Babylon Health
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. The subscription for private healthcare services opened in the UK in 2013 and have since been expanded internationally to Rwanda and Canada. In the UK, Babylon's NHS service covers more than 40,000 registered user-patients, which has caused controversial disputes over NHS funding models.
There have been a number of concerns raised regarding the governance of Babylon Health, in particular the use of misleading promotional claims and the safety and quality of the advice offered by its artificially intelligent Chatbot. In addition, for the same symptoms, cases have been reported of doctors giving diagnoses of panic attacks for female patients, and heart related issues for males, which raises concerns. In April 2020, Alberta's privacy commissioner launched two investigations into Babylon, by Telus Health, over non-compliance and medical privacy concerns. The commissioner encouraged doctors and patients to extend their absence while investigation was on-going. A data breach was reported in June 2020, which Babylon admitted to. In addition, Babylon Health’s app security score was 10/100, putting it in the “critical risk” category.
In April 2020, Kinnevik have reduced their valuation of Babylon due to "greater uncertainty over the roll-out of existing partnership contracts as a result of COVID-19." Babylon also furloughed 5% of workforce during that month and admitted that "others have left the business as they fell outside of the scope of their renewed longer-term focus". As of June 2020, there are approximately 1,300 employees and contractors listed on Babylon Health's LinkedIn page.
History
The company was founded in 2013 by Ali Parsa. Babylon Holdings Limited is a holding company based in Jersey, 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. In 2018, Babylon Partners lost £66.7 million before tax credit.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.
In January 2016, Babylon raised $25M in funding from its Series A round. This was considered the highest raised funding for a digital health venture in Europe. Its investors include the Hoxton Ventures and Kinnevik AB. In April 2017, it raised a further $60 million to develop its artificial intelligence capabilities.
Later that year, Babylon expanded into Rwanda under the 'Babyl' brand which continues as of July 2019.
In 2017 Babylon took part in an 'NHS111 Online' pilot, where its AI-powered ‘triage’ chatbot was made available in some regions of London.
In April 2018 it agreed to provide its artificial intelligence technology to WeChat in mainland China. However, in February 2020, Tencent announced that it is collaborating with Zhong Nanshan to set up a Big Data and AI Joint Lab. The lab is headed by Zhong Nanshan, who is now an academician of Chinese Academy of Engineering, the leader of the high-level expert group of the National Health Commission, and the director of the National Clinical Research Center for Respiratory Disease. Tencent also self-developed its own AI Triage Assistant and open sourced the codes to help fight COVID-19
In June 2018, the company announced an arrangement with Bupa to make the technology available to corporate customers.
In March 2019 "Babylon by Telus Health" went live in Canada.
In August 2019 the company announced another round of capital worth $550 million, with the largest investment coming from the Public Investment Fund of Saudi Arabia, chaired by Mohammad bin Salman Al-Saud. Media coverage reported the valuation of the firm at more than $2 billion.
In October 2019 the company launched a service called Ask A&E which is a new digital service for patients with urgent care needs, available for anybody in the Birmingham and Solihull area in the UK.
It announced a partnership with Royal Wolverhampton NHS Trust in January 2020 to develop “digital-first integrated care”.
In March 2020 the company signed a 10-year contract with the Government of Rwanda to roll out their Babyl service over the next ten years through the community-based health insurance scheme, Mutuelle de Santé. This is intended to establish a universal primary care service.
In May 2020, Samsung UK notified its users that services powered by Babylon will no longer be available via Samsung Health.
Services
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 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 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.
In addition to the direct healthcare services, users can access various health monitoring tools such as an activity tracker, ordering home blood-test kits and reviewing general lifestyle and fitness questions.
The Babylon Health app features a controversial Chatbot Symptom Checker. 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. Babylon's Chatbot prefaces every conversation with the disclaimer that the "it's not applicable to pregnant women". The Chatbot also states that users with long-term medical conditions or disabilities may have different needs and risks than shown.
Controversies
Unsupported claims and Chatbot safety
There has been controversy around the company's claims of it having the “world’s best doctors” and the “world’s most advanced AI .” 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 and the methods of evaluation utilised by Babylon discredited. A number of critical safety concerns relating to the Chatbot have been raised with the UK regulatory authorities. Forbes spoke to doctors who had tested the AI chatbot, who revealed that "10% to 15% of the chatbot’s 100 most frequently suggested outcomes, such as a chest infection, either missed warning signs of a more serious condition like cancer or sepsis or were just flat-out wrong".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. Further clinical evaluation is necessary to ensure confidence in patient safety."
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, hence is not subject to any form of regulatory approval.
In March, Alberta Medical Association announced that they are examining reports from other jurisdictions, where the introduction of Babylon had undesired and unintended consequences.
Care Quality Commission
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”. The Commission found that Babylon "had addressed the issues identified at the last inspection" in their February 2019 inspection, however.Matthew Hancock
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. 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. Dominic Cummings advised the company on its communications strategy and senior recruitment up to September 2018. Jon Ashworth said the links between Cummings, the health secretary, and Babylon were “increasingly murky and highly irresponsible”.NHS funding
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.Privacy concerns
The rollout of Babylon by Telus in Alberta, Canada in March 2020 amidst the COVID-19 pandemic triggered massive backlash from the medical community and users alike. One Albertan doctor pointed out that by using Babylon, users are agreeing that their personal data can be transferred outside of Canada and "may be accessible by foreign government agencies", quoting directly from Babylon's Terms & Conditions and Privacy Policy. The Alberta Medical Association also stated in March that they were not consulted prior to the Babylon's app launch in Alberta.Sales of COVID-19 tests
In May 2020, Babylon Health incorrectly claimed that its COVID-19 antibody test that uses capillary blood is based on the PHE-approved test using Abbott's kit which Abbott immediately rebutted to be not the case. The Medicines and Health Products Regulatory Agency asks all providers of COVID-19 antibody testing services using capillary blood collected by a finger-prick to temporarily stop providing this service until home collection of this sample type has been properly validated for use with these laboratory tests. MHRA advises that public should ignore any result they get from the private kits. After complaints from customers, Babylon responded in an email update to customers that they aim to process all refunds within 10 working days. This contradicts with Babylon's initial position, claiming that "testing kits are considered a medical product, and as such they are non-returnable and non-refundable." There are discussions whether Babylon's actions constitute mis-advertising, breach of Consumer Rights Act 2015 and CQC standards.Data breach in GP app
On the 9th June 2020, a data breach occurred in which three patients were provided with access to recordings of other patients video consultations. Babylon Health claimed the breach was live for 2 hours and was due to a software error. Wim Jongejan, a General practitioner based in the Netherland opined that Babylon's attempt at hushing the complainer is "just about the stupidest thing you can do with a data breach, especially if there is medical data." According to Dr Jongejan, conversations between patient and doctor are covered by medical professional secrecy. Following the breach, a Digitial Health New investigation found that a series of technical information exposing potential weaknesses in Babylon Health’s technology was freely available through a Firebase database mistakenly left open. Babylon Health’s app security score was 10/100, putting it in the “critical risk” category, according to the CVSS scoring, globally recognised standard for testing software and scoring its weaknesses. The full assessment report has been published on Github.GP at Hand
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.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. The practice defended itself by pointing out that payments were made under the standard GP contract.
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
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%.
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. 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. 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. In January 2019 there were 41,000 total registrations. About a quarter of the patients who register eventually go back to their original practice.
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.
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. 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.
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.
Expansion
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. 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. It opened registrations for patients in Birmingham and Solihull on 19 June but was limited to 2,600 registered patients. The cap was removed in December 2019, and there are plans to expand the service into Manchester.Funding
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. This will leave them with the base payment of £87.92 per patient per year.In August 2019, Babylon Health closed a $550 million round of Series C funding. PulseToday reported that this funding came from SAMA Foreign Holdings, Saudi Arabia's sovereign wealth fund.
Ask A&E
Ask A&E is a triage tool similar to NHS 111. It allows patients to input their symptoms, and then advises a course of action – such as attending emergency department, calling an ambulance, booking a GP appointment, visiting a pharmacy, or staying at home and monitoring their symptoms. In 2020 it was in use at Royal Berkshire NHS Foundation Trust, Royal Wolverhampton NHS Trust and University Hospitals Birmingham NHS Foundation Trust.Legal Disputes
On March 5, 2020, Babylon Holdings Enterprises Ltd, the holding company behind Babylon Health, filed a Part 7 claim against insurer Arthur J Gallagher. Babylon is represented by Mishcon de Reya LLP. The case is Babylon Holdings Enterprises Ltd. v. Arthur J Gallagher Ltd., case number QB-2020-000942, in the High Court of Justice of England and Wales.In 2019, Babylon raised a legal complaint about an article by The Times titled "Blitzscaling Babylon: Ali Parsa’s break-neck scramble for success".
In 2017, Babylon made a legal challenge in the High Court to prevent the CQC from publishing a report that raised a number of concerns regarding the potential for prescriptions being misused and information not always being shared with the patient’s primary GP. The High Court ruled against the injunction and the report was published on 8 December. Babylon has also agreed to pay the regulator £11,000 in costs.