Doctor on Call

1st August 2014

‘You can get an app for that…’

Jennifer Lipman explores the ways in which technology is changing our access to medicine

Not long ago, Ali Parsa was in Hawaii with his daughter, when she cut her foot. Concerned about infection, he wanted medical advice. So he got out his phone, connected to the wifi on the beach, and consulted with a doctor in the UK.

He did this using Babylon Health, a new app that advertises the chance to ‘get medical questions answered by real GPs… within minutes’, via phone, message, or video consultation. Authorised by the Care Quality Commission, Babylon doesn’t just tell you what’s wrong; it also sends a prescription to your pharmacy so you can get better.

“Even if you have time to see a doctor, why should you?” asks Parsa, the former Goldman Sachs banker who co-founded Babylon and believes it could revolutionise access to healthcare, not least for the 70% of the global population currently without it. “Around 95% of our healthcare interactions are for simple consultations and diagnostics. Yet we do that in the most arcane way - we phone up, wait a few days, and take half a day off to see a doctor.”
Indeed, in a world where you can do everything digitally, from house-hunting to filing your tax return, why should medicine remain offline? “You can go and see your bank manager in person, but when was the last time you did?” says Parsa. “You deal with banking on your computer or phone.”

For many, apps like Babylon represent the future of healthcare. The Government appears to agree, with online prescriptions, web registration at practices and online access to patient records all in the works. In April, the Department of Health announced a £50 million fund to improve GP access, partly to expand appointment times, but also to bring in ‘forward-thinking services to suit busy lifestyles, including greater use of Skype’. By next May, they want all GPs to offer electronic appointment booking or have plans in place to do so.

With depleted finances, and rising life expectancy – by 2026 it is estimated there will be 6.3 million over-75s – the NHS needs to reduce pressure where it can. And as Ben Foster, Operations Director at Patient.co.uk, points out, technology means real ‘patient power’.

“It makes economic sense to treat citizens as equals in decisions on healthcare and empower them to take control through technology,” he says. “Healthier people need the NHS less.” He adds that when patients book their appointments online, fewer forget to turn up – and missed appointments represent an enormous cost for the NHS.

Unfortunately, says Foster, “the NHS has been slow to adopt patient-focused technology”. In any case, some GPs – already unwilling to open later or on weekends – are sceptical. In June, Chaand Nagpaul, chairman of the BMA GPs’ committee, cited reservations over “ethics, confidentiality, clinical safety and standards”, and criticised the new “mantra” that technology “can somehow solve NHS pressures”.

Their patients may not wait. Already, says Foster, “they are choosing the technology that they like to seize control of their own health and wellbeing, from apps to self-monitoring wristbands.” At the very least, they’re wising up online: in the last two years, the number of monthly visitors to Patient.co.uk has nearly tripled.

Patient.co.uk is hinged upon expert advice from qualified UK doctors, and Parsa emphasises that Babylon only works with NHS doctors, in tandem with a rigorous selection process and hefty expenditure on keeping GPs up-to-date on the latest advice. Yet in the Wild West of the internet, how do you know the technology you are relying on is offering you medically-sound advice?

To an extent, you don’t. But argues Parsa, out and about, you may still be better off “than the lottery of walking into any practice”.

“It takes 17 years for best practice in healthcare to become commonplace. When you see a GP you have no idea where in that they are,” he continues. Added to which, the app is not necessarily the final step. “It’s about the intervention that follows.”

Foster advises people to check quality stamps, such as the Information Standard, which ensures health suppliers produce accurate, evidence-based and up-to-date information. The NHS, for its part, offers a Health Apps library, listing apps reviewed by an expert clinical assurance team. The team work with developers to identify concerns and iron them out, testing, for example, whether the app is ‘limited to providing information from a trusted source – or might it go on to provide personalised medical recommendations?’.

The key is not to assume that robots can replace the family doctor. “I’d worry if an app of mine ever said ‘you don’t have to see a doctor’. I don’t know how people who make those can defend it,” says Chris Seaton, the developer behind Mersey Burns, the first regulated medical app in the UK.
Crucially, his app was developed with plastic surgeons and is specifically for use by doctors – not patients. “With a doctor you can provide training and have confidence they’re going to follow it. With a patient you have no idea of how able they are to follow instructions.”

Seaton says testing is key – developers should “assume the hardware is working against us” – but doesn’t advocate more regulation, arguing that this discourages innovation. Instead, he wants peer-review – “encouraging lots of people to create apps, and letting the best bubble to the surface”.
Foster agrees. “Apps that move from tracking metrics into offering medical advice should be classed as a medical device, and should go through the existing assurance processes.”

Others worry about putting personal health information into the hands of unknown software developers. “Quite rightly, this is an area of concern and needs properly considered measures to safeguard vulnerable patients,” says Foster.

Parsa emphasises that Babylon is secure, and they would never sell patient data. In any case, he queries, is offline any safer? “How difficult is it for someone to go into a GP surgery and steal the records?”

Regardless of that, what Babylon and the like are not is cheap. The former is £7.99 a month or £24 as a one-off. But with growing calls for patients to pay for GP appointments, the idea of free to the point of delivery is perhaps old-fashioned. And when it comes to value for money, Babylon is open for business when your GP isn’t. In our time-poor culture, plenty of us feel that’s worth paying for.

Foster believes that it is only the first step, and that we are about to enter a new era of citizen health, with innovations such as patients contributing their own data, secure e-messaging, or e-prescribing in partnership with community pharmacists. “Online GP-led triage will save expensive face-to-face consultations and ensure [doctors] concentrate on the patients that need them most,” he says. Likewise, he thinks we will start embracing wearable technology, such as smartphones that can monitor blood pressure, which will help people “become more in tune with their bodies’ physiology and understand what a healthy lifestyle actually means.”

And the technology will only get more powerful. ”Whatever you cannot imagine technology can do, it will do,” prophesises Parsa. He predicts people will start trying to create machine intelligence to compete with doctor’s brains. “It’s just a matter of when.”

In which case, the NHS needs to jump on board, to contain costs, if nothing else. “Patients need the power to access their records, transact with the NHS online and take more responsibility through self-care technology,” says Foster.

“We need genuine buy-in and support from the NHS,” echoes Seaton. “At the moment apps are a curiosity – the next step is to make them the default. Technology allows you to do more with what you already have. If the NHS invested in technology they would earn it back in productivity.”
Ultimately, says Parsa, healthcare is about giving people what they need – and technology can help.

He points to a recent review of Babylon. “It said: ‘my kid comes home with a temperature, within a minute I have an appointment, within 10 minutes we see a doctor and my kid never left the bed’.

“Once you do that once, why would you ever do anything else?”

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