Thread by @ManeeshJuneja

Now reading the the #TopolReview report - Preparing the healthcare workforce to deliver the digital future. It's an illuminating read topol.hee.nhs.uk #DigitalHealth

It's clear that a lot of effort has gone into the #TopolReview - it paints a glorious vision of what healthcare would look like over the next 20 years (for both staff and patients) - enabled by technology such as #genomics, #AI and #robotics

For me the #Topolreview has too narrow a focus. It's been commissioned by healthcare, yet we know that with an aging population, many people with long term conditions have to rely upon #socialcare as well. We need joined up thinking, imho.

Page 21 --> "While the Review was asked to focus on the impact of emerging technologies on clinical roles and the consequent implications for education and training, many of the findings will also be relevant to the wider health and social care workforce." #TopolReview

From a patient's perspective, there are numerous mentions about the need for the NHS to co-design new services from the beginning WITH patients. I am very happy to see this critical message in so many sections of the report. #TopolReview

Good to see @wearemHabitat cited in the #TopolReview as how to co-design #digitalhealth services with patients. I've met quite a few staff in the NHS who think this way by default, but many still operate in a culture where the system knows best.

Here is a mention in the #TopolReview of a #mentalhealth triage bot which uses #AI - I think this area is very tricky, and we have to proceed very carefully cc: @MarkOneinFour @AlysColeKing #SuicidePrevention

Whilst there is a big focus on #genomics in the #TopolReview, there is at least some mention about prevention and #publichealth

Here is an example in respiratory care in 10 years time. It sounds lovely, but I'd love to hear from clinical staff, how realistic they think this vision is? cc: @76whit @Laconic_doc @shanemuk @andy #TopolReview

Here is another bold vision for 10 years time. It would take a lot of different systems to work together to enable this vision. Not sure about the autonomous ambulance though. #TopolReview

So when it comes to this recommendation about educating healthcare professionals, I would say this applies to any organisation today, not just those in healthcare. Wherever you work, all your staff should have a basic knowledge of data and AI #TopolReview

This point about the NHS needing to be open to collaboration is critical. It really is astonishing how much progress is being slowed down because department X won't share information with department Y. #TopolReview

So whilst the technology will be the relatively easy part, the most difficult part is the culture shift required. Too many ignore this aspect and just expect that rolling out a new app or sensor is enough to transform healthcare. #TopolReview

When it comes to leadership, in order to achieve the vision set out in the #TopolReview, will the NHS have the courage to remove or re-assign those leaders whose beliefs, attitudes and values are holding back innovation? It's a challenge, especially if those leaders are senior.

No mention in the #TopolReview about #Brexit, but given that changing the way staff are educated would require financial investment, I wonder what will happen should economic constraints over the next few years limit the desired investment in education?

Good to see "Health inequalities" discussed in the #TopolReview - It's something that we have to keep front of mind when developing #digitalhealth services

If you work in the #NHS and you look at this chart from the #TopolReview, how does it make you feel? Are you concerned about your role changing (or even disappearing) or are you excited about new parts that could be added to your role?

So if video cameras in hospitals and care homes will use #computervision #machinelearning to detect falls etc, is the productivity gain that you can employ fewer nurses/carers or is about maintaining workforce levels but freeing up time for "care"? #TopolReview cc: @dr_shibley

This part of the #TopolReview is interesting with regard to #DigitalTherapeutics, and how healthcare professionals would have to be digital prescribers but also act as data interpreters. Many GPs I speak to are afraid of being overwhelmed with mountains of data from patients!

Polygenic risk scores - to identify people at risk of certain diseases much earlier than possible today. This sounds like a good thing, provided people can be trained in this effectively. cc: @shanemuk @PhilippaBrice #TopolReview

This is one of the most critical points in the #TopolReview - in terms of the regulators and the regulatory framework when it comes to #DigitalHealth

On the topic of regulators, you can see here from the MHRA board meeting (Oct 2018), that they mention a couple of issues, which are relevant to the adoption of the recommendations from the #TopolReview assets.publishing.service.gov.uk/government/upl…

When it comes to #robotics for helping those patients with a physical disability, it's great to see that patient benefit as the reason behind developing or procuring these new technologies. #TopolReview

Since organisations from around the world are competing to recruit #AI talent, then I do wonder if the NHS is in a position to offer salaries that are lucrative enough, given how much industry roles are paying at the moment? #TopolReview

So one of the key reasons why everyone should be getting excited about the future is that many administrative tasks would effectively be performed by #AI systems (that talk to one another), leaving HCPs with more time to devote to patient care. #TopolReview

Ethics and privacy are mentioned in the #TopolReview - I'm curious, how many patients will be asking doctors and nurses in the future to explain the ethics and privacy of the new digital service that is being offered to them? Will the doctor/nurse be able to explain this to them?

Announced today - Topol programme for twenty Digital Fellowships in healthcare for clinicians and non-clinicians, to incorporate digital health expertise within their careers and pursue training in informatics and #digitalhealth topol.hee.nhs.uk/2019/02/11/dig… #TopolReview

Announced today - a blog post on "Making the NHS ready for the digital revolution" topol.hee.nhs.uk/2019/02/11/top… #TopolReview

Now I've had a chance to digest the #TopolReview a bit more, here are some further thoughts, regarding educating the workforce, and topics the report has made me think about

Consider all the connected devices in the future, transmitting & receiving data (and the number of software updates required) - How will everyone (including patients/carers) be educated about #cybersecurity? Makes me recall #WannaCry theregister.co.uk/2018/02/02/nhs… #TopolReview

In terms of connected devices, is that a role for existing staff or a new type of role, where someone helps patients/carers deal with connected devices? Or will patients/carers be expected to educate themselves? Who helps me setup my smart inhaler? #TopolReview

Also, whilst carers are mentioned in the #TopolReview, unpaid carers vastly outnumber the NHS workforce, I'm curious how much £ will be set aside to provide education for unpaid carers? They are frequently overlooked when it comes to support. kingsfund.org.uk/projects/time-… @dr_shibley

Part of the #TopolReview is about #patientsafety - so when it comes to educating the workforce, I'm curious if the education is on happens when the #AI generates a decision that will harm the patient? How literate about AI will the doctor/nurse/pharmacist need to be?

What role will education play in helping people (both HCPs and patients) about what they can trust when it comes to #DigitalHealth? Can a patient always trust a chatbot? #TopolReview