Mobihealthnews’ interview with Ali Parsa of Babylon Health illuminates what hasn’t been obvious about the company’s global plans, in our recent focus on their dealings with the NHS. For its basic smartphone app (video consults, appointments, medical records), Babylon last year announced a partnership with one of Asia’s largest health insurers, Prudential [TTA 18 Sept 18], licensing Babylon’s software for its own health apps across 12 countries in Asia for an estimated $100 million over several years. Babylon has also been active in Rwanda and now reaches, according to their information, nearly 30 percent of the population. There’s also a nod to developments with the NHS.
Parsing the highlights in Dr. Parsa’s rather wordy quest towards less ‘sick care’, more ‘prevention over cure’, and making healthcare affordable and accessible to everyone ’round the clock:
- Asia-Pacific: Working with Tencent, Samsung and Prudential Asia through licensing software is a key component of their business. By adding more users, they refine and add more quality to their services. (Presumably they have more restrictions on the data they send to Tencent than what they obtain in China.)
- Africa: How do you offer health apps in an economically poor country where only 5 percent of the population has a smartphone? Have an app that works for the 75 percent who have a feature phone. Babyl Rwanda has 2 million users–30 percent of Rwanda’s population–and completes 2,000 consultations a day. Babyl also works with over 450 health clinics and pharmacies. The service may also be expanded across East Africa, and may serve as a model for similar countries in other regions.
- UK and NHSX: About the new NHS-formed joint organization for digital services, tech, and clinical care, Dr. Parsa believes it is ‘fantastic’ and that “it is trying to bring the benefits of modern technology to every patient and clinician, and aims to combine the best talent from government, the NHS and industry. Its aim, just like ours, is to create the most advanced health and care service in the world, to free up staff time and empower patients.” (Editor’s note: NHSX will bring together the Department of Health and Social Care, NHS England and NHS Improvement, overseeing NHS Digital. More in Digital Health, Computer Weekly.)
There, it’s said. A recent investigative article by a Forbes staff writer, European-based Parmy Olson (as opposed to their innumerable guest writers), that dropped a week before Christmas Eve raised some uncomfortable questions about Babylon Health, certainly the star health tech company on the UK scene. These uncomfortable bits are not unknown to our Readers from these pages and for those in the UK independently following the company in their engagement with the NHS.
Most of the skepticism is around their chatbot symptom checker, which has been improved over time and tested, but even the testing has been doubted. The Royal College of Physicians, Stanford University and Yale New Haven Health subjected Babylon and seven primary care physicians to 100 independently-devised symptom sets in the MRCGP, with Babylon achieving a much-publicized 80 test score. A letter published in the Lancet (correspondence) questioned the study’s methodology and the results: the data was entered by doctors, not by the typical user of Babylon Health; there was no statistical significance testing and the letter claims that the poor performance of one doctor in the sample skewed results in Babylon’s favor. [TTA 8 Nov].
The real questions raised by the Lancet correspondence and the article are around establishing standards, testing the app around existing standards, and accurate follow up–in other words, if Babylon were a drug or a medical device, close to a clinical trial:
- Real-world evaluation is not being done, following a gradual escalation of steps testing usability, effectiveness, and safety.
- How does the checker balance the probability of a disease with the risk of missing a critical diagnosis?
- How do users interact with these symptom checkers? What do they do afterwards? What are the outcomes?
Former Babylon staffers, according to the Forbes article, claim there is no follow up. The article also states that “Babylon says its GP at Hand app sends a message to its users 24 hours after they engage with its chatbot. The notification asks about further symptoms, according to one user.” Where is the research on that followup?
Rectifying this is where Babylon gets sketchy and less than transparent. None of their testing or results have been published in peer-reviewed journals. Moreover, they are not helped by, in this Editor’s view, their chief medical officer stating that they will publish in journals when “when Babylon produces medical research.” This is a sad statement, given the crying need for triaging symptoms within the UK medical system to lessen wait times at GPs and hospitals. But even then, Babylon is referring patients to the ED 30 percent of the time, compared to NHS’ 111 line at 20 percent. Is no one there or at the NHS curious about the difference?
And the chatbot is evidently still missing things. (more…)
Babylon Health’s CEO Ali Parsa announced at their headquarters last week that the company would be spending $100 million to develop the ‘world’s leading AI healthcare platform’. In the company of Health Secretary Matt Hancock, an admitted GP at hand fan (nothing goes better after poring over your red boxes), Mr. Parsa confirmed that the 1,000 data scientists, programmers, and clinicians would be based in London after a global search of suitable cities. They will be helping to design the next generation of health AI for diagnosis and to support patients with long-term conditions.
The report in Digital Health noted that the audience included key figures such as Malcolm Grant, chairman of NHS England; Dr Simon Eccles, NHS England CCIO; and Juliette Bauer, head of digital experience. This is despite Babylon challenging the Care Quality Commission (CQC) over an unfavorable report [TTA 11 Dec] and being put on hold by Birmingham as well as Hammersmith and Fulham CCGs [TTA 23 Aug].
Babylon is well able to afford this as Prudential Asia (Prudential plc) has licensed Babylon’s software for its own apps across 12 countries in Asia for an estimated $100 million over several years. Forbes It also inked a deal in June to provide insurer Bupa’s Instant GP to corporate clients [TTA 21 June]. Will this include a foray into the US? No clues so far!