Engaging children and young people on the potential role of artificial intelligence in medicine.

INTRODUCTION: There is increasing interest in Artificial Intelligence (AI) and its application to medicine. Perceptions of AI are less well-known, notably amongst children and young people (CYP). This workshop investigates attitudes towards AI and its future applications in medicine and healthcare at a specialised paediatric hospital using practical design scenarios. METHOD: Twenty-one members of a Young Persons Advisory Group for research contributed to an engagement workshop to ascertain potential opportunities, apprehensions, and priorities. RESULTS: When presented as a selection of practical design scenarios, we found that CYP were more open to some applications of AI in healthcare than others. Human-centeredness, governance and trust emerged as early themes, with empathy and safety considered as important when introducing AI to healthcare. Educational workshops with practical examples using AI to help, but not replace humans were suggested to address issues, build trust, and effectively communicate about AI. CONCLUSION: Whilst policy guidelines acknowledge the need to include children and young people to develop AI, this requires an enabling environment for human-centred AI involving children and young people with lived experiences of healthcare. Future research should focus on building consensus on enablers for an intelligent healthcare system designed for the next generation, which fundamentally, allows co-creation. IMPACT: Children and young people (CYP) want to be included to share their insights about the development of research on the potential role of Artificial Intelligence (AI) in medicine and healthcare and are more open to some applications of AI than others. Whilst it is acknowledged that a research gap on involving and engaging CYP in developing AI policies exists, there is little in the way of pragmatic and practical guidance for healthcare staff on this topic. This requires research on enabling environments for ongoing digital cooperation to identify and prioritise unmet needs in the application and development of AI.

UCL MotionInput: Touchless computing interactions in clinical training, radiology and operating theatres.

Coupled with advances to federated on-device computer vision, the convenience of use and ease of access of cameras integrated into existing computers and tablets will increase touchless computing uptake in the form of gesture recognition software in healthcare for both clinicians and patients.

Defining the Enablers and Barriers to the Implementation of Large-scale, Health Care-Related Mobile Technology: Qualitative Case Study in a Tertiary Hospital Setting.

BACKGROUND: The successful implementation of clinical smartphone apps in hospital settings requires close collaboration with industry partners. A large-scale, hospital-wide implementation of a clinical mobile app for health care professionals developed in partnership with Google Health and academic partners was deployed on a bring-your-own-device basis using mobile device management at our UK academic hospital. As this was the first large-scale implementation of this type of innovation in the UK health system, important insights and lessons learned from the deployment may be useful to other organizations considering implementing similar technology in partnership with commercial companies. OBJECTIVE: The aims of this study are to define the key enablers and barriers and to propose a road map for the implementation of a hospital-wide clinical mobile app developed in collaboration with an industry partner as a data processor and an academic partner for independent evaluation. METHODS: Semistructured interviews were conducted with high-level stakeholders from industry, academia, and health care providers who had instrumental roles in the implementation of the app at our hospital. The interviews explored the participants' views on the enablers and barriers to the implementation process. The interviews were analyzed using a broadly deductive approach to thematic analysis. RESULTS: In total, 14 participants were interviewed. Key enablers identified were the establishment of a steering committee with high-level clinical involvement, well-defined roles and responsibilities between partners, effective communication strategies with end users, safe information governance precautions, and increased patient engagement and transparency. Barriers identified were the lack of dedicated resources for mobile change at our hospital, risk aversion, unclear strategy and regulation, and the implications of bring-your-own-device and mobile device management policies. The key lessons learned from the deployment process were highlighted, and a road map for the implementation of large-scale clinical mobile apps in hospital settings was proposed. CONCLUSIONS: Despite partnering with one of the world's biggest technology companies, the cultural and technological change required for mobile working and implementation in health care was found to be a significant challenge. With an increasing requirement for health care organizations to partner with industry for advanced mobile technologies, the lessons learned from our implementation can influence how other health care organizations undertake a similar mobile change and improve the chances of successful widespread mobile transformation.

Making the invisible visible: New perspectives on the intersection of human-environment interactions of clinical teams in intensive care.

Understanding human behaviour is essential to the successful adoption of new technologies, and for the promotion of safer care. This requires capturing the detail of clinical workflows to inform the design of new human-technology interactions. We are interested particularly in the possibilities for touchless technologies that can decipher human speech, gesture and motion and allow for interactions that are free of contact. Here, we employ a new approach by installing a single 360° camera into a clinical environment to analyse touch patterns and human-environment interactions across a clinical team to recommend design considerations for new technologies with the potential to reduce avoidable touch.

Clinical perception of effectiveness of virtual appointments and comparison with appointment outcomes at a specialist children's hospital.

INTRODUCTION: A transition from face-to-face to virtual consultations occurred in response to the COVID-19 pandemic. Evaluation of outcome data is essential for future healthcare modelling. METHODS: Clinicians at a children's hospital evaluated perceptions of face-to-face video and telephone appointments by questionnaire. Responses were compared with operational outcomes from June 2019 and June 2020. RESULTS: Ninety-three clinicians responded from 28 subspecialties. Virtual consultations increased from 6% (2019) to 67% (2020). No differences were found between appointment types for recording a medical and social history; a significant difference (p<0.001) was seen for the perceived ability to detect clinical signs, organise investigations and make a diagnosis. The proportion of appointments resulting in discharge compared with face-to-face visits was unchanged. The proportion of patients requiring further contact increased from 35% (32% face-to-face and 3% telephone) to 46% (14% face-to-face; 21% telephone and 11% video; chi-squared 426; p<0.0001).The percentage of patients offered an appointment following two 'was not brought' appointments increased from 71% (2019) to 81% (2020) and was most common following telephone appointments (20% face-to-face, 43% telephone and 18% video; chi-squared 474; p<0.0001). CONCLUSION: The perception of clinicians is that virtual appointments enabled continuity of paediatric care with improved clinical assessment capability and attendance during video consultations compared with telephone consultations.

The essence of healthcare records: embedded electronic health record system microblogging functionality for patient care narrative.

INTRODUCTION: Electronic health record (EHR) systems capture information relating to patients across many specialties but can be complex, making rapid evaluation and communication of current important issues difficult. METHODS: As part of a children's hospital EHR implementation, we developed and implemented an embedded microblogging platform to allow users to provide a short summary of main issues or actions relating to the encounter, 'Essence' capturing the essence of the interaction. We reviewed usage by specialty and user type over a 1-year period. RESULTS: Ninety-one thousand, nine-hundred and fifty Essence entries were committed across 49 specialty areas during a 12-month period, April 2019 - April 2020. The specialties with greatest usage were cardiology, neurosurgery, intensive care, respiratory medicine and neurology, with 70% of entries by nursing staff. The median number of words used per entry was 17 words (range 1-120; mean 20.7), and microblogs were mainly used to describe actions, events or planned care. Manual content analysis of 200 representative entries demonstrated categories of importance (including clinical status, treatment plan, investigations, procedures and diagnoses) suggesting appropriate clinical utility. CONCLUSION: Incorporation of an embedded EHR microblogging platform to capture key interactions with healthcare professionals represents a novel approach to coordinating care communication and is widely used across specialties, especially by nursing staff.