The apps attempting to transfer NHS 111 onlineBMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k156 (Published 15 January 2018) Cite this as: BMJ 2018;360:k156
All rapid responses
Armstrong describes the rush by private firms to transition a clinical decision support system onto our mobile phones. This merely adds another layer of uncertainty onto an already hazy field of medicine. We already lack good quality evidence surrounding NHS pathways.
There is a paucity of randomised control trial evidence for NHS pathways in their current, telephone based form. Retrospective evaluations(2), before and after studies(3), and case study analysis(4) are no substitute for RCTs.
Any triage test balances the ability to pick up ill persons (“safety” or sensitivity), with over referral to hospital and further testing: admission to hospital is not a benign procedure. From the patient’s perspective it is potentially harmful. For the health system it is expensive and risks adding to the overburden of A&E departments.
There are currently pilots of automated triage apps, and the best evidence of their effectiveness Armstrong can find is from a “Wired” magazine article(5), and Babylon’s own, non-peer reviewed study(6), involving only 33 simulated patients. This is not good enough.
Escalating numbers are being triaged by these systems.
To paraphrase Churchill: never in the field of human medicine was so much done to so many with so little evidence.
1. Armstrong, S. The apps attempting to transfer NHS 111 online. BMJ 360, k156 (2018).
2. Turner, J. et al. Evaluation of NHS 111 Pilot sites. Final Report to the Department of Health. Med. Care Res. Unit Univ. Sheff. (2012).
3. Turner, J., O’Cathain, A., Knowles, E. & Nicholl, J. Impact of the urgent care telephone service NHS 111 pilot sites: a controlled before and after study. BMJ Open 3, e003451 (2013).
4. Pope, C. et al. Has the NHS 111 urgent care telephone service been a success? Case study and secondary data analysis in England. BMJ Open 7, e014815 (2017).
5. Can you really trust the medical apps on your phone? Wired (2017).
6. Middleton, K. et al. Sorting out symptoms: design and evaluation of the ‘babylon check’ automated triage system. (2016).
Competing interests: No competing interests