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“We’re still in the foothills of digital transformation”

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Long before the global pandemic, eConsult was pioneering remote consultations with doctors. Then came C19 and suddenly 15 million patients accessing its technology became 30 million. Health Tech World spoke to CEO Dr Murray Ellender about the firm’s journey.

During the pandemic, demand for remote consultation software eConsult’s services skyrocketed, with the number of GP practices using it doubling to 3,000 in just six weeks.

The platform is no COVID-fuelled newcomer, however. It was, in fact, developed nearly ten years ago by a group of London clinicians, and is now headed up by co-founder and CEO Dr Murray Ellender.

Health Tech World caught up with him to find out more about his journey from GP to tech entrepreneur – and what the future holds for digital healthcare.

How did the idea for eConsult come about?

After starting out in A&E, I ended up in the Hurley Group, an innovative London-based inner-city practice. We went through a really exciting journey, taking on failing practices in London and turning them around; we ended up with around 15 in the group.

The link to digital came from the fact that, although we had this big, innovative group, if a patient wanted to see a GP, they’d still have to get on the phone at 8am morning, wait 40 minutes to get through, and then get an appointment a week next Thursday.

We realised that we needed to do something to link these practices and make that journey better for patients.

We started out thinking we’d do video consultations, but soon realised that actually, video doesn’t save any time, because you still need 10 minutes to see the patient and 10 minutes to review. The other problem in NHS practices is that broadband can be terrible! As soon as you’ve got a couple of doctors on a call, it can all crash.

We came up with a different idea; to gather the story from the patient upfront and put it in front of the doctor. The doctor then has all the information they need to make a decision about what the patient needs.

The next step was to test it with our own patients and it worked; patients and GPs liked it.

And how did it grow from there?

In 2013 / 2014 when we were first experimenting with this, we were a bunch of clinicians with one tech guy. Then we started to slowly build a team around him and that was the first version of the platform.

The next step was a six-month pilot with about 20 practices in Tower Hamlets. Again, it worked really well.  After that we started attending events telling GPs about what we’d done. They would ask if it was available to buy – which is when we decided to launch it as a business.

It grew organically from there and then the NHS got wind of what we were doing and put some funding behind it. It then took off.

And then COVID hit

Absolutely, and suddenly there was a real need for these solutions.

We doubled the number of practices in about six weeks, to 3,000, and the number of patients therefore went from about 15 million to 30 million.

What was really interesting, however, was the growth in the number of patients actually using the system. In February 2020, we were seeing around 120,000 e-consults a month. By the summer, we were doing 1.2 million.

For us, behind the scenes, that gave us two priorities; one was scaling the infrastructure so it wouldn’t fall over in the face of such demand – and it didn’t, so that was a huge triumph.

The other was how fast we could deploy practices. We got a process that used to take four weeks to get a surgery up and running, down to 24 hours. That was another triumph, as there was such a real need for it on the ground.

Was there any friction in scaling up to this magnitude?

Definitely, and we’re seeing some of the fallout from that now. Part of the reason we used to take four weeks to get up and running was because we did a lot of work with practices in thinking through how they were going to use the tech, rather than being dominated by it.

The problem with landing something in 24 hours is if you don’t spend enough time doing that. So now we have to go back and help a lot of those practices to think about how they’re implementing technology, making sure it’s useful to them, and not just seen as something extra to deal with.

You’ve scaled up during the pandemic. What happens next?

eConsult has done amazingly well in general practice; we’re in about 45 per cent of practices, reaching about 30 million patients, and that is fantastic.

The next step for us is to take what we’ve done there and apply it to a hospital setting, and we’re already trialling it.

We want to replicate that element of digital triage in A&E. Normally, patients see a receptionist, wait for a while, see a triage nurse, wait for a long while, and then see a doctor.

In our trials, which are live in nine A&E departments, when a patient walks in there’s a bank of iPads, which are used to gather all the information the receptionist and triage would ask for.

Based on that information, they can be prioritised effectively, but in the patient’s time, not the doctor’s.

We’re also planning to roll this out to the third door through which patients access clinicians – specialist healthcare, such as dermatology or cardiology.

The idea is to bring the patient journey forward by getting as much information from them as possible before they even see the specialist, who can then order any tests or procedures before the appointment.

Do you have plans to roll the platform out globally?

Eventually, yes, but you’ve got to take things a step at a time and our goal in the next one to two years is to do something transformational in the NHS.

Once we’ve achieved that, then that’s a good time to show the impact we’ve had on transforming the biggest unified health system in the world. Off the back of that, we would look to take it to one or two overseas markets initially.

You’ve made some acquisitions to date. Are you looking for more to support your growth?

We have around 100 people in our team, and our whole approach to mergers or acquisitions is that, if someone can do what we need them to do, it’s better to work with them rather than build it ourselves.

The biggest example of that so far has been the acquisition of Qdoctor, which offers the communication tools that a doctor uses to get back to the patient.

So we were partnered with them for about a year and then we acquired the business and brought them in-house.

The key thing I’ve learned is that you’ve got to really match the cultures of the business, which is why this acquisition worked really well, because they were a business with a similar mentality.

Does your medical background help when it comes to selling eConsult?

Absolutely, in fact it’s our USP that we’re not a purely tech business, we’re a mix of technologists and clinicians, which gives us a real understanding of the customer and the market.

About 20 per cent of the team are clinicians, either doctors or nurses, who author new clinical content and review existing content. We get them involved in sales as well – it’s quite useful if you’re selling to a bunch of doctors to send in a doctor.

Do you think there’s more to do in digitally transforming healthcare?

If anything, we’re still in the foothills of digital transformation. Even though we’re doing 1.2 million e-consults a month, in those practices, there are 12 million consultations a month, so we’re only doing 10 per cent of them digitally.

One aspect that we are investing in is artificial intelligence [AI]. While we gather the story from the patient and put it in front of the doctor, it’s still human intelligence, as in, the doctor is still making the decision about what to do.

So I do think as we do more and more of this, we can start to build in AI to help make that decision-making process more efficient.

For example, if we see 50 cases of hay fever a week, and all were sent to the pharmacy, the tech could step in and suggest sending [other such cases] to the pharmacy, without any human involvement at all.

What will also really transform healthcare is remote diagnostics, the ability to remotely capture things like pulse, blood pressure and oxygen level.

We’re already seeing this, with asthmatics and Covid patients being given oximeters to monitor their blood oxygen at home. Of course, everyone’s now used to taking nasal swabs themselves too – that’s been one unexpected benefit of the pandemic.

If we can start merging that data into the history that we’re capturing on the app, you then have the option of starting to assess those physical measurements and gaining an even fuller picture.

Is it a challenge to change attitudes among clinicians in encouraging them to adopt technology?

Definitely, because we’re trained to see people face to face and so the profession is adjusting. Now, they need to learn to be able to consult remotely and face to face.

That is the challenge, to get GPs of 30 years standing to change their mindset and do things differently.

But we need to now be thinking about how we train the next generation of doctors, to get used to this new world of both remote working and in person.

We’re already having quite a few conversations with Health Education England, which focus on training doctors. I’m also building partnerships with universities too, to get involved in the research side of this.

Finally, how would you describe your role now?

I’ve been a doctor for 22 years, but I don’t really think of myself as a GP nowadays, although I still do general practice now and again.

When I meet people on holiday or wherever, I’d say that I run a tech business, but I’m a GP on the side.

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