Protecting Confidential Data in a Digital World · 61-million-person experiment in social influence...

Protecting Confidential Data in a Digital World

Dr Felix Jackson

• A doctor and digital health entrepreneur

• Developing digital technology for the health and care sector for over 10 years

• Founder and Medical Director of medDigital and medCrowd

• Joined the first cohort of the DigitalHealth.London Accelerator

• Member of London South Bank University’s Simulation for Digital Health

© 2018 medDigital Limited | 22 Upper Ground, London, SE1 9PD, UK. [email protected]. +44 (0) 20 3637 2100

http://www.meddigital.com/

http://www.medcrowd.com/

http://digitalhealth.london/accelerator

World-changing technologies

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The World has Changed


• People connected wearable devices through their

mobiles to the Internet

• To collect, process and share data to improve their

fitness and wellbeing:

− Activity: steps, breaths, movement

− Routes: ran, cycled, swum

− Effort: power output, heart rate, suffer scores

• People are now using mobiles and wearables to

manage their health and care

• To diagnose, manage and treat conditions:

− Diagnosis: atrial fibrillation, depression, malaria

− Management: trackers, records, appointments

− Treatments: injuries, prescriptions

It all began with ‘wellness’ and wearables… …and is becoming ‘health and care’

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Fitbit

12© 2018 medDigital Limited | 22 Upper Ground, London, SE1 9PD, UK. [email protected]. +44 (0) 20 3637 2100

Image

Garmin


Image

Apple Watch 4


Apple Health App

© 2018 medDigital Limited | 22 Upper Ground, London, SE1 9PD, UK. [email protected]. +44 (0) 20 3637 2100 8

Apple HealthKit


Apple ResearchKit


Apple CareKit


The Evolving NHS



DrDoctor


Image needed

15

Google DeepMind


Google DeepMind Streams


Protect Confidential Information


NHS Data Security and Protection Toolkit

Data Protection Act

HIPAA

GDPR

ISO 27001

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Digital Communication

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Connecting Digitally


Communication underlies it all:

• People are now using mobiles to

keep in touch.

• With each other, and health and

care workers:

• Peer-to-peer: messengers,

communities

• Health and care workers:

messengers, online consultations

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INSTANT MESSAGING FOR HEALTH AND CARE

medCrowd keeps everyone in touch while

protecting confidential health and care

information to the required standards.

Messaging apps are the best way to keep in

touch with your health or care team, including

doctors, nurses, social workers, caregivers,

and everyone receiving care.

But popular messaging apps don't protect

confidential information to the required

standards so private information may not be

safe.


23© 2017 medDigital ltd | 22 Upper Ground, London, SE1 9PD, UK. [email protected]. +44 (0) 20 3637 2100

A study conducted by Dr Georgina Gould and Dr Ramin Nilforooshan in July 2016 on the

use of WhastApp by junior doctors at St Peters Hospital in Chertsey, UK, showed:

- >33% of all messages consisted of advice or support.

- 72.5% doctors' perceived it was a good thing.

- 80% reported improvement in the relationship between grades.

- Concluded that messaging is performing an essential function.

Messaging apps perform an essential function

Gould G, Nilforooshan R WhatsApp Doc? BMJ Innovations 2016;2:109-110.

40 junior doctors were asked about their use of WhatsApp.

http://innovations.bmj.com/content/2/3/109


A major study in 2015 showed extensive use of non-compliant mobile apps and devices by

health and care workers to send patient-related clinical information at work:

- 65% of doctors used SMS messaging.

- 33% of doctors used messaging apps.

- 46% of doctors used picture messaging apps.

In 2015, 71.6% of doctors and 37.2% of nurses wanted a secure alternative.

Widespread use of non-compliant messengers

Mobasheri MH, King D, Johnston M, et al The ownership and clinical use of smartphones by doctors and nurses in the

UK: a multicentre survey study BMJ Innovations 2015;1:174-181.

Large London-based NHS Trust with 5 hospital sites. n = 2,107 doctors + 4,069 nurses

http://innovations.bmj.com/content/1/4/174


Jane Wakefield. BBC Technology News. 6th July 2017. www.bbc.com/news/technology-40507440




Despite the NHS position on WhatsApp being clear

"Don't put patient, sensitive or security classified information on social

media [including messaging apps like WhatsApp]; this would breach data

protection laws or patient confidentiality and result in a security incident.”

NHS Digital's Use of Social Media User Guide issued on 23rd May 2017.

Note:

NHS Digital published and withdrew guidance from the Information Governance

Alliance about sharing patient data with instant messengers.

https://digital.nhs.uk/cyber-security/policy-and-good-practice-in-health-care/social-media/user-guide

Social Media Use

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Kevin Pho


Marie Ennis-O’Connor


Psoriasis – Ask for Clear


@ViiVHC on Twitter


Patients Know Best


Case Study: Facebook ‘I voted’ intervention


During the 2010 US election, without user consent, Facebook ran a “61-million-person experiment in social influence and political mobilization”

Facebook users were shown a non-partisan ‘get out the vote’ message with useful supporting information

Users were able to click an ‘I voted’ button, so their vote and their profile picture were shown to their friends within their friends’ ‘get out to vote’ messages

The results were published in Nature (without a big a storm of protest) and showed that clicking the ‘I voted’

button was more likely to influence close connections in a positive way to vote, compared with 600,000

control users who saw a plain informational message without their friends’ ‘I voted’ responses.

33

http://www.nature.com/nature/journal/v489/n7415/full/nature11421.html


Clinical Research

18

Improving Clinical Research


The desire to improve on the

traditional clinical trial

Digital is supporting the drive for better data

The recognition that treatments

work differently in the ‘real world’

A drive for real-world evidence, in

real time

New technologies are enabling different clinical studies with different ways to capture data.

36


Case study: MyHeart Counts


McConnell MV, et al. JAMA Cardiol. 2017;2:67–76.

• Began recruiting in 2015

through the MyHeart Counts

app alongside the launch of

Apple ResearchKit

• About 11,000 applicants within

the first 24 hours

Recruitment

• Among those who consented,

20,345 individuals (41.5%)

completed 4 of the 7 days of

motion data collection.

• 1,334 (2.7%) of those who

consented completed all fields

needed to compute heart age

and a 10-year risk score

Results

• Between March and October

2015, 48,968 participants in

the US consented to

participate.

• Participants recorded physical

activity, filled out health

questionnaires, and completed

a 6-minute walk test

Analysis

In January 2017, researchers concluded that “a smartphone-based study of cardiovascular health is feasible

and allows rapid, large-scale, and detailed assessment of physical activity, fitness, and sleep.”

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Ethical considerations


Declaration of Helsinki: Created in 1964 to guide clinical research Good Clinical Practice: Details how moral codes can be enacted

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Supporting RWE

18


Case study: Apple Heart Study


Uses an app designed to monitor participants heart rate through the Apple

Watch and notify them if an irregular heart rhythm is observed

Stanford Medicine is aiming to improve diagnosis and treatment of arrhythmias to

prevent serious heart complications

After the notification, participants receive a free video consultation on their iPhone with

the study’s medical professionals from American Well for further analysis

Began recruiting in February 2018; enrolment closed in August 2018;

analysis is ongoing

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Case Study: Salford Lung Study


Integrated care records.

• Healthcare professionals from eight organisations across Greater Manchester collaborated on the Salford Lung Study (SLS) to examine the safety and effectiveness of Relvar Ellipta for chronic obstructive pulmonary disease (COPD).

• The study involved over 2,800 consenting patients, supported by 80 GP practices and 130 pharmacies in Salford and the surrounding Greater Manchester area.

• Bespoke software was integrated with existing electronic health medical records to collect near real-time data across patients’ everyday interactions with their GPs, pharmacists and hospitals.

• The study was designed for minimal intrusion into patients’ everyday lives.

• Sponsored by GSK.

Pragmat Obs Res. 2017; 8: 175–181.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614786/

Real-World Evidence


An old technique given a new name in a digital data world.

Supported by the FDA and other regulators since 2016 to accelerate access to medicines and reduce drug development costs.

Integrates and analyses multiple sources of observational data.

May not be as ‘valid’ as RCT data, but it is ‘real’.

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Artificial Intelligence

04

AI and Machine Learning


Predicting and diagnosing:

• Predicting risks and outcomes to

optimise treatments.

• Assisting or making diagnoses.

• Assisted Diagnosis: Health guides,

Decision support.

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GP at Hand


Ada


Augmented and Virtual Reality

04

AR and VR


Immersive experiences that

improve care:

• AR and VR are helping people to

understand and learn

• So they can improve the care that

they receive or give:

• Understanding: experiencing care

environments, enhancing treatment

• Learning: information, training

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Dr Keith Grimes

Using virtual reality to help

distract patients to reduce

need for sedation during

invasive procedures.

Medical Realities


The health and care evolution


The way we predict, diagnose, manage and treat conditions

has fundamentally changed…

…we need to join in to be part of this incredible evolution!

55

Thank you

22 Upper Ground

London

SE1 9PD

United Kingdom

+44 (0) 20 3637 2100

[email protected]

Follow @medDigital on Twitter

www.medDigital.com/contact

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Protecting Confidential Data in a Digital World · 61-million-person experiment in social influence...

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