Soon many Marin residents might consult a computer program via their smartphone before deciding whether a trip to a doctor’s office or hospital emergency room is necessary.

Babylon, a London-based digital health company, has acquired Meritage Medical Network through its affiliated California medical corporation. The purchase price for the acquisition, which closed in late April, was not disclosed.

Meritage, originally known as Marin IPA, was formed in 1981 to organize the physicians of Marin County into an individual practice association so they could collectively contract with health maintenance organizations.

Some 250 to 300 physicians, nearly all of the doctors in Marin not employed by Kaiser Permanente, are Meritage members. The HMOs pay Meritage a flat fee for each of their enrolled patients regardless of the amount of care they receive. Meritage oversees the care of 20,000 Medicare Advantage and commercial HMO patients.

Babylon has developed a digital healthcare application, Babylon 360, that allows patients to communicate their symptoms to a chatbot via their smartphones and get recommendations on what steps to take next.

Wojtek Nowak, the chief executive of Meritage, said he expects its doctors will begin offering the app to their patients within the next 12 months.

The app uses artificial intelligence “to empower people with knowledge of their health, with the goal of relieving pressure on clinicians. It mimics the way a doctor operates, performing some of the cognitive tasks they carry out,” according to Babylon’s website.

“Answer a few questions about your symptoms,” the website says, “and our AI-powered Symptom Checker will direct you to potential causes and recommended next steps. It can also connect you with a doctor, if you choose to go that route.”

Dr. Marcus Zachary,  a U.S. executive for Babylon, said many trips to the doctor are unnecessary. He uses the example of someone who twists an ankle.

“Answering a couple of questions, the AI computer neuronet can figure out that you’ve got some kind of ankle sprain,” Zachary said. “You don’t need to come in and be seen.”

“There is enough computing power out there in AI models that can safely delineate what is a low-risk condition,” Zachary said, “and then can feed back to the patients ways they can manage the condition by themselves. You interact with it the same way you would with Siri or Alexa.”

The technology has had its critics. In 2018, Forbes reported that some of Babylon’s in-house physicians raised issues about the accuracy of the advice dispensed by the triage chatbot, which was being prepared for use by the United Kingdom’s National Health Service.

The doctors conducted their own audit and found that approximately 10{a7758c3706987b952e6c06b8e84de22b0478c6ec9e4b4c13f69a9ea693861278} to 15{a7758c3706987b952e6c06b8e84de22b0478c6ec9e4b4c13f69a9ea693861278} of the chatbot’s 100 most frequently suggested outcomes “either missed warning signs of a more serious condition like cancer or sepsis or were just flat-out wrong,” Forbes reported.

Dr. David Watkins, a consultant oncologist in the U.K., has been criticizing Babylon’s triage chatbot since 2017. British regulators were looking into some of the concerns raised by Watkins, according to a March article by TechCrunch.

“They made misleading claims with regards to how [the chatbot] should be used — its intended use — with [Babylon CEO] Ali Parsa promoting it as a ‘diagnostic’ system — which was never the case. The chatbot was never approved for ‘diagnosis,’” Watkins said in the article.

Watkins initially made his criticisms anonymously via Twitter. After he revealed his identity by appearing on a BBC news program last year, Babylon issued a statement that characterized Watkins as an internet troll.

“As the data shows, this anonymous user has spent hundreds of hours trying to trick our AI,” Babylon said. “All credit to him for the effort. He ran thousands of tests, but was proved right in just 0.8{a7758c3706987b952e6c06b8e84de22b0478c6ec9e4b4c13f69a9ea693861278} of cases.”

Nowak said, ”Certainly the earlier version may not have been perfect. The app has since been significantly enhanced.”

“I’m looking at the positive side of it,” Nowak said. “Improving access. Giving a tool to a patient that can be accessed 24/7. To me this is complementary.”

Zachary said, “The app has definitely continued to be refined and improved. The more data sets we get, the more the models can be validated. They grow stronger over time.”

Jennifer Rienks, who heads the Marin Healthcare District board, said, “I’m not really sure if the research basis is there to do this on a large scale. I would like to see a lot of research regarding (AI’s) efficacy and would be concerned if people were in any way misdirected not to go to the emergency room.”

Demand for Babylon’s telehealth services surged during the pandemic. The company is valued at $2 billion.

Babylon raised $550 million, with the lead investor being Saudi Arabia’s Public Investment Fund, to build a 50-state network in the United States. The company’s app-based services are being provided to health plan members in California, New York, Missouri, Nevada and Iowa.

In March, Babylon acquired Fresno-based FirstChoice Medical Group, which serves nearly 50,000 Medicare Advantage and Medi-Cal members and supports a network of 180 primary care providers and 1,000 specialty providers.

The company also has a 10-year agreement with the government of Rwanda to help digitize its health system and is providing telehealth services in Canada and Saudi Arabia.