Intelligence in health and care:
      results from a state of the nation survey
                                                                                                                                                                                       Accelerating Artificial Intelligence in health and care:
                                                                                                                                                                                                     results from a state of the nation survey    35

     Data quality, sharing                                                                                                                                           Consistent labelling                         Data sharing for

     and interoperability                                                                                                                                            methods for imaging
                                                                                                                                                                                                                 medical imaging for
                                                                                                                                                                                                                     AI training

                                                                                                                           Extremely important                                   54%                                         69%
The importance of a sound data                Respondents’ comments include:
infrastructure with high quality
                                              • ‘The current datasets in                                                            Very important                               31%                                         24%
data and the relevant standards
                                                healthcare are patchy, dirty
on sharing and interoperability
came through as key factors in
                                                and often incorrect! Garbage                                                       Quite important                               11%                                          6%
                                                in garbage out. Often data are
realising AI’s potential.
                                                not digitised. The first action
                                                in machine learning or AI is to
                                                                                                                          Somewhat important                                       3%                                         1%
Data quality                                    clean up dirty data’

A key concern affecting the ability           • ‘We need clean labelled un-
                                                                                                                             Not at all important                                  1%                                         0%
of AI to deliver on its potential               gamed datasets’
is that of the quality of the data
                                              • ‘We need data compatibility
itself, much of which is not
                                                through labelling and
digitised or in machine-readable
format. ‘Data readiness’ (getting
data ready for AI) was a key                                                                               Data sharing and interoperability
                                                                                                           Overall, the view emerged that                 Key points voiced by respondents                • ‘We need distribution across
                                                                                                           the underlying data infrastructure             were:                                             public and private sectors,
                                                                                                           is not fit for purpose for AI                                                                    with patient access to any
                                                                                        Open standards     and requires standards to
                                                                                                                                                          • ‘The role of private companies
                                                                                                                                                                                                            information generated and
                                                                       Clarity around   to promote data                                                     and developers including
                                                                                                           facilitate data sharing and the                                                                  ease of sharing this’
                                                Data sharing           ownership of       sharing and                                                       ownership of and access to
                                                                                                           development of appropriate
                                                                                                                                                            public and patient data and                   • ‘Clarification of concepts
                                                 framework                  data        interoperability   commercial models to leverage
                                                                                                                                                            how data sharing agreements                     around patients being curators
                                                                                                           the value of public/NHS data.
                                                                                                                                                            are negotiated’                                 not owners of the (“their”) data;
                                                                                                           This is an especially pressing
     Extremely important                              56%                     54%            47%           concern where public sector                    • ‘The underlying IT
                                                                                                                                                                                                            compliance with GDPR but still
                                                                                                           entities have entered into                                                                       allowing retention of images/
                                                                                                                                                            infrastructure in the NHS is
             Very important                           24%                     28%            31%           agreements with companies to                     poor and not AI ready. We need
                                                                                                                                                                                                            blood results/other data to
                                                                                                                                                                                                            feed Big Data’.
                                                                                                           process data. These datasets                     a large push to standardise IT
           Quite important                            16%                     10%            19%           often end up in proprietary
                                                                                                           format or in difficult to access
                                                                                                                                                            formats and data sharing’

                                                                                                           repositories. Intellectual property            • ‘Robust development,
     Somewhat important                                4%                     7%             2%            of algorithms developed using                    testing and validation of AI
                                                                                                           these proprietary data sets often                is key. Without appropriate
                                                                                                                                                            governance it will be a liability’
      Not at all important                             1%                     0%             1%            rests with the companies (outside
                                                                                                           the public sector/NHS)4.

                                                                                                            Naylor, A. and Jones, E. (2017). Unleashing the potential of health and care data. Future Care Capital. Available at:
36     Accelerating Artificial Intelligence in health and care:
       results from a state of the nation survey
                                                                                                                                                                                               Accelerating Artificial Intelligence in health and care:
                                                                                                                                                                                                             results from a state of the nation survey    37

        Towards a
                                                                  A number of respondents endorsed the                               NHS Digital and NHS England are also laying the
                                                                  establishment of open data ecosystems in order                     groundwork for open innovation with a number of
                                                                  to leverage insights from multiple datasets,                       initiatives including:

                                                                  enabling the real power of AI to come into its own.                • Apperta Foundation, which recently published
                                                                  For example, Transport for London provides a                         ‘Defining an Open Data Platform’
                                                                  common API to access 80% of the UK’s transport
                                                                  data. Thousands of developers (including the                       • Code4Health, which provides a home for the

       ecosystem                                                  original Citymapper app) build on top of this open
                                                                  API platform. Similarly, Open Banking, recently
                                                                  introduced in the UK, will see the UK’s nine biggest
                                                                                                                                       increasing number of open source projects
                                                                                                                                       providing software suitable for use in health and
                                                                  banks release data in a secure, standardised form,
                                                                  so that it can be shared more easily between                       • International exemplars in the area of open
                                                                  authorised organisations so they can then use it                     innovation platforms in the health and care space
                                                                  to create more products and services to benefit                      include REshape Centre Radboud (Netherlands)
                                                                  citizens. The intention is to put citizens in control                and Boston Children’s Hospital (United States)
                                                                  of their own banking data, providing an easier way                 • Closer to home, University Hospitals Plymouth
                                                                  for them to move, manage and make more of their                      NHS Trust and Great Ormond Street Hospital are
                                                                  money.                                                               exemplars in building open data ecosystems and
                                                                  In order to unlock open innovation around data-                      fostering open innovation.
                                                                  driven health and social care services, any open
                                                                  data ecosystems must provide mechanisms for
                                                                  data to flow safely and securely across disparate

                                                                                                                                         Case Study
                                                                  health and care organisations, whilst ensuring
                                                                  informed consent and transparency. Enabling
                                                                  citizens to ‘donate’ their consumer data (e.g. from
                                                                  banking, retail, transport, telecommunications,
                                                                  utilities, etc) and data from sensors and IoT-enabled                  Great Ormond Street Hospital DRiVE Unit (Digital
                                                                  devices could also support citizens to stay healthy
                                                                  and in their own homes for longer5.
                                                                                                                                         Research, Informatics and Virtual Environments)
                                                                  Momentum is growing to establish open data                             GOSH’s DRiVE unit provides a good example          in a secure environment in the cloud that
                                                                  ecosystems across health and care. This should                         of the type of open data ecosystem and             is compliant with ICO and GDPR guidance
                                                                  accelerate over time as forthcoming Industrial                         infrastructure required for exploitation of AI’s   regarding the use of data for research.
                                                                  Strategy Grand Challenge investments in initiatives                    potential within health and care. The DRiVE        Clinicians, researchers and industry partners
                                                                  such as Digital Innovation Hubs (connecting regional                   unit provides both a concept and a physical        looking to address specific problems can come
                                                                  health and care data with biomedical data in secure                    space dedicated to accelerating research           together in secure virtual ‘workspaces’ to run
                                                                  environments) and the Healthy Ageing Challenge                         and evaluation of new AI-enabled technology        analyses and APIs. The data therefore does
                                                                  start to bear fruit.                                                   and data analysis, with the aim of developing      not leave GOSH’s control and governance,
                                                                                                                                         scalable solutions for child health. Working       providing full transparency. The GOSH team
                                                                                                                                         with partners including University College         and regulators have full data provenance,
                                                                                                                                         London (UCL)/ Alan Turing, major industry          including details of IP addresses accessing the
                                                                                                                                         partners and NHS Digital, early areas of focus     code and whether changes have been made.
                                                                                                                                         will include machine learning, assisted decision   During the development phase, the GOSH
                                                                                                                                         making and the use of medical chatbots.            team are also working to generate synthetic
                                                                                                                                                                                            datasets for innovators to test their early
                                                                                                                                         GOSH’s open data ecosystem captures
                                                                                                                                                                                            algorithms on, prior to validation on real data. ​
                                                                                                                                         and integrates data from multiple sources
 Woods, T.M. and Kihlstrom, E. (2018). Data and the Future of Health and Social Care. Report, Proceedings and Key Recommendations.
Round Table, 17th November 2017. FutureHealth Collective. Available at:
38   Accelerating Artificial Intelligence in health and care:
     results from a state of the nation survey
                                                                                                                                       Accelerating Artificial Intelligence in health and care:
                                                                                                                                                     results from a state of the nation survey    39

                                                                               Where are we now?
                                                                            Whilst AI solutions are increasing   is currently reviewing technical         1. Build fairness and transparency
                                                                            in their complexity, most now        and clinical safety requirement             in digital health innovations,
                                                                            delivering impact are on the low     and design standards before                 algorithms and clinical decision
                                                                            complexity end of the spectrum.      publishing onto the library.                support tools.
                                                                            Understanding the vast potential     Ultimately, the NHS must
                                                                            of AI – as well as its limitations                                            2. Help identify the requirements
                                                                                                                 protect its reputation as an                and standards that
                                                                            - will be key moving forward.        internationally trusted health and
                                                                            As one survey respondent                                                         organisations and suppliers
                                                                                                                 care system, ensuring patient               need to fulfil in order to show
                                                                            commented, ‘AI is still evolving…    safety and high quality care, and
                                                                            it won’t solve all the problems                                                  that products are safe, secure
                                                                                                                 preserving the trust between                and maintain public trust.
                                                                            healthcare faces as the moment’      citizens, clinicians and the wider
                                                                            and we must avoid the trap of        health and care system. In order         3. Identify gaps within regulatory

                                                                            ‘overhyping potential, unrealistic   to do this we have collated a set           and approval processes that
                                                                            claims, and poorly thought out       of principles outlined in a Code of         need to be addressed to
                                                                            products’.                           Conduct, which is in early stages           accommodate developing
                                                                            Top AI enablers include              of development.                             technologies.

                                                                            engagement with health               The purpose of the Code is               By working collaboratively with
                                                                            professionals, as well as            to provide a source of clear             academia, industry, innovators,
                                                                            grounding the use of AI in           principles and guidance for the          commissioners and AHSNs to
                                                                            real problems as expressed           development of trusted digital           iterate and continually update

                                                                            by citizens, carers and other        health innovations and intelligent
                                                                                                                                                          these principles, we can go
                                                                            health professionals. Providing      algorithms within the UK NHS
                                                                                                                                                          some way to staying abreast of
                                                                            mechanisms for improving data        health and care sector. This
                                                                                                                                                          evolving technologies, helping to
                                                                            quality and the underlying data      code can be used by innovators,
                                                                                                                                                          catalyse the scale and adoption
                                                                            infrastructure will also be key,     industry, commissioners,
                                                                                                                                                          of intelligent technologies.
                                                                            along with introducing a safe,       academia and individuals,
                                                                                                                                                          Addressing these requirements
                                                                            evidenced and transparent            as a framework to support
                                                                                                                                                          with the right solutions will spur
                                                                            approach to how algorithms and       development and deployment of
                                                                                                                                                          collaboration across the NHS,
The analysis of survey responses, together with the constellation of        innovations are developed.           any DHI or intelligent algorithm
                                                                                                                                                          social care and other partners in
                                                                                                                 (IA). Whilst this code will ensure
                                                                            Currently in the NHS, we have                                                 the ecosystem and build public
organisations in the AI map and illustrated by the case studies in this     a number of programmes such
                                                                                                                 that the DHI/IA being developed
                                                                                                                                                          trust. Strong cross government
                                                                                                                 are in line with the principles and
report, reveals that AI in health and care is still at a relatively early   as the Local Health and Care
                                                                                                                 values of the UK health and care
                                                                                                                                                          collaboration, including pooling
                                                                            Record Exemplars, NHS Test                                                    resources and partnering on joint
                                                                                                                 system, it is still a requirement
stage. At the same time, there are many promising early use cases           Beds and the forthcoming Digital
                                                                                                                 that the relevant regulatory
                                                                                                                                                          initiatives is also underway and
                                                                            Innovation Hubs that give us the                                              is the key objective of the AHSN
for AI in this space, especially in diagnostics. The health and care        opportunity to test and refine
                                                                                                                 and/or approval processes are
                                                                                                                                                          Network AI initiative.
                                                                                                                 adhered to.
                                                                            digital health innovations (DHIs)
AI ecosystem continues to grow at pace, with a range of promising           and algorithms with our partners.    This code, if followed, can ensure
                                                                                                                 that within the NHS and the wider
interventions in the pipeline, currently gathering evidence that they       The NHS Apps Library and
                                                                                                                 UK health and care sector we
                                                                            Digital Assessment Questions
are safe, effective and offer value prior to regulatory approval and        are examples of how the NHS          collectively:

widespread implementation.
You can also read