Kaiser Permanente’s Reimagining Health Promotion & Behavior Change with Patients
April 26, 2021 
As one of the largest metabolic and bariatric surgery centers in the world, Kaiser Permanente Southern California sought to reimagine how it prepared and supported its patients every step of their journey. Kelly Dumke, DrPH, Senior Learning Consultant from Kaiser Permanente’s Center for Healthy Living presented their Human Centered Design process insights at MadPow’s Health Experience Design Conference HxD 2021 within the Person- Centered Care Experiences track.Ochsner Health System’s O Bar & Digital Medicine Program Success & Expansion
October 27, 2020 
Ochsner Mobile O BarOver five years ago, Ochsner Health launched their O Bar (Apple genius-like concept) to support patients getting started with digital health tools. Today, Ochsner has nine physical O Bars located in the bottom floor of their health centers and one mobile O Bar.
Although any Ochsner patient can visit the O Bar to begin using a curated set of digital health apps and devices, patients who are invited to join a digital medicine program can go to the O Bar to get set up with selected digital tools to manage and monitor their health journey. Digital medicine program participants have the option to have their digital tools sent via the mail, without going to the O Bar and can call their program tech support for any assistance. Pre-Covid, about 5-10% of patients chose to receive their digital health tools by mail. During the pandemic, it is mostly all mail.
Ochsner Hypertension Digital Medicine ProgramTo date, Ochsner Health is offering digital management initiatives for hypertension, diabetes, pregnancy and the latest COPD program. Patients do not need to have access to WIFI to participate, just a smartphone or tablet. Less than 5% of patients participating in the digital medicine program use the tablet and instead have their apps downloaded to their smart phone.
“Our digital medicine programs are realizing 2-3x better outcomes rates than the standard of care”, explains Dr. Richard Milani, Chief clinical transformation officer and innovationOchsner Medical Director, Ochsner Health. “In order to understand how these programs were designed, it is important to take a step back and think about how we need to help patients manage their chronic condition(s). First, we need more frequent data to know at any point in time if their chronic disease is under control. Second we must make sure individuals are prescribed guideline-directed pharmacotherapy. With the number of new medications coming onto the market and medical research about the profile of patients experiencing the best outcomes, we must be sure patients are having the best chance to achieve an optimal outcome. Finally, we need engage our patients on the “right behaviors” (e.g. nutrition, fitness, stress reduction).”
"We set up our digital medicine programs to be supported by a dedicated team who interacts with and manages the patient’s condition(s)”, shares Dr. Milani. “Their doctor invites the patient to join the program, but it is a digital medicine team who responds to the incoming data and alerts from the digital health tools.” Ochsner’s digital medicine team consists of a pharmacist/APP to help the patient with the “right guideline-directed medicine” and a health coach to provide guidance on lifestyle decisions using behavioral health science techniques. Patients that are on two of Ochsner’s digital medicine programs engage with the same pharmacist/APP and health coach, creating a holistic approach to patient care.
Patients access all of digital health tools in the digital medicine program area with their patient portal. A patient logs in to access patient education information (videos), communicate with her team by scheduling a phone call or sending asynchronous messages and view monthly reports which shows how she is doing, and progress made over time. The patient can also contact the digital medicine team for technical support for their digital tools, which is rare because these connected devices are easy to use for even less tech savvy patients.
Ochsner Connected Mom Pregnancy Digital Medicine ProgramIn addition to appropriate connected devices given to patients to capture and transmit key measures (e.g. diabetes/wireless glucometer, hypertension/ wireless blood pressure cuff, COPD/wireless inhaler and pregnancy/ wireless blood pressure cuff & wireless scale), patients receive texts to capture changes in condition (e.g. COPD severity level), track self- efficacy measures or to be notified of a health concern (e.g. warning about the poor air quality level). Patients have the option of connecting in and sending more information such as weight measures from their own digital scale or steps from their fitness tracker to share with the digital medicine team.
Program Success Measures & Expansion Plans
Ochsner has enrolled more than 15,000 patients across their digital medicine programs.
Over the past 5 years, Ochsner has received positive feedback from their digital management team (e.g. Pharmacist, Health Coach) and from patients in the program.
“The role of a clinical pharmacist isn’t always to add more medicine. We work with each person to incorporate lifestyle changes and medications that are right for them. This includes stopping or decreasing medicine doses when lifestyle changes lead to improved health.” -- Carrie, Clinical Pharmacist
“I work with individuals to make small, achievable goals that will not only improve their health, but ultimately improve the way they feel mentally and physically. This allows the patient to feel confident in themselves to make healthier choices in any situation.” – Christina, Professional Health Coach
“I like that it is private. I don’t have to take a blood pressure reading at a Walgreens or CVS. It’s encouraging to know that the lifestyle choices I’m making as well as my compliance to my drug regiment is having a positive effect.” – Alan, Digital Medicine Hypertension Program
“For anyone who has doubts about joining the program, I would say step out and take the journey.” – Lance, Digital Medicine Diabetes Program
“You get a lot out of Ochsner Digital Medicine. You get a family who is by your side every step of the way.” - Gaylan, Digital Medicine Hypertension Program
In addition to patient and staff feedback, Ochsner uses a set of quantitative measures to evaluate success. Dr. Milani is proud to share the Net Promoter Score of patients in the digital medicine program of 87.5, which indicates a high level of recommending the program to others.
Dr. Milani explains, “the key success measure is the reengineering of chronic disease care into a new model of care delivery. Our metrics of success are control measures for the disease (i.e. better blood pressure control, better diabetes control, etc.).”
Ochsner has plans to grow their digital medicine programs in 2021. “We are expanding the population we currently serve and will be adding more disease categories (like lipid management and others). We look at the prevalence of disease burden and the opportunities for better control when deciding on new digital medicine programs,” Dr Milani concludes.
chronic care management, educating consumers about health and wellness, health coaching, mobile health application, patient generated health data in Connected Health, Data Driven Health Engagement, Mobile Health, Patient Decision Support, Patient Engagement, Patient Experience, Patient Journey, TeleHealth, TeleMedicine, digital health, patient health education Providence Health’s Bot Grace engages and guides patients to the digital front door for care
February 25, 2020 
According to the 2019 Accenture Digital Health Consumer Survey, patient’s expectations are increasing for providers to offer digital capabilities. Patients value convenience (appointment times, location) and are increasingly considering “non-traditional” service channels such as retail clinics and virtual care.
Providence Health’s Innovation team continuously monitors these trends to identify ways to deliver a better patient care experience. “With the tremendous growth of chatbots and voice assistants, we decided to develop a virtual health assistant and begin to understand how to support the patients in their search for care”, explains Maryam Gholami, Chief Product Officer at Digital Innovations, Providence Health.
In fall 2018, Washington State based Providence St Joseph started developing and testing Grace, a chatbot which asks the patient about their symptoms and based on their location, time of the day and scope of services provided in various care options (virtual, clinics, or At Home) directs them to the best care. Eventually Grace was enhanced to also address frequently asked questions by patients.
Since the healthcare system is complex for consumers to navigate, Providence Health designed their digital tool to provide answers and guidance to help the patient find the right care and make the best care decisions. For example, a consumer may not know which modality of care to use (e.g. Emergency Room. Urgent Care, Retail Clinic, Virtual/Telehealth) or what symptoms trigger an immediate visit.
On the consumer side, Providence Health wants to stay aligned with their patient’s increasing expectations for service on demand. Consumers are already using digital assistants for shopping, banking and travel 24x7.
“From a business perspective, we want to provide accessible, convenient and affordable care. Therefore, we need to improve operational efficiency, free-up professional caregiver capacity for the right care and tasks, while increasing the care options and quality for consumers. We want to have our virtual health assistant take on the administrative tasks so that our clinical staff can focus on patient care. For example, Grace conducts a virtual patient intake to schedule a visit, collecting information such as reason for the visit, demographics, insurance and payment details”, explains Maryam. “This digital health assistant also assesses the best modality of care based on patient’s input and availability of care, matching the right resource to meet each patient’s needs. With this type of service navigation, Providence Health can ensure that the required license level is designated for the visit, reducing care cost and ensuring availability of providers for the appropriate level of care. Healthcare is supply-constrained, so this is a very important value.”
Patient Experience with Grace Bot
Providence Health has worked closely with the patients to design the Grace bot. Here is a look into the patient experience.
Patient Patricia who lives in Washington State, types her symptoms into Google to figure out what she has and where she can get care. Within her search results, Patricia sees a Providence Health website link and then meets Grace, a pop- up text chatbot ready to help her.
The Grace bot helps Patricia in two important ways:
1. Care Navigation: Given that Patricia needs “same day care” and has a low acuity health problem, she types into the Grace bot that she has a fever and sees that Grace has recommended a virtual visit or a same day clinic appointment. Patricia provides her zip code, chooses the clinic near her house and schedules an appointment for 7 PM that evening.
2. Customer Service/Concierge: Patricia has questions about whether her insurance is accepted and types in “what insurance do you take?” Grace provides a list of insurance options. Patricia can also ask for information to read about her health problem before her visit.
Patient Experience with Grace Bot
The Grace bot was designed for patients by patients. Throughout the development process, the product team at Providence Health worked closely with patients to understand the “tasks they were trying to complete” and defined how Grace needed to guide them through these steps. During testing, the team monitored where patients dropped off and tuned the messages to “optimize” their care journey.
“We are digging into the questions that our customers ask so that we can improve our knowledge base. This enables Grace to better respond to our patient questions”, Maryam explains.
With ongoing patient feedback, Providence Health has identified and has been addressing several areas to improve the patient experience.
Chatbot Persona: Maryam shares that “we used emojis to make the digital interaction more casual and friendly. Our patients did not like the emojis because they felt emojis do not convey trust which is essential when communicating health information. Patients also needed to feel comfortable that the responses and recommendations were not coming from a human. We are working on the right persona for Grace and defining the best interaction”.
Chatbot Behavior: Providence Health’s product team is determining when Grace needs to confirm information with the patient so that it accurately reflects her needs. There is a fine line between repeating back to be sure and being annoying to the patient who is looking to quickly complete her task (e.g. set up a visit). However, there is a risk of sending the patient to a modality that does not meet her needs (i.e. she needs to see a doctor and not an RN). “We need to understand the clinical operations from end to end so that we can define the business rules to successfully guide the patient interaction”, Maryam comments.
Consumer Adoption: Some patients are pleasantly surprised about what the Grace chatbot can do for them. Others may not understand what to ask her. Health organizations will need to educate consumers on the types of questions to ask so that patients can gain the most value when engaging with the bot.
Provider Adoption: Providence Health is working on enabling the Grace bot to support virtual care. Grace can engage with the patient to capture information prior to the telehealth visit. However, we need to ensure that this is designed and implemented in such a way that clinicians can properly review all of the information captured before the visit begins and that we are not increasing provider burn-out. It needs to improve the experience for both patients and providers.
Patient Representative Experience: When the Grace bot “hands off” the patient for the scheduled visit or for further follow up, it is important that the representative knows that patient just engaged with the Grace chatbot, has the context and the information already collected and can address the patient accordingly.
Chatbot Success Evaluation
Maryam shares some key success measures for the Grace bot. “We currently know that over 42% of our patients who engage with Grace get answers to their questions or get help navigating to the right modality of care. 18% of these engagements result in completion of appointments booked with one of our ExpressCare Clinics (Urgent Care). We are also learning which questions Grace doesn’t know how to answer or which tasks she can’t currently complete. This learning is very important to help us with our future product direction and iterations”.
Patients interacting with Grace can navigate to Providence Health’s ExpressCare options based on a chief complaint or use a symptom checker before choosing recommended ExpressCare options. Providence Health is seeing a 90% accuracy rate for patients that have been directed to ExpressCare from the patient’s chief complaint.
According to Maryam, there are weekly meetings with the product analytics team to understand how patients are using Grace so that they can enhance the patient experience. “We measure every interaction in the funnel to understand if we’ve helped users complete their tasks. Some of these measure include # of click rates, # of patients questions answered, # of appointments booked, # of visits completed along with type of visits, and chatbot engagement when the customer support center is closed”, describes Maryam.
At the end of each interaction, Grace asks the patient if he is satisfied with the task – “Was I able to address your needs today”? According to Maryam, about 40% indicate that the Grace bot met their needs. Providence Health is closely listening to patient feedback to increase the satisfaction percentage.
Providence Health has received insightful patient feedback about the Grace bot experience:
“This was the first time I’ve seen something like that, I thought it was extremely helpful. It asked a lot of good questions to get me the right help.”
“I felt like it was really easy to get an appointment. Very quick automated responses got me to the right place.”
“I thought it was excellent. I research a lot of my own health issues, so I’m excited about this. Anything that can help me learn about my symptoms and what to do about them, I’m excited for it.”
“For me, it was kind of cold. If it could change the wording to make it more human it would be better. I’d prefer a more human touch to it. I think in this field personality is important, so work on making it more warm, caring, and friendly.”
Future Plans with Grace:
Providence Health is committed to enhance the Grace virtual health assistant experience for patients by:
Expanding the patient journey: Currently, Grace is available more in the discovery phase, when patients are searching for care options. “Next, we are incorporating Grace into the Virtual waiting room to gather intake information before the patient participates in the telehealth visit. Our goal is to have Grace available when/where appropriate to help consumers navigation through health journey”, Maryam adds. “We are looking to move beyond low acuity to helping patients find and book PCP and Specialty appointments”.
Increasing the personalization: While Grace currently does some personalization based on consumer’s location, time and symptoms. Providence Health believes there is still a great deal of opportunity to leverage various sources of data including patient records. They will proceed carefully given the consumers’ data security and privacy needs.
Improving the High Tech & High Touch Collaboration: “We view our virtual assistant as an augmentation tool for our professional caregivers. We are working on creating a warm hand off to human caregivers with the conversation context. We are designing these tools so that based on consumer’s choice, human caregivers can step in to assist our patients”, explains Maryam.
Providence Health’s clinical and business leaders believe that offering these virtual health assistants are essential to delivering the best care experience for the patient, today and in the future.
“We are levering technology to connect the consumers to the right place for care with the right service and providers at the right time. AI is going to help us to improve the seamless experience.” Thanh Nguyen, Executive Director and Chief Clinical Officer of Express Care
“AI-powered virtual assistants will have a significant impact on healthcare by engaging consumers through voice/chat, a more natural way of interaction, and by intelligently automating mundane tasks and simplifying complex ones at scale.” Aaron Martin, EVP, Chief Digital Officer
chatbot, consumer generated health and wellness content, educating consumers about health and wellness in AI, Care access, Care collaboration, Connected Health, Data Driven Health Engagement, Decision support, Mobile Health, Patient Decision Support, Patient Engagement, Patient Experience, Patient Journey, TeleHealth, Virtual Health Assistant, digital health, patient health education Banner Health brings AI driven virtual assistants for better patient experience
February 5, 2020 
Buoy Health AI triage botTrue to their mission “Making health care easier, so life can be better”, Banner Health has invested in digital health technologies to support their patient experience.
Banner Health, a large regional health care system headquartered in Phoenix, manages 28 acute hospitals across 6 western states, with 5,000+ Banner Health doctors and specialists and over 50 urgent care centers.
Given trends towards consumerism and digital health usage, Banner understands that many patients begin their care journey with internet searches, at a time when these patients feel sick and most vulnerable. Sorting through search responses, patients have the burden of finding trusted health information, interpreting what they need and figuring out where to go to address their latest health issue. Unfortunately the default care setting for patients in the United States is the emergency room, which results in $32 billion in annual avoidable ED visits.
Banner Health Triage Bot
When Banner’s Digital Business group looked for potential solutions, they wanted to understand the patient’s journey and explore digital solutions to complement their high touch hospital experience.
“Through research, we learned that our patients often do not know what is causing their symptoms or what to do about it. They do not know whether to go see their primary care doctor, visit an urgent care facility or go directly to the hospital ER”, explains Dr. Jeff Johnson, Banner Health’s Vice President of Innovation and Digital Business.
With their commitment to delivering both a superior patient experience and reduce unnecessary spending, Banner has tested the idea of empowering customers with a digital tool containing clinical content to engage and triage them to the right care setting.
During the fall of 2019, Banner Health evaluated different digital triage tools and selected Buoy Health’s AI assisted chat bot after both an internal clinical leadership evaluation and patient testing for value and desirability.
As part of their solution evaluation, Banner recruited patients who had gone to a doctor, ER or Urgent Care in the last 30 days and asked them to think about the symptoms that had driven their visit while testing several digital triaging tools.
“Our patients commented that the Buoy bot was ‘easy to use’ and they liked not having to log in to use it. Patients felt the bot interaction was also ‘easy to understand’ and was ‘credible’. These patients did not ‘second guess’ the information that they received in the bot exchange”, shares Johnson.
While preparing for the launch, Banner worked closely with their clinical team, informing them about the triage tool and how it works. If the patient mentions using the bot, Banner wanted clinicians to be aware of the digital tool, acknowledge that the patient had invested time into learning about her condition before arriving and recognize that it is part of the Banner patient experience.
In early January, Banner soft launched the Buoy Health bot across all 28-hospitals with a “Get Care Now” link on their website, giving customers the option of interacting with this tool or calling their Nurse on Call.
After clicking on the “Get Health Now” button, patients are asked questions about their profile (e.g. gender, age) and specific symptoms (e.g. which ones, how long, better/same/worse than before). Banner likes that the bot gets smarter with each patient interaction. Since the Buoy digital tool is available to consumers on the internet and patients across different health care systems, this bot has over 3 million interactions per month.
To evaluate this digital tool, Banner gathers feedback from patients about their bot interaction. Specifically the “Buoy bot askes the patient at the end of an exchange to rate the experience and share what she plans to do next (e.g. wait and see, doctor, urgent care, ER). So far we have received excellent star ratings for the tool, 4.7 out of 5”, adds Johnson.
“Working closely with Buoy, we have learned about the patient’s expectations for their experience with this type of digital tool. The bot exchange cannot be too short so that the patient doesn’t trust the responses. And the text exchange cannot be too long so that the patient feels the tool doesn’t know what it is doing”, Johnson comments.
Banner’s Digital Business team is looking closely at bot tool usage and feedback to guide further development. The bot reporting will give them insight into which care setting patients were directed, what questions they asked and which symptoms and conditions were discussed in the exchange with the patient.
In the first 3 weeks after launch, the Buoy triage bot has had 1,200+ users. Moving beyond the soft launch, Banner plans to incorporate the triage bot in their mobile app and to promote it as an option when patients call the Ask the Nurse line. Banner is discussing developing a Triage Summary Report which captures the information that the patient has already provided to share with her doctor. Banner is also looking to expand care settings to include directing the patient to a virtual visit in the right situation.
Banner Health Emergency Department (ED) Bot
Lifelink ED chabot
Like many of the ER experiences across the country, Banner Health patients want more information and communication about what is happening and what will be happening next to adjust their expectations.
The Banner Health team brainstormed about how to help patients get the information that they need throughout their visit without having to trying to find their doctor, walk up to the nurses station or wait for the nurse to come to their room.
Johnson shares that “we found an interesting chatbot solution from a start- up, Lifelink. We started slowly by having patients use the bot on their smart phones while in the ED and we manually responded to their questions. This gave us tremendous insight into what patients wanted to know and when. Based on this insight, we designed the chatbot (available both in English and Spanish) to give the patient a status from the time her labs (or images) are ordered to the time they are ready and then reviewed by her doctor. We needed to set expectations that the lab will take 45 mins before it is done. In order to enable these real time updates on labs and images, we integrated the LifeLink bot into our EMR. We promote that the patient signs up to our patient portal to access all of the notes, labs and images from her ED visit”.
Since the ED bot was rolled out across all 28 Banner Hospitals, there are over 100,000 patient users, one million plus conversations with an average of 5-10 conversations with the bot per person.
“We have seen our patient satisfaction score for our EDs increase by up to 35%. This ED bot is such a satisfier”, Johnson explains. “Here are some patient comments about the value of using our ED bot”:
“It was nice to be given updates instead of just sitting in a chair and waiting for someone to get to me.”
“It gave me updates on my progress without bothering the nurses.”
“Very informative, relieved my husband’s worries by 90%”
In the near future, Banner Health is planning to “connect the dots” and engage the patient from the moment of interest and throughout their care journey. “We are looking to begin at the first part of the journey when the patient goes online to let us know that they are coming to the ED. Our ED bot will let the patient know that ‘we will be waiting for her’, provide map, picture of the entrance and parking directions. We also want to have the ED bot support the patient post discharge, reminding her to fill her medication, the date of her follow up visit, signs of what to look for and where to go if there is a relapse”, Johnson explains.
Later in this year, Banner Health is planning to extend the bot to inpatient care, with the goals of helping the patient get the highest outcomes and reducing their length of stay. This inpatient bot project is part of a bigger ‘patient flow’ initiative. Banner wants to get patient’s engaged at the beginning of their stay for a successful discharge. The bot will give guidance and recommendations so that the patient improves her eating, walking and bowel movement activities. Banner is also exploring ways to engage the family/care network to ensure an optimal recovery.
chatbot, mobile health and wellness texting, online health and wellness support, research on consumer health in AI, AI consumer engagement, Decision support, Mobile Health, Patient Engagement, Patient Experience, Patient Journey, Personalization eHealth, digital health, patient health education Boston Children’s, Brigham and Women’s & Northwell Health leverage virtual assistants for a better patient care experience
September 27, 2019 
During the World Congress Patient Experience & Engagement Summit in Boston, I led a panel with these innovative health systems, discussing how they are using virtual health assistants (e.g. AI Chatbots, Voice) to increase efficiency in care delivery and enhance the patient experience.
Virtual Assistants in Healthcare
Consumers are demanding convenience and want to interact with companies any time anywhere. Companies across different industries such as retail, travel and financial services are responding with virtual assistant tools, enabling consumers to get answers and transact 24x7.
Within healthcare, innovation driven organizations are exploring how to empower patients with virtual health agents to access relevant care information (e.g. learn about how to prepare for a procedure, determine when to call the doctor following surgery), get tasks done (e.g. schedule and participate in a virtual visit) and get guidance on a care plan (e.g. reminders to refill medication, follow up doctor’s appointments).
The strong interest in AI driven virtual health assistants aligns with Accenture’s Digital Health Tech Vision 2019 trend #5 “MYMARKETS: Meeting customer’s needs at the speed of now”. The Accenture report explains “digital expectations have now evolved and a new opportunity to deliver better experiences is on the table: capturing moments. Technology has created a world of intensely customized and on-demand experiences, so healthcare organizations must reinvent themselves to find and capture those opportunities as they come”.
Value of Virtual Health Assistants
When you think about the gaps in healthcare efficiency today, you can envision how virtual health assistants can support patients and the care team.
There are many valuable use cases for Virtual Health Assistants to help patients prepare and manage their care, with reminders, education (e.g. health condition, procedure) and the capability to escalate to a care provider as needed.
On the clinical side, the care team can capture, monitor and communicate with patients. Instead of making outbound calls trying to reach patients, staff can see which patients are in pain, have questions/concerns or are in need of immediate care.
Panelist Virtual Health Assistant Use Cases
When presenting their use cases for Virtual Health Assistants, panelists shared their specific business goals such as decreasing readmissions/ED visits and costs, increasing service utilization, improving care plan compliance and enhancing the patient experience. All panelists view these virtual health assistants as an “extension” of their care delivery.
Boston Children’s Hospital (BCH): In 2018, BCH teamed up with Seattle Children’s on an Alexa skill, Flu Doctor, providing parents with answers to questions about the flu which are “personalized, science-backed data and recommendations”. Panelist Devin Nadar, Senior Partnerships Manager, Innovation and Digital Health Accelerator discussed a more recent Alexa skill -“My Children’s Enhanced Recovery After Surgery (ERAS)”, which is part of the program for all cardiac patients undergoing specific surgeries at BCH. Built on the Amazon platform, this skill to desgned to capture information from the parent about how the child is doing after the surgery and indicate if there is a follow up appointment scheduled. “We know that parents really don’t want to come back to the hospital after surgery”, Devin adds. After accessing “My Childrens” through the Amazon Alexa Store, the parent begins to “check in” the day after the patient is discharged and receives pertinent information for that day.” Before this tool, it was “like a black box” about what happens while the patient is recovering. Now BCH can focus clinical resources on patients with priority needs.
Dana-Farber/Brigham and Women's Cancer: “Earlier this year we developed and are planning to launch an Orbita powered health assistant to support prostate cancer patients who are on a “lifelong journey” with ongoing PSA testing” shares Rich Boyajian, NP Program Director, Virtual PSA Monitoring, Radiation Oncology. This chatbot will send a link to the patient to engage via text and/or voice on their phone. It is designed to “onboard” him into the program, present the closest lab, deliver good PSA test results and enable him to request contact with a care team member. “Patients can select the modality for this follow up contact by email, a call or even a virtual visit”, explains Rich. “It was easy for me to write the virtual health assistant script (i.e. questions and answers) to engage with the patient since I do this all the time. We selected the Orbita platform because we can put this content in one time and it be accessed by the patient through their preferred modality”.
Northwell Health: In 2018, Northwell launched Health Chats, an AI text chatbot powered by Conversa Health, which empowers patients to stay connected to their care navigator through recovery. This gives the staff visibility into what is really happening when the patient leaves the hospital. “We selected Conversa Health because it is easy for the patient who doesn’t need to download an app. Instead the patient receives a chat notification through an email or SMS text message and simply clicks on the link to start the chat through their mobile phone”, explains Hallie Bleau, ACNP-BC, AVP Transitional Care Management, Health Solutions. The Health Chat engages the patient post discharge to “self -assess and manage symptoms”. Since Northwell Health integrated the Health Chat into their care management system, the information that the patient types in (problems, pain level) is feed into an algorithm to flag the patient on the nurse’s dashboard for an immediate contact. The patient can connect with a nurse through the Health Chat application at any time.
Panelist Insights on Virtual Health Assistants
Many lessons learned were shared by the panelists including considerations for both patient and staff engagement. One common theme was that the planning for these Virtual Health Assistants takes time. “We needed 6-8 months to get staff buy- in and patient consent”, admits Hallie.
Patient Considerations:
Determine fit with the patient’s current technology. “With our 65+ Medicare population at Northwell Health, we realized that one big barrier was some patients still have a flip phone which will not work with our chatbot”, Hallie explains.
Understand patient expectations. “In our Alexa skill, we ask if the caregiver would like the doctor/nurse to call. We know there are differences in how long the call back will take so we need to set the proper expectations for when they can expect a return call ”, shares Devin.
All panelists expressed an interest in learning from patients about their experiences. “We built into the Alexa skill ‘did that answer your question’ so that we can capture their feedback and make changes to our script”, Devin explains.
Patients have shared insightful comments about their virtual health assistant interactions. “Our patients at Northwell Health feel that someone is always thinking about them. In a 30 day period, we are able to increase the number of touches by 5-6 contacts”. Hallie went on to say “we thought that caregivers would be more interested in seeing these digital conversations with mom. We learned some didn’t because ‘she doesn’t live with me’. Several seniors do not want to ‘bother their daughter with this information’. We have also learned that patients who are hard of hearing really like to use the chatbot because it is easier to communicate with the care team”.
Staff Considerations:
During the planning stages, panelists feel it is important to educate their staff. They need to feel comfortable with this new digital interaction, understand how to describe it to patients and have a clear picture how this will impact their workflow. Specific considerations include:
Extensive staff education. “We were surprised at the amount of time/education required with our staff. They needed to understand why and what does it mean for them”, admits Hallie.
Devin adds “we train with our staff, demonstrate the app and provide a cheat sheet for reference, which tells about them about our Alexa skill, how to open it, start it, stop it, what you can ask and what it is used for”.
Stage the implementation. “We have limited the roll out of the voice app to 5-10 per week because we did not want to overwhelm our staff at BCH”, explains Devin.
Success Measures & Future Virtual Health Assistants
Later in the year, panelists will be evaluating their program from an experience (patient, staff), operational efficiency and clinical perspective.
“At BCH, we want to see if parents are completing the questions and determining where they drop off so that we can build a better experience”, describes Devin.
“Our virtual health assistant is replacing the manual labor from looking up the nearest lab to calling cancer patients about positive test results”, shares Rich. “As an extension of our care, we expect to decrease the number of follow up in person visits which will free us up to care for more patients”.
“Our staff is seeing the fruits of labor… ‘we don’t have to call him’, ‘we can quickly get to the root of the problem”, adds Hallie.
Panelists expressed the need in the future to capture and place pertinent information from the digital health interaction into the patient’s electronic medical record.
Future Plans:
Refine conversation based on role. “At Northwell Health, we are talking about tweaking the conversation for the caregiver”, explains Hallie.
Expand languages. “We currently offer our chatbot in English and Spanish but will add other languages”, Hallie shares.
Add new capabilities. “We plan to add more symptoms to our health assistant to provide more information for our PSA monitoring”, explains Rich.
Extend the Experience. “We are working on expanding the digital conversation from 30 to 90 days so that we have more insight into their receovery”, mentions Hallie.
Connect into Virtual Care. “At BCH, we are thinking about triggering a virtual visit when the parent indicates that she needs to speak with someone”, shares Devin.
Northwell Health is planning to continuously launch Health Chats across their organization given their strategic investment in ConversaHealth. “We have already launched Health Chats to patients with head and neck cancer and are getting ready to roll out them out in our cardiac surgery department” Hallie concludes.