Introduction to PATCHS AI

What is PATCHS AI?

PATCHS AI is an optional feature of PATCHS that automates parts of the triage and workflow when processing patient requests. The aim of PATCHS AI is to reduce GP practice workload and improve patient safety. PATCHS AI has been available since January 2021, and all GP practices that use it have found it both useful and safe.

There are different PATCHS AI modules, which do different things:

  • Urgency AI flags patient requests as urgent or emergency as soon as they are submitted.
  • Signpost AI signposts patients away to self-care, NHS 111, or emergency services as appropriate.
  • Topic AI works out the clinical topics of a patient request and can be used to ask patients further questions before they submit their request.
  • Assign AI assigns requests to a ‘Clinical’ inbox if they need input from a clinician.
  • Face-to-Face (F2F) AI highlights requests that may need an in-person consultation so they can be booked in sooner.

How does PATCHS AI work?

PATCHS AI using Natural Language Processing (NLP) and both deep and shallow machine learning to analyse free text responses from patients. PATCHS AI has been ‘taught’ how to do this by the triage decisions made by GP practice staff using PATCHS each time they process real life patient requests (this is called supervised learning), and through other unsupervised learning techniques.

PATCHS is not a keyword search or pre-programmed algorithm, though for certain AI modules we sometimes use additional keywords and algorithms to improve performance.

PATCHS AI has learned from the experience of hundreds of PATCHS users across the country who have triaged thousands of real patient requests (see: the wisdom of the Crowd). And it's learning more every day - each time a user makes a triage decision they are teaching PATCHS how to triage similar patient requests in future.

Because PATCHS AI makes clinical decisions, we primarily use triage decisions made by clinicians to teach PATCHS AI rather than triage decisions from non-clinical staff (although we do use triage decisions made by non-clinical staff when they don’t need clinical input). Therefore, it’s important that where appropriate (e.g. where a request needs clinical input), GP practices assign requests to clinicians within PATCHS so they can add appropriate triage decisions.

PATCHS AI can therefore deal with real-world patient health problems, spelling mistakes, and uncertainty - all of which are essential for General Practice. However, just like the humans that teach it, PATCHS AI isn’t perfect. It isn’t 100% accurate – nothing is.

How is PATCHS AI regulated?

PATCHS AI is considered a Class I Medical Device because it offers ‘triage and signposting of next steps based on filters by severity and probability of a match’, but without ‘direct diagnosis’. It is registered with the Medicines and Healthcare products Regulatory Agency (MHRA) and is UKCA marked. This means we undertake rigorous clinical evaluations and safety assessments before releasing PATCHS AI modules to customers, and conduct ongoing post-market surveillance after they are released. This process includes multiple stages of testing including on historic patient requests, newly collected patient requests, interviews with staff and patients, and direct comparisons with GPs.

Because PATCHS AI is used in the NHS, it is also governed by DCB0129: Clinical Risk Management: its Application in the Manufacture of Health IT Systems. This means it regularly undergoes clinical risk assessment and has its own Clinical Safety Case Report, which should be read and understood by GP practices before it is used.

How should PATCHS AI be used by GP practices?

PATCHS AI is meant to assist, not replace, human decision-making. It is an optional feature of PATCHS and is used by GP practices at their own risk.

We recommend that GP practices become familiar with using PATCHS without AI first so they fully understand how PATCHS works. If GP practices use PATCHS AI before this point they may become reliant on it. Because PATCHS AI isn’t 100% accurate, if a GP practice relies on PATCHS AI, the risk is they will not have processes in place for the cases where PATCHS AI is incorrect. As a guide, we recommend you get to the levels of PATCHS requests recommended in this article before switching on PATCHS AI.

Because it isn’t 100% accurate, staff should still read, respond, and triage all patient messages as soon possible when using PATCHS AI.

To conduct post-market surveillance of PATCHS AI as required by medical device regulations, we monitor triage decisions made by staff to ensure that it is safe. Because PATCHS AI makes clinical decisions, we primarily use triage decisions made by clinicians to do this rather than non-clinical staff (although we do use triage decisions made by non-clinical staff when they don’t need clinical input). Therefore, in order to use PATCHS AI, where appropriate (e.g. where a request needs clinical input), GP practices must assign requests to clinicians within PATCHS so they can add triage decisions. If GP practices do not do this, we cannot monitor the safety of PATCHS AI and they will be unable to use PATCHS AI.

How does PATCHS AI work with PATCHS Translate?

PATCHS is primarily meant to be used in English, however, GP practices can choose to use PATCHS Translate. This feature allows patients to submit requests in non-English languages that are then automatically translated into English by PATCHS. PATCHS AI has primarily learned from requests written by patients in English, so non-English language requests are first translated to English then analysed by PATCHS AI. This may reduce the accuracy of PATCHS AI. To make translated patient requests quicker and easier to identify in the PATCHS inbox there is a language icon next to them.

mceclip7.png

What work are we doing on the use of AI in general?

The use of AI in clinical care is a developing and fast-moving area. PATCHS is at the forefront in terms of AI research, practice, and regulation. We are working with NHS Digital on how best to assure AI in online consultations using PATCHS as an exemplar. We are also preparing peer reviewed scientific publications on PATCHS AI with The University of Manchester.