A health service in your pocket
Imagine being able to book a consultation with a doctor via your smartphone within minutes, at any time, rather than having to wait hours, or even days, for an appointment at your local practice.
That is the vision behind mobile healthcare app Babylon, which was launched earlier this year and promises to let you monitor and track symptoms, book a virtual GP consultation and arrange prescriptions on the fly.
pharmaphorum spoke to the man behind the service, Dr Ali Parsa, a healthcare entrepreneur and ex-engineer, who believes primary care services are ripe for revolution.
Babylon is now rolling out in five practices in Jersey – the tiny English-speaking holiday isle and tax haven just off the coast of France.
The pilot covers around 60 per cent of the island's population – and is also being trialled by a clinical commissioning group (CCG) in England in order to help provide cover in situations when there is a shortage of doctors, according to Parsa.
"In the UK health service, one in five patients cannot get the appointment they need, while among those who do see a doctor, one in eight gets mis-diagnosed," Parsa told pharmaphorum.
"There is considerable room for improvement in the UK, let alone other countries in the world where healthcare systems are less sophisticated"
Add in the 15,000 to 20,000 people who die each year because of an avoidable medical mistake, and it is clear that there is considerable room for improvement in the UK, let alone other countries in the world where healthcare systems are less sophisticated, he maintains.
Parsa came to prominence in UK healthcare circles as the former chief executive of Circle, the firm running Cambridgeshire's Hinchingbrooke Hospital, the first in the NHS to be managed by a private company. He left the firm in 2012 in order to pursue "social entrepreneurship" projects.
A driver for that was the recognition that rising use of mobile phones means that there is now a democratically-distributed network that can be tapped into by people all around the world.
"For us the question was: why don't we see how healthcare can be delivered to people on the platform they already have in their hands?" says Parsa.
All the doctors that provide the consultations via Babylon are employed by the company and use a cloud-based platform to interact with patients and gain access to medical records and prior consultation history. Specialist consultants are employed under contract, with a payment for each patient session that uses the system.
A subscription to Babylon costs £7.99 a month for daytime access, or a pay-as-you-go charge, with higher-level subscriptions coming soon to allow 24-hour use or even access to a 'personal team'. Consultants' fees range from £49 to £79 per session.
In 2014, Parsa told the Wired conference that healthcare insurers BUPA and Aviva had decided to offer Babylon to their customers.
As yet there is no information available on how they plan to make use of the platform, but it is interesting that in the US, some employers have started to offer discounts to employees on their healthcare schemes, provided that they agree to make use of technology to help monitor and track their health and fitness.
Enabling technology
In general terms, the NHS still has a fragmented approach to the deployment of enabling technologies, despite strategic-level initiatives such as online prescriptions, web-based registration and appointment booking at practices and online access to records in the pipeline.
Last year, the Department of Health set up a £50 million fund to improve GP access, which included a commitment to greater use of technologies such as Skype consultations.
"It's very difficult for large existing systems to deploy innovations en masse, and that's why, when you see disruptive technologies coming in, it tends to be from a new company that can operate without the constraints of legacy systems," says Parsa.
In some respects, programmes like the one in Jersey are out of the company's hands. The company provides the platform technology and a marketing push, but it is the local service provider - Digital Jersey in this case - that will operate and run the service.
"Jersey is a local service, delivered by local GPs for local patients, and it is up to them whether they want to push it hard," he notes.
Questions remain about how the information held within Babylon can be joined up with patients' other health information, particularly as the NHS moves towards an electronic healthcare record (EHR) standard, although Parsa insists all information is automatically forwarded to a patient's NHS team unless specifically requested to remain private.
There has also been scepticism about the potential for Babylon and other technologies to tackle NHS problems - with the British Medical Association expressing its concern in 2014 that online doctor appointments are inherently insecure and raise issues of "ethics, confidentiality, clinical safety and standards".
"I just don't understand that point of view," says Parsa, who describes these types of argument as "almost Luddite".
"How is it more ethical to make patients wait and travel for a consultation ... or any more confidential to keep your records in piles of paper in an office that can be burgled, rather than on secure servers?"
People involved in one model of healthcare delivery often just worry about change, he suggests, adding that the march of technological and digital progress will probably make any such arguments irrelevant in coming years.
"He argues that a digital platform actually makes doctors more accountable for their diagnoses and treatment advice than the current face-to-face situation"
He also argues that a digital platform like Babylon actually makes doctors more accountable for their diagnoses and treatment advice than the current face-to-face situation, as there is an easily accessible digital record of all interactions, including recordings of video interviews, that is retained for years.
Meanwhile, the cost of the service led to suggestions that Babylon will become a tool for more well-off consumers and perhaps the 'worried well', but Parsa is equally unfazed by that.
"That's OK! It is very difficult to provide the service that suits everyone, but that does not mean that it is a bad service," he stressed, adding that the basic premise behind Babylon is already being tweaked to suit other healthcare environments.
For instance, the company will shortly announce a programme in Rwanda, tapping into the phenomenon in much of Africa where use of mobile phones is rising rapidly and leapfrogging more traditional means of accessing online networks.
"We want to create a situation in which a peasant in Tanzania has the same access to healthcare as an investment banker in London," says Parsa. "Today, both of those individuals can have the same access to digital information or music, which 10 years ago was not the case."
About the interviewee:
Ali Parsa is a healthcare entrepreneur. He built Circle in a five-year period to become Europe's largest partnership of clinicians, with some £200 million of annualised revenue, nearly 3,000 employees and a successful IPO. Ali left in December 2012 to found Babylon and is its CEO. Prior to Circle, he was an investment banker with Goldman Sachs. He was the recipient of the Royal Award for the Young Entrepreneur of the year in 1993 for his first business, V&G, and of the healthcare Entrepreneurial Achievement in 2010. Ali was named by The Times among the 100 global people to watch in 2012, and by the Health Service Journal as among the 50 most influential people in UK healthcare. He is the UK Cabinet Office Ambassador for Mutuals and has a PhD in Engineering Physics. He will be speaking at this conference hosted by eyeforpharma in Barcelona in March.
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