good evening everybody I'd like to
extend a very warm warm welcome to this
evening's meeting medicine for members
they're all  free London
in partnership with deep mind my name is
Jude Bailey and I'm privileged to be one
of your public governors I recently
retired from the trust as a senior
midwife having worked across the three
sites and during that time I also served
as a staff governor
I personally am very excited about the
collaborative work with clinicians and
deepmind to improve the out the clinical
outcomes for our patients before we
start a couple of housekeeping points we
aren't expecting any testing of the fire
alarm system however if there is one
that goes on that is a continuous fire
alarm then we would have to leave and
there are two doors at the back but most
people at the front doors on the left
and on the right the loos are just out
of here turn right down the corridor and
there on the right hand side and I would
like to welcome our panel this evening
dr. Craig E Jenny cross sorry Jenny
consultant nephrologists and clinical
director for nephrology at at UCL and
dr. Dominic King who is the clinical
lead for a deep mind and Tosh Mondale
who is a deputy chief information
officer and head of IT infrastructure at
they're all free London after the
presentations have finished there will
be time for Q&A and I asked you to be
kind enough to leave questions until
that point in time
if there are any members of the media
could you please be kind enough to let
yourself that you are here be known to a
member of staff so Ian Loyd one of our
communications team is here any media
questions should be raised via the
communications team so without any
further delay I would like to ask Jenny
to start the presentations thank you so
I am a working nephrologist so I'm a
kidney specialist and when you get
kidney failure of a law degree or a high
degree you would come and see me or one
of my team now for the purposes of this
presentation what I'm thinking of is
perhaps not what you're thinking of most
of kidney disease is about chronic
kidney disease that comes over a long
time and what I'm thinking of in this
presentation is people who are
unfortunate enough to get really sick
really quickly and develop acute kidney
trouble as part of a much bigger serious
illness I want to talk a little bit by
what we've been doing over the last
couple of years in partnership with deep
mind like one of our many other partners
that we have in the NHS to try to use
modern technologies to improve the
delivery of healthcare in real time so
we're going to move through the talk in
this way we're going to describe the
technologies that we could use and the
advantages that that have for improving
patient care we're going to tell you
about a very particular type of app or
application a program that we've used to
try and help us to identify sick
patients much earlier to use those
golden errors at the beginning of the
illness really effectively so we can get
them better quicker to me that outcomes
better are we're going to talk a little
bit moving on to dr. Dom King from deep
mind how patients and the public can
help and become involved in this kind of
work and I'm going to talk a little bit
with Dominic King about the sorts of
technologies that we might have for the
future who in the room in the last 24
hours has used a smartphone a computer
at your
at your desk or a laptop or an iPad
hands up okay so I can see you all its
the vast majority there's two or three
people over the whole audience who
haven't used a smartphone this is what
it looks like on the train everybody's
got one everybody uses one they're easy
they're intuitive they help because it
makes it easier to get to some of the
stuff that you want to access quickly
why wouldn't we use that in healthcare
if we use it in everything else
why wouldn't we try to so NHS hospitals
have I think traditionally and I've had
a lovely conversation with the gentleman
in the front row here about his
experience of what we've got in the NHS
which is one of our systems is called
Cerner and he tells me that he received
six letters about his ophthalmology
appointment in Barnet the technologists
that we have in many ways are excellent
and many other ways just don't fit
together because there are sixteen or
seventeen systems that don't talk to
each other and we've all had the
experience of things just not fitting
together when you come and see the
doctor in primary care with your GP or
in the hospital or with your specialist
on a different site seeing a hospital
doctor and royal free seeing a different
doctrine Barnet and being told that the
Royal Free doctor can't see the Barnet
doctors results how frustrating is that
for all of us what a waste of time and
the point that you need what a waste of
money
the way that we currently work with our
systems with our pagers with our
telephones logging on to slow computers
on our desks having to leave the patient
and the wardroom to look for test
results and then go back to the patient
means there are processes slow down our
ability to give patients quick accurate
high-quality care in my view and I think
this is definitely a view shared by the
kidney team at the Royal three who also
provide kidney services on all of our
other sites around the north central
London sector so that's Barnet edge
where the North Middlesex University
College London hospital and the
three all of which some of which are
specialist hospitals so I want you to
imagine a scenario because I think it's
most useful to think about what this
actually means for people in clinical
practice
so scenario one twenty five-year-old man
just completed University let's call him
Tom he sublet becomes well unwell after
falling over in his garden onto a spike
he thinks it's nothing he's got no
problems with his health in the past he
leaves it for two or three days and he
progressively becomes unwell with fever
a fast heartbeat breathlessness and
eventually at his mother's insistence
he's brought to the emergency department
the emergency department junior doctor
sees him not a huge amount of experience
but he knows what he needs to do so he
puts on line and he tries to get some
fluid in but he doesn't know how fast to
give it he takes the blood tests he
sends them off to the laboratory the
patient goes to the ward and new team
takes over the junior doctor is called
back about the results from the
laboratory they're very very abnormal
they're seriously abnormal he's very
worried about the patient but he's got a
whole emergency department full of
patients and the patient's gone to the
ward so he telephones the person who's
looking after the patient no he can't
get called of them because that person
is looking after somebody else he leaves
a message for the nurse in charge who
speaks for the doctor by this time two
and a half hours has passed eventually
we have a kidney problem identified we
have inadequate fluid resuscitation and
we eventually have the consultant call
that he said it's clearly an emergency
get the emergency intensive care team
down let's get this thing sorted we all
arrived on the ward on mass and we
aggressively treat the patient the
tragedy is that the senior members of
that team sometimes come to this sort of
scenario a young fit healthy person
where we used two or three or four of
those hours processing through our
processes and we get to the bedside and
we know that things have gone too far
and whatever we do we think we're going
to have a bad outcome and many many
times our intensive care colleagues have
said that it is unbe
to get to the bedside of a patient
knowing that there were subtle signs of
the problem very early on like their
kidney function going off and people
didn't realize the significance of it
and four hours later it became
absolutely apparent how important that
was imagine a different scenario that we
have some technology that takes out the
human factor of passing complex
information between teams in an
organization that employs 10,000 people
imagine we had it on a smartphone in the
back pocket where all of the results are
integrated together and we get alert to
see I think this person's got kidney
trouble not only are you looking at the
result but you're looking at the
synthesis of the result what it means
you miss out the block from casualty to
the ward you don't have to ring the
nurse because the consultant on call in
kidney medicine is alerted he's never
seen the patient before he doesn't know
the patient exists either at his home or
on the ward he will receive an alert on
his spoon as if you got a ping from your
bank or a text from your daughter or are
alert from the guardian seeing that
Putin's done something new there's a
headline that focuses your attention on
a critically unwell patient in the trust
that you previously wouldn't have heard
about until four hours later those are a
golden four hours they are the kind of
four hours that change a young person's
response to sepsis or acute kidney
failure very markedly it could be the
difference between surviving and not
surviving it can be the difference
between going to an intensive care unit
or not going to an intensive care unit
the Royal Free is privileged and lucky
enough to have been chosen to be a
global digital exemplar and what that
means is that were given 10 million
pounds by NHS England to develop
technologies and digital services for
the improvement of patient care because
what does that mean what do we want to
use that
ten million pounds to do well we would
like to stop having variations in the
way that we manage patients if we find a
brilliant way to treat something if
that's the best way everybody in all of
our hospitals should receive the best
treatment not variations on a theme in
different hospitals that improves
outcome and it improves patient
experience we aspire and were on track
for having the first completely digital
hospital on the chase Farm side
everything digital we hope to be able to
implement population health and that is
trying to do something preventative not
reacting when it happens but doing
something about it before it happens by
trying to coherently integrate to
sensibly put together what your GP is
doing with what we were doing so that
we've got some memory of what happened
to you in the 20 years before patients
ever came to the hospital which is of
course the majority of their life
because and people don't spend
necessarily long times in hospital or
lengthy periods in hospital we want to
give our staff time to clever things
that reduce the waste of time that we
have entering data trying to find data
trying to manipulate data if there's a
clever way to do it give it to us we're
young we use these all the time in our
normal lives we would like to use them
for patient care because they work well
and for most people they're fairly
intuitive it's not just about hospitals
I alluded to this earlier we could use
it for primary care even in your own
home anybody check their blood pressure
at home
anybody regulate what their exercise
does anybody look at the health app on
their iPhone with the heart on it what
it counts your steps all of those things
could be used as part of your health
care because we should be able to
perhaps in the future import it into
your healthcare if you record your blood
pressure on your iPhone we could
Bluetooth it into your health record
there's many examples of how we could
utilize this sort of technology to make
easier for all of us some people have
said that hospitals operate in an island
that's the NHS but of course then it
chess is absolutely not an island there
are hundreds of examples where the NHS
partner with industry in order to get
the best that technology has to offer
for patient benefit so examples of that
are companies like Baxter Healthcare
that's a private company they produce
all the fluids that we give in hospital
and the dialysis stuff we give in
hospital Fresenius they're a
multi-billion dollar company they
produce machines that we do use on
intensive care units and finally things
like CT scanners Philips limit your
radios limit your radio alarms nucleus
other things headphones and they make CT
scanners and we buy their CT scanners
because they're very good of course drug
companies that's another private and NHS
partnership we can't do without them we
use them all the time we are constantly
in partnership with industry so after
that I think that's all I've got to see
thank you for attention I'd like to hand
over to Donna King who is one of the
clinical senior advisors for deep mind
will tell you a little bit about the
technical aspects of the app that we use
great thank you dr. cross and sue I'm
very honored to be here today and
firstly because we're really proud of
the partnership we have with the raw
free secondly because I live around the
corner and so I care as much about this
hospital is as you guys do actually my
son my two-year-old son has been
admitted here three times than last year
and so I'm expecting social services to
knock on our door anytime soon and take
him away but you know he's we see very
like amazing care here so for that for
that to remember I'm really honored to
be here
so before joining deepmind two years ago
and I worked actually Imperial College
at Saint Mary's Hospital in Paddington
for about 50 about 1213
years I was a general surgeon and I also
had a deep interest research interest in
patient safety
so I spent many years researching why as
dr. cross said why patients deteriorates
how many patients deteriorate and like
what kind of interventions we can do to
like make sure patients receive really
the best possible care and the reason I
joined deep mine a couple of years ago
was because I was really excited about
the potential for the technologies they
were building to really transform
healthcare delivery so I'm not sure if
many of you are familiar with deep main
so just to give you a little bit of
background so deep main is like a very
proudly black British company it was
founded by three Londoners and is widely
considered to be the leading kind of
advanced technology company advanced
into an artificial intelligence company
in the world so we say it joined forces
rather than was acquired by Google back
in 2014 the reason we say that is
because all the decisions we take are in
London not in California the founders of
deep mind remain in charge of it now to
North London founders who take all the
decisions about what where errors would
work in who we partner with and it's
grown like massively when I joined deep
mind two years ago there's about 200
people there there's now 800 people who
work in Kings Cross and it's widely
considered as I said to be the greatest
concentration of like artificial
intelligence talent anywhere in the
world and I personally think is a great
thing that you know that that's taking
place in London we do have in the last
year we have opened offices in Canada
and in the US but 98 percent of our
staff are based in London and it's a
very diverse group of people about
two-thirds of that 800 people have PhDs
we come from 40 or 50 different
countries we have dozens of professors
neuroscientists mathematic
physicists computer scientists and
engineers all working on on these
technologies so deep mind itself is
broadly split into two groups
we have about two-thirds of the team
working on research trying to progress
their kind of field of artificial
intelligence and then I sit in a team
that looks about how we apply advanced
technologies to areas that we think are
really important and you know the most
important area we think is is in
healthcare so lots of people talk about
artificial intelligence I want to like
be very clear right at the beginning
what we're doing at the war free does
not involve any artificial intelligence
it doesn't involve any robots or
anything anything that would cause cause
you guys any concern I think there's
huge potential for artificial
intelligence in healthcare and I'll give
you some examples of why but hopefully
by the end of this presentation you'll
get a very clear sense of what we're
doing in partnership with the war free
and why it doesn't involve artificial
intelligence now but that will be cut
become clear hopefully by the end of
this presentation but like what is
artificial intelligence lots of people
talk about it this is the kind of wiki
definition and computer systems to now
have been pretty stupid okay they do
what we tell them to do and like this
sense that there in any way human is not
like it's just not been at the reality
and when we talk about artificial
intelligence what we're talking about is
can computer systems demonstrate their
ingenuity and of people sitting in this
room can they do things like translate
can they look at pictures and tell what
something is can they make a decision
based on very complex data without the
input of of human experts and there's
like many types of artificial
intelligence and I'm just going to give
you the two types of describe - the two
types of artificial intelligence we use
a deep mind so it's like pretty
remarkable with ten years ago a computer
system on its own was unable to tell the
difference in a picture between a cat
and a dog like that's like something my
two-year-old son who keeps hitting his
head
and falling over is able to do and
probably has been able to do you know
not far off his first birthday
but the advanced computer systems these
like huge supercomputers weren't able to
do that and that's because what we
actually do how humans think and
perceive is actually like remarkable and
we're nowhere close like computer
systems are just nowhere close to
matching our abilities but what we're
seeing with something called deep
learning which is a type of artificial
intelligence is that we can kind of
start recreating how neurons in the
brain work and actually about ten years
ago someone published a paper that said
actually we can tell like the difference
between a cat and a dog and so if you go
into a photos apps on your phone whether
you have an Apple device or a Google
device you're you are at your photo our
system will now start dividing your
photos up and start saying or this is
holidays this is your pet cat and we're
starting to see this intelligence being
implemented into these systems the other
thing is something called reinforcement
learning which again like children learn
through trial and error and computer
systems now are starting to learn
through similar processes like what
gives them the biggest reward for the
least possible input and deep main
actually became famous four or five
years ago and that's what led to their
move an acquisition from Google on this
piece of work which this system this
algorithm that I'm showing you some of
you will remember this computer game
break out when the algorithm first
started playing the game it was pretty
useless like if we started playing it
we'd be like this not really knowing its
way around the game and after about 300
games it got as good as anyone in this
room so it's getting the ball back it's
breaking the wall down and and the
arcade score was going up it's not being
trained how to do anything and his myth
has it the engineers went home and left
it playing overnight and when they came
back the next day after it played 500
games the algorithm had learned through
trial and error
this way of playing the game that really
boosted the score up and you know caused
it the least amount of work possible so
this is what we mean by reinforcement
learning
now when you join these things together
you start getting some really powerful
impact so for those people that have
worked in academia in the room you know
nature is the world's leading academic
journal this is this is the types of
journal that people spend the whole
academic careers the whole labs working
towards getting one paper here and
deepmind have been really successful at
publishing lots of papers in nature so
the Atari game the work we did and that
was published a couple of years ago
there's an ancient Chinese game called
go which is much more complex than chess
when we beat the world champion of go
last year which was another nature paper
we showed that computer systems can
develop memory which was another nature
paper and then earlier this year we
showed these systems could play chess
better than any system that ever existed
before and also could start learning and
playing things without any human
training at all so I just want to give
you the science of artificial
intelligence is really progressing it
like an enormous pace and we're starting
to see this technology being deployed in
a in the real world so on the kind of
Jenny described the devices that all of
us are using every day so the ability to
translate Maps speech you know if you
have a lecture at home or Syria on your
phone all this is now being driven by
this type of artificial intelligence and
this type of artificial intelligence is
also opening up new opportunities now
that may be things like autonomous
vehicles like this is all being driven
by this type of approach now what I'm
really interested in pancha passionate
about I'm not an artificial intelligence
researcher I'm interested about could we
take some of this technology and deploy
it in like our hospitals could it help
doctors and nurses and patients prevent
the types of deterioration or accidents
that we see all over the hospital
and that's why we set up deep main
health and we think points in the future
the types of technology I showed you
will have an impact they will help us
diagnose disease earlier and x-rays that
will help us pick up the patient it
needs urgent attention of dr. cross or
our colleagues and but there's a lot of
work to be done to get to get there so I
just want to quickly talk about our
research projects because this is very
separate but it kind of confuses some
people about what we're doing are we
doing a research project that we're all
free is there some artificial
intelligence work going on here the
answer is no we are doing artificial
intelligence research in healthcare we
have a project with Moorfields Eye
Hospital looking at eye scans
those of you that are diabetic or fat or
have had any visual problems you may
have had retinal scans they're very
complex to look at and I'll show you
some of the results of that we're
looking at radiotherapy planning at UCL
H so if you have a head and neck cancer
it can take a radiotherapist up to eight
hours to carefully segment the scan that
plans your radiotherapy and we're
helping the radiotherapy see if these
artificial intelligence approaches can
help with that and we're working with
Imperial College London looking at
mammography just quickly on the
ophthalmology work you know two million
fellow Brits have sight loss much of
it's entirely preventable diabetic
retinopathy
changes age-related macular degeneration
these like scans are like beautiful
images that you get off the back of the
eye now but they're really difficult for
experts to like interpret and there's
really lengthy delays in people getting
treatment now what we're seeing in our
work at Moorfields
is that the top row is what the
ophthalmologist sees the middle row is
what the world's leading expert
ophthalmologists at Moorfields this is
areas that they segment out draw around
which are areas that they're really
worried about these things need urgent
treatment or this patient is going to go
blind or hat get gets a loss and what
we're finding with our
artificial intelligences that we can
pick these areas up just as well maybe
better than people that have been doing
this for 20 years so we think you know
we'll be publishing the results of this
soon but we think that this type of
technology particularly medical imaging
can be really beneficial but in the word
which dr. Krauss described we're like
doctors and nurses are still using pages
they're still using page lists we're
still using fax machines you know the
vol.3 is uses technology and they're
much more sophisticated we're in
advanced way than many NHS hospitals but
still common to see lots of paper around
paper charts the idea that you can use
advanced artificial intelligence and
this type of environment it's just it's
just actually not realistic and so we
think a really important first step is
to like help use our expertise to help
hospitals like the war free and we're
also working with a number of other NHS
hospitals to like move away from a
technology at pages that were invented
50 years ago and are not used in any
other industry apart from healthcare
this I should say this is not an NHS
problem I was actually in the u.s. just
a Monday if you go to the leading
hospitals all over the world including
them all free this is what you see in
pretty much every leading healthcare
provider we just haven't moved the
needle as much as we should in terms of
enabling technology so our partnership
at the Royal Free began three years ago
and it's interesting I think to like
talk through how that started so I'm not
sure how many of you have heard of acute
kidney injury it's a really serious
problem it kills 40,000 people a year
there's not just in the UK in England
and a quarter of that's entirely
preventable so just to be clear 10,000
people a year is estimated at least die
from acute kidney injury every year that
is way more than dying car crashes and
and there are ways you know if you have
an acute kidney injury you want to like
dr. Cross to come and see you and sort
you out and get home safely
now Chris Lang who is one of the other
nephrologists here actually approached
deepmind a couple of years ago and
there's an initiative is an existing
alert in the NHS which is used to try
and flag patients with acute kidney
injury and Chris had seen some of the
work deepmind had done and said surely
you guys the current alert works if one
of your blood is one blood test goes up
and alert is flagged to dr. cross or
colleagues and Chris said look if if you
guys can do this amazing stuff with go
and Atari games surely you can come up
with a better algorithm for identifying
acute kidney injury an earlier stage
because you only currently get a flag or
an alert when a lot of your kidney is
already injured and our team spent a lot
of time at the wall free and we're very
confident that we can come up with a
better alert in fact we're working on
that in a separate project research
project and we're very confident that we
are going to come up with a better alert
for acute kidney injury the problem is
that on the top half if you're in a
world of pages and fax machines and
phone calls it takes ages for anyone to
respond to that and not saying all the
time some people like that and I'm not
talking specifically about the wall free
but there's lots of like delays in the
process so we think it's much more
important that we sort this top problem
out and that we know this is the basis
of the streeams app before we start
thinking about what's the role of
artificial intelligence in acute kidney
injury so just to kind of be clear about
what streams is streams is a secure
mobile app so it sits on like
smartphones it's like the apps that many
of you use for all kinds of other
reasons and the aim of it is to give dr.
cross and colleagues the right
information at the right time about the
right patient you know there are you
know in every hospital in the world
limited numbers of clinicians and
particularly X really expert consultants
and professors and if you're the most
unwell patient in the hospital you want
you need to be seen by that expert and
this technology allows alerts to be sent
to doctor
often colleagues about the patience that
they most need to see now streams does
lots of things for clinicians so you
have to like either be a clinician or
follow them around to understand how
difficult is at the moment you're
logging in and out of different systems
their vital signs your heart rate and
blood pressure is on a piece of paper
then in the bed your blood tests are in
one electronic system if you want to
look at an x-ray it's in another system
so that can take 10 15 minutes you're
unwell and the the nurse pages the
doctor sometimes that takes 10 minutes
for the doctor to come they then need to
spend 20 minutes looking after your
medical record what we're able to do is
within seconds like the the clinician
can look they can see all your past
medical problems they can see your vital
signs they can see your heart rate and
so vital signs heart rate blood pressure
your blood tests at the moment of the
war free we're really looking at
specifically a blood test but also
radiology reports what x-rays you've had
done what microbiology tests and we're
starting to see signs of like really
tremendous impact here so previously it
would have taken many hours if you had a
severe acute kidney injury many hours
for dr. cross to come and see you
because for her to come and see you
would be dependent on one of the junior
doctors and another team recognizing a
problem often starting initial treatment
then paging dr. crosses team then dr.
cross team may have then escalated dr.
Carson said I think you will need to
come and see this patient that's now
this is can take many hours what we're
seeing with streams is that over this is
over the course of six months there
we've identified thousands of acute
kidney injury and it just in this
hospital and this is a very busy
hospital and a very big nephrology unit
but it is taking a median time like an
average time of about 12 minutes for
someone like dr. cross or whoever's on
core a specialist to see that alert when
it would have I think
you know conservatively taking many
hours and I think this is like a really
positive thing that you know over the
last six months 1,300 bedside reviews
have been done by the nephrology team
now many of them will have happened
anyway but I think we can all say that
they've been met almost every single one
of them will have been speeded up
because of this process in February of
last year we disk
you know the Evening Standard published
a story of this lady who had a cesarean
section at the war free and she
developed sepsis and acute kidney injury
immediately afterward well not
immediately afterwards shortly
afterwards and you know the specialist
team here was seeing her almost
immediately as soon as those blood
results were back now they would have
seen her at some point but there as dr.
cross said those that ten minutes of
that hour can make all the difference
between someone needing dialysis for
life or ending up in the intensive care
unit or unfortunately sometimes even
worse now I'm just to like go a bit off
at peace for a minute I like absolutely
think and we're we're committed to
providing this type of technology to
patients in the public and you know my
son the two-year-old is is very well now
but he was born prematurely and we spent
many many weeks and weeks in hospital
and many months afterwards going to lots
of appointments like it's really
frustrating if I can change a flight or
change restaurant reservation or a
message my relatives in Australia that I
can't do the same in health care I can
look at when my next appointment is I
can't change easily if I have a blood
test I'd quite like to see that that
evening and not wait for days to find
out what it is no we have a very I'm
sure a tailored group of patients here
but most of you would want access to
this information if you're using
wearable data you would like that in
your medical record you would like to go
to communicate directly and securely
with your clinicians so I absolutely
think this technology should be being
provided also at some point to patients
that's ultimately a decision obviously
for the their hospitals and trusts and
the patients
they're looking after just what where is
the AI and at some point we think that
you know as our algorithms get to a
standard where we can deploy them there
you know if if we're able to pick up
they're on an x-ray which we are already
or some of our colleagues that someone's
got pneumonia as we're able to summarize
a medical record for discharge letter as
we have better alerts that we're now
able to surface that within streams and
that's ultimately where we want to get
to but it's absolutely not what we're
doing now and it's not part of any
contract or part of the current
partnership agreement that would only
come in future if we thought that was
there or the trust thought that was a
sensible thing to do now many of you
will be familiar with some of the
headlines I can say from my clinical
perspective in like my involvement at
the wall free I think what we're doing
is like absolutely transformative
project and I think it is going to
deliver really like major improvements
to patient care but it has been
controversial and in a number of ways
and I'm sure we can we'll talk about
this on the panel and I think you know
we with this there's positives and
negatives to any type of partnership as
most of us know and no I think we need
to reflect on some of the lessons that
that we've learned for me what the most
important of those lessons is that it's
incredibly important that the patients
who were here to serve and the
clinicians were here to serve are aware
of how their data is being used in
process so if you want the raw free
website now you'll see like an amazing
video and information about how data is
generally used they're all free as Jenny
said but lots of different providers are
essentially using data to try and help
deliver a better care so I think there's
lots lots more information now available
about how your data is actually being
used and I think that's incredibly
important from deep mains perspective
you know most of us are academics most
of the
that's senior team that deep minded
clinicians and academics that we are
really committed to publishing what we
do ensuring that we're having impact so
everything that we do is published and
and will be published all our contracts
are made transparently available this is
very kind of strange for most commercial
companies you can gone to the deep main
website go to the wall free part of that
website and download the full contract
describing what the partnership does so
we think it's really important that
we're as transparent as possible with
patients and the public about the work
we're doing and I just want to like
point out you know really strongly say a
few things that the raw free is in
charge of patient data in this
organization they decide all the
companies that Jenny described the war
free decides how and whose data they
process and we are one of many different
processes so we will only ever use that
data for the purposes in which the war
you want us to and that's substantiate
it in legal contracts these contracts do
not allow any type of AI research they
do not allow any type of things for us
to do outside of the contractors for the
delivery of streams no people worry
are we mixing this with like I you know
your Gmail or are we doing advertise you
know targeting advertising because we
now have health data that is absolutely
not the case it would be illegal and
absolutely not something we would do so
you know this is all very formally done
and legal contracts but it's also like
you know this this the approach to how
data is used is very important to us
from an ethical standpoint we've spent
the last year speaking to lots of groups
like this patient groups patient
representatives on Friday we actually
had last Friday we had 12 patients that
came in visited our office had lunch
with our team
any of you would be welcome to join next
event and please come up and ask me and
I'll put you in touch with the right
people it's really important to us as I
said that we're working with you to
deliver this technology so this was an
event we ran a couple of months ago
where we brought lots of patients and
the public together and asked them like
how should a technology company like
deepmind
work with hospitals and with patients
and in doing so came up with a list of
principles and approaches which were
very committed to following being
transparent about the work we're doing
solving problems that are important to
you guys measuring impact publishing
results working towards social good
making sure that data's safe and secure
and really collaborating with the
amazing experts that we do at the War II
and other partners so I think I have a
couple of minutes left so I'm going to
sue Jenny talk through what does patient
care look like if you get all this
technology right so I'm just going to go
back to I'm going to call him Robert so
let's imagine Robert you know young guy
has poorly controlled diabetes and he
collapses at home and hits his head now
already there's technologies I have an
Apple watch but there's already
technologies that many of us use that
are very soon if not already able to
pick up strange things in your behavior
so if you're an epileptic you have an
epileptic fit if you are diabetic and
you're usually at work during the day
and suddenly you're on the floor at home
and you're not getting up an alert could
be sent to either your family or a
clinician to say this is a bit strange
Robert should actually be playing
football now he should be at school or
university and an alert center physician
so if that lads going to be sent to a GP
for example it's very useful for this GP
dr. Jones who gets to alert to be able
to like she may never have met you know
we've all experienced going to see the
GP who's never met you the emergency GP
she's never met Robert before but she's
now able to look at his medical history
his vital signs
his last blood glucose to see is this
abnormal for Robert is there something
strange here that should be worried
about he's hit his head he's not
responsive so she knows that this isn't
something that can probably be managed
in the community so she can make sure
that Roberts admitted to the right
Hospital again many of us have had
frustrating times when we go to a
hospital and you find that they don't
have this specific speciality so you're
waiting for hours and hours to be
transferred to another hospital
as soon as Robert arrives in the
hospital the right doctor gets an alert
if you any of you have experience being
an emergency department waiting hours to
be seen sometimes that's because you
know the charge nurses paging lots of
different teams to find out who the
right doctor is that should be coming
down but this could be intelligently
done through alerts like this as Robert
goes to see sorry as this doctor gets
the alert she's got lots of things going
on she's got loads of patients to see
but because Roberts unwell his care is
prioritized over other patients in the
hospital when this doctor goes to see
Robert like you know again how
frustrating is it when the doctor is
constantly writing notes or in front of
their computer and not looking you in
the eye actually you know if any of you
use it on your smartphone is great voice
recording technology these consultations
are recorded they're in the medical
record if you have any questions and you
want to hear the consultation later that
evening because you've forgotten what
was said you have access to it but this
these kind of consultations can be
recorded
Roberts hits his head the doctor wants
to order a CT scan there's probably at
least 1520 people in this hospital who
are all waiting for a CT scan tonight
that need those CT scan should be
prioritized and robert's scanners
prioritize given his clinical
deterioration there's not always a
neuroradiologist available to look at a
scan so there may be an imaging
algorithm that's able to look at that
scan and say actually there's a bleed
here this needs urgent attention Robert
goes to the operating theatre Imaging's
and control software gauges
operation this stuff is already
happening all over the place it's just
not really joined up in the right way as
you know many of us have had operations
as you make your recovery you develop a
temperature you start becoming unwell
rather than those temperatures and heart
rate rises being put onto paper chart
that put into an electronic system
it automatically recommends a chest
x-ray the chest x-ray is done the chest
x-ray picks up a subtle pneumonia we
know from recent research that
artificial intelligence approaches are
picking up pneumonia more sensitively
now an x-ray than radiologists so now
Roberts getting a diagnosis way quicker
than he previously would have done he's
getting his antibiotics he's getting
treatment and so you know he makes a
good recovery he's ready to go home and
like what happens when you're ready to
go home in hospital well you're gonna
stay here for another 12 hours because
someone needs to do your discharge
paperwork and get your medications ready
a lot of this could be automated so we
can create automatic discharge letters
and summaries coding and already as
Robert leaves the hospital his GP is
pinged a message to say Roberts leaving
so that care is nicely joined up you
know maybe add a bit far-fetched but
again like what keeps you what keeps you
in the hospital for six hours the
hospital transport needs to take you
home you know there are there are other
approaches that could speed things up
for people in this room and importantly
Roberts making a recovery at home he's
able to track his progress
if he has a question have you ever been
there where you have your question and
you have to ring up there you know
hospitals their switchboard you get
through to the consultant secretary say
I've got a question about my operation
or what I need to come back in and you
can spend hours and hours in that
process
why shouldn't like most of us as
clinicians would be quite happy I think
in the secure way to be able to message
and chat with patients who have
questions that would save everyone time
and most importantly Robert is measuring
his blood glucose anyway he's managed
his own illness he's you know young
intelligent and in future he may get a
prompt to say actually you're developing
hypoglycemia as why don't you change
your insulin this whole episode of cash
should have been prevented in the first
place by Robert changing his medications
and so they kind of sense of like as
Jenny said like working on more
preventive care rather than reactive I
think is it's becoming the new paradigm
in reality so hopefully that gives you a
sense this is like the the Nirvana that
every hospital in the world wants and
every health system wants to get to but
I like genuinely think that the war free
is is well places anywhere for this to
happen and the success of this is not
dependent on deep mindless dependent on
largely the war free and also lots of
different partners of which we are one
we think we can provide some useful
solutions but there's the need for lots
and lots of different providers and
partners to make that a reality and hope
improve care for all of us so on that
note thank you very much and I think
we're open to any questions you have
