The French start-up Doctolib, an app for booking doctors' appointments, has announced that it raised 150 million euros in its latest round of funding, to develop its video-based consultation service.
The French public health system began reimbursing video consultations in September 2018, in an attempt to fill holes in medical coverage in parts of the country lacking in doctors. For many French doctors, this is the future of medicine.
“You can see the patient, the camera is pointed at him, and you can examine him,” explains Laurent de Bastard an emergency doctor in Versailles, who gets called by doctors for video consultations on complicated, emergency cases.
“You can look at a brain scan and give advice on whether or not to operate, or if there is a haemorrhage, whether or not there is a stroke and a need to operate right away.”
This kind of interaction between doctors is not new: “You know a dermatologist, and you see something on your patient, so you send your friend a photo or a video, and he or she will answer,” says de Bastard.
But with telemedicine tools, that interaction, as well as phone calls and emails between doctors and patients, is formalised.
“The public insurance body, the state and doctors wanted these interactions to be recognised, so doctors could be paid and the consultations traceable and documented,” explains de Bastard, who serves as co-coordinator on the new technology commission for the URPS health professional union for the Paris area.
There were also concerns about data confidentiality, so that medical information is not exchanged via email or other unsecured means.
“The systems put in place had to protect medical confidentiality, and have secure networks and severs,” he says.
On 15 September 2018 France authorised the reimbursement of these consultations, with certain conditions: that they be video consultations, and that they be with a doctor who already has a relationship with the patient.
These consultations can be done in special areas in clinics and retirement homes, where patients can get help from nurses or health aides and have access to equipment like blood pressure monitors. They can also be done via online apps.
Several companies have jumped into the market.
A lucrative market
In its 2018 provisional budget, the state health insurance body predicted 500,000 video consultations in 2019, a million in 2020 and 1.4 million by 2021.
Doctolib, which launched in 2013 to provide online booking services to doctors, and has partnered with doctors and hospitals in France and Germany, announced that it would be introducing a video-consultation tool at the start of 2019.
“Patients can stay at home, they go on their mobile app…they can do a live video consultation with their doctor, and at the end of their consultation they have an online prescription,” Doctolib CEO and founder Stanislas Noix-Chateau, told RFI.
“It's a totally digitised experience for a consultation.”
For him, video consultations are part of the future of medicine in France, and around the world. It can be useful for certain treatments, like “a check-up after surgery, or GPs can do up to 50 percent of their consultation via video. The main idea is to connect patients with doctors.”
Doctolib is not replacing doctors, says Noix-Chateau. It is actually allowing them more time to work with patients: “We are not a platform, we are a service to enable doctors to have more time with their patients.”
For now, doctors appear to agree. Doctolib is quickly becoming Europe's largest e-healthcare service, and has been valued at more than a billion euros.
Video consultations appear to be seducing more patients than doctors in France, says de Bastard: “Access to care is complicated because of demographics, there are territories that are very isolated.” Some rural areas no longer have doctors within a reasonable distance, and even in Paris, there is a large population and not enough doctors.
There is also the issue of older people, for whom driving long distances can be a problem.
“These services can be in retirement homes, or for patients with chronic disorders… who need regular check-ups,” says de Bastard. Though older patients need help navigating the new technology.
And yet, doctors are wary. The Paris area URPS conducted a study on the 22,000 doctors in its network, and found that while 66 per cent of doctors used online appointment services, 44 per cent of them worried about how the data on the sites was being used.
The URPS wrote up confidentiality guidelines in 2018, that 15 platforms have signed, including Doctolib.
But de Bastard also says that doctors who are already overwhelmed with patients do not see the need to open up their practice using video consultations.
“There is pressure from patients, who prefer not to have to go to an office,” he says. “A certain number of doctors are asking why they should get involved in it, saying 'I don't need patients'. But they will do it because of patient demand.”