Babylon Health

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Babylon Health
Babylon-health-logo.png
Founded2013 (2013)
Headquarters
Founder(s)Ali Parsa
IndustryHealth Care
Websitewww.babylonhealth.com
CommercialYes
Current statusActive

Babylon Health is a health service provider that provides remote consultations with doctors and health care professionals via text and video messaging through its mobile application.[1]. The subscription private healthcare services opened in the UK in 2013 and have since been expanded internationally to Rwanda,[2] Canada and China. In the UK Babylon's NHS services cover more than 40,000 registered user-patients which has caused controversial disputes over NHS funding models.[3]

There have been a number of concerns raised regarding the technology used by Babylon Health, in particular including the use of misleading promotional claims and the safety and quality of the advice offered by the Chatbot triage tool.[4][5][6] The Babylon App includes a Symptom Checker chatbot that aims to provide patients with relevant health and triage information based on their symptoms; however the reliability of this system has been called into question.[7]


History[edit]

The English company was founded in 2013 by Ali Parsa in London. Babylon Holdings Limited is a holding company that owns the technology branch Babylon Partners Limited and the healthcare services branch Babylon Health Services Ltd. Babylon Partners lost £12.9 million in 2016 and £23.3 million in 2017.[8]

In 2014 Babylon Health Services Ltd. became the first service of its kind to be registered with the Care Quality Commission, the health care services regulator and inspector in England.[9] Over time the remote health consultation marketplace expanded and other companies arose (Ada Health, WebMD, Your.MD etc.) and the CQC maintained a close check on Babylon Health monitoring them regularly. This has lead to some negative media attention surrounding the disruption caused to the NHS.

In January 2016, Babylon has raised $25M in funding from its Series A round.[10] This was considered the highest raised funding for a digital health venture in Europe.[11] Its investors include Hoxton Ventures, Kinnevik AB as well as the founders of Google DeepMind. In April 2017, it raised a further $60 million to develop its artificial intelligence capabilities.[12]

Later that year, Babylon expanded into Rwanda under the 'Babyl' brand [13] which continues as of July 2019.

In 2017 Babylon arranged a partnership with the NHS to trial providing its AI-powered chatbot ‘triage’ service as a prospective alternative to the NHS 111 telephone service in some regions of London.[14]

In April 2018 it agreed to provide its artificial intelligence technology to WeChat in mainland China.[15]

In June 2018, the company announced an arrangement with Bupa to make the technology available to corporate customers.[16]

In August 2019 the company has announced another round of capital worth $550 million, that values the firm at more than $2 billion.[17]

Services[edit]

Babylon Health provides healthcare services through either their website or iOS and Android mobile applications, this is funded variously through a subscription based model, pay-as-you-go payments, centrally funded initiatives like NHS or as part of health insurance packages.

Users are able to send questions or photos to the company's team of health care professionals (Which includes doctors, nurses, and therapists)[9] in a manner similar to a text message. Alternatively, users can hold video messaging consultations with a clinician to answer questions for common medical topics such as fever, sore throat, allergies, skin irritations, and colds. This service also allows users to receive referrals to health specialists, have drug prescriptions mailed to the user or sent to a pharmacy or to can consult with therapists to discuss topics such as depression and anxiety. In situations where a physical examination is required users can book health exams with a limited number of facilities in London, nurse appointments are limited to one location [18].

In addition to the direct healthcare services, users can access various health monitoring tools such as an activity tracker, ordering home blood-test kits [19] and reviewing general lifestyle and fitness questions.

The Babylon Health app features a controversial Chatbot Symptom Checker than claims to be able to provide suitable triage for patient issues. The website states "Babylon understands symptoms you enter and provides you with relevant health and triage information" however there have been accusations that this is not suitable for all patients.[7]

Controversies[edit]

Unsupported Claims[edit]

There has been controversy around the company's claims of it having the “world’s best doctors” and the “world’s most advanced AI [artificial intelligence].”[20] In June 2018, the company announced that its AI had the ability to diagnose health issues as well as a human doctor, however these claims have been widely disputed. Safety concerns relating to the Chatbot have been raised with the UK regulatory authorities and there have been further concerns raised regarding the methods used by Babylon in evaluating the accuracy of its Chatbot.[4][5][6] The AI chatbot that Babylon Health developed with the UK National Health Service (NHS) has been removed from the NHS Digital Apps Library and results of the experiments of the beta version are pending.[21]

In November 2018, a Lancet publication concluded; "Babylon's study does not offer convincing evidence that its Babylon Diagnostic and Triage System can perform better than doctors in any realistic situation, and there is a possibility that it might perform significantly worse. If this study is the only evidence for the performance of the Babylon Diagnostic and Triage System, then it appears to be early in stage 2 of the STEAD framework (preclinical). Further clinical evaluation is necessary to ensure confidence in patient safety."[7]

Chatbot Accuracy[edit]

In June 2016, Babylon pitted its Symptom Checker Chatbot against a senior A&E nurse and a junior doctor from Oxford University. UCL Professor Irwin Nazareth compared the results and stated Babylon's Chatbot was consistently faster and more accurate in triaging patients than its human counterparts.[22] However, there have been challenges to this assessment because "‘data in the trials were entered by doctors’ and not real-life patients or ‘lay users’". In 2018 the company said they were "currently in the process of performing a larger, real-world study, which we intend to submit for peer-review."[23]

The safety concerns relating to the Babylon Health Chatbot, have highlighted significant gaps within the current medical device regulatory framework for eHealth Apps. The Babylon Chatbot is registered as a Class 1 Medical Device (comparable to spectacles & walking frames), hence is not subject to any form of regulatory approval.[24]

Care Quality Commission[edit]

The Care Quality Commission published results of its July 2017 inspection in December 2017, finding that the company was not providing safe and effective care because some GPs did not follow the company’s own policy around checking a patient’s identity and prescribed medication outside “of their licensed indications”.[25] The Commission found that Babylon "had addressed the issues identified at the last inspection" in their February 2019 inspection, however.[26]

Matthew Hancock[edit]

The UK Secretary of State for Health and Social Care, Matt Hancock has been criticized for appearing to specifically endorse Babylon Health & GP at Hand on a number of occasions.[27][28] In November 2018, Hancock was featured in a paid-for promotional article sponsored by Babylon Health that appeared in the Evening Standard. As a consequence, Hancock has been accused of breaking the ministerial code by endorsing a private healthcare company in a sponsored newspaper supplement, and the Shadow Health Minister, Justin Madders, has written to the Prime Minister demanding an inquiry.[29]

NHS Funding[edit]

A report by Ipsos MORI published in May 2019 concluded that the Global Sum Allocation Formula was not an appropriate way of funding the service because it “doesn’t take into account demand for services”, the higher rates of turnover and the financial impact on the wider health system. The spokesman for Babylon said that the Carr-Hill formula, weighted by age and gender, meant that they received about 40% less funding per patient than the national average.[30]

GP at Hand[edit]

A new service using Babylon technology was launched in London during November 2017 and was promoted with an extensive advertising campaign. The adverts claimed that patients could 'book an appointment within seconds' via its smartphone app and have 'a video consultation with an NHS GP typically in under two hours of booking, anytime, anywhere'. The advertising was ruled misleading by the Advertising Standards Authority in October 2018 because it did not make it clear that users would first have to leave their GP, and registration could take up to three weeks. Nor did it state that potential users must live within 40 minutes of one of five surgery catchment areas in London in order to see a GP in person.[31]

Patients are registered with the practice, GP at hand partnership, online via the website - and deregistered from their existing general practice. It was criticised as promoting "inequitable access to NHS-branded GP services." by the British Medical Association.[32] The practice defended itself by pointing out that payments were made under the standard GP contract.[33]

A list of patients not permitted to register with the service was published in November 2017:

  • Women who are or may be pregnant
  • Adults with a safeguarding need
  • People living with complex mental health conditions
  • People with complex physical, psychological and social needs
  • People living with dementia
  • Older people with conditions related to frailty
  • People requiring end of life care
  • Parents of children who are on the ‘Child at risk’ protection register
  • People with learning difficulties
  • People with drug dependence[34]

Conventional practices are not permitted to refuse to register patients based on factors of these kinds. In November 2018 after a review by NHS England which decided that the technology met its safety standards these restrictions were removed.[35]

The Care Quality Commission rated the service good at its first inspection in May 2019 although it was rated “requires improvement” for effectiveness, largely because of its failure to meet childhood immunisation targets of 90%.[36]

Babylon GP at Hand[edit]

The GP at hand partnership is based in Lillie Road Health Centre in Fulham. In November 2018 the practice was renamed “Babylon GP at Hand”. Before the launch of the app it had 4,000 patients. There is no charge to patients for GP services and the services is financed through a General medical services contract as are conventional GPs. Face to face appointments are available at six locations in central London.[37] By February 2018 it was providing about 2,000 10-minute video consultations a week, 30% outside normal 8am-8pm GP opening hours, and with many of the doctors working from home.[38] In May 2018 Hammersmith and Fulham Clinical commissioning group was looking for an additional £18 million to meet the cost of the 26,000 patients then registered with the practice. Almost all of the new patients are in the 20-64 age group, with three-quarters under 35.[39] In January 2019 there were 41,000 total registrations. About a quarter of the patients who register eventually go back to their original practice.[40]

Matt Hancock called for it to be available across England in September 2018. Richard Vautrey, Chair of the British Medical Association's General Practitioners Committee, claimed this could lead to ‘significant destabilisation’ of general practice because it would need a completely different model of funding for general practice which he felt was not likely.[41]

Hammersmith and Fulham Clinical Commissioning Group removed the clinical restrictions on registration in November 2018, though 'patients will still be advised that sometimes it may not be clinically appropriate for patients to register with a practice that is not local to their home'. The practice has changed its name to Babylon GP at Hand and at that point had 36,555 registered patients, of which 73% are between 20 and 34 and only 5% live in Hammersmith and Fulham. Their advertising now makes it clear that patients will have to give up their existing GP and re-register with GP at Hand.[42] Other Clinical Commissioning Groups challenged the decision to reallocate some of their funds to Hammersmith and Fulham in respect of patients in their area who had registered with GP at Hand. Tower Hamlets, Lambeth and Southwark are the CCGs most affected. [43]

The practice established a Care Coordination Team in 2019 to support people with very high needs such as complex mental health issues, multiple medical problems, or addiction.[44]

Other areas[edit]

In February 2019 it was announced that the service could be extended to Birmingham. This was not welcomed by Richard Vautrey who said that this would lead to further disruption of GP practices, and pointed out that the independent evaluation into Babylon GP at Hand had not yet been published.[45] GP Survival a campaigning group with 8000 members said it believed the GP at Hand model was "harmful for equity of care to all patients" and called on GPs to boycott working for it. Babylon said GPs working for them reported much higher satisfaction and motivation than doctors in traditional practices.[46] It opened registrations for patients in Birmingham and Solihull on 19 June but was limited to 2,600 registered patients. [47]

Funding[edit]

The 2019 GP contract will reduce funding for GP at hand, because out-of-area rules, which were not designed with digital registration in mind, about premiums for rurality and London weighting will be altered. The application of the new patient premium, currently 46%, will be reviewed.[48] This will leave them with the base payment of £87.92 per patient per year.[49]

In August 2019, Babylon Health closed a $550 million round of Series C funding.[50]

See also[edit]

References[edit]

  1. ^ "Tech pioneer brings GP appointments into the living room". Telegraph.co.uk. 28 April 2014.
  2. ^ "Babylon boss on why we need video doctors: 'Try calling your GP... a peasant in Rwanda has faster access to healthcare'". This is money. 4 March 2019. Retrieved 5 March 2019.
  3. ^ Burgess, Matt (2019-04-26). "Major concerns are being raised about Babylon's impact on the NHS". Wired UK. ISSN 1357-0978. Retrieved 2019-05-17.
  4. ^ a b Heather2018-06-11T05:59:00+01:00, Ben. "Safety regulators reviewing concerns about Babylon's 'chatbot'". Health Service Journal. Retrieved 2019-01-01.
  5. ^ a b "High-profile health app under scrutiny after doctors' complaints. Babylon advice service faces warnings it can miss symptoms of serious illness". Financial Times. Retrieved 2019-01-01.
  6. ^ a b "BBC Two - Horizon, 2018, Diagnosis on Demand? The Computer Will See You Now". BBC. Retrieved 2019-01-01.
  7. ^ a b c Wong, David; Coiera, Enrico; Fraser, Hamish (24 November 2018). "Safety of patient-facing digital symptom checkers". The Lancet. 392 (10161): 2263–2264. doi:10.1016/S0140-6736(18)32819-8. ISSN 0140-6736. PMID 30413281.
  8. ^ "Company behind GP at Hand recorded £23m loss for 2017". Pulse. 15 October 2018. Retrieved 27 November 2018.
  9. ^ a b "Babylon app puts a GP in your pocket". Wired UK.
  10. ^ https://techcrunch.com/2016/01/13/babylon-health/
  11. ^ Barlow, James (2016). Managing Innovation in Healthcare. Hackensack, New Jersey: World Scientific Publishing Company. p. 248. ISBN 9781786341525.
  12. ^ "Babylon Health raises further $60M to continue building out AI doctor app – TechCrunch". techcrunch.com. Retrieved 2018-06-27.
  13. ^ "GP at Hand-like service in Rwanda surpasses 2 million members". digitalHealth.
  14. ^ "Babylon Health raises further $60M to continue building out AI doctor app". Tech Crunch. 25 April 2017. Retrieved 23 May 2017.
  15. ^ "Babylon expands its AI technology to mainland China". Digital Health. 10 April 2018. Retrieved 30 May 2018.
  16. ^ Crouch, Hannah (18 June 2018). "Babylon partners up with Bupa for 'one of a kind' health service". Digital Health. Retrieved 20 February 2019.
  17. ^ Wilhelm, Alex (2019-08-02). "AI-Health Startup Babylon Health's Epic New Round In Context". Crunchbase News. Retrieved 2019-08-02.
  18. ^ "AI, robots, pocket doctors: Patient-centred health tech". BBC News.
  19. ^ "Doctor in your pocket? Babylon replaces your GP with an App". The Memo.
  20. ^ McCartney, Margaret (5 September 2017). "Innovation without sufficient evidence is a disservice to all". British Medical Journal. Retrieved 15 November 2017.
  21. ^ André, Arthur (2018). Digital Medicine. Cham: Springer Nature Switzerland AG. p. 38. ISBN 9783319982151.
  22. ^ "Babylon: Bringing digital health to the world". Tech City News. 2017-03-20. Retrieved 2017-07-13.
  23. ^ "Review says Babylon's AI claims lack 'convincing evidence'". Digital health. 7 November 2018. Retrieved 7 November 2018.
  24. ^ "An introductory guide to the medical device regulation (MDR)" (PDF). Retrieved 2 Jan 2019.
  25. ^ "Revealed: Digital providers in drastic safety turnaround". Health Service Journal. 21 March 2019. Retrieved 7 May 2019.
  26. ^ Babylon Healthcare Services Ltd Inspection Report (PDF) (Report). Care Quality Commission. 21 May 2019. Retrieved 26 June 2019.
  27. ^ "Rachel Clarke: Why Matt Hancock's promotion of Babylon worries doctors". The BMJ. 2018-12-04. Retrieved 2019-01-02.
  28. ^ Mclellan2018-09-19T11:00:00+01:00, Alastair. "Matt Hancock's endorsement of Babylon risks undermining NHS innovation". Health Service Journal. Retrieved 2019-01-02.
  29. ^ "Exclusive: Matt Hancock Accused Of Breaking Ministerial Code Over Private Health Firm Endorsement". Retrieved 30 November 2018.
  30. ^ "Funding model for GP at Hand 'not appropriate', Ipsos Mori review finds". Digital Health. 29 May 2019. Retrieved 8 July 2019.
  31. ^ "GP at Hand's smartphone doctor ads ruled misleading". BBC. 3 October 2018. Retrieved 30 October 2018.
  32. ^ "GPC to 'seek legal advice' over Babylon's attempt to register London patients". Pulse. 10 November 2017. Retrieved 15 November 2017.
  33. ^ Butt, Mobasher (16 November 2017). "Margaret McCartney: General practice can't just exclude sick people". British Medical Journal. Retrieved 19 November 2017.
  34. ^ "Online GP provider makes push for patients to switch from their practices". Pulse. 6 November 2017. Retrieved 15 November 2017.
  35. ^ "GP at Hand safety restrictions lifted after NHS England review". Health Service Journal. 16 November 2018. Retrieved 21 December 2018.
  36. ^ "GP at Hand digital service given first rating by CQC". Health Service Journal. 22 May 2019. Retrieved 8 July 2019.
  37. ^ "GP clinic locations in London". GP at Hand. Retrieved 15 November 2017.
  38. ^ Lydall, Ross (21 February 2018). "GP at Hand: 21,000 Londoners sign up for smartphone consultations (with doctors based across the country)". rosslydall ~ Reporting London. Retrieved 23 February 2018.
  39. ^ "CCG needs £18m in extra funding to cope with GP at Hand patient influx". Pulse. 8 May 2018. Retrieved 10 May 2018.
  40. ^ "The messy, cautionary tale of how Babylon disrupted the NHS". Wired. 18 March 2019. Retrieved 18 March 2019.
  41. ^ "GP at Hand should be available across England, says health secretary". GP Online. 13 September 2018. Retrieved 13 September 2018.
  42. ^ "NHS lifts clinical restrictions on patients eligible to join Babylon's GP at Hand". Pulse. 16 November 2018. Retrieved 17 November 2018.
  43. ^ "CCGs contest being charged for Babylon GP at Hand patients". Pulse. 7 December 2018. Retrieved 8 December 2018.
  44. ^ "Funding model for GP at Hand 'not appropriate', Ipsos Mori review finds". Digital Health. 29 May 2019. Retrieved 8 July 2019.
  45. ^ "Babylon GP at Hand given green light to expand NHS services to Birmingham". Pulse. 13 February 2019. Retrieved 14 February 2019.
  46. ^ "GP campaign group calls for Babylon boycott until 'full impact' is known". Pulse. 14 February 2019. Retrieved 18 February 2019.
  47. ^ "GP at Hand to go live in Birmingham after expansion is approved". Digital Health. 19 June 2019. Retrieved 21 July 2019.
  48. ^ "New GP contract will cut income for 'digital first' providers". Health Service Journal. 4 February 2019. Retrieved 17 March 2019.
  49. ^ "The messy, cautionary tale of how Babylon disrupted the NHS". Wired. 18 March 2019. Retrieved 18 March 2019.
  50. ^ "Babylon Health confirms $550M raise at $2B+ valuation to expand its AI-based health services". TechCrunch. Retrieved 2019-08-06.

External links[edit]