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Google DeepMind is giving the NHS free access to its patient monitoring app

DeepMind StreamsGoogle DeepMindDeepMind’s Streams app.

The financial terms of Google DeepMind’s partnership with the Royal Free London NHS Foundation have been disclosed for the first time.

Google’s artificial intelligence lab DeepMind is currently allowing the Royal Free to use its patient monitoring smartphone app Streams for free, the Royal Free Trust told Business Insider following a freedom of information (FOI) battle that went on for six months.

However, the Royal Free must pay DeepMind a “service fee” if DeepMind ends up providing more than £15,000 in “support,” which is likely to come in the form of computing power and DeepMind staff costs. That threshold is yet to be breached, as the Royal Free said it has not paid DeepMind any fees.

The Streams app sends an alert to a clinician’s smartphone if a patient’s condition deteriorates. It also allows clinicians to view a patient’s medical records and see where patients are being looked after.

A DeepMind spokesperson said: “Streams is an entirely new clinical app, and we don’t believe it’s right to charge the NHS anything other than modest service fees until it shows sustained impact and value.” DeepMind and the Royal Free have not established what the service fees would be if the Royal Free were to cross the £15,000 threshold.

There is an argument that DeepMind is initially offering the app to NHS trusts for free as a “data play” to get access to valuable NHS patient data. If the app doesn’t cost anything to use, then NHS trusts are going to be more inclined to deploy it.

Dr Julia Powles, a legal academic who has co-authored published research on DeepMind’s work with the NHS, told Business Insider that it is incumbent on DeepMind to disprove this argument.

“One side of this is the consistently obfuscated point about why DeepMind has needed every single Royal Free patient’s data, and how this has informed the app it is now starting to distribute around the country,” said Powles. “But the other is about value for data — ensuring that we’re not allowing a private company patroned by Google to build networks of knowledge about health and disease in a way that will end up with long-term costs.”

DeepMind has previously said that it needed access to the medical records to help it test Streams. Medical records contain some of our most private information, including things like whether a person has had an abortion or what a person’s HIV status is, as well as our full names and addresses

DeepMind would likely dispute that it is providing services to the NHS in return for data. At no point has the patient data been combined with Google products, services, or ads.

“Once the sustained benefits of Streams are proven then we’ll aim to charge future partners fees in line with current IT supplier market rates, ideally tying some of these fees to the practical impact we can have on patients, clinicians and the hospitals we serve,” a DeepMind spokesperson said.

DeepMind’s first deal with the Royal Free was criticised for a lack of transparency

Mustafa Suleyman DeepMindDeepMindDeepMind cofounder Mustafa Suleyman oversees the company’s healthcare unit.

DeepMind has signed two deals with the Royal Free. The first was signed in September 2015 and the second was signed in November 2016.

The financial details that the Royal Free has disclosed relate to the second deal. The first deal didn’t specify anything concerning financials.

DeepMind and the Royal Free have always insisted that their partnership is legally sound on the basis that Streams is providing “direct care” to patients — something that automatically assumes “implied consent” on the patient’s behalf.

However, a letter leaked to Sky News and published last month shows that the National Data Guardian (NDG), Dame Fiona Caldicott, wrote to the Royal Free in February 2017 to let them know that the legal basis for the data-sharing deal used to test Streams was inappropriate.

Legally speaking, patients are implied to have consented to their medical records being shared if it was shared for the purpose of “direct care.”

But Caldicott, the UK’s health data regulator, wrote in her letter: “When I wrote to you in December, I said that I did not believe that when the patient data was shared with Google DeepMind, implied consent for direct care was an appropriate legal basis.”

She added: “Given that Streams was going through testing and therefore could not be relied upon for patient care, any role the application may have played in supporting the provision of direct care would have been limited and secondary to the purpose of the data transfer,” she wrote. “My considered opinion therefore remains that it would not have been within this reasonable expectation of patients that their records would have been shared for this purpose.”

The Information Commissioner’s Office (ICO), the UK data regulator, is carrying out its own investigation into whether the data transfer from the Royal Free to DeepMind was legal under the Data Protection Act. A verdict is expected to be made public in the coming weeks.

Two other NHS Trusts — Imperial College Healthcare NHS Trust and Taunton and Somerset NHS Foundation Trust — have also signed deals with DeepMind to use the Streams app. Taunton and Somerset Trust is on the same tariff as the Royal Fee, according to a spokesperson from the trust. Imperial did not immediately respond to Business Insider’s request for comment.

It took 6 months and a complaint to the UK data regulator to get the Royal Free to open up

The Royal Free blocked an FOI request by Business Insider on December 21, saying the financial details of the DeepMind partnership were “commercially sensitive”.

In the FOI response, Alison Macdonald, board secretary at the Royal Free, said that the trust could only disclose the figure “when it is satisfied that the public interest in withholding the information outweighs the public interest in disclosing it.”

At the time, Macdonald said that the trust’s “starting point” for revealing the financials was “in favour of disclosure” adding that it would help the trust to become more accountable and transparent. But she said disclosing such information may enable DeepMind’s competitors to “obtain commercially sensitive information thus causing prejudice to their commercial interests.”

Royal Free HospitalRoyal Free NHS Foundation TrustThe Royal Free Hospital in North London.

On December 24, Business Insider requested the Royal Free carry out an internal review into why the financial information was not disclosed.

On January 24, Emma Kearney, director of corporate affairs and communications at the Royal Free, said: “In balancing the arguments for and against disclosure, I am satisfied that the public interest lies in maintaining the exemption. I am therefore satisfied that the information is exept from disclosure under section 43(2) of the FOIA.”

Business Insider then complained to the ICO in February. Responding to Business Insider’s request on May 15, ICO senior case officer Susan Duffy said she had been allocated the case to investigate.

On June 8, Duffy followed up saying: “I have now had a response from the Trust. They have reconsidered your request and have now decided that the information you have requested should be disclosed.”

DeepMind has also refused to disclose the financials in the past but it said it “supports” the Royal Free’s decision to release the information this week.

“It’s our goal to be one of the most open and transparent companies working with the NHS today,” said a DeepMind spokesperson. Despite refusing to disclose the financial details of its NHS partnerships on multiple past occasions, DeepMind said it supported the Royal Free’s “decision” to release the information this week.

DeepMind is working with a number of other NHS hospitals on different projects that don’t involve Streams. They include an eyecare project with Moorfields and a cancer detection project with University College London Hospital.

The commercial values of these deals have not been disclosed.

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