The GP API

We are convinced that there will be a general trend to move away from relying on a central system to hold our data and respond to our illness, towards collating personal data and using it to manage our own health.

People want to become more active participants in the healthcare and services they receive. This is not just about making services better for the engaged few, but by delivering services to the unengaged many.

The single largest untapped resource in the NHS is the patient and

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that patient is more than ready to get involved.

DIY Health
This general trend can be referred to as DIY Health and it relies on a confluence of factors all of which are already in place and gaining traction extremely quickly:

  • Mobile technology used to collate data
  • Apps to deliver services
  • Social networks to share experiences
  • Crowd-sourcing to collate and rate services
  • An ability to process vast quantities of (realtime) data

From the NHS Scotland eHealth Strategy 2011 – 2017 we can see a recognition of some of these changes:

  • Improved broadband coverage across Scotland is allowing greater and faster internet access from home and smartphones
  • For young people in particular, the internet and mobile phones are fast becoming the primary means by which they can be communicated with and through which they expect to access services
  • Society is increasingly comfortable with self-service models of interaction

Paradigm shift not Channel Shift
On the surface, providing mobile access to an NHS portal which connects me to my patient record and allows me to access information and book services would address the trend identified in the strategy document. But this approach would miss the point entirely.
This channel shift would offer benefits but it is still reactive, relies on one-to-one service delivery and enshrines the sticky issue of accessing a patient record.

People are using devices / apps / smartphones to build their own Health Graph richer and far more complete than their existing patient record. That Health Graph may not (yet) contain the list of medical facts and incidents the NHS patient record contains but it will hold vast swathes of data that provide the means by which I can receive warnings and recommendations, support and advice, nudges and reminders – all of which provides the foundation for DIY Health Services.

What we now need are precisely those services which operate on this data, and a way for apps to consume these services and make them useful to us.

Introducing the GP API
The patient needs a new type of service from the NHS which works with our new patient record. This will incorporate:

  • The ability to accept, process and analyse a large amount of personal data
  • The ability to recognise salient patterns within this data
  • The ability to connect these salient patterns to useful information and advice
  • A way to package this service to allow data to be securely transmitted and recommendations to be immediately provided

This is the GP API.

Like a real GP apps using the GP API could be used by to assess your data – your extensive range of vitals – and to form an opinion about your health, offering warnings and advice about changes you might make.
They could make recommendations about specialist service providers best placed to deal with your complaints.
They can perform differential diagnosis based on you making simple answers to questions they pose.
Given a diagnosis they can recommend a treatment plan.

Unlike a real GP apps can go home with you, provide you with a huge resource of additional material to help you understand your condition, nudge you to stay with your prescribed treatment and help monitor your rehabilitation.

Unlike a real GP, if you are unfortunate enough to have a chronic illness, apps will be on standby for the remainder of your life giving you and your family and friends practical advice and support to manage your condition.

Unlike a real GP apps using the GP API would provide a highly available service operating 365x24x7 in every part of the country simultaneously, servicing thousands of concurrent requests – without falling over.

Why is the NHS well placed to create a GP API?

  • The NHS has access to the expertise needed to provide such a service
  • The NHS has the authority to assure patients that they are getting safe and considered advice
  • The NHS has the scale and resources to manage a single central system tasked with collating and analysing vast amounts of data

Why should the NHS want to create a GP API?

  • Making good use of existing resources and investment (in line with strategic objectives)
  • Improves healthcare services for patients
  • Isolates expert services from the distributed delivery of those services
  • Provides an architecture that breaks down the healthcare stack into more manageable units
  • Having access to this data and developing these services would allow the creation of a world class system capable of delivering global services, at a profit

What would the GP API look like?
This is the sort of thing I do with my GP:

  • Get a health check
  • Take the advice to avoid getting ill, or discover I may already be ill
  • Get a differential diagnosis to narrow down the condition I might have
  • Find out more about this condition, read about symptoms, causes and the potential treatment plans
  • Look for a specialist to investigate further

Here is an overview of GP API v0.1

//to get a health check – using data from your health graph
Consultation(data){

Potential conditions
Recommended Actions

}
//to diagnose a condition – similar to theengine behind NHS 24 decision tree
DifferentialDiagnosis (data, answers to simple questions){

Possible conditions
More simple questions

}
//to find out more about a condition – similar NHS Choices API
GetDetailsAboutCondition (condition){

Symptoms
Causes
Treatment Plan

}
//to find out where to get specialist services – should leverage patient ratings
GetRecommendedSpecialist (condition){

Specialist practitioner
Centres of excellence

}
Using the GP API
By publishing a GP API we would see an explosion of apps built by vendors across the globe. Storm are involved in building precisely the sort of apps in the private sector that would leverage this type of service.

Apps might use the GP API to treat a range of DIY Health scenarios:

  • Preventative health management: ‘wellness’
  • Post consultation support (understanding diagnosis, managing prescriptions, rehabilitation programmes)
  • Management of chronic conditions (such as diabetes, depression, etc)
  • Social care

This fits entirely with the NHS Scotland eHealth Strategy 2011 – 2017, where we find the following strategic aims:

  • “support people to communicate with the NHSS, manage their own health and wellbeing, and to become more active participants in the care and services they receive; “
  • “contribute to care integration and to support people with long term conditions;”
  • “improve the availability of appropriate information for healthcare workers and the tools to use and communicate that information effectively to improve quality;”
  • “improve the safety of people taking medicines and their effective use.”

Additionally this approach speaks directly to the heart of the quality ambitions for eHealth, entirely delivering a person-centred approach:

  • “support innovative applications of eHealth which enable the delivery of the NHSS’s Three Quality Ambitions
    • Person-centred
    • Safe
    • Effective

Ultimately this approach finally delivers on long held ambitions which precede even the current eHealth strategy:

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