In November 2016, the Royal Free London entered into an exciting 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.
The agreement means that some of the best minds in healthcare and technology will be working together to transform care through the use of a mobile app called Streams.
The app delivers improved care for patients by getting the right data to the right clinician at the right time. Similar to a breaking news alert on a mobile phone, the technology notifies nurses and doctors immediately when test results show a patient is at risk of becoming seriously ill, and provides all the information they need to take action.
Work on Streams started in 2015 and the app is helping clinicians detect a condition called acute kidney injury (AKI) at its earliest stages. AKI affects one in six in-patients and is an indication that a patient is deteriorating but it can be difficult to diagnose. Streams uses a range of patient data to determine whether a patient is at risk of developing AKI and sends an instant alert to clinicians who are able to take appropriate action promptly. In July 2019, the results from our peer-reviewed service evaluation were published in Nature Medicine, demonstrating that the app improved patient outcomes, reduced costs and enhanced the experience of both clinicians and patients.
Because patient information is contained in one place – on a mobile application – it reduces the administrative burden on staff and means they can dedicate more time to delivering direct patient care.
One patient who has benefited from Streams is Afia Ahmed, 38, from Hampstead, who suffered complications following the birth of her daughter Aleeza by emergency caesarean in January 2017.
Afia developed sepsis (an infection in the blood) during her labour, which then led to AKI. Using data from Afia’s blood test, the Streams app detected a problem with her kidney function and an alert was sent to a specialist kidney doctor.
The kidney specialist was able to provide guidance to the obstetric team on Afia’s condition and advised them to adjust the antibiotics, intravenous fluid treatment and pain killers that might put a strain on her kidneys. Afia continued to be monitored by a kidney specialist until her kidney function recovered and she was discharged home with baby Aleeza.
It is thought that the number of extra deaths in England each year associated with an episode of AKI may approach 40,000. The financial burden of AKI on the NHS in England alone is also believed to be in excess of £1 billion every year, which is greater than the annual cost of treating breast cancer.
The partnership uses an unprecedented level of data security and audit. All data access is logged, and subject to review by the trust.
The Streams app itself is provided by Google Health but they are only a data processor in respect of the personal data on Streams. This means that they can only use that personal data on our instructions for the purpose of providing Streams. Google Health is not permitted to use that personal data for any other purpose.
Streams is fed with information from the other information technology systems we use in our hospitals. In particular, these systems generate a stream of automated messages in a standardised format (known as HL7) which are added into Streams, along with HES data. We also include details of patients undergoing dialysis to avoid the system triggering false alerts. The independent audit report into the operation of Streams contains further technical information about the data used in Streams.
We use personal data in Streams for two purposes. First, we use that personal data to provide the app itself so that we can detect and treat AKI in the way set out above. Secondly, we may need to use personal data to test that Streams is working properly, for example when the technology is changed or upgraded. We only use live data for testing where it is necessary and only to the extent that is reasonable and proportionate.
The legal basis for our use of personal data is to fulfil our statutory duty to provide healthcare services (as set out in Article 6(1)(e) of the General Data Protection Regulation and section 8(c) of the Data Protection Act 2018). This personal data contains medical information so is treated as special category personal data. Our legal basis for using special category personal data is the provision of healthcare services and management of healthcare systems (as set out in Article 9(2)(h) of the General Data Protection Regulation and paragraph 2 of Schedule 1 of the Data Protection Act 2018).
The personal data in Streams is subject to a 10-year retention period. This means that if you do not have any contact with us for a 10-year period, your information will be deleted from Streams. This retention period was set after careful consultation with our clinicians and reflects the fact that a person’s medical record remains clinically relevant to the treatment of AKI for a long period.
You have various rights under data protection laws including the right to access or correct your information and to object to its processing. In particular, you can ask us not to include your information in Streams. You also have the right to complain to the UK Information Commissioner about our processing. More details of these rights, and details of how to exercise these rights or contact the Information Commissioner, are available from our privacy notice, here.