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Alberta Health gives way on doctors' billing for virtual services, but plunges ahead with controversial 'virtual care' app

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Bowing to pressure from the Alberta Medical Association and critics of the controversial Babylon "virtual care" app that's created significant disruption to public health care in the United Kingdom, the Alberta United Conservative Party government agreed yesterday to pay doctors already practising medicine in Alberta the same rate for online and telephone consultations.

That's another victory for AMA president Dr. Christine Molnar in the AMA's recent battles with the Kenney government, although it won't make the potential for serious disruption by the venture between Burnaby-based Telus Corp. and London-based Babylon Health go away, or Babylon's partnership with the Alberta government any less controversial.

In a news release yesterday, Alberta Health Minister Tyler Shandro said new temporary billing codes would allow Alberta physicians to bill the same rate for online and telephone consultations during the response to the COVID-19 pandemic as the rates the government had agreed to pay the service dubbed "Babylon by Telus Health."

The name "Babylon" was not mentioned in the release, although the online brouhaha that followed Thursday's announcement by the same minister touting the controversial online diagnostic service was clearly what prompted the course adjustment by the government. Alberta Health had been planning to pay Alberta physicians $20 for the same service the department had agreed to pay Babylon $38 to provide.

As was said in this space on Sunday, probably the best way for Shandro to evade the worst of that controversy was to say the plan to use Babylon "also includes higher rates for family physicians doing telephone and internet consultations with patients." In effect, by giving Alberta physicians the same $38 rate, yesterday's announcement does just that.

"These new virtual care codes will make it possible for physicians to deliver care safely and effectively to patients during the pandemic," Molnar said in the government's news release. "These codes apply not only for COVID-19 care, but for all the physical and mental health needs of patients as they present every day … These codes represent an important step towards ensuring the viability of physicians' practices, and supporting the thousands of Albertans they employ."

Telus spokesperson Jill Yetman confirmed yesterday that Telus and Babylon Health "entered into a partnership to bring Babylon's innovative virtual care technology to Canada."

"TELUS is responsible for technology hosting, marketing, communications, and sales activities, while Babylon is responsible for product development, operations and primary care delivery," she said in an email. "More broadly, TELUS is actively looking for ways to integrate Babylon's virtual care technology into the primary care ecosystem, including its EMRs, Pharmacy Management Solutions, etc. to improve health care accessibility for Canadians and enhance provider and patient communications."

But practices in the United Kingdom by Babylon Health, founded in 2013 by British-Iranian ex-banker Ali Parsa, suggest the company's corporate strategy includes exploiting local peculiarities of public health-care funding to lure patients away from traditional medical practices and scoop up billings.

A lengthy article in Wired magazine last March explains how the presence of Babylon's online practice has forced the National Health Service "to reallocate millions of pounds in funding to mitigate for the disruption it has caused."

Babylon has been criticized for cherrypicking "easy, low-maintenance patients" in a system that pays general practitioners a set amount for patients regardless of the complexity of their needs, Wired said.

The British practice has also been criticized for the accuracy of its app's diagnostic artificial intelligence component, "a symptom-checking chatbot," Wired said.

"The problem was," Forbes reported in 2018, according to some doctors employed by Babylon, "the bot's advice was often wrong."

Babylon aggressively responded to a British physician who made such claims, the MobiHealthNews website reported last month, posting details of oncologist David Watkins' search data and accusing him of "preferring to troll on Twitter" and posting "over 6,000 misleading attacks."

When Babylon sparked controversy in the U.K. last year by boasting that its AI programs could diagnose medical conditions better than a living, breathing doctor, the Royal College of General Practitioners took issue. "No app or algorithm can do what a GP does," RCGP chair Helen Stokes-Lampard told CNBC last summer.

Then there's the matter of who has money in Babylon -- a group that includes the sovereign wealth fund of Saudi Arabia, the very country that's driving the prices fetched by Alberta's fossil fuel industry toward what's starting to look like the end times.

As for privacy and patient confidentiality, those issues have already come up in connection with Telus's terms and conditions, which have been criticized in detail in Alberta since last Thursday's announcement. "I would not feel safe sharing my confidential health information through this app," said Edmonton physician Amir Pakdel in a tweet.

Moreover, the CBC reported yesterday that while Telus Health submitted a privacy impact assessment of the Babylon app to Alberta Privacy Commissioner Jill Clayton, a review of its impact on confidentiality of health information could take a year or more.

A tweet by Watkins quotes Parsa saying: "We believe data belongs to our patients & we don't own it. But as with every technology, you have unforeseen circumstances. It's a nonsense to promise that the data will not get leaked."

Whether or not Babylon by Telus plans to store Alberta patients' data in Canada or on Babylon's servers in the U.K., none of this backstory is likely to make controversy about the Babylon app and its implications for public health in this province go away. This story has legs.

It would be interesting to know if Shandro and the UCP view Babylon's potential for disruption as a bug to be fixed, or a feature to be deployed. That's a question mainstream media reporters might want to ask the minister the next time they see him.

David Climenhaga, author of the Alberta Diary blog, is a journalist, author, journalism teacher, poet and trade union communicator who has worked in senior writing and editing positions at The Globe and Mail and the Calgary Herald. This post also appears on his blog, AlbertaPolitics.ca.

Image: diego romero/Pinterest

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