The name Rizwan Malik is becoming increasingly well known in NHS diagnostics. He tells Matthew D’Arcy that more radiologists need to be engaged in technology and why the wrong communications can cause damage in the age of AI.

Rizwan Malik has been an NHS radiologist for more than 13 years. His name is becomingly increasingly well known, and not just for work at Royal Bolton Hospital, where he serves as a consultant radiologist and an associate chief clinical information officer.

He is also a prominent player in the NHS diagnostic technology procurement environment and, as of September 2019, vice president responsible for industry liaison for the UK Imaging and Oncology Congress. 

Even so, it is only relatively recently – in the past 12 months – that Malik has started to see what he regards as real engagement from NHS technology leaders with those in the diagnostic space; something he believes has a long way to go. 

“Imaging doesn’t get as much exposure as it should,” he says, speaking to Highland Marketing in a personal capacity. “The digital space is still very much IT driven whereas, as a specialty, you would think radiology would be the ideal blend – we have been using interoperability standards, and digital imaging for more than a decade.”

Digitisation has been universal in NHS radiology for many years – light boxes and physical x-rays are a distant memory for hospitals. The quest to eliminate paper is still an ongoing battle for most other parts of healthcare.

So, you might think radiology could offer a lesson or two. Malik would agree, pointing to the fact pathology is already looking for “lessons learned” from radiology as it starts to digitise.

Desperately short of radiologists to engage in tech?

Of course, there are radiologists who do influence NHS digital strategy. Malik describes colleagues like The Christie’s Rhidian Bramley as a “CCIO before people knew what a CCIO was”.

And he is grateful to people like NHS Digital Academy CEO and former Salford Royal CIO Rachel Dunscombe, whom Malik credits in part for his own engagement in technology.

But he would like to see more radiologists sat in the driving seat of the NHS technology landscape. Part of the challenge is finding those able or willing to engage.

“Technology leadership roles like CCIOs are very niche for radiologists, which is ironic for a speciality that spends its entire career in front of computers and very high-tech machines,” he says.

“But in radiology especially we are so desperately short of people, and there is so much to do, that we don’t really have the ability to step off the hamster wheel.”

Time pressures faced by radiology is down to more than growing demand, but the changing ways imaging services are used. “A decade ago radiology was a 9-5 speciality, now it operates 24/7, rightly and understandably,” says Malik.

“The vision of radiologists being moles in darkrooms, where all they do is churn reports, is also incorrect. Multi-disciplinary team meetings used to be a niche nice thing for a radiologist to do every so often, but now they are the cornerstone of patient management.”

It’s not human vs machine – get your comms right

And it’s not just a lack of time that is preventing radiologists from taking the lead in tech. “Very few seem to want to engage with the broader IT industry,” says Malik. “It takes two hands to clap.”

He compares the situation to the US where clinicians engage with IT and investment companies. “Here, in the NHS, it is seen as selling out to have those kind of conversations. As clinicians we need to be a little bit more mature,” he says, having recently decided to dedicate a substantial part of his own professional life to such engagement.

A new urgency for radiology clinical engagement comes from the onset and expectations placed on artificial intelligence in the diagnostic landscape.

One of Boris Johnson’s first commitments to the NHS on entering Number 10 was to announce £250 million for AI, and the creation of a new National Artificial Intelligence Lab that will sit within NHSX. This is expected to have a substantial focus on improved screening and early diagnoses.

Concurrently, radiology and the reading of images by computers to identify illnesses has been a predominate focus for many AI developers.

Malik argues that for AI to really have value, organisations like NHSX and developers need to find a way to engage practising radiologists in the creation of algorithms – not just the CIOs and CCIOs of the NHS world. “They need to speak to more Indians and fewer chiefs. The same conversations are had with the same people far too often.”

Media and marketing messages that suggest machines might replace humans in diagnosing illnesses have not been helpful in achieving this, he adds. “Language is important, but it has sometimes been used to headline grab, rather than to engage,” he says.

“Some companies have spent years saying ‘buy our products, reduce the cost of clinicians’. Some who threw that hype have been burned by it and are attempting to redesign their comms. But those messages have sat long in memory.”

Brave investments: not always headline grabbing but vital

So, what would radiologists tell developers? Malik argues the most valuable developments from AI may do little to attract media attention. “At the moment we have a range of algorithms that look at specific problems.

“The real-value is in the non-sexy repetitive stuff. There are many ways to make what I do more efficient, rather than putting blue or red circles around nodules on a scan, or putting different colours on a chest x-ray. I’m trained to do that, anyway.”

He has his own vision on AI, but fundamentally wants it to “free up my time to let me do the useful stuff, but also to prove the quality of what we do” because: “We are now having to churn through work so quickly that quality is being sacrificed a little. The profession isn’t being allowed to grow because the pressure is just too much.”

Using AI to deal with mounting reports “depends on people being brave enough to put development into things which are more useful and less headline grabbing”, says Malik. “The challenge then is to attract investors who have a deeper understanding of the market,” he adds.

“Investors should solicit advice from clinicians on what they actually want, so they can target limited funds appropriately.” To do that you need people to engage. “It’s a vicious circle that we need to turn virtuous. We need to identify the people that want to engage and give them the mechanisms to do it.”

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