CEO & founder of ORCHA, the digital health company, Liz Ashall-Payne talks about her company and experiences in the industry

We speak to Liz Ashall-Payne, all about her digital health company ORCHA. Read about her experiences so far, her roles prior to being a CEO, and her advice for others looking to work in the industry.

Can you introduce yourself and tell us about the role you plat at ORCHA?

I’m Liz Ashall-Payne. I’m the founding Chief Executive. I started my career working in the NHS as a healthcare professional, working in complex paediatric care. This passion for me started before I worked clinically. From when I was 15, I wanted to help people and that was still my passion when I started seeing patients.

By the end of day one, I felt really frustrated, because I had only been able to see 6 patients. I had only been able to help 6 patients. That was really frustrating, because I knew that there were hundreds waiting to see me, and even more on the waiting list. That took me on a journey of trying to see more patients. This was a long time before technology was in our lives, I didn’t have a computer on my desk at the time, as a clinician. I had a telephone and access to a photocopier, everything was handwritten.

I got really interested in how can we strip away, so that we as clinicians can see more patients. And I managed to get to being able to see about 10 patients a day, then managed to get everybody to seeing 10 patients a day instead of 6. We absolutely smashed our waiting targets, and we were all able to see more patients.

I got the bug and I went around basically any other service you can think of in health and care, and stripped out ways so that we could see more patients. Working across health and care at system level. I started supporting other system leaders to be able to do the same in their patch.

The emergence of technology

Then technology started to emerge as an enabling driver to support us in efficiencies and being able to see more patients; and achieve better health outcomes. I thought, wow, we have a real opportunity here, particularly with the rise of digital health, because I can deploy a digital health solution to a million people all at the same time and they can all use it without being compromised.

I took a role working at an academic health science network as their Digital Health Lead. My job was to support the NHS to adopt innovations but also to support the companies to achieve traction so that they could employ more people, because wealthy populations are healthier. What happened to me was I got really frustrated again, I was back to being one person, telling one other person which solutions to use. I thought this was ridiculous. I was back to where I was seeing one patient at a time. How can I scalably tell people about products so that everybody can get the benefit of them? I got obsessed with that as a problem.

I worked across Europe and saw it was the same no matter what healthcare market I worked in. Ultimately the biggest problem was trust. People just didn’t trust these things. I thought, how do we build trust in digital health? Then how do we activate people to use the trustworthy products. That’s really what ORCHA is founded on.

ORCHA

ORCHA stands for the Organisation for the Review of Care and Health Apps. We review and rate more digital health solutions than anyone else in the world. Our mission is to get high quality products to people who need them. In order to do that you have to answer the question: which are high quality?

We review and approve, and we repeatedly do that job every time a product updates and changes. Then we put that information into digital health libraries and formularies. Doctors are used to using formularies to find a trusted drug to prescribe from. So we’re doing that, but for digital health. So digital health formularies, that doctors, nurses, therapists, pharmacists, can go to and find a high quality product and prescribe it via text message to the patient.

Because we are continuously re reviewing these products, should a future fault be found, we can do a recall. Since we started 5 years ago we’re now working with national bodies in the UK like NHS England, NHS digital, Public Health England, Royal Colleges. We also work with 70% of the NHS at a regional or local level where they have their own digital health libraries and formularies they are prescribing from.

Working Internationally

We’re also working internationally so we’re working Europe, the Middle East, Australasia, the States and Canada. India, Africa and China are places we’re really keen to work in. The problem we solve is a sector problem, how do you know what products you can trust? And how to get the trusted products to your patients in a safe way. It’s a sector problem.

You can see the real opportunity, particularly in third world countries. There are more smart phones on the planet than toilets and toothbrushes. When we were able to travel, one of the last places we went to was Marrakesh. We went up into the mountains it was amazing. It was sad as there is a lot of poverty there, but everyone got a smart phone. They might not have a toilet or a toothbrush, but they have smart phones. And that’s the reality – we can get health to people. But the problem is, only 20% of health apps can be trusted, 80% are not fit for purpose.

The issue of Trust

It’s a trust train. What happens in a health care system is there are bodies who will suggest that these are the right solutions for you to trust. You have to trust the body that’s saying use these solutions. As a healthcare professional, I want to go to a trustworthy area before I signpost anyone or recommend anything, I’ve got to trust them.

The patient then has to trust the healthcare professional. If we can get it so that the patient can trust the body who is suggesting using these products, then that would be even faster. But the reality is that as a patient, you’re 10 times more likely to use something if your healthcare professional tells you to use it. That’s because it’s all about trust. As a healthcare professional we’re trained to ask questions. A big part of what ORCHA does is training and education, and then providing the mechanism for recommending or prescribing.

The biggest concern we have in this space is that only 20% of health apps meet the quality criteria. But everyday, 5 million people download a health app. That’s a big problem. Some of these products aren’t just not regulated, they’re out and out dangerous. There are things like when you put your finger on a screen it tells you what your blood pressure is. It’s giving you a false positive, which means its telling you you’re ok when you’re not. Which means you might go on to have a stroke, heart attack or death.

There are other products on the marketplace that apparently diagnose HIV. This happened to a young woman in India, she downloaded this app, it told her she was HIV positive – she wasn’t, it didn’t work – and she was going to kill herself. These are not unfounded trust issues. The biggest opportunity we have is at least we can help people know which products are good, we can cut out the missed opportunity when someone downloads a solution.

How does an app developer approach you, what steps do they need to take?

We have national contracts to review and approve digital health solutions for bodies like NHS England or MacMillan Cancer Charity, or the public health body for mental health in the Netherlands to ministries of health in the Middle East. They come to us and say we have these apps, we want you to test them for us. That’s one way. We have other bodies like accelerator hubs, investors come to us, big pharma want to know which are best in class. They come to us and ask us to do that due diligence. Developers themselves come to us to show they have gone through a review, so they might come to us to go through this process.

Finally, we might pull that product ourselves. How we choose which product to next pull is a combination of our clients. So, professionals who are wanting to prescribe these things. They will tell us about an app that they want reviewing. Every week we have a global curation, which is bringing data in about the world of digital health, putting the products into clinical categories and subcategories. Then putting them into rank order from highest downloaded backwards. That then gives us a queuing system. Then we pick the next highest downloaded product in the next condition area. On the premise, that if people are using these things, we need to know if they are safe. We have about 350 slots a month. Over time, us pulling products has been less and less and the slots of people asking has increased.

We cover all the different clinical conditions, to all the product types. In digital health, you have products that are low risk, like a digital book. Or to the other end, you might have something that’s based on a clinical algorithm that tells you how much of a drug to give yourself. Or that pushes and pulls data into a clinical data set. The way we asses and review depends on the risk of the product we are looking at.

Growth of digital health app

Everyday we see about 30 new products enter the marketplace. We have seen an increase of 25% of downloads of digital health apps. The marketplace is growing. Across our platforms, we have seen a 6500% increase in healthcare professional recommending apps to their patients.

We are seeing more digital health solutions that are therapeutic interventions, as apposed to fitness trackers etc. Tools that can really help people living with a condition. Long term conditions like managing diabetes, COPD, asthma, diagnostic tools, products that can tell you what your ECG is to whether you have got skin cancer. If you can think of a condition, there is an app out there. The question isn’t is there an app, its is there a good app.

When you get on the app store you have to go through some data assurance tests, but there are not tests from a clinical perspective. What we have seen, is a huge increase in downloads of mental health apps. If you’re vulnerable and you download a health app that’s telling you to do something that isn’t quite right and you do it and it has a negative consequence, the impact of that is really significant.

What has been the most exciting development at ORCHA over the last 2 years?

The most exciting thing is that we’re now at able to work across an eco system at a global scale. And share our experiences and learning. As I say, this is not just a problem for the NHS and the UK, it’s a global problem.

Our aspiration is to be able to share that learning further and wider to countries that maybe aren’t quite where we are, who aren’t quite as privileged as we are, and they can leverage the work that the other healthcare systems have done. The other thing that has been most exciting is the adoption side.

COVID has been around us, but its absolutely shone a light to say we need digital health. We can’t deliver care in a face-to-face environment like we used to, but also we cant do nothing; we have to provide people with care in a different way. Everyone has smart phones so why not use that as a platform to be able to support people with their health.

What do you see as the future for digital healthcare?

The adoption has been amazing. The reality is what we have seen is the digitisation of the current process. So instead of seeing someone face to face, we now see them through a video platform. That’s really great, but its only the first step on the journey. Normally if you came into see me and said you were worried about heart palpitations, I would send you to have an ECG, which can’t happen at the moment, but you could use an app like Fibracheck on your phone. It uses the camera and the lights to be able to monitor the heart palpitations, then you can just show and share your results. That’s the next step for me, we need to move towards using digital to replace chunks of the pathway, particularly around diagnostics.

There are just so many amazing tools that people don’t know about. My hope for the future is that we’re not just digitising a process from an admin point of view, that we’re actually able to replace chunks. We’re never not going to need face to face. There are always going to be people who don’t want to receive digital interventions, which is fine.

This isn’t about one size fits all. Its for those people who want to, and are able to, they can have access to that healthcare right now. For those people who can’t or don’t want to, they can have a face to face appointment. What we’ll see is a freeing up of capacity, so actually what happens is we all get what we want.

What do you think would encourage more women into the digital health industry?

At GCSE level, we see more girls wanting to get into healthcare careers and more boys wanting to get into digital. We just need to raise the awareness that you can work in digital and health at the same time.

People don’t know that there is this huge explosion of workforce that’s needed in digital health. There is an education part for our students, but also for our teachers and our curriculum based support unit. We struggle to find people, there are a lot of jobs out there. We’re going from 50 to 180 people this year. There is loads of work in this area but people don’t know there is the opportunity.

I think awareness and engaging raising is important. Sharing stories like mine, I was a healthcare professional and now I’m the chief exec of a digital health company. Engaging with people who have been on that journey and learning more about the different kinds of careers available is really important. It’s the same as everything, you have got to see people like you to know you can do it.