GENOMICS
fairly, and that public trust in these new technologies is maintained.15
The Post-eXam phase The Post-eXam phase, driven by the NHS 10-Year Plan,3
is the mechanism for
‘Continuous agentic AI Improvement’ (Fig 1). This feedback loop creates a dynamic learning health ecosystem that continually refines the PHM for pathology prevention and shifts care from hospitals to the community and analogue to digital.3
The
ethical imperative here is to ensure that this continuous improvement process is not only technically sound but also human-centric.
The Post-eXam phase relies on real- world outcome validation, where data from agentic AI-powered Clinical Decision Support (CDS) is systematically monitored to validate Pre-eXam predictions and eXam efficacy as trials become routine services.1-2,16
This iterative feedback loop
(Fig 1) is crucial for continuously improving the HPO models and ensuring they are fit for purpose. However, as Table 2 and 3 show, there are considerations – such as data quality and consent management – that must be addressed to maintain public trust. The Ethical People Ontology Plan ensures trust that the Post-eXam phase incorporates feedback from clinical staff and the public, promoting transparency and accountability in the ecosystem.17
The Ethical People Ontology Plan for our communities The Ethical People Ontology Plan is not merely a component of this ecosystem; it is the aim, the human-centric destination that the technical phases are designed to serve.1-4
This plan expands upon the
NHS People Plan by encompassing both workforce and the public, recognising the symbiotic relationship between a skilled, supported workforce and a trusting, informed populace.4
As shown in Figure
1 in blue, this plan is a culminating phase for community goals that ensures the
Stakeholder engagements
Public
engagement Healthcare
provider
Societal benefits
Targeted therapies; improved outcome; reduce adverse events
Precision prescribing; optimised treatment pathways
Biobank and cloud Real time data access for trials. hybrid servers
Data for bio-drug discovery Governance and (life science) Agile regulation; streamline medical
federated platform devices and clinical trials Biopharma
Develop rapid drug approval Adopt personalised medicine
The Pre-eXam’s focus on proactive risk identification is a key driver of population health benefits, it enables targeted interventions that can mitigate health inequalities and improve outcomes.
PHM of HPO benefits society through an ecosystem. The core tenets of this plan are:
n Workforce development and skills: The plan prioritises upskilling the healthcare workforce to manage the data-intensive, proactive genomic and AI-driven models.18
and the privacy concerns surrounding ‘genomic passports’.20
Cultivating a
learning culture and compassionate leadership is essential for adapting practices and building the sustained trust necessary for this strategic public transformation.4,19
This includes
creating new roles like genomic navigators and AI clinical support specialists, who can interpret complex HPO data and facilitate agile patient pathways across phases.1-3
n Democratic stewardship and public trust: The plan mandates a framework for democratic stewardship of genomic data.1-4
Initiatives like federated This directly
addresses workforce gaps and ensures that the human element remains central to the digital ecosystem in a strategic evolution.19
n Ethical acuity and patient-centred engagement: A key function of the People Plan is to navigate the complex ethical implications of predictive genomics.1,4
This involves
transparent communication with the public about topics like variants of unknown significance, gene editing,
Consideration remedy
Access parity; high cost; ethics Steward fair and ethical access policy
Cost; interoperability; secure data Federated platform, HIMSS
Data quality; consent management Steward data and federated platform
Public trust and accountability AIDRS, HIMSS, HEMSS, XAI
Market access; off label; reimburse NICE, MHRA and value-based care
Table 3. Benefits and considerations of Biopharma eXam intercepts. 50
platforms and the work of the AI Digital Regulation Service (AIDRS) and the AI Security Institute (AISI) are crucial for ensuring that public data is handled securely and ethically.21-23 The concept of ‘genomic passports’ must be carefully stewarded to provide insight while protecting vulnerability and maintaining societal confidence.20 The article argues that ethical care interdependence requires a supported workforce for patient safety, while citizen autonomy and trust demand robust informed consent and bias mitigation.15,17
Stewarding scalability and impact with the People Plan The success of this PHM ecosystem is contingent upon public understanding and robust stewardship with a clear implementation roadmap. The Ethical People Ontology Plan serves as a blueprint for this, working in concert with organisations like the AIDRS and AISI with Research Resource.21-24
and processes are crucial for ensuring softer regulatory requirements, technical reliability, and promoting innovation while upholding the highest ethical standards.13-14
The discussions on agentic AI highlight SEPTEMBER 2025
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