A slew of GP-inspired start-ups – some cool, some controversial – are about to hit the market and suddenly GP centric telehealth and AI are at a tipping point
This story started its life with an “incoming” from a PR agency about a group called Dr Sicknote relaunching as Qoctor. The PR firm cleverly used the tag line “controversial doctor service relaunches” to get our attention.
The Medical Republic never did a story on Dr Sicknote. We just rolled our eyes collectively when we heard, and moved on, thinking it would slide quietly into the dodgy start-up graveyard.
The AMA did a job on the company though.
Then AMA president Dr Brian Morton went on a tirade in the consumer press saying the service was risky, ripe for exploitation, and raised serious ethical and legal issues.
“It really surprises me that an employer would accept [a certificate from] Dr Sicknote as a legal document because there’s no treating relationship there,” Dr Morton said.
We wonder if the Dr Morton ever talked to the Dr Sicknote GPs. Without talking to them you could easily assume a lot of bad things, just from the terrible name. We did.
Any boss auditing their “Mondayitis” sufferers who saw drsicknote.com.au on a medical certificate couldn’t fail to chuckle, surely.
#JUSTABUNCHOFGPs DOING THE RIGHT THING?
So TMR phoned Qoctor, and who’d have thought? It’s run by #justabunchaGPs who decided it was crazy that some of their patients trekked, on average, 1.6 hours to their surgery and back, when sick (presumably), for something that could be done over Skype in a few minutes.
They thought they could deliver something of value to their patients, reduce surgery waiting times, and improve their own working lives by restricting these minimalist types of consults to certain periods of the day.
They also certainly contemplated a little extra cash. But when you add up how much so far, it’s hard to conclude this was a venture based on seeking fame and fortune. After about 2900 sick notes written by the group, and various other types of teleconsults, they might just have cracked $60,000 in year one. The venture probably isn’t in profit (yet).
“The whole thing started as a means of making things easier for patients. In many situations they know what is wrong with them,” Qoctor director and full-time practising GP Dr Aifric Boylan said.
“But getting to the surgery and back is a drama, especially for families. Sometimes, they just don’t need to be in surgery.”
NON-SIGHTED REFERRALS AND SCRIPTS
A centrepiece of Qoctor’s relaunch is that they intend providing instantaneous new and repeat specialist referral letters, only using an algorithm and website forms, and with no formal doctor review. Letters will be generated automatically, complete with digital signatures. So, essentially: “Robot referral letters.”
The AMA doesn’t know if this legal or not, and a review of the Medical Board of Australia guidelines on Technology Based Patient Consultations reveals that there is nothing technically preventing such a service.
“The reality is, that for certain referrals, this is completely feasible if you have your algorithm right, and we’ve spent some time getting it right,” says Dr Boylan.
Qoctor is planning on the same process for writing scripts for certain conditions that are “very basic”.
WHY AI IN FINANCE AND NOT MEDICINE?
There are a few emerging precedents for what Qoctor is attempting here, which is essentially a doctor-licensed DIY AI system.
Financial planning groups, which are licensed to provide financial advice, like doctors are licensed to provide medical advice, use their licence to provide automated, computer-based funds selection for a lot of their clients. It’s call “robot advice” – an algorithm worked up by licensed professionals.
The service is faster, and significantly cheaper. It means that thousands more Australians can afford to get reasonably robust professional financial help which they previously had no access to.
What do you think a patient would risk more: using a robot for their life savings or for a specialist referral letter?
TIP OF THE TECHNOLOGY ICEBERG?
You suspect that Qoctor is the tip of a technology-change iceberg that might split the GP profession down the middle over the question of care delivery via computers.
If, for the for the sake of argument, “robot prescribing” could be done safely and ethically, how much could that improve the patient and doctor experience, save on the MBS, and help GP income? These are important and complex questions.
One issue for groups such as Qoctor is how robust the technology is, particularly in terms of security.
Referral and prescribing data isn’t the sort of information you want in the wrong hands. We audit a GPs’ professional knowledge, but not their IT know-how.
While the name Qoctor is still dubious (meant to convey Quick Doctor), its marketing strategy is brilliant. The company has almost no money, and although not admitting it, it is poking the AMA, and others, to come out and blast the company in the consumer press.
The publicity will be priceless, and will almost certainly lead to public adoption of the service at a much higher rate.
ENTER A SERIAL-KILLING DOCTOR?
Enter another start-up, understood to be launching next week, called Dextrs.com. This time we like the name. Seems a bit like “external doctor” as well as the take on dextrous. And not too like Dexter, the serial killer you can see on Netflix.
Dextrs isn’t all that different from Qoctor. Again, #justabunchaGPs, and one smart “other”, putting available technology together to create a service they say will help patients, streamline practices and make a bit of money on the side.
According to one of its founders, Dextrs will go further than Qoctor in terms of technology-assisted service. Instead of your run-of-the-mill Skype, it will use a purpose-built teleconsulting platform from the CSIRO Data 6 group called Coviu.
The Dextrus tagline says a lot: “Great care doesn’t start with a wait”. Notwithstanding, neither Dextrs nor Qoctor have really solved the waiting issue. Both services require you to book an appointment time.
The reality is, that for certain referrals, this is completely feasible if you have your
algorithm right, and we’ve spent some time getting it right.
ENTER THE DRAGON – MICROSOFT
Enter the next interesting telehealth start-up which is just about ready to go. It’s called Welio. This is in trial as we write and is a much bigger venture and its premise is exciting for patients and doctors – true “on demand” telehealth. Just call in and an algorithm will send you either to your local GP who, hopefully, has signed up (the service is free to sign onto), or if no one is available, the next “best” available GP, matched by a condition and geo-algorithm, in case you need a follow up, or to go to hospital. All instantly, or at least, much closer to instantly than you’ve ever seen before.
We hate to use this term, but this sounds awfully “Uberish” to us.
When working, any doctor in the country who has the app can theoretically see any patient who has the app. With enough GPs on the service, a patient should be able to see a GP at any time of the day or night.
As a doctor, you are only on this service when you want to be. Turn yourself on or off depending on your priorities – just like an Uber driver. The system will poll you with a job if you’re on. If you want, turn it on at night time when you’re watching Dexter.
This app even has a touch of Tinder to it. Meet a new doctor or patient you don’t like? – swipe and move on (not that anyone at TMR know how Tinder works )
Teleconsulting, per se, isn’t that new to GP practices. Practices have, over the years, come up with solutions for telehealth and there have been long-time businesses, such as OzDocsOnline, which offer a white-label service, albeit mostly using older desktop-based technologies.
TELEHEALTH ON DEMAND
If Welio works, it will solve some key issues many doctors have struggled with to date on teleconsulting. It’s on demand, so there is no appointment scheduling. It does all the work on the payment side seamlessly, it’s fully mobile, and it’s at your convenience and the patient’s.
Most GPs do tele-consults already. They just don’t get paid for them. Welio feels like an obvious technology that had to happen.
To give you a sense of what sort of people think Welio is a neat idea, Microsoft is a backer, providing its robust Skype-at-work platform to the company for free.
In the patient and doctor side of the app, Skype-for-work is pre-loaded and ready to go.
It feels more like a banking or travel app than a healthcare app which thus far have managed no meaningful connection to the epicentre of healthcare delivery – a GP.
Microsoft is also potentially going to tack on their own cloud-based patient management application – again for free. That should have MedicalDirector and Best Practice thinking a bit harder on their business models in the not too distant future.
SOLVING A REGIONAL PROBLEM
Welio’s main market is Southeast Asia, where smartphones abound in non-urban areas, but doctors and nurses are few and far between.
It is working with Microsoft to combine the service with simple-to-use wireless diagnostic tool kits that are cloud-based and will talk to clinical centres in the cities.
In this way, Welio hopes to solve a lot of issues with health delivery in developing economies.
Imagine if Welio was one of the available functions on MediTracker, which is a live-updated medical record and chronic health management patient app that talks to most patient management systems? And then let’s add HealthEngine appointments. Imagine all that in one app in your patient’s pocket.
One wonders how the AMA, ACRRM, the RACGP and the regulators are going to respond to these enterprising GPs and their friends.
I hope it’s not going to be like how the taxi industry greeted the arrival of Uber.
Statement of interest:
The Moose Republic, which owns The Medical Republic, helped a little in the concept development, market planning and strategy of Welio. For this we were not paid. However, when Welio launches it will be advertising in our publications, and for this we will be paid (we hope).
