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The team behind Streams - our secure mobile app for clinicians - is joining Google.

What we've learned so far

Given the importance of the NHS to the UK, it’s striking that relatively few British tech companies and start-ups are developing tools for our health service. In part, this is because NHS technology projects haven't always had a smooth ride and have struggled to have a measurable impact due to the large and complex nature of the NHS itself.

Despite our best efforts, we know that we’ll face challenges and make mistakes, too. We’re committed to sharing these openly, and hope that what we learn will be useful to others.

In addition to the points below, we've also appointed nine Independent Reviewers to review and scrutinise our work. In July 2016, they produced their first annual report which outlined several recommendations on how we work, including significantly improving our work with patients, the public and the wider health community. As a result of this process, DeepMind Health has committed to a series of changes to our work and practices to try to set higher standards in our second year. We know we need to work harder to be responsive and accountable to the needs of a far greater cross-section of medicine and society. You can read what we’ve committed to change here.

The importance of transparency

What we did

We chose to wait until our first hospital project was already underway (signed in September 2015) before announcing DeepMind Health in February 2016. Our team wanted to demonstrate progress and clinical impact before seeking publicity.

What we’ve learned

Given the importance and sensitivity of health data, and given the potential confusion caused by our relationship with Google, many people have told us that we should have publicised our intentions before starting any work. We agree. We should have announced our plans for DeepMind Health before our first hospital partnership. 

We should also have done more to engage with patients and the public at that time, including by proactively providing information about how patient data would be processed, and the safeguards around it.

What we’ve done since

We’ve been taking steps to become the most transparent company working in NHS IT. We will use this website to publish our contracts with NHS hospitals and address frequently asked questions. We appointed a panel of Independent Reviewers in February 2016 to scrutinise our work, and we’re building an unprecedented set of audit tools called Verifiable Data Audit. We’ve also started a major programme of patient and public involvement, with our first event in September 2016 and more events planned throughout 2017.

Patient involvement on a par with clinician involvement

What we did

From the outset, we have worked with both patients and clinicians to guide our priorities and provide feedback on our ideas. However, because our first tools are designed to be used by clinicians, the involvement of nurses and doctors was more formal and systematic, including the establishment of a clinical advisory group. The involvement of patients was less structured.

What we’ve learned

Although our technologies are used by clinicians rather than patients, that doesn’t mean that the patient voice should be less formally represented. On the contrary, patient representatives should be fully involved in any project that could ultimately affect the care they receive.From the start, we should have put patient involvement on a par with clinician involvement.

What we’ve done since

We worked with the late Rosamund Snow, formerly patient editor of the British Medical Journal, to devise an innovative patient and public involvement strategy. This will put patient involvement at the heart of DeepMind Health, with patient leads, advisors, events and more. We will be posting more information about this over the coming months. 

The importance of public engagement to explain NHS technology

What we did

When we began working with our partner Trusts, we were overwhelmingly focused on getting our first projects up and running. We didn't fully recognise the need for significant public engagement around the use of technology in the NHS.

What we’ve learned

There's very low public awareness of NHS technology, and the way patient data is routinely used in the provision of care. For example, many people assume that patient records are normally stored on NHS-owned computers, when they are in fact routinely processed by third party IT providers. This confusion is compounded by the potential future use of AI technologies in the NHS. 

What we’ve done since

We recognise that we need to play a more active role in explaining our work in the broader context of NHS technology. We've published blog postsspoken at events and taken part in dozens of media interviews. We'll continue to find new ways to expand the conversation around NHS technology, within patient groups as well as the wider public. 

Lessons learnt from the Information Commissioner’s Office investigation

What happened

The Information Commissioner (ICO) concluded a year-long investigation that focused on the Royal Free’s clinical testing of Streams in late 2015 and 2016, under the initial agreement with DeepMind Health which has since been superseded. This testing was intended to guarantee that the service could be deployed safely at the hospital. However, the ICO wasn’t satisfied that there was a legal basis for this use of patient data in testing (as the National Data Guardian said too), and raised concerns about how much patients knew about what was happening. The undertaking recognises that many of these issues have already been addressed by the Royal Free, and has asked the Trust to sign a formal undertaking to ensure compliance in future. The ICO also recognised that the Royal Free has stayed in control of all patient data, with DeepMind confined to the role of “data processor” and acting on the Trust’s instructions throughout. No issues have been raised in relation to the safety or security of the data.

What we’ve learned

Although today’s findings are about the Royal Free, we need to reflect on our own actions too. In our determination to achieve quick impact when this work started in 2015, we underestimated the complexity of the NHS and of the rules around patient data, as well as the potential fears about a well-known tech company working in health. We were almost exclusively focused on building tools that nurses and doctors wanted, and thought of our work as technology for clinicians rather than something that needed to be accountable to and shaped by patients, the public and the NHS as a whole.

What we’ve done since

We have worked hard on some major improvements to our transparency, oversight and engagement.

Our initial legal agreement with the Royal Free in 2015 could have been much more detailed about the specific project underway, as well as the rules we had agreed to follow in handling patient information. We and the Royal Free replaced it in 2016 with a far more comprehensive contract (available on this page), and we’ve signed similarly strong agreements with other NHS Trusts using Streams. We made a mistake in not publicising our work when it first began in 2015, so we’ve proactively announced and published the contracts for our subsequent NHS partnerships.

In our initial rush to collaborate with nurses and doctors to create products that addressed clinical need, we didn't do enough to make patients and the public aware of our work or invite them to challenge and shape our priorities Since then we have worked with patient experts, devised a patient and public engagement strategy, and held our first big open event in September 2016 with many more to come.

In an effort to significantly increase the oversight of our work, we also invited nine respected Independent Reviewers to scrutinise DeepMind Health, long before any regulatory or media criticism. 

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