Digital tools to improve safety

My Topol fellowship problem / project:

Polypharmacy, where patients are prescribed multiple different medicines, is becoming more common. More than 20% of UK adults routinely take more than 5 medicines, and in one of my hospitals I found more than 10% of people admitted take 14 or more. The number of community prescriptions has doubled in the last 20 years in England.

Whilst most prescribing is very good, there is a growing evidence that polypharmacy can be harmful.

Patients with polypharmacy are more likely to be prescribed high risk medicines, and are more likely to suffer harm through adverse drug reactions, drug interactions, medication errors and poor adherence. Inappropriate polypharmacy also places a considerable financial burden on the NHS, both from unnecessary  spend on medicines and costs related to harm from medicines.

The need to get a handle on inappropriate polypharmacy is becoming ever more critical as we deal with the rise of multi-morbidity (people who have many different chronic medical problems at the same time), identified by the Chief Medical Officer as one of the main challenges that healthcare  must face.

Clinical pharmacologists have expertise in the safe and effective use of medicines, yet it is challenging to ‘scale up’ our work. Medication reviews are demanding in patients with polypharmacy and multi-morbidity, given the huge variety of medicines patients take, the number of possible interactions and side effects, and the siloed nature of healthcare. “De- prescribing” (the safe withdrawal of inappropriate medicines) can be more challenging than prescribing.

Digital tools have huge potential to help, and for my Topol fellowship I intend to explore how we can use these to address this challenging area. I will explore whether we can use digital tools to help identify people at risk of harm through inappropriate polypharmacy, flag drugs commonly implicated in adverse drugs reactions and prescribing cascades, and for clinical decision support around which medicines which could be prudently altered, stopped or started.

I am a registrar in Clinical Pharmacology and Internal Medicine at University College Hospital. I am interested in the safe and effective use of medicines, and how we can use digital technology to ‘scale-up’ solutions to help drive better patient care.

My clinical work involves general internal medicine and acute medicine, with a focus on patients with combined cardiovascular and renal disease, toxicology and hypertension. I have a PGCert on medical education and am keen on teaching both undergraduates and postgraduates. I have developed both in person and electronic teaching resources, and regularly teach on topics including internal medicine, safe use of medicines and clinical trials. I am very interested in clinical leadership, and spent a year as a clinical fellow to the Medical Director for NHS England.

I am passionate about service improvement within the NHS, and have worked on a number of local, regional and national projects using routinely collected electronic health record data (and electronic prescribing data) to improve patient care.

I have a particular interest in the potential of Artificial Intelligence. I am the lead author of the Academy of Medical Royal Colleges report on the implications of AI in healthcare commissioned by NHS Digital,  and am working with the AI Centre for Value Based Healthcare to help safety deploy and evaluate AI software in hospitals.