‘Doctor in your pocket’ launches in Ontario

TORONTO – Trouble getting a quick appointment with your GP? Tired of waiting two hours at a walk-in clinic to see a doctor?

If you’re an Ontario resident, you can now sign on with Akira, a mobile telehealth service that enables you to reach a board-certified physician within minutes. You can text-chat for many problems, but if needed, the doctor can also turn on the video so you can see each other – all on your smartphone.

“A video call can be done on the spur of the moment or at a pre-arranged time,” said Dustin Walper, who launched Akira in May with co-founder Dr. Taha Bandukwala, a radiology resident at the University of Toronto. Walper is an entrepreneur and has raised $500,000 in start-up capital from investors who include Tobias Lütke, one of the founders of Shopify.

Many of the problems that patients typically see a doctor for can be treated using text or video, Walper said. These include anxiety or depression, urinary tract infections (UTIs), rashes, and the flu.

Doctors at Akira can write prescriptions and send them electronically to the patients’ pharmacies. The medications can also be delivered, if desired, as Akira has an arrangement with PopRx for free, same-day delivery of meds to homes and offices.

Moreover, Akira’s physicians can provide patients with requisitions for lab tests, and they will provide quick results. “We get the results here, and then we contact the patients,” said Walper. “We’ve had next-day follow-ups.”

Notes about encounters, prescriptions and lab tests can be sent electronically or by fax to the patient’s regular physician, so there is a complete record with the family doctor.

Walper sees Akira as a supplementary service and recommends that all patients should have a clinic-based GP as their main physician – for in-depth, in-person exams and to ensure their records are all kept in a centralized place.

Akira, however, can fill in the gaps when it’s hard to get an appointment or inconvenient to leave the home or office.

The company bills itself as the ‘doctor in your pocket’, as you can contact a physician on your smartphone within minutes, just by tapping the app.

Akira is a privately run service that’s available for $9.99 per month – with unlimited access to a physician. Six doctors and two nurse practitioners are currently working with Akira; all of them are employed in family practices three or four days a week, but they dedicate one or two days a week to Akira, where they interact with patients via using chat and videoconferencing.

The clinicians are paid by the day by Akira. This model is allowed under the Canada Health Act and OHIP’s regulations, Walper said.

Records created by physicians are all encrypted and the data is stored in Canada. Patients are able to retrieve copies of their own records – to show other physicians or for their own purposes.

Chat and video visits with doctors have already caught on in the United States and in many European countries. In the U.S., hospital and clinic giant Kaiser Permanente is delivering a large portion of its primary care this way, and many pharmacy chains have allied with telemedicine companies to offer access to online physicians. The cost is typically US$50 per video visit.

By contrast, Akira is more like the Netflix of medicine, charging patients $9.99 per month and offering unlimited access to clinicians.

“$50 a pop [in the U.S.] is a lot of money, and it often acts as a disincentive to see a doctor,” said Walper. “People are avoiding visits to save money.”

Akira’s patients can contact its doctors continuously, until their problems are resolved.

The company launched after running a three-month pilot, with 2,000 patients. During this time, the patients had 750 encounters with the online doctors.

A good deal was learned during the test. “Most people seem to prefer texting, especially when they’re at work,” commented Walper, who explained that people at work don’t want to be overheard discussing problems with a doctor. “And they don’t want to be seen taking off their shirts, to show a rash, when they’re in their glassed-in offices.”

About 25 percent of the cases involved dermatology, something that can be treated using telemedicine. Indeed, the still cameras and video used today in smartphones are more than adequate for capturing images of a rash or lesion.

At his office, Walper demonstrated how these images can be enlarged by a physician to get a close-up view.

He also demoed the sign-up procedure for Akira. After downloading the app from the iTunes store or Google Play, patients go through a short registration and medical history using an online Q&A. This includes listing their medications, allergies, illnesses and hospitalizations. They also provide Akira with a photo of themselves, for identification purposes, which is part of the app.

The patient then goes into a chat with a doctor; if the doctor is busy, a chatbot comes up that can begin taking notes about the problem at hand.

If the doctor is really tied up, he or she can alert the patients and let them know when they will be available – say, in ten or twenty minutes.

After the encounter, the patient is asked to rate the doctor and the online experience on a scale of one to five. In the beta test, Walper said, almost all of the patients gave at least a 4.5.

One of the physicians working with Akira is Dr. Paul Frydrych, a GP who also practices family medicine at the Humber River Family Health Team, in Toronto. Dr. Frydrych recently completed a residency in the United States, and has a good deal of experience with electronic medical records and telemedicine.

He gives Akira high marks for the quality of its system. “It’s the first I’ve seen that uses Open Notes,” said Dr. Frydrych, referring to a leading-edge U.S. system that gives patients secure access to the clinical notes that doctors have made about encounters with them.

By providing patients with these notes, they’re better able to remember what was discussed during the encounter, and can follow through with instructions much more accurately.

“We believe that patients are more engaged and motivated when they have access to their records,” said Walper. “It helps them follow through with their medications and care plans.”

It also allows them to share information with other members of their care team, meaning that everyone is on the same page.

A team of software developers works at Akira’s downtown Toronto office on enhancing the system. Already, it contains an extensive electronic record, including SOAP notes, along with its video and chat capabilities.

“We’re following all of the privacy and medical guidelines,” said Walper. “But we can move fast to test new things.”

Currently, the Akira solution is available only in Ontario, but Walper says the plan is to soon expand to British Columbia and Alberta.

In Canada, medical services are delivered on a provincial basis, and the physicians providing care in BC and Alberta through Akira will need to be provincially licensed. Eventually, he hopes to have the solution available across the whole country.

“We’d like to see everyone in Canada using a service like this.”