I wrote a blog article in 2019 about important work the UK National Screening Committee (UK NSC) has done to provide guidance on what evidence is needed before incorporating artificial intelligence (AI) into NHS screening programmes. This work is due to be updated shortly.
AI refers to a range of activities that computers can do, where they think and learn in similar ways to humans. It's a fascinating area, and there are lots of exciting opportunities for screening.
Any developers looking to produce something for the health and care sector will likely already have looked at the NHSX AI Lab. This has a range of resources for researchers and developers.
You will also likely be aware of funding available through the Artificial Intelligence in Health and Care Award. We encourage you to consider entering this award.
In this blog article, we provide more information for suppliers looking to develop an AI product. Specifically, we outline the process developers need to follow if they’d like to see their products used in screening.
Pre-research stage
AI developers that do not have a specific tool available yet, may want to learn more about the NHS screening programmes and their requirements.
To do this, we recommend developers focus on contacting clinicians and academics working within the programmes, as they will be best able to identify areas where AI may be useful.
Contact with clinicians is best done through their employing organisations or via their professional bodies.
If needed, Public Health England (PHE) Screening may be able to put developers in contact with clinicians. Send any queries to the PHE Screening helpdesk.
Research and development stage
Companies in the research and development stage will want to learn more about:
- how new technology is approved for use in NHS screening programmes
- the process by which screening programmes are modified
You will need to show how your technology will benefit the screening programme. To do this, you may wish to learn more about:
- the needs and priorities of NHS screening programmes
- getting access to data to help train or evaluate AI
Needs and priorities
The priorities for all NHS screening programmes are focused on improving the benefit to the population – doing more good than harm at a reasonable cost.
In practice, this means AI should help:
- reduce the harm from the disease of interest
- improve delivery and quality of the service
Reducing harm means:
- better identification through screening of people who can be helped
- minimising false positives (where people are told they may have a condition, when they do not)
New technology should be cost effective or provide equivalent quality for less money. Its introduction should also consider the impact on the wider NHS clinical pathways to avoid additional costs or service disruption elsewhere.
Access to clinical data
Any team developing an AI product will likely need data to train and test their product. A range of health sector datasets can be accessed through the Health Data Research Innovation Gateway. However, you may need data directly from the programmes.
Access to personal identifiable information is controlled through a strict data release process which needs:
- a clear legal basis
- evidence of relevant data controls
- a data release agreement
Personal identifiable information will only ever be shared with developers undertaking approved research and have legal and ethical approvals. Depersonalised or anonymised data may be shared under appropriate controls.
PHE’s Office for Data Release oversees the release of any data which PHE controls. Where data is controlled by the NHS service provider, they will have their own process for overseeing possible data sharing.
If you want access to identifiable data, you will either need consent from every participant, or a successful application to the Health Research Authority Confidentiality Advisory Group. This is regardless of which NHS screening programme you want to get data from, or who the data controller is.
In order to work, some AI products may require changes to information systems currently used in screening programmes. Do discuss this with your clinical and academic partners and raise with the relevant Research Advisory Committees (RACs).
RACs
You need to submit all research with the potential to impact existing screening programmes to the relevant screening programme RAC.
Screening services need to discuss research projects with commissioners before starting a study. This is because commissioners will want to be assured that the screening service will be still provide effective care for those not involved in the research project. Commissioners will ask if a study has had RAC approval.
RACs are hosted by PHE and are responsible for reviewing research proposals which may affect people being screened by altering current screening programmes. The RAC reviews applications to make sure research will not inadvertently harm patients or lead to difficulty in the provision of NHS screening.
A RAC is also one way in which PHE's Director of Screening Programmes is made aware of new research on the horizon. This is essential as it allows PHE to plan for what the UK National Screening Committee (UK NSC) will likely need to review in future.
The RAC will want to see a detailed research proposal with:
- descriptions of what you plan to do, including what data you plan to use
- how it will benefit the public’s health
- any information governance approvals
- ethics approvals from relevant oversight bodies
- an assessment of any potential impact on current service delivery
Once you have a research proposal, you’ll need to email the programme-specific RAC.
A review can take several weeks and the RAC may request further details, so make sure you factor this into your planning.
More to come
We really hope this article has been of help. We'll soon be publishing another blog post on current developments in AI in breast screening.
PHE Screening blog
The PHE Screening blog provides up to date news from all NHS screening programmes. You can register to receive updates direct to your inbox, so there’s no need to keep checking for new blogs. If you have any questions about this blog article, or about population screening in England, please contact the PHE screening helpdesk.