Earlier this year a report by the King’s Fund highlighted the tremendous difficulties startups have in scaling up their technologies in the healthcare sector.  It cited things such as a lack of appetite for change and insufficient resources to scale up successful pilots as key factors holding back innovation in the sector.  Such conclusions are not new however, with many shared with previous reports on the topic.

For instance, the King’s Fund report follows on from the Accelerated Access Review, which was designed to speed up the introduction of technologies and innovations into the NHS.  Many of the recommendations from that are shared with the King’s Fund report, as they are with another report from the Health Foundation.

It makes successes such as telehealth pioneer Babylon Health especially rare, yet especially  valuable. The company has been fighting the good fight since it was founded by Ali Parsa in 2013 and recently showcased the latest development in it’s AI-driven technology, which was documented in a recently published paper.

Their AI system performed a number of clinical tests, including many from the MRCGP examination, alongside practicing clinicians.  It was an approach that mirrored a previous test of their AI-powered triage service, which managed to outperform a range of clinical experts last year.  Likewise, the Babylon system managed to outperform clinicians in the MRCGP test by nearly 10%.

The exam is important because it acts as the final test General Practitioners (GPs) take to prove their competence and clinical skills and begin independent practice.  The average pass mark for the test over the past five years is 72%, but the Babylon AI managed to score 81% in its first attempt. It’s a score that Parsa believes can be comfortably improved upon as the system becomes smarter, but despite it undoubtedly having a high level of training prior to its public examination it is still an impressive performance.

Changing healthcare

It’s a result that Babylon believe can lead to a transformation of healthcare and make highly qualified diagnoses available to more people.

“The World Health Organisation estimates that there is a shortage of over 5 million doctors globally, leaving more than half the world’s population without access to even the most basic healthcare services.  Even in the richest nations, primary care is becoming increasingly unaffordable and inconvenient, often with waiting times that make it not readily accessible. Babylon’s latest artificial intelligence capabilities show that it is possible for anyone, irrespective of their geography, wealth or circumstances, to have free access to health advice that is on-par with top-rated practicing clinicians,” Parsa says.

Except the Babylon journey has been one best characterized by extreme persistence.  Since their creation in 2013 they have been banging their head against the wall of the UK’s National Health Service (NHS) in an attempt to get their technology to the masses.  It’s been a long and arduous journey that has only recently begun to bear fruit with a successful pilot in London that began towards the end of 2017.

Even after this pilot however, the path is far from certain, as the NHS has an unfortunate reputation for having more pilots than British Airways, and seldom are these pilots scaled up in any meaningful way.  It’s a challenge that scale-up expert Sherry Coutu is all too familiar with. As founder of the Scale Up Institute she has been a leading voice in the startup community and advised the UK government on how they can best deliver the support required to help create the rapidly growing unicorns so desired by countries around the world.  She is also an investor in medtech startup Ieso Digital Health, which aims to help tackle the mental health crisis that is emerging across much of the western world.

“There do seem to be forces that are preventing the rapid adoption of proven technologies,” she told me.  “That’s very, very damaging to our tax dollars, it’s painful to citizens and patients, and we can do a lot better.”

She suggests that there should be a fundamental obligation on anyone conducting a pilot to scale up that pilot if it proves successful against some pre-ordained metrics.  The onus for creating and spreading this change too often falls upon external innovators however, with the NHS having ongoing challenges in disseminating innovation. This was certainly the case with Ieso, which gained traction much faster in the United States than in the United Kingdom.

“Even though the system was proven to work in the UK in terms of outcomes per patient, and we achieved a 50% decrease in the time required to treat a patient who was clinically depressed over a traditional method,” Coutu said. “And more convenient for patients as well, who can have sessions with therapists at convenient times.”

Measuring innovation in healthcare

There are attempts being made to try and make drawing comparisons between the health systems in various countries easier.  For instance, the Healthcare Innovation Index aims to allow us to compare the performances of healthcare providers around the world.  The project, which is still very much a work in progress aims to provide an objective measure of the capabilities of a health system in taking up innovations, and indeed of the country’s ability to generate innovations in the first place.

League tables such as this can be catnip in terms of their actual use, and I do wonder whether this might succumb to giving healthcare executives a metric by which they can pat themselves on the back rather than actually improve patient care.  After all, you could argue that few healthcare providers have really cracked innovation, so comparing yourself to a fellow laggard is not only unhelpful, but not really what your patients will be doing. With competition in healthcare often minimal, they will instead be looking at the service and pace of change they experience in other aspects of their life.  If provision and service levels are compared to retail, travel or any number of other industries, then the comparison may be more illustrative.

This perhaps explain the relatively mooted response to the roll-out of Babylon, as whilst this kind of telehealth capability is undoubtedly novel in healthcare, it’s been around 15 years since Skype began to make the concept of video conferencing commonplace.

There’s little doubt that healthcare as a sector is in urgent need of change, but equally there is precious little indication that it’s an industry that is up to the job.