Building bridges between patients and doctors

Mydoctor.pk, Marham, ZocDoc, AugmentCare and a few others have launched digital startups that make doctor appointments for patients as easy as ordering pizza

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Mobile apps are the new mode of living life in Pakistan. After mobile phones reducing distances in making conversations, now mobile apps are slowly removing the need of a person-to-person contact. From ordering food to hitching a ride, mobile apps have taken over almost every part of commute or consumer requirements of an urban resident.

In a totally automated process, customers can place their orders and receive the product or service delivered at their doorstep. In terms of efficiency as well, these apps grant much more freedom, certainty and control to people in their daily lives.

One thing, however, still dominated by phone calls and personal communication is booking an appointment with a doctor. The receptionists are there in every clinic and every hospital. Patients have to either make calls or visit the clinic and book a time at which they can consult the doctor in order to be treated. The waiting rooms of clinics and hospitals are chock a bloc, and patients and their attendants have no option other than to wait or leave.

But now, in keeping with the spirit of the times, a few innovators have tried to eliminate this by bringing doctor appointments to mobile apps – albeit with a mix of success and failure. ZocDoc, Marham, Augment Care and Mydoctor.pk (now oladoc.com) are a few cases in point.

To gain a deeper insight into the challenges and scope of such services, Profit has tried to reach out to the men who came up with the concept and those that are giving it a go.

Abid Zuberi, the man who launched Mydoctor.pk app along with his brother Arif Zuberi, has a vision: everything involving health care must be under one roof. One of the top 15 startups in Startup Istanbul and incubated with the accelerator Virtual Force in Lahore, is two-faced: Mydoctor.pk for the patients and Mypractice for the doctors. His initiative is based on equity plus $100,000 investment from Virtual Force aiding in product development, in marketing and sales.

Doctors don’t give two hoots to patients’ comfort

So far Mydoctor.pk (now oladoc.com) has more than 300 doctors on board and gets around 350 bookings out of 2,500 hits per day from the patients looking for a doctor. The hits and bookings, however, go beyond these 300 doctors and include a much larger directory of 13,000 plus doctors that Abid has put together. Three hundred appointments out of a pool of 13,000 doctors might seem almost inconsequential but for Abid, this marks a major milestone. Though he is not breaking even at the moment and does not expect that to change until the end of next year, he is convinced that being in a stage where he has to change the mindsets while operating in an industry where he will have to overcome the status quo, he is doing pretty well.

“One of the key challenges was to develop a new category. When Uber and Careem came to Pakistan, they kept giving free rides for a year and a half. But they had the kind of muscle and money to afford that. In Pakistan, electronic appointment booking, record keeping is not anywhere. The doctors don’t give two hoots about patients having to wait. So, it will take time for this trend to make a niche.”

He had the basic version of his app ready by end 2015 but everywhere he went he found people advising him against stepping into such a business. “When we started, we talked to several doctors and everyone advised me against it.”

This might not have been such a bad advice since the co-founder of ZocDoc, another online doctor appointment booking app, shared that his venture faced an impenetrable barrier when the doctors completely refused to document their earnings in fees. He and his friend started this project with an investment of Rs700,000. They developed an app, prepared a model of earnings through subscription fee and set out to look for doctors, from fresh graduates to successful, renowned ones. “There is no denying that the conventional way of making an appointment with doctors is tedious. Then there is always a chance of some ‘preferred’ patient showing up, further pushing you down the queue. We started this initiative a few years back and we approached quite a few doctors, including some in the Shaukat Khanum Memorial Cancer Hospital & Research Centre. We prepared a subscription model and made a platform after research.

‘Quantifying income’ is doctors’ bugbear

But doctors, at that time, were simply not prepared to buy the service because of one particular reason. They did not want to be included in any mechanism that can quantify their earnings. Then we consulted experts who told us that doctors here work on cash and insurance is not as much of an influencing factor here for them to have any incentive to document their workings.” Eventually, ZocDoc was set up for sale to an interested investor in Dubai but the complicated setup at the back end made it virtually impossible for a second player to build up on the same model and ultimately ZocDoc came to the end of its life.

Arif does not dispute this challenge but insists that the arrival of Uber and Careem made it far easier for him to succeed. Despite facing a major backlash in the early days of his initiative, now he feels that doctors are becoming more willing to digitize their records. He also claims to have found a solution to the doctors’ concerns with regard to not disclosing their earnings. “The tax evasion challenge is there and we are still suffering from it. They say that you have all this data and you will give it to FBR [Federal Board of Revenue]. So, we have made a deal with them that we will give them all the data. The point is that I am not here to produce documented economy but we are here to facilitate the patients and for that we have to facilitate the doctors too.”

He added that being an HIPAA (Health Insurance Portability and Accountability Act) compliant company, he is obligated to protect the doctor and patient information. “According to this international standard data is not going to be public anyway. So, if a doctor asks us that he doesn’t want his data to be in the cloud with us but wants to keep it between himself and his client, we provide that option too.”

AugmentCare, seems to have had an easier road to market than Mydoctor.pk (now oladoc.com). Its CEO, Hyder Mumtaz has worked in the digital health industry out of the Middle East and comes from the family behind Fazal Din & Sons, one of the largest healthcare groups in the country. Hyder & his co-founder Ahmed’s experience with healthcare systems around the world is probably what has made them focus on multiple stakeholders in the patient care journey and not just private practices of doctors. AC is already working with hospitals and will be releasing more partner updates in September.

His Business Development Manager Aleena Iqtidar said that hospital managements have been very responsive to their proposals of digitizing patient records because it not only helps them keep track of the quality of care/doctor efficiency but allows for an easy ‘app friendly’ experience with their patients.

The sales team at AugmentCare gave insight into how a lot of the clinics they have met have not only been willing to adopt such a technology and platform but were anticipating such an opportunity to improve their operations and digitize the clinic environment. While the doctors might not be readily open to the idea of forgoing independence in favour of efficient organization, for hospitals the idea is more attractive since a record of all of their doctors takes precedence over the individual performance of each doctor. However, Hyder said that even the private clinics they contacted have been willing and, in some cases even anticipating, such an opportunity to digitize patient files and other data.

Convincing doctors to come on board

Interestingly Mydoctor.pk (now oladoc.com), ZocDoc, and AugmentCare have all chosen to charge a subscription fee to doctors instead of patients. On the face of it, the doctor patient ratio, as well as patients being the primary facilitators of these apps, paint this model in irony. However, all these players had a similar explanation for this. Abid said, “We need to convince doctors to come on board. If they are not willing to completely switch their paper/pen mode, the main objective of keeping a time-bound appointment becomes redundant. If the receptionists are still squeezing in patients than the selling point of facilitating patients fades away.”

ZocDoc owner said that patients themselves will not be willing to come to this platform unless there is no other way and that will only happen if the doctors get rid of the conventional model. “If I can get an appointment sooner because someone I know knows the doctor I want to see, why would I even go to the effort of making an online appointment?”

Mydoctor.pk charges the consultancy fee for two patients per month (and upwards) to the doctor according to their individual fees, making a different fee charged to every doctor. ZocDoc had a uniform fee structure which they never got to put in practice. Augment Care refused to share their fee as yet. Abid, however, added that there are some more models under discussion towards their earning models.

Mydoctor.pk has partnered up with Fonepay as their exclusive partners for payments. They also have Servaid on board as the medicine provider. Chughtai Labs is on board with the company to provide testing facilities to interested patients and Aman Foundation’s doctors are available for free consultation. “The telemedicine or video conferencing for a consultation with doctors is not as yet available, but we have already developed its technology and we are in the testing phase.” AugmentCare’s Aleena also said, “Partnerships are the essence to the success of any organization. We love to partner up with companies who share the same vision as us”. The company’s Product Manager Wajih Shafiq added, “We are currently working with doctors and hospitals and will be more than happy to share advance updates in the coming month.”

The arrival of at least half a dozen players in the market can either revolutionize the industry practices or end up crowding it out altogether. As of now, each of these players has high hopes, banking upon their claims of providing something different but worthwhile.  

How these start-ups may proceed in this nascent business, how all this eventually pans out only time shall tell. One thing is certain, though: the doctors shall have a major say on which way it blows.