Babylon Health criticized by Manchester CCG, cardiac activists in UK, Canada

News you may have missed. Over the holidays, Babylon Health took some hard knocks on two fronts, right after the announcement of their expansion into North America. 

The Manchester Clinical Commissioning Group (CCG) rapped the developer of GP at Hand fairly hard on their expansion plans to this Northern city. “We are not convinced that Babylon GP at Hand’s model of care is sufficiently integrated with other local and national services to ensure safe and effective care for local people. Areas of concern include screening programmes and safeguarding. We therefore asked Hammersmith and Fulham CCG, the formal commissioner of BGPaH, to object to the Babylon proposal to begin operating in Manchester from early 2020.” There is a 1,001-person cap on registrations which may be lifted this month if Babylon can address and mitigate these patient concerns.

It should be said that Birmingham had similar concerns to Manchester, but a similar cap was lifted last month. Babylon’s stated strategy is to work with the CCGs on their concerns to successfully roll out the service to offer in-person appointments and 24-hour digital appointments by early 2020. Digital Health

There’s also been charges of gender bias in diagnosis of cardiac symptoms by Babylon’s chatbot. When presented with

identical cardiac symptoms, the chatbot reportedly will tell a man to seek immediate care, but a woman is advised that it may be a panic attack or even depression. Here’s the Twitter discussion between @DrMurphy11 and past TTA contributor Carolyn Thomas, the “Heart Sister”, on this bias. When asked, Dr. Keith Grimes, Babylon’s Clinical Innovation Director, replied: 

Ms. Thomas is a long-time Canadian writer and activist on women living with cardiac conditions, how they are often misdiagnosed (The Grinch’s Guide to Women’s Heart Attacks), and how women’s symptoms of cardiac disease differ.  Her blog is personal, interesting, and informative. (Do read her 22 December post on the Christmas truce of December 1914)

News, moves and M&A roundup: Appello acquires RedAssure, Shaw departs NHS Digital, NHS App goes biometric, GP at Hand in Manchester, Verita Singapore’s three startup buys, Novant Health and Tyto Care partner

Appello telecare acquires RedAssure Independent Living from Worthing Homes. A 20-year provider of telecare services to about 700 homes in the Worthing area in West Sussex, the acquisition by Appello closed on 1 October. Previously, Appello provided monitoring services for RedAssure since 2010. Terms were not disclosed. Release.

Another NHS Digital departure is Rob Shaw, deputy CEO. He will be leaving to pursue a consulting career advising foreign governments on national health and care infrastructure. He is credited with moving the NHS Spine in-house and establishing NHS Digital’s cybersecurity function. The Digital Health article times it for around Christmas. Mr. Shaw’s departure follows other high-profile executives this year such as former chief digital officer Juliet Bauer who controversially moved to Kry/LIVI after penning a glowing article about them [TTA 24 Jan], Will Smart, Matthew Swindells, and Richard Corbridge.

One initiative that NHS Digital has lately implemented is passwordless, biometric facial or fingerprint-based log in for the NHS App, based on the FIDO (Fast-Identity Online) UAF (Universal Authentication Framework) protocol (whew!). NHS Digital’s most recent related announcement is the release of two pieces of code under open-source that will allow developers to include biometric verification for log in into their products.

Babylon Health’s GP at Hand plans Manchester expansion. The formal notification will likely be this month to commissioners of plans to open a Manchester clinic as a center for GP at Hand’s primarily virtual consults. This follows on their recent expansion into Birmingham via Hammersmith and Fulham CCG which will be notified. How it will work is that patients registering in Manchester would be added initially to a single patient list for GP at Hand located at Hammersmith and Fulham CCG. Babylon is now totalling 60,000 patients through GP at Hand.  GP Online

Singapore’s Verita Healthcare Group has acquired three digital health startups. The two from Singapore are nBuddy and CelliHealth, in addition to Germany’s Hanako. Verita has operations in Singapore, the US, Asia-Pacific and Europe, with 35 alliance partnerships with medical clinics and hospitals across Australia, Southeast Asia and Europe. Mobihealthnews APAC

Novant Health, a 640-location health system in North Carolina, is introducing Tyto Care’s TytoHome integrated telehealth diagnostic and consult device as part of its network service. Webpage, release

Babylon Health’s ‘GP at hand’ not at hand for NHS England–yet. When will technology be? Is Carillion’s collapse a spanner in the works?

NHS England won’t be rolling out the Babylon Health ‘GP at hand’ service anytime soon, despite some success in their London test with five GP practices [TTA 12 Jan]. Digital Health cites an October study by Hammersmith and Fulham CCG (Fulham being one of the test practices) that to this Editor expresses both excitement at an innovative approach but with the same easy-to-see drawback:

The GP at Hand service model represents an innovative approach to general practice that poses a number of challenges to existing NHS policy and legislation. The approach to patient registration – where a potentially large volume of patients are encouraged to register at a physical site that could be a significant distance from both their home and work address, arguably represents a distortion of the original intentions of the Choice of GP policy. (Page 12)

There are also concerns about complex needs plus other special needs patients (inequality of service), controlled drug policy, and the capacity of Babylon Health to expand the service. Since the October report, a Babylon spokesperson told Digital Health that “Commissioners have comprehensively signed off our roll-out plan and we look forward to working with them to expand GP at Hand across the country.” 

Re capitation, why ‘GP at hand’ use is tied into a mandatory change of GP practices has left this Editor puzzled. In the US, telemedicine visits, especially the ‘I’ve got the flu and can’t move’ type or to specialists (dermatology) are often (not always) separate from whomever your primary care physician is. Yes, centralizing the records winds up being mostly in the hands of US patients unless the PCP is copied or it is part of a payer/corporate health program, but this may be the only way that virtual visits can be rolled out in any volume. In the UK, is there a workaround where the patient’s electronic record can be accessed by a separate telemedicine doctor?

Another tech head-shaker: 45 percent of GPs want technology-enabled remote working. 48 percent expressed that flexible working and working from home would enable doctors to provide more personalized care. Allowing remote working to support out-of-hours care could not only free up time for thousands of patient appointments but also level out doctor capacity disparities between regions. The survey here of 100 GPs was conducted by a cloud-communications provider, Sesui. Digital Health. This is a special need that isn’t present in the US except in closed systems like the VA, which is finally addressing the problem. The wide use of clinical connectivity apps enables US doctors to split time from hospital to multiple practices–so much so on multiple devices, that app security is a concern. 

Another head-shaker. 48 percent of missed NHS hospital appointments are due to letter-related problems, such as the letter arriving too late (17 percent), not being received (17 percent) or being lost (8 percent). 68 percent prefer to manage their appointments online or via smartphone. This preference has real financial impact as the NHS estimates that 8 million appointments were missed in 2016-2017, at a cost of £1bn. Now this survey of 2,000 adults was sponsored by Healthcare Communications, a provider to 100 NHS trusts with patient communications technology, so there’s a dog in the hunt. However, they developed for Barnsley Hospital NHS Foundation Trust a digital letter technology that is claimed to reduce outpatient postal letters by 40 percent. Considering my dentist sends me three emails plus separate text messages before my twice-yearly exam…. Release (PDF).

Roy Lilley’s daily newsletter today also engages the Tech Question and the “IT desert” present in much of the daily life of the NHS. Trusts are addressing it, junior doctors are WhatsApping, and generally, clinicians are hot-wiring the system in order to get anything done. It is much like the US about five to seven years ago where US HHS had huge HIPAA concerns (more…)