Trust Me – I’m a Robot…

You’re feeling peaky, but daren’t leave your work station to go to the doctor as the CEO is over from New York – and is prowling. Your child is off sick at home and has just texted to say she’s feeling nauseous. It’s Saturday night and you’ve conceived weird needle pains in your upper arm – but you just can’t face the torture of the local A&E[i] Unit…

No problem. Just get online or download the app on your smartphone – and bring up www.babylonhealth.com…

Babylon Health is the first online automated doctor service in the UK – and it’s all made possible by further leaps in Artificial Intelligence (AI). Let’s just call it a robot doctor – or, if you really insist, an expert system.

If you live in the UK and you want to see a doctor right now, apparently you are one of about 14 million people in the queue for what we call the GP (General Practitioner). Some of you might not get that appointment for a week, depending on demand in your area. Things are even worse in winter when flu is widespread. Meanwhile, whether you’re just worried (Am I being silly?) or you’re unable to go to work (I feel ghastly!) or you’re in real discomfort, pain and distress (Can’t you see I’m f****ing dying here…?), you just have to wait in line…

Yes, there’s always A&E. But I just hope you don’t ever contract a vomiting virus on a Saturday night and render yourself to the A&E in Bromley or Solihull (wherever) where you wait in a sterile holding pen with the huddled masses for at least four hours while drunks witter and other sickies gape at you.

Nigel (Lord) Lawson (of Blaby), whom you probably remember as Mrs Thatcher’s Minister of Finance, but whom I think of as one of the finest after-dinner speakers going, once said that the English have only one creed left: the sanctity of the National Health Service. No politician can curry favour by knocking the NHS or the millions of selfless exemplars who work for it. Any criticism of the principle of universal free healthcare on demand meets with instant social ostracism in contemporary Britain, so I must be very careful what I say…

But back to expert systems…  Babylon’s smartphone app called Ask has been set up to act like a triage nurse, asking a series of questions to work out if the condition is nothing to worry about or something that requires further attention – or indeed emergency treatment. In the latter case the user is advised to dial 999. It does not give a formal diagnosis. The algorithms behind it were developed with the help of a large team of doctors.

Users can ask questions about their condition and can submit photos and then get a response usually within a couple of hours. The app further allows users to book an appointment with a human GP or specialist and then get a Skype-type online consultation on their mobile phone, tablet or PC.

For £4.99 per month, app users can get unlimited access to consultations. Alternatively there is a pay-as-you-go option offering £29 per consultation. In comparison Bupa On Demand offers a 15 minute face-to-face appointment, usually scheduled for the next day, at around £70. There is another online competitor – PushDoctor.co.uk – which currently offers a 10-minute online consultation for £19.

What could be of long-term significance in my view is that Babylon offers a long-term health monitoring service by which you can transmit all your personal metrics (blood pressure, cholesterol, kidney function and so on) to a scanning system which might pick up on adverse health developments before you are even aware of them. Babylon can provide a kit which enables you to gather much of this data with a few pinpricks of blood. This opens the way to the extraordinary world of data mining in healthcare which I discussed recently in the context of Google’s DeepMind Technologies’ tie-up with an NHS Hospital Trust[ii].

Babylon is cagey about the number of subscribers who have signed up but they have revealed that employees of Citigroup, MasterCard, BT, Sky, Aviva, Next and Bupa are all covered under corporate deals. It’s clear that the subscriber base is growing rapidly across the UK and Ireland.

Babylon Health was founded by Ali Parsa in 2013 and went live in early 2015. Mr Parsa previously founded Circle Holdings PLC (LON:CIRC). Circle was the controversial hospital management company which in November 2011 signed a £1 billion contract to run Hinchingbrooke NHS Trust in Huntingdonshire. You might recall that Circle pulled out of that contract in January this year just as the Care Quality Commission (CQC) was about to rate Hinchingbrooke Hospital “inadequate”. What went wrong there is something that I would like to discuss another time.

Babylon is now sufficiently confident in the efficacy of its service to have issued a challenge to the medical profession. Babylon has offered to compare its outcomes with those provided by flesh and blood doctors and nurses to determine which can deal most quickly and accurately with a range of common health problems. It is certain that Ask will outperform the medicos[iii].

Of course, formal diagnosis is the logical next step but there will surely be resistance to this from the medical profession who will argue – with some justification – that even a small risk of misdiagnosis could have far-reaching consequences. The question will then be: what is the chance of misdiagnosis by a machine as compared to misdiagnosis by a human? But this technology could disrupt not just the medical profession but the billion pound medical insurance industry as well.

In developing countries, where there are often insufficient doctors to minister to the local population (not least because doctors in India and elsewhere have been lured to the NHS) the take-up of automated medicine may be more rapid than in the developed world. That is why Babylon is already rolling out a platform in one of the poorest nations of Africa, Rwanda.

Steve Hamblin, Head of AI at Babylon Health says that the aim is not to put doctors out of business but to provide the medical profession with additional tools. I wonder if junior doctors and nurses see it like that.

If I were Jeremy Hunt, Secretary of State for Health, I would ask Mr Parsa if he could offer the NHS a helping hand. But that initiative would no doubt be shouted down as another evil attempt to privatise the NHS by the back door.

Babylon Health is privately owned. In January this year it raised $25 million in a fundraising round led by Investment AB Kinnevik with participation from Hoxton Ventures, Innocent Drinks cofounders Richard Reed, Adam Balon, and Jon Wright, as well as Deep Mind Technologies’ co-founders Demis Hassabis and Mustafa Suleyman[iv].

Hassibis’ participation is doubly encouraging and assures me that Babylon is one to watch. I can’t wait for its listing – but I have to.

[i] The average wait in NHS England to see a practitioner at a hospital Accident and Emergency (A&E) service last December was around 4 hours.  In NHS Scotland it was slightly shorter – but the statistics there are calculated differently.

[ii] Florence Nightingale’ Deep Mind, posted 03 June 2016, http://masterinvestor.co.uk/equities/florence-nightingales-deep-mind/

[iii] See: It’s man versus machine in the battle of the doctors, Daily Mail 05 June 2016.

[iv] See: http://mobihealthnews.com/content/uk-based-babylon-raises-25m-its-app-enabled-remote-healthcare-service