CANMORE – A new app launched by the Alberta government offering online medical advice has local doctors questioning how the lack of continuity of care will affect the overall health of their patients.
The government launched the app Babylon in partnership with TELUS Health last Thursday (March 19) to serve as a way for Albertans to consult with licensed physicians using their smartphones.
Family doctor Liana Hwang of Mountain Maternity and Family Medicine said she is concerned about the effect Babylon could have on the continuity of care patients receive.
“As family doctors, we know our patients better than a doctor who’s never met them before,” Hwang said, adding they are also able to provide services over the phone and are working on viable telemedicine options.
“We’re hoping that our patients will remember that we are still available by phone if they are having health concerns."
Babylon is designed to aid Albertans in accessing health-care information, especially in response to COVID-19, said a government press release. The app can be used as an alternative service to visiting a doctor in person by allowing users to check symptoms, book appointments, see a doctor, get prescriptions and referrals for diagnostic imaging and specialists.
All costs of online visits are covered by Alberta Health Services.
Patients who use the service will be unable to provide access to their medical records during consultations and it is not clear who will follow up on lab tests if they are requested via the app.
However, patients will not be able to access their own family physician through the app. Those doctors will also not be notified if a patient has accessed Babylon unless a patient explicitly asks.
“There are a few things that are a little concerning,” Hwang said.
Hwang said she understands there is a need for telemedicine and virtual medicine especially during the COVID-19 coronavirus pandemic and doctors are working to minimize their patients exposure to the virus.
She added the app puts an added strain on family doctors due to ongoing negotiations with the province regarding the potential changes to complex modifier billing for physicians.
The initial charge was $20 for a consultation on the app. This has been adjusted, but continues to undercut clinic overhead for local family physicians, she said.
Babylon has been used in British Columbia and a similar app is available in the United Kingdom.
The data available from areas where the app is used indicates that virtual medicine is not able to meet the standard of care offered by family doctors, Hwang said. She explained that as a family doctor, if she is concerned about the patient after talking on the phone she has the opportunity to see them in person for further care, this option is not possible with Babylon.
“With Babylon, it tends to be that single episode with no way to followup,” Hwang said. “There are definitely concerns.”
The United Kingdom found people who use the app tend to be younger and healthier with less complex needs, but, the health care costs that came out of the patients were still higher and there were more ER visits in comparison to those with family doctors, according to an article from the British Medical Journal.
“That circles back to the lack of continuity – if they weren’t able to address your issues through the app then essentially what they told you was to go see your family doctor, or go to the emergency room,” Hwang said. “I don’t think that’s a cost-saving and I don’t think it’s a time saving for the patient – it’s definitely not providing better care.”
Echoing these concerns, physician Emma Morin of the Ridgeview Medical Centre said her clinic is concerned about the lack of connection between Babylon and family doctors.
“It connects you to a doctor who doesn’t know your medical history and has no access to your medical chart that lives at your family doctor's office,” Morin said.
She added that she will only be able to access transcripts from Babylon if a patient makes that specific request.
Morin said this affects continuity of care and means she may not know a patient's complete medical history, which effects treatments that may be recommended.
Dr. Megan Cuthbertson of Mountain Maternity and Family Medicine said one-on-one visits with clinics play a pivotal role in ensuring patients receive the care they need.
“In family medicine, it’s the backbone of the care that we provide patients in having that continuity and relationship with them,” Cuthbertson said. “It allows us to give them individualized care.”
Cuthbertson said she questioned the need to introduce this additional avenue of health care given the availability of doctors in the province who live in communities and know patients’ needs while offering the same services.
“In the Bow Valley and Alberta, we’ve had a very strong primary care system for many years – most of our patients have access to family medicine,” Cuthbertson said.
“I think Babylon doesn’t have a huge place in Alberta right now.”