keith grims photoKeith Grimes is an experienced GP and technology expert. He is the lead for Clinical Innovation at Babylon Health, developing new approaches and techniques for delivering healthcare, in the UK and worldwide. Originally from Scotland, he trained at Aberdeen University and worked as a GP for many years. During his time as a GP he founded the VR Doctors group, trying out new approaches to medical care and was the lead for innovation at Eastbourne, Hailsham, and Seaford CCG.

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Interview

Can you tell us about your background?

I am Scottish but I have travelled all around the world as my father was in the oil industry. I’m the eldest of six boys, and I come from a family of engineers. The thing that I remember most about growing up was my love of tech, Sci-Fi and gadgets.

We were living in Singapore and that’s when I acquired my first computer, a ZX8, and things went on from there.

The ZX80: 'My First Computer'

The ZX80: ‘My First Computer’.

At Aberdeen University Medical School I spent all my time trying to figure out how to use technology to solve clinical problems. After my house jobs and a year in Brisbane, Australia, I wasn’t sure what to do but I chose to do general practice training in Edinburgh and I qualified as a GP in 2001.

At that time I was trying to find more IT stuff, and I was accepted onto the Electronic Clinical Communication Implementation programme (ECCI). ECCI was all to do with setting up electronic referrals, discharges, email, lab results and appointment booking. This has became the backbone of the Scottish urgent care summary. I was a doctor doing IT and working as a locum GP travelling around Scotland for a couple of years.

Then there was a sudden move down south. My wife is an opera singer and we moved to be closer to Glyndebourne in East Sussex. There was a role as an Out-of-Hours Doctor. I thought that I’d hold my nose and get on with it, but I surprised myself and really enjoyed it. I worked as a GP for a bit and eventually ran the walk-in health centre at Eastbourne station. This is where I worked from 2011 until this year (2019). Along the way I tried to innovate the practice. I remember trying out Skype with my patients; the Kardia ECG device; smartphone otoscopes; wearables – that type of thing. This was all tinkering around the edges of what was possible with technology in general practice.

Then two big things happened, the first was that I went to Exponential Medicine (ExMEd), San Diego in 2014. This was part of the movement around the thought that we are all heading towards some form of technological singularity. This was headed up by Daniel Kraft and is all about the art and the science of what’s possible. I was blown away by all the stuff – the robotics and the genomics. At this point, I thought, ‘I’ve finally totally found my tribe’. The last 4 years have been an effort to try and make that kind of thing my job.

The question is – how do you actually try and do that in the NHS? And that is the tough thing. It’s something that actually led me to burnout last year and I had to take some time off.  I think I was trying to do too much. I was getting busier and busier – I had a role as the Clinical Innovation Lead for the local CCG and I was a governing body member as well as working as a GP. I was in a position where I thought that I could start effecting change, but I couldn’t. There was no budget that I could spend on innovations. The combination of this and the workload eventually led me to burnout.

This is an important message for portfolio doctors. For every extra role that you take on, it doesn’t just add, it multiplies and it becomes unmanageable. I think that at one point I had 11 roles. That was shortly before I decided that I wasn’t able to bear that load any more! I realised that you have to be true to what it is that you truly enjoy. I’m sure that in the Doctorpreneur readership there will be doctors who at their heart want to be something else. A lot of people will be a doctor and then try to find a way of doing the thing that they really love, either alongside or on top. You’ve got to be careful because you’ll borrow energy from wherever to pursue the thing that you love. That’s what caught me out. I was constantly trying to do the thing that I love on top of a lot of clinical commitments and that’s what burnt me out.

You’ve got to be careful because you’ll borrow energy from wherever to pursue the thing that you love.

How do you describe your current role?

My current job title is ‘Clinical Innovation Director at Babylon Health’. It’s a title that every time I say aloud I just smile. In part it’s about identifying external and celebrating internal innovations. I’m also involved in more specific work with regards to our AI products and using them to augment the work of our clinicians that see patients. The other major part of my job is the ‘education lead’ aspect – I supervise the AI fellows. These are doctors with an understanding and affinity for the use of technology in digital health with a clinical background. We have people in who have Masters in Information Technology, PhD’s, coders, all sorts – who are also doctors.

I’m also looking at things around AI safety, AI regulation and governance and that’s such an important and interesting area. AI is a technology that sits somewhere between the role of a human and the role of a computer – it’s between the two. You can’t explicitly use existing clinical governance and medical device regulations – they are struggling to catch up with what artificial intelligence as a whole is. Finding the best blend of those two is paramount. You’re constantly trying to establish what best is.

How did this opportunity come up?

I was fortunate enough to have been sought out. I was aware of what Babylon were doing from an early stage. I came along and met the team as far back as 2014 and knew what they were doing on and off. It was always in the back of my head that I’d like to be working alongside them. When they started work with artificial intelligence that’s when I got very excited. It was very fortunate that around the time I was recovering from burnout. I was rebooting my interest in digital health and doing some sessions relating to AI testing. Off the back of that, they got in contact and we started having some discussions about AI. It was a mutual interest that turned into something more.

What’s the lesson for Doctorpreneurs here?

Once you’ve found your tribe, maintain your network. It’s about meeting people, being positive and contributing towards the work in that sector.

Once you’ve found your tribe, maintain your network.

What are the major challenges that you have faced in your career outside clinical medicine?

The most significant challenge came internally, when I started the process of separating my role as a doctor from my role as an NHS employee. I had spent my entire clinical life within the NHS, so it’s no surprise that I might think the two were inextricably linked. It turns out that’s not the case! As a volubly delighted and publicly active member of a disruptive health tech scaleup, I’ve faced the criticism of colleagues. I guess that means I must be doing something important. Medicine is a remarkably conservative and cautious place, especially when it comes to career paths. Expect people to question your decisions if make your own road.

Expect people to question your decisions if make your own road.

What have you learnt along the way?

There’s been many. The first lesson I learned was to keep my mind open to new ideas. That said, the further you climb up the ladder, the more you realise that no-one really knows the answers.

When it comes to social media, resist the urge to respond to trolls. As Michelle Obama said: “When they go low, we go high”.

Finally, take care of your mental health – it’s a lot harder to get it back than to look after it.

Take care of your mental health – it’s a lot harder to get it back than to look after it

I understand you have done some work with Virtual Reality (VR), can you tell me a bit more about this?

The thing that I’ve done most with virtual reality is to reduce pain and distress in patients who require wound care. There is a lot of very strong evidence to support virtual reality – it’s been shown to significantly reduce perceived pain and distress in patients having dressings changes. There are a lot of theories about why that is, but it’s likely to do with the attentional spotlight theory – if your attention is drawn elsewhere it takes your focus away from other noxious stimuli. I was using a low cost, high quality VR headset and I had it in the practice. I started to use the technology more, speak about it more and that’s when I founded VR Doctors. This is still a Facebook group dedicated to bringing together people who are interested in VR and healthcare. It includes doctors and patients from around the world, and is all about bringing people together to network and connect.

I’ve also been involved in a project called ‘prevent ICU delirium’ at the Royal Brompton and Harefield. Here, the idea is that you can use virtual reality to pre-expose people to the intensity of an intensive care pre-op to help reduce their anxiety and to reduce the incidence of ICU delirium post op.

Other uses of VR is as a form of diagnostics. When a person is in virtual reality you can measure how they move and look around which is quite hard to do in real reality. There’s a company who have developed a simulation of a supermarket, for example, and they look at how you interact with the environment. One of the first things to change in the early stages of cognitive impairment is location sense and ability to perform ordered or complex tasks. In virtual reality you can measure this and potentially get a diagnosis earlier in an automated way.

It’s also useful in medical education and training, Shafi Ahmed’s company Medical Realities does that.

What advice do you give to doctors who want to adopt more technological solutions in their day-to-day work?

Firstly I would suggest to get a good understanding of what technology you already immediately have available and try to make the full use of that. That’s a slightly dull answer, but if you’re a GP there’s actually a lot of functionality that can make your life an awful lot easier. Secondly, make safe use of the internet, making sure that you’ve got trusted references quickly at hand and that you participate in decent social media groups, such as TIKOs , a closed Facebook tech group for GP’s. These can be fantastic places to get support and ask questions. Twitter is a good way of getting good contacts and information, as well as hearing patient opinion. Get yourself some smartphone devices, if you’re a GP I’d definitely recommend an AliveCor ECG and a Cupris otoscope and then load up your phone with apps that are validated, or build your own library. For clinical communications get yourself something like medCrowd rather than WhatsApp.

Beyond that I’d always say about using the VR side of things. VR is so easy and simple to use and makes a difference.

What should I do, wait for my local CCG to provide it for my patients? If I’d done that it never would have happened. So I elected to make a risk assessment myself and be clear with my patients. I spoke with my indemnifying organisation to make sure that I was covered from that point of view. I created consent forms. I had a process in which I covered infection control. These things are technically not that difficult to do, you just have to step through them, and then appropriately share what you have learned with your patients and with your colleagues. Then you need to contribute and support other people.

What are your predictions for future trends in healthcare delivery?

We’ve had a clear indication in the recently published (January 2019) NHS Long Term Plan that ‘Digital First’ services are going to grow significantly over the next few years – something we are seeing incredible demand for at Babylon. Could this be the moment that the NHS finally gains some momentum in its never-ending mission to modernise? I believe that clinical applications of Artificial Intelligence will continue to grow in number, quality, and proficiency, and these will power changes in NHS GP and Hospital care for everyone. With the recent completion of the 100k Genome project, I’d also expect to see a flurry of advances in the area of personalised medicine in the next few years. As for immersive technology like VR and Augmented Reality (AR), I think this will continue its steady progress on the back of wider evidence of benefit in pain management, mental health disorders, rehabilitation, and training.

Oh, and there will be voice interfaces everywhere!

Is there a health start-up that you are you particularly excited by?

The UK scene is thriving, but two come to mind. I’ve been tremendously impressed by the work of Echo Healthcare who have addressed the seemingly simple yet incredibly frustrating process of obtaining repeat prescriptions.

As a practicing sessional GP who has struggled with employing locums at times, I also love the work done by Dr Ishani Patel and Melissa Morris, co-founders of Lantum (declaration: I act as an unpaid Digital Health Champion for their company).

Any final words?

As someone who waited 28 years to get the job I wanted, I’ll say the same thing that I said to Simon Stevens, Sir Bruce Keown, and the audience at my TEDxNHS talk – don’t wait, JFDI!

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