Streaming the right information to the right clinician at the right time

With our Streams app, we’re helping transform the way nurses and doctors prevent avoidable patient deterioration in NHS hospitals. Too many lives are lost because clinicians don’t have real-time information about who urgently needs their care. One in ten NHS in-patients suffers some kind of avoidable harm, and 40% of people in intensive care could have been prevented from ending up there. We think technology can help.

Our vision is of an NHS where every patient receives the right care from the right clinician at the right time, made possible through cutting-edge mobile technology that pushes patient alerts to nurses and doctors, enables them to securely assign and communicate about clinical tasks, and gives them all the information they need to make the right diagnoses and decisions. 

We’re working closely with our partner trusts to make this vision a reality. Streams' technology will speed up the time to alert nurses and doctors to patients in need down to a few seconds. And by freeing clinicians from juggling multiple pager, desktop-based, and paper systems, Streams will help redirect significant amounts of time from admin and towards direct patient care. 

We’ve built Streams in close partnership with NHS clinicians, who know exactly what they need, and are holding ourselves to the highest standards of security and oversight. We're also working with digital product studio ustwo to bring the very best of user-centric design techniques to the field.

In time, we hope that this can help unlock the next wave of innovation in the NHS. The infrastructure that powers Streams is built on state-of-the-art open and interoperable standards (known as FHIR). This infrastructure will allow our partner trusts to have other developers build new services that integrate more easily with their systems, helping them bring new innovations to the clinical frontlines.

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What Streams does

Based on what clinicians have said they need, our partner Trusts will have the ability to implement the following:

  1. Results viewing. Providing nurses and doctors with quick and easy access to all of their patient’s test results.
  2. Alerts. Notifying nurses and doctors as soon as observations or test results indicate a potential problem with a patient, helping to provide much faster care for widespread problems including acute kidney injury, sepsis and more.
  3. Patient medical history. Presenting clinicians with key facts about the patient’s medical history such as previous diagnoses, procedures and admissions, so clinicians have the fullest understanding of their condition in deciding the right care. 
  4. Teamwork. Replacing the current outdated system of allocating tasks amongst clinical teams by phone, paper, pagers and fax machines, by allowing nurses and doctors to request actions from other members of the team, such as looking at test results or checking on a patient.
  5. Messaging. Enabling frontline staff to communicate simply and securely with one another about the care they’re providing. 

Bringing these features together in one app could save millions of hours every year that would otherwise be wasted by sharing information using the current, out-of-date technology, which in turn could save millions of pounds for the NHS. 

play Streams Features

Clinicians play an invaluable role in helping us ensure our products are as clinically effective as they can be. We are looking for nurses and doctors working in hospitals who would be interested in testing and providing feedback on the Streams application at the DeepMind office in Kings Cross. Click here if you’d like to find out about getting involved.

Our Partners

The Royal Free London NHS Foundation Trust

Since late 2015 we’ve been working with the Royal Free London NHS Foundation Trust on Streams, starting out with a version of the app focused solely on acute kidney injury (AKI). AKI is a contributing factor in up to 20% of emergency hospital admissions, and is linked to 40,000 deaths in the UK every year – a quarter of which NHS England estimates are preventable.

The partnership began when kidney specialists approached us to ask if technology could help them to detect AKI in its early stages. Every minute counts for patients who develop AKI: it can result in minor loss of kidney function all the way through to dialysis, transplant, and even death.

Michael Wise, a patient who developed the most serious type of AKI while in hospital, describes his experience of undergoing dialysis and receiving a kidney transplant, and the impact of his illness on his family, here:

play Acute Kidney Injury – a patient's journey

To help clinicians to detect AKI at an early stage, the app automatically alerts them as soon as a blood test indicates a possible AKI, and provides them with all the historical patient information they need to make the right diagnosis. 

We’re also pleased to have entered into a longer-term partnership with the Royal Free that will see us extend Streams to cover illnesses other than AKI, including conditions such as sepsis and other organ failure, as well as implementing additional features such as clinical task management. 

We’re proactively publishing our agreements with the Royal Free with minimal redactions, including our master services agreement (covering the partnership as a whole) and our information processing agreement (covering how patient data is processed).

Some reactions to our new partnership with the Royal Free:

Professor Keith McNeil, NHS chief clinical information officer:
"The health and care system stands poised to harness the power of information and technology to substantially improve the care we provide to patients and to promote world class health outcomes.

“We cannot do this alone and we need to work with world leading partners, and I am delighted that the Royal Free are going to be able to use the brilliant technology and innovation offered by a partner of the stature of DeepMind to help deliver better, safer care to their patients. I commend them for their initiative and wish them every success with the venture.”

David Myers, President of the Royal Free Kidney Patients Association: 
“As a kidney patient for more than 25 years I am really excited about the potential of the Streams AKI app. This seems to me something that will revolutionise the speed with which AKI patients will be cared for. I think this system could not only save lives but could improve patients chances of living longer whilst reducing their stay in hospital. This must not only benefit patients by ensuring that they receive the correct care immediately but also should reduce the cost of caring for patients if AKI incidents are recognised at an early stage. I am happy that patient data is safe.”

Professor Jane Dacre, President of the Royal College of Physicians:
“The Royal Free London NHS Trust and DeepMind’s new partnership […] offers exciting possibilities for improved care for patients and more efficient systems for physicians to work with. It is encouraging to see the NHS harnessing technology to make a difference at the bedside and the clear focus on delivering real differences to patients’ lives and health.  Whenever we develop new ways of using patient data, it is essential that safeguards are in place for appropriateness and confidentiality, but with these we should embrace the opportunity to improve healthcare quality and reduce the burdens of bureaucracy on clinicians so they can focus on their patients.”


Imperial College Healthcare NHS Trust

In December 2016 we agreed a five year partnership with Imperial College Healthcare NHS Trust to help it bring on board the latest technology in delivering patient care.

Over the last two years the Trust has moved from paper to electronic patient records, and mobile technology is the natural next stage of this work. By giving clinicians access to cutting-edge healthcare apps that link to electronic patient records, they’ll be able to access information on the move, react quickly in response to changing patient needs, and ultimately provide even better care. 

We’ll be working with the Trust to deploy our clinical app, Streams, which supports clinicians in caring for patients at risk of deterioration, particularly with conditions where early intervention can make all the difference. Like breaking news alerts on a mobile phone, the technology will notify nurses and doctors immediately when test results show a patient is at risk of becoming seriously ill. It will also enable clinicians at Imperial to securely assign and communicate about clinical tasks, and give them the information they need to make decisions on care.

As in our partnership with the Royal Free, we’re also implementing state-of-the-art open and interoperable standards, via what’s known as a FHIR API. This will allow the Trust to easily, securely and consistently integrate other apps that could improve care, whether developed by third parties or innovators within the Trust. Our partners at Imperial are excited about the potential for a wide range of apps to improve care, and we’re delighted to be working with them to make this possible.

We’re proactively publishing our agreements with Imperial with minimal redactions, including our master services agreement (covering the partnership as a whole) and our information processing agreement (covering how patient data is processed).

Streams FAQ

  • What does Streams do?

    Streams is a mobile-first platform that delivers the right information to the right clinician at the right time. 

    It puts important patient information in the palm of clinicians’ hands, allowing them to view and update records, assign clinical tasks to each other and receive medical alerts, all from their smartphones, substantially reducing the administrative burden on clinicians and enabling them to redirect the time saved into patient care. Its alerting function speeds up the time nurses and doctors are alerted to patients in immediate need, down from hours to a few seconds.

  • Does Streams use AI?

    Streams does not currently use AI. However, we do think that there’s potential for machine learning to better detect acute kidney injury (AKI) in the future. We are not working on this research right now, and the agreements we have in place today with the Royal Free and Imperial College Healthcare NHS Trusts do not allow us to carry out research or develop machine learning or AI tools. If that changes in the future we will make an announcement on this website.

  • Why is an AI company focusing so much on a tool that doesn’t involve AI right now?

    We think that there’s huge potential for AI to help clinicians and patients, but the reality is that current IT infrastructure in the NHS is way behind where it needs to be to make this kind of healthcare innovation possible. 

    We want to help patients anywhere we can. Working with hospital trusts to fix more fundamental problems means we can have an immediate impact and lay the foundations for more advanced technology in due course.

  • What is a FHIR API?

    Patient information is a vital part of clinical care – doctors and nurses treating you in hospital need to be able to access your complete medical history to help diagnose what is wrong with you and work out the best course of treatment. 

    Streams helps bring that information together and allow doctors to access it securely and instantly on smartphones when they need it. But to make this happen, Streams and other clinical apps and systems need to use a shared computer language.

    We have committed to building our infrastructure on open and interoperable standards, namely the FHIR API (Fast Healthcare Interoperability Resources Application Programming Interface) created by the Health Level Seven International (HL7) health-care standards organisation. Not only will this ensure the data we process is in a modern infrastructure, but it will help to develop common information processing standards that other technologists and clinicians can also use to build their apps and other software (subject to those third parties seeking all the appropriate approvals).

    FHIR is being rapidly adopted by a wide array of health and social care providers internationally (eg. Boston Childrens’), and is supported in the UK by NHS Digital, NHS England and the INTEROPen group.

  • Why are Streams and Hark being combined?

    To improve patient safety and clinical outcomes, we need to be better at identifying patients at risk of deterioration and then mobilising an effective and timely clinical response. Our initial work on AKI focused on delivering an earlier alert of kidney deterioration but still relied on pagers, pen and paper. Learning more about Hark and the work done at Imperial College, London, it quickly became clear that bringing these technologies together could provide even better patient outcomes. We worked with clinicians on that basis to integrate these technologies together into a single platform that we’re excited to be bringing to patient care.

Streams is a mobile-first platform that delivers the right information to the right clinician at the right time. 

It puts important patient information in the palm of clinicians’ hands, allowing them to view and update records, assign clinical tasks to each other and receive medical alerts, all from their smartphones, substantially reducing the administrative burden on clinicians and enabling them to redirect the time saved into patient care. Its alerting function speeds up the time nurses and doctors are alerted to patients in immediate need, down from hours to a few seconds.

Our Partnerships and Data Processing

  • What’s different in the new partnership with the Royal Free compared with your previous agreement with the Trust?

    Following our work on kidney injury, we wanted to explore whether Streams can be used to improve patient care in other ways, to help make the Royal Free one of the safest hospitals in the world.

    We’re expanding our alerting technology to a range of other potentially fatal conditions, including sepsis and organ failure. Alerting doctors and nurses to patients who need their attention in seconds rather than hours could dramatically improve patient safety.

    We’re also planning to include the task management features of Streams at the Royal Free, allowing them to view and update records and assign clinical tasks to each other from their mobile, which we hope will eliminate the need for doctors to shuffle through paper and receive pager alerts.

    By knitting this system together into an infrastructure based on open standards, other medical innovators will also be able to develop their own technologies for the Royal Free.

    Finally, we’re also building an unprecedented level of data security with our audit infrastructure, which will allow the Royal Free to verify exactly when and by whom patient information is accessed, with no possibility of falsification or tampering.

  • What data does Streams process for the Royal Free?

    Right now, Streams processes data from pathology tests taken from the past five years alongside coded diagnoses (e.g. diabetes). The app shows data over five years because it is important to identify, among other things, whether kidney problems are acute (a new problem) or chronic (a longstanding problem). Clinicians will be much more worried about an acute deterioration compared to a long standing chronic kidney problem. Coded diagnoses further help nurses and doctors prioritise patients by identifying if there are any relevant contributory conditions, such as diabetes, kidney stones or a renal transplant.

    In addition, Streams processes data about whether a patient is currently on dialysis treatment so that the app does not deliver out false positive results about patients who are already receiving treatment. This holistic pool of data is key to allowing clinicians to truly understand what is happening to their patients.

  • What data does Streams process for Imperial College Healthcare NHS Trust?

    We haven’t yet started processing data for Imperial College Healthcare NHS Trust, but expect to start in 2017 as our technologies go through clinical safety testing followed by a phased deployment.

  • What can DeepMind do with patient data?

    Data processing by third parties is an essential part of modern healthcare. Clinicians need fast access to patient medical information, and the NHS doesn't generally have the ability to process data in this way in-house. NHS Trusts therefore routinely work with third party data processors like DeepMind, just as they work with external providers of a range of essential services that keep hospitals running smoothly.

    Our partner Trusts remain in control of their patients’ data at all times. DeepMind cannot do anything with it other than to store it securely, and stream it to a nurse or doctor at the right time in accordance with the Trust’s instructions. Access to the data is strictly controlled and logged, and subject to audit by the Trust and our independent reviewers.
  • Why does DeepMind need to store the data itself?

    The only way to provide information at the speed nurses and doctors need is for DeepMind to securely store data ourselves, so we can stream it to the right clinician in seconds when an alert is triggered. We believe that the speed improvement Streams brings will help clinicians treat patients before they suffer significant deterioration, and can ultimately save lives.

  • Why is historic data relevant to a condition like AKI?

    The primary blood test used by the NHS to detect Acute Kidney Injury is serum creatinine, which is often the most commonly performed blood test at many acute NHS Trusts, including the Royal Free. Assessing renal function is a standard test that is undertaken as a routine investigation on the majority of adult inpatients in an NHS hospital. Creatinine levels vary from person to person, dependant upon age, gender, ethnicity, muscle mass, and underlying kidney disease. Retrospective trend analyses help produce a more informed diagnosis as there is not an absolute level of creatinine that represents an AKI. This means that current creatinine levels must be compared with previous results to detect AKI using the nationally mandated algorithm (PDF link).

    Evidence from the National Institute for Clinical Excellence tells us that patients with other medical problems (eg. diabetes, kidney transplant, myeloma, or a history of kidney stones) may require different or more intensive treatment if they develop Acute Kidney Injury. They are also at risk of having more complications from AKI. Clinicians asked us to provide information on historic tests, diagnoses and procedures so that they can prioritise care for the most unwell patients.

  • What approvals do you have to process patient data?

    DeepMind cannot (and nor would we seek to) process information for any other purpose than those covered in the agreements – for the provision of potentially lifesaving direct care to patients.

    We’ve sought all the requisite NHS governance approvals. We also abide by the very important regulatory standards set by the Information Commissioner’s Office and the National Data Guardian.

  • What are you doing to protect patient data?

    Before processing any patient data, we undertook a major project to design an information and data security architecture of the highest quality, working in partnership with clinical and security experts to analyse and mitigate risks, as well as conducting on-site risk assessments with partners.

    We completed a self-assessment of our information governance toolkit and assessed our compliance to be at Level 3, the highest level possible across each of their requirements (NHS Digital’s assessments verified that we had reached Level 2, the highest level at which NHS Digital assesses organisations as standard).

    All data access is logged, and subject to review by our Trust partners  as well as DeepMind Health’s nine Independent Reviewers. In addition, DeepMind’s software and data centres will undergo deep technical audits by experts commissioned by its Independent Reviewers.

    Furthermore, DeepMind is developing an unprecedented new infrastructure that will enable ongoing audit by our Trust partners, allowing administrators to easily and continually verify exactly when, where, by whom and for what purpose patient information is accessed. This is being built by one of the world’s leading security engineers, Ben Laurie, co-founder of the OpenSSL project which enables encrypted connections to websites around the world (familiar to millions through the padlock in their browser bars).

  • Can patients opt out of having their data processed?

    DeepMind acts as a data processor on behalf of hospital Trusts, who remain the controller of patients’ data. DeepMind only processes data on the Trusts’ instructions, and we don’t determine their data processing policies.

    Patients who wish to discuss opting out should contact their Trust’s Patient Advice Liaison Service (PALS).

  • How long do you have access to patient data?

    Our agreements with the Royal Free and Imperial last until 2021, before which date the data will be passed back to the Trusts or destroyed unless the agreement is extended.

Following our work on kidney injury, we wanted to explore whether Streams can be used to improve patient care in other ways, to help make the Royal Free one of the safest hospitals in the world.

We’re expanding our alerting technology to a range of other potentially fatal conditions, including sepsis and organ failure. Alerting doctors and nurses to patients who need their attention in seconds rather than hours could dramatically improve patient safety.

We’re also planning to include the task management features of Streams at the Royal Free, allowing them to view and update records and assign clinical tasks to each other from their mobile, which we hope will eliminate the need for doctors to shuffle through paper and receive pager alerts.

By knitting this system together into an infrastructure based on open standards, other medical innovators will also be able to develop their own technologies for the Royal Free.

Finally, we’re also building an unprecedented level of data security with our audit infrastructure, which will allow the Royal Free to verify exactly when and by whom patient information is accessed, with no possibility of falsification or tampering.