15 May 2017
Update September 2019: In November 2016, the Royal Free London entered into a five-year partnership with the British technology company DeepMind. In November 2018, it was announced that Streams, and the team behind it, would move to Google Health UK so that the app can grow and support more doctors to deliver faster, better care to patients. In September 2019, after careful consideration, we have now replaced our partnership agreements to continue our work with Google Health UK.
A spokesperson for the Royal Free London:
"The Streams app was built in close collaboration with clinicians to help prevent unnecessary deaths by alerting them to patients in need in a matter of seconds. It is now in use at the Royal Free, and is helping clinicians provide better, faster care to our patients. Nurses report that it is saving them hours each day.
"We took a safety-first approach in testing Streams using real data. This was to check that the app was presenting patient information accurately and safely before being deployed in a live patient setting. Real patient data is routinely used in the NHS to check new systems are working properly before turning them fully live. No responsible hospital would ever deploy a system that hadn't been thoroughly tested. The NHS remained in full control of all patient data throughout.
"This project, designed to help prevent unnecessary deaths using new technology, is one of the first of its kind in the NHS and there are always lessons we can learn from pioneering work. We take seriously the conclusions of the NDG, and are pleased that they have asked the Department of Health to look closely at the regulatory framework and guidance provided to organisations taking forward this type of innovation, which is essential to the future of the NHS.
"We are proud of the work we have done with DeepMind and will continue to be bold and brave for the benefit of our patients."
Notes to editors
- The issue that the National Data Guardian’s (NDG) has raised relates to the way the Royal Free used patient data to test that Streams was working safely, in advance of deploying it. This testing period is over. Streams is now in use at the Royal Free and the NDG has not raised any issues with the way Streams operates today.
- The NDG says in her letter dated 20th February 2017 that she and her panel “entirely accept the importance of careful clinical safety testing of any new technology or application before it can be relied upon for patient care.” She also recognises that“further guidance would be useful to organisations which are undertaking work to develop and test new technologies, where that work might require the use of identifiable patient data at some stages” and confirmed that the Department of Health is looking at the guidance.
- The Royal Free has remained in control of all patient data at all times, and DeepMind can only use patient data on our strict instructions to help us improve hospital care for patients. There has been no “data mining” or AI research, and the data has never been shared with any Google services, products or ads.
- David Myers, patient governor at the Royal Free and a kidney patient for the last 25 years, said: “When treating kidney injury, speed matters – and yet every day patients across the UK suffer serious and avoidable problems because the system isn't able to get their urgent test results to renal clinicians fast enough. I am hugely excited that these kinds of projects are already helping with this, and it's just the tip of the iceberg for how technology could help with safer and better care. As a long term kidney patient I would expect that any new services had been thoroughly tested before use, and as a Governor at the Royal Free I am confident that Royal Free management working with DeepMind have a secure system.”
Background on Streams
- Each year, it is estimated (BMJ, 2013) that up to 40,000 people in UK hospitals die preventably from conditions like acute kidney injury (AKI), because warning signs are not picked up or acted on in time.
- Streams is a clinical app which helps ensure clinicians can identify and treat those patients as quickly as possible. It pulls together all relevant patient information in one place and generates an automatic alert when a problem is detected (like a breaking news alert). It does not use artificial intelligence or machine learning technologies
- The app is now live at the Royal Free and is helping clinicians react to patient deterioration in seconds, speeding up urgent care. Feedback from nurses, doctors and patients has so far been extremely positive, and nurses have said it is saving them hours every day (London Evening Standard, Feb 2017) giving them more time to spend with patients.