Professor Joe McDonald pens an open letter to Facebook’s founder and chief information officer on what the Great North Care Record is learning on consent. In the current climate, he suspects Mr Zuckerberg just may find it helpful.
Dear Mr Zuckerberg,
Let me first apologise for my impertinence in writing to you. You are clearly a very bright young man, you have made something wonderful in Facebook, and I’m sure you have no shortage of advisors. I am a massive fan of your product and – despite the recent revelations about Cambridge Analytica and the unfortunate revelations about data sharing between your company and theirs – I will not be deleting my account just yet. Despite all the possible misuses I believe Facebook is, on balance, a force for good, although I do believe it could be an even bigger force for good if you put your mind to it.
Who the heck am I to be offering advice to you? Well, my name is Joe McDonald and I have been a psychiatrist working for the English National Health Service for the last 34 years. So I have spent a long time talking to citizens about confidentiality, its limitations and the need to share information with others for care or research.
NPfIT: we learnt a lot…
A decade back, I worked on England’s National Programme for IT in the NHS as national clinical lead for IT in mental health, with exposure to the intricacies of sharing extremely sensitive data. That programme was generally, perhaps unfairly, considered to have failed – despite having spent nearly £13 billion. But we did learn quite a lot about information sharing and confidentiality… well, some of us did. At the time I remember explaining to my young daughter our attempt to give every citizen an electronic patient record, to which she replied: “Why bother, Dad? Just give them an extra Facebook account each and they only friend their doctors and nurses. That would be free.”
More recently I have become a professor of health informatics practice at Newcastle University in the North East of England, where, I’m sure you will know, we invented electricity, trains, computer programming, the light bulb and of course, Newcastle Brown Ale.
Let me tell you about the Great North Care Record
My final credential is that I am director of a project called the Great North Care Record. That sounds a rather grandiose name given we only serve 3.6 million citizens compared with the two billion citizens you serve on Facebook, but sometimes it’s easier to understand problems if you delve into the detail with smaller numbers.
The Great North Care Record has three aims:
1) To make our region the best place in the world to get care
2) To provide information to the NHS to enable our taxpayers to get best value from the NHS
3) To provide the best health and care research environment in the world
It is in number three that our interests come together and where we might usefully help each other I think, Mr Zuckerberg.
In building the Great North Care Record we want to be able to share citizen’s identifiable health data to do research which will, say, identify the best treatment for a person with schizophrenia and certain features on their genome.
It’s all about informed consent, Mr Zuckerberg
The NHS has been extremely successful at introducing electronic patient records but very poor at getting any meaningful information out of them. 25 years of data on 50 million people. Just sitting there. Doing nothing. The reason? Well as you know very well now, you need informed consent to share that information for research and in the past it was considered too difficult to collect all that informed consent.
So, going back to basics and in an attempt to come up with a model for informed consent we ran 20 workshops across our region attended by citizens. We asked them to help us design a consent model to unleash the power of their data for genomic and precision medicine. We discussed the concept of “the creepy line” – the point at which information sharing gives the citizen a creepy feeling which causes them to withdraw.
The creepy line
Facebook went over my creepy line when you shared my friend’s telephone number from my data without my friend’s permission. What we found in our 20 workshops, not surprisingly, is that everyone is different in terms of their creepy line – some very relaxed about sharing and some really passionate about privacy. Some people are happy to share their data for their own healthcare but not for research by big pharma.
Previously, to get around this problem our government came up with a concept called “implied consent” which was rather colourfully described by a former shipyard worker in one of our workshops as: “Clearly some London-based bollocks. Nobody implies my consent.” I fear in your recent troubles, you have knowingly or not been operating on implied rather than informed consent, and it has bitten a chunk out of your share price. That doesn’t matter. Share prices recover. What matters is trust.
Trust is learned at your mother’s breast; it is the foundation of successful personality development and underpins all successful enterprises including Facebook and The Great North Care Record. You, we, can’t afford to lose trust. We will shortly be publishing a report from our consent model workshops which may be of use to you. But ahead of that I can share two principles: firstly, citizens want control and secondly, transparency.
An offer you can’t refuse
So within the Great North Care Record we have worked with our citizens and our government agencies (NHS Digital and NHS England) to come up with a model which gives the citizens control and transparency with regard to their data. It allows them to manage their own creepy line and therefore allows them to feel happier about being a data donor. This I hope will mean privacy lobbyists in the UK who recently criticised the government for “always doing the right thing – but only after they’ve tried everything else” will be able to support it. I learned recently that this quote was originally from Winston Churchill. “You can always count on the Americans to do the right thing – after they’ve tried everything else.” How rude. I’m confident that’s not true of you, Mr Zuckerberg.
Anyway, I am going to be a bit busy the next few weeks bidding for some government funding (£7.5 million) to develop the next phase of the Great North Care Record under what we call the Local Health and Care Record Exemplar (LICRE) programme. If we aren’t successful in that process I was wondering if we might help you by sharing our consent model work so that you can do the right thing with your members’ creepy lines in return for, say, £7.5 million? Let’s face it: you could do with a good news story and I may need some cash. I will be in the US in May if you would like to meet and discuss.
Professor Joe McDonald
13 April 2018 @ 01:34
I am amazed that no-one else has gone ‘£7.5 million?’ What are you building? For that money it should be (at least) national stuff, not just for a relatively local thing, especially with the Leeds Care Record also on the table.
9 April 2018 @ 11:09
If you are having creepy line issues then you are not presenting the opportunity of implied consent well enough.
With the media jumping on any data story clouding public’s view on data sharing, simple and clear evidence needs to be demonstrated to the public on the current waste and care impact (not caring proactively and waiting for us all to get ill when it could have been avoided, and the number of staff that could be in place if everything wasn’t done 2 or 3 or 4 times) for patients to see that data sharing is in all of our best interests as patients, parents of patients, NHS staff and the tax payers.
If they see the waste, stress and impact and how data sharing can stop this the public will see that implied consent is the fastest way to fix what was an OK decision sharing decision way back in NPfIT but with today’s tech it needs reviewing, and fast. Let’s show the power of data to patients and clinicians so our care can catch-up with retail, banking, manufacturing etc etc please.
Of course you need to be a bit forward thinking and brave to point our what’s wrong about how you currently work!
7 April 2018 @ 21:47
what are U joe, clinical or technical? you can make the choice, i have 30 years experience of health data, i am tecnical, you, like nhs england, might stick to what you do best, boring but efficient, consumer choice joe, that’s what IT is about in my world, IT is a people business, funding is not the issue it’s people
7 April 2018 @ 21:34
social media, including face book, is not funded by the tax payer, it stands on it’s own two feet, facebopk focussed on the good and the bad slipped in. facebook has messed up, they have admitted that and i am confident they will sort IT, with no uncapped funding from the tax payer i.e. future generstions money, is that not one of the key teasons we are appy to psy our taxes, it is for me anyway
7 April 2018 @ 07:51
In spite of the recent revelations I too like facebook – liked the article too.
I wonder if we would make more progress if we looked at the ‘low hanging fruit’ (so not research) and get data moving safely – then build up to something more complex. Guided by a small number of principles based on the Patient e.g.
1. The Patient has a right to expect the HCP treating them have complete access to their full (best quality) medical record while treating them.
2. The Patient has a right to control access to their medical record
3. The Patient has a right to view access audits to their medical record (and their NHS medical record)
I believe the first principle has the highest priority, closely followed by the others. We need to keep consent as simple as possible so Patients can use it effectively (and not get confused by NHS processes). As a patient I don’t mind if NHSD, GNCR, apple, google, facebook, etc allows me to control access to my record (2 above) – I do want to use a single consent controller (that I can pick?), not a myriad of apps and paper/electronic forms from a number of care providers.
8 April 2018 @ 13:07
spot on Kevin, but I would change “NHS Medical Record” to “Health and Social Care Medical Record mainained by both NHS and non NHS Providers” – the NHS and the underlying principles on why it (the NHS) was launched are awesome, however digitized health data was not around much when it was launched and let’s all be honest, can this country afford an NHS that no only provides the care for people but also provides the digitized National Health … Record for people. non NHS Providers might include organisations like BUPA, the Nuffield, Oasis, Boots, Lloyds … (a bit like a 5,000 piece jigsaw puzzle) – sorry is that advertising !
6 April 2018 @ 22:22
the national hs is sitting on a gold mine, a mine of data which belongs to the people it serves, the very least it can do is share it all with all the owners, the people it serves, this sharing should be done at a national level, facebook has had the balss to admit it has messed up …
6 April 2018 @ 21:39
Who is Joe McDonald? Whoever he is Mark, you should employ him!
6 April 2018 @ 14:44
Co-production of the Local Health and Care Record Exemplar (LICRE) programme sounds like an excellent idea.
After recently spending £50 to access and receive a copy of my health file, I eagerly await national implementation of The Great North Care Record.
Dr Neil Bhatia
6 April 2018 @ 14:47
I’m not sure access to the GNCR will give you your complete electronic GP record, or even if you (the patient) can access your own “GNCR” (yet).
But from 25th May it should cost you nothing to get a full copy of your GP record.
Dr Neil Bhatia
6 April 2018 @ 14:22
Indeed, as you have previously said: “The secret of consent is to get consent”.
Informed and explicit.
dr joseph mcdonald
7 April 2018 @ 10:52
Patient access and control are very much part of the GNCR ambition but not yet delivered. Currently we only deliver a view of the GP record to secondary care. With further funding we hope to evolve into a full patient controlled longitudinal record.
7 April 2018 @ 21:25
investment is required in the people who can provide technical care as much as investent is required in the people who can provide clinical care, that is my truth and that is the cultural change that is required in uk health provision, our best hope is now with the hscic not nhs england, nhs england has failed to deliver access to health data so that requirement needs to be taken away from NOW !!! appy to discuss any time dr …
7 April 2018 @ 21:54
i was once invited by u to speak at an nhs mh conference, i ended my talk by asking what are nhs leaders scared of, not fair to ask that without being prepared to answer it myself, here goes … i am scared of losing my nhs job, still am, i am technical …