NHS Physicians Associates and the Digital Human Cardiac Coach©
Left: NHS Physician Associate. Right: The Digital Human Cardiac Coach ©
Human Intelligence (HI) plus Artificial Intelligence (AI) is the Solution to Health Service Accessibility
There has been some controversy over the role of “Physician Associate” in the NHS UK: including criticism over the way these roles have been described as “specialists” and “physicians”. The British Physician Associate (PA) initiative has reignited the old fire storm about the transfer and evolution of medical health services from the traditional custodians to new market entrants and methods.
Initially, I also had concerns about the role of PAs. But after investigation, I can see great positives in this initiative. I see this diversification of the workforce as a good thing. But diversification is not transformation. We need to go much further.
In my view, this is all about access. Long waiting lists mean that people in most need, and without financial resources really don’t get access to services. Putting the marketing of these roles aside, what matters is access. Nobody is questioning or devaluing the value of a specialists with decades of training and experience.
But if people can’t get access, because of workforce shortages caused by demographics or budget rationing, then the system has failed everyone.
We are already seeing examples of this diversification: pharmacists performing some of the duties of general practitioners including vaccinations and selected diagnoses and treatments. Consumers of health services, including myself and my family, will always care about the quality of the health services we receive. We rely on governments and commercial organisations that deliver health services to meet high standards.
But the highest of standards are irrelevant if we do not have access to the services at all. Accessibility of health services is one of the wicked problems of our time.
But we need to go beyond simple workforce diversification. To a transformation of servicing, augmenting HI with AI in the way services are delivered and accessed.
Accessibility of health services is limited by the decreasing availability of practitioners and by ever increasing cost. Any initiative that has its objective meeting these challenges head on should be applauded. The Digital Human Cardiac Coach that Al Johnson (aka #CardiacMan) and I designed is one such way of tackling these problems. It can be available 24 x 7 and at low cost point. The other massive issue it addresses is health literacy but more on that later.
What the NHS is proposing could and should be seen as the start of a revolution in the application of Human Intelligence (HI) to augment access to health services. What I proposed and continue to develop is a revolution in the application of Artificial Intelligence (AI) to augment access to health services.
Let's look at how we can combine HI and AI to improve the delivery of health services. I believe there is significant synergy between the two.
The scope of the Digital Human Cardiac Coach is deliberately constrained by design. It is not a Large Language Model (LLM), but a constrained/bounded domain with contextual depth. The boundaries that are set for it cannot be exceeded. Its AI corpus is co-designed not web scraped, nor sourced from the general population, a great proportion of whom are health illiterate. By the way, I have previously written and spoken about poor quality information and advice delivered online by professional medical personnel; this would also be web scraped in an LLM approach.
In its current form, we have excluded the capability to perform diagnosis and treatment. Rather, it focuses on helping patients navigate their health journey including preparation for hospital, their in-hospital stay, discharge, recovery at home, rehabilitation and then through-life management of their condition. This service chain is currently seriously impacted by inaccessibility to health services and population-wide problems of health literacy. We deliberately declared the capability of the Digital Human Cardiac Coach, to be a coach because it is there to help guide patients on this difficult journey, but also to direct them to any professional services they might require. After all, a football coach doesn’t perform knee surgery or physiotherapy on their players.
The Digital Human Cardiac Coach "Carer Conversation" with Marie Johnson on YouTube
By way of contrast, the NHS Physician Associate will perform diagnosis and treatment. But there is also overlap in their scope of practice with the Digital Human Cardiac Coach. Patients, consumers if you'd like to call them that, ask whoever they want about their journey and how to navigate it. GPs are not by design or experience typically able to address all of the minutia of the patient cardiac journey from prehospital through the various post surgical stages. Unfortunately, the patients concerns start as soon as they hear those words from their GP “we need to send you for more tests and you might need surgery”. By not addressing these concerns from the get go, we create stress in the patient that can build up and result in poor health outcomes. The Digital Human Cardiac Coach can be a valuable tool for the Physician Associate. They can either provide access to it for their patients or use it themselves to answer patient concerns and questions.
Development is another opportunity to leverage the synergy between HI and AI. We excluded diagnosis and treatment from our scope for the Digital Human Cardiac Coach because it meant that in its earlier forms we did not necessarily need to address some of the higher regulatory requirements that exist for these medical activities. But AI is already used for diagnosis and treatment (such as in the interpretation of x-rays) and there is no reason why the Digital Human Cardiac Coach could not perform these activities in the future. There is a great opportunity here to develop both the Physician Associates’ knowledge and skills in their particular stream (e.g. cardiac) and at the same time expand the capabilities of the Digital Human Cardiac Coach as a major tool in their arsenal. This could radically change training costs, enhance standardisation and help manage the workload of these new Physicians Associates. Their training and then use of the Digital Human Cardiac Coach would also be an important component of the initial and ongoing co-design.
The domain boundaries of the Digital Human Cardiac Coach are tightly constrained by design. This is critical in the use of AI to provide safeguards and to alleviate fears about rogue activities. Unlike some of the worst examples of AI sprouting offensive material or plain rubbish, the Digital Human Cardiac Coach when asked a question that is not part of its co-design will simply refer the patient to the appropriate health practitioner. A similar approach will be required for the Physicians Associate to ensure that issues outside of their scope of practice are referred on to the various experts in their field. The Digital Human Cardiac Coach would be a powerful tool for the integrity of the scope of practice of the Physician Associate. The corpus could contain the rules around the scope of practice and the Physicians Associate could simply query the Digital Human Cardiac Coach on a particular issue and be advised where it should be referred to.
The HI-AI operating model is one of ongoing continual transference of knowledge. As with Nadia, the Digital Human Cardiac Coach is a training system - both a trainer and a trainee.
The concept or model of a trainee “learning system” is not new. In domains across industries, examples of training systems that learn and provide performance feedback include flight simulators and Formula1 training models.
In each of these domains, people train the systems. People are also trained by and train on the systems. Through an operating model of data analytics and performance feedback, the performance of the system and the performance of the people using the system, improves. In high risk or regulated environments such as aircraft operations, practitioners are trained and accredited on the training system before graduating to a real-life operational setting.
For example, a flight simulator artificially re-creates aircraft flight and the environment in which it flies, for pilot training and other purposes. It includes replicating the equations that govern how aircraft fly, how they react to applications of flight controls, the effects of other aircraft systems, and how the aircraft reacts to external factors such as air density, wind and so on.
Flight simulation is used for a variety of reasons, including pilot training, the design and development of the aircraft itself, and research into aircraft characteristics and control handling qualities. The Digital Human Cardiac Coach could provide a similar simulation environment for the Physicians Associate.
And this is the thinking behind the digital human as the trainee: a training system, with the emphasis on co-design, performance analytics and research.
The Digital Human Cardiac Coach becomes a continuous learning system and a continuous training system, and in this respect, a new dimension to augment the human workforce of Physician Associates.
For seventeen years, my heart patient husband Al Johnson - known globally as #CardiacMan - and I have travelled this life journey of access to cardiac health support and the compounding impact of health illiteracy. We were so traumatised and motivated, that we created the Digital Human Cardiac Coach.
We applaud the NHS for this initiative of Physician Associates, as a significant strategy to improve access to services in an era when demand is unmeetable. A level of access that would have changed the trajectory of Al Johnson’s cardiac journey for the better.
Imagine, the HI Physicians Associates empowered with the AI Digital Human Cardiac Coach, has the potential to match that demand and radically transform access into the future.
Read more about the Digital Human Cardiac Coach at https://marie-johnson.com/digital-humans and in the book “Nadia: Politics | Bigotry | Artificial Intelligence” on Amazon https://amzn.asia/d/08iIGWHn
Note: Digital Human avatar provided by Trulience. We built the Agent in Google Dialogflow.