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.  

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.

The National Cancer Institute reports 2017 U.S. cancer care expenditures were $147+ billion, with anticipated increases from our aging population. 

According to Deloitte’s report in Evidence Based Oncology ( The American Journal of Managed Care publication), many organizations are exploring ways to control costs and enhance care quality for oncology patients (e.g. Patient Centered Medical Homes, CMS’ Oncology Care Model).

With many different types of cancer and treatment options, each patient embarks on a personal care journey.

Oncology patients often experience a long journey. Although some steps entail engaging with care staff at a hospital or clinic, most of the time patients are challenged with managing their disease on a daily basis away from the health system.

Healthcare organizations need to closely monitor oncology patients to determine when care and support is required. To be proactive and stay aligned with patient needs, health systems must collect patient information (e.g. Patient Reported Outcomes/PROMs, Patient reported experiences/PREMs). This patient information can guide the care team to intervene, reducing hospitalizations and costs.  

Northwestern Medicine’s Oncology Program

“We wanted to take a holistic approach with our oncology patients; mind, body and spirit”, explains Dr. Martha L. Twaddle MD FACP FAAHPM HMDC, Medical Director - Palliative Medicine & Supportive Care, Northwestern Medicine, Lake Forest North Region. “We wanted to help our patients navigate their oncology journey, figure out their new normal and participate in their care”.

“A few years ago, we successfully used a patient engagement care tool with our palliative patients. Our palliative team is embedded within Oncology. Eighteen months ago, we introduced this telehealth type of application to our oncology patients. We felt it would be valuable to extend TapCloud to our general oncology patients because we had seen such a positive response using it for those with high symptom burden and advance disease. We believe many patients and caregivers will benefit from having this tool available to use”.

Patient Experience

How does TapCloud support the oncology patient? What is the patient experience?

Last month, Robert (not his real name), a 77 year old patient was diagnosed with prostate cancer. Dr. Twaddle and her staff worked closely with Robert through the onboarding process to provide an overview, demonstrate how to use TapCloud, help him download the TapCloud app onto his phone and iPad and discuss what symptoms they will manage to personalize the app for his specific condition.

The Nurse Coordinator explained “Robert, with this tool (TapCloud), we can think about you when you are not in front of us, get a sense of how you are doing and that we are on the same page”.  Robert was relieved to get a message from his Nurse Coordinator confirming that she can see Robert listed on the dashboard to keep a close eye on him.

Most of Dr. Twaddle’s seventy active patients using the TapCloud App are in their 60s and 70s, with a few in their 80s and 90s.

Through the TapCloud app Care Plan, patients like Robert are asked a set of questions. How are you feeling today compared with yesterday? Which of these meds are you taking? Which symptoms are you experiencing today? Symptoms that were selected the prior day are displayed bold. Patients can add symptom(s) which typically takes less than a minute to provide this critical information. 

Symptom tracking is made easy by using a word cloud. Each day, the patient sees a personalized word cloud containing symptoms.  This personalized symptom cloud incorporates his condition and medications and his list is continuously enhanced from machine learning. TapCloud’s predictive symptoms cover 100+ conditions and 14,000+ side effects.  The patient simply touches those symptoms he is noticing. Additionally, he views personalized education based on his journey stage (e.g. tips for managing chemo side effects) and what he is experiencing. He can also upload this biometric information (e.g. vitals, etc.).

How has Northwestern Medicine used the TapCloud tool to deliver better care to Oncology Patients?

Dashboard displays demo data only

• Prioritize Patient Outreach. The TapCloud platform analyzes all the patient clinical and self- reported data in real time.  Using advanced algorithms, patients with a clinical need are identified and alerts are sent to the care team. Patients are prioritized based on alerts, severity and risk. Nurses use the TapCloud Triage Dashboard to efficiently track, monitor and respond to patients requiring an intervention. Nurses can drill down on a specific patient to see how many days since check in, recent events (e.g. vitals, medication usage), pain and anxiety levels. 

• Intervene on specific symptoms: Instead of “fishing” for information about how a patient is feeling or having the patient end up in the ER, Nurse Terri can call the patient and say “I've noticed that you've had increased pain the past 2 days…”.  TapCloud can also be set up to send alerts for symptoms associated with a patient’s treatment. Patients can send a picture within the TapCloud app with a secure message about their concern.

• In the Patient’s Words: “We had one patient who didn’t feel pain but entered ‘yuk’. He selected that to communicate in his words what he was feeling. One of the features that I really like is journaling. A patient may share that today he is ‘discouraged by his illness’.  Although he does not expect us to respond, it gives us insight into how he is doing and the support that he may need from us”, shares Dr. Twaddle. 

• Stay Connected with patients who do not come in regularly: When patients are going through infusion treatment, Dr. Twaddle explained that her team sees them on a frequent basis. “However, when our patients are on oral chemo, we feel that TapCloud is especially valuable to give us a window into their experience. We risk losing them because they cannot tolerate the medications and stop without communicating to us.”

• Address Patient Needs with Right Resource: When patients are not in the Clinic or Hospital, it is important to understand what they need. “We may see in a patient’s journaling that she is feeling afraid which is not physical but may be best addressed through our psych- social resource. Or a patient may be ‘running out of her medication’ or ‘checking in on an upcoming appointment’, which can be managed by our Nurse Coordinator."

Measuring Success

Dr. Twaddle uses a set of quantitative and qualitative measures to evaluate the success for the TapCloud solution for oncology patients including:

1) Patient Engagement. How involved are patients in participating in their care?  How often did they check in with the app?  Which symptoms are most common? What are the new symptoms that have been added by the patient? 

2) Improved symptom management. Was pain successfully controlled (e.g. pain scores, pain direction)?  Were negative symptoms (e.g. fatigue, bloated, shoulder pain) managed in a timely and effective manner?

3) Cost reduction. How much money was saved by avoiding ER through interventions on symptoms? “When one of our cancer patient ends up in the ER, we explain that we may be able to help avoid the admission with a check in on the TapCloud tool. We had one patient with a side effect that we could have spotted and intervened since it was dangerous for her”.

“We have found that TapCloud is helpful both with cancer patients who have declining function (e.g. pancreatic, advanced lung, brain tumor) and with those that may be curable (e.g. head & neck, breast)", shares Dr. Twaddle.

AMITA Health’s Program will leverage TapCloud

AMITA Health, one of Illinois’s largest health systems is in the process of planning their program which will use TapCloud.

“When I first heard about TapCloud, I was on board immediately”, explains Dr. Robert O. Maganini, Breast Cancer Specialist at AMITA Health. “We have a compliance problem with our breast cancer patients. Although the hormone therapy treatment (e.g. Tamoxifen, Class Aromatase inhibitor) is for five years, some patients will stop after two years because of the side effects. Our working theory is if we have insights into where these patients struggle and when, we can do more aggressive interventions instead of waiting for their next appointment”.

“Our plan is to offer TapCloud to all 200 patients who want to use it, from newly diagnosed to those in year two when we experience a drop in treatment adherence”.  After describing his patient population – mostly women 40-75 years old, Dr. Maganini expects a high opt- in rate since it is “ideal for them because it enables faster and more convenient access to their provider”.

Like Dr. Twaddle, Dr. Maganini is planning to use a patient- centric approach when introducing TapCloud, ensuring that patients understand why they are using TapCloud, how to use it, and when to use it. 

Dr. Maganini plans to introduce TapCloud to patients at the time of diagnosis. Nurses (e.g. NPs, Navigators) will get patients set up and show them how to use the digital health application. “Since surgery is typically the first step, we plan to use as a follow up with discharge instructions. For those in going through chemo treatments, we will monitor their symptoms. We want to get our patients accustomed to using TapCloud and then they will be using it for the long run with hormone therapy”.

As part of the planning process, Dr. Maganini is working with his team to define the list of side effects including the words that these patients use to describe them. He is leveraging his own and his nursing staff’s patient experiences to devise the TapCloud  symptom list in “patient speak”. This is helpful to patients who often struggle to describe their symptoms and feelings.

From this program, Dr. Managini expects to learn about the top side effects, interventions and the effectiveness of the interventions. He will be looking at different success factors – “increase in the therapy completion (3, 4, 5 years) and longer term (beyond the 2 years) hopefully a decrease in mortality rate and reoccurrence”.

“With a program showing demonstrative effectiveness, we envision scaling this to the AMITA Health 2.0, 19 hospitals”, concludes Dr. Managini.

Northwell Health, New York’s large integrated health system with 22 hospitals and 550+ outpatient facilities, recognizes the importance of leveraging technology to extend the care team and personalize the patient journey.

With the launch Northwell Health Chats (powered by Conversa Health), patients are empowered to connect, communicate and collaborate with their care team, while their clinicians closely monitor the patient’s evolving needs. 

Think about a patient’s journey today.  Pamela, a 78 year old Medicare patient has just been discharged from a Northwell Hospital for a heart failure episode.

Fortunately for Pamela, Northwell’s Health Chats, a new conversational AI platform will help support her during her recovery. With this text based chatbot, Pamela receives many more outreaches from her care team, a three- fold increase from about five times to fifteen during the 30 days post discharge period. 

When she returns home, Pamela starts receiving notifications through SMS text message and clicks on the link to begin her chat about how she is doing. These chats continue to support Pamela through her recovery.

Pamela is asked to confirm her weight uploaded automatically from her Withings scale. She sees her weight trending map with an educational message about working towards her goal. Next, Pamela responds how she is doing with her leg swelling and then about any difficulty breathing.

Finally, the chat asks Pamela to indicate any side effects of her new medication. Based on her responses, she may be connected with her nurse to discuss any medication adjustments.  All of the information that Pamela provided to the chatbot is shared with her nurse for their discussion.

Since this patient engagement solution is seamlessly integrated into Northwell’s work flow (e.g. care management tool/HIE), Pamela receives these personalized chats from her specific Nurse Navigator at Northwell and the chat content is tailored for her specific care journey. Pamela trusts the information that she receives and can respond with questions and concerns at any time. Pamela’s Nurse Navigator will determine if she needs to come right in to the office or if they can address her issues through a text, email, call or telehealth visit.

Northwell is leveraging their Health Chats for population health. For example, the chat support patients as they prepare for a colonoscopy in their own language, ensuring the patient understands the instructions and knows how important this screening is to their health. This chat helps increase the patient’s health literacy and confirms that the patient knows how to prepare, reducing delays in diagnosis and additional health costs.

Positive Results with Northwell Health Chats

Sabina Zak, VP Northwell Community Health believes this chatbot is a “way to engage patients, by embedding information that is accurate, actionable and enables them to make more informed decisions which leads to better outcomes”.  

As Northwell rolls out their Health Chats across the enterprise, they will be monitoring care quality, care cost and patient satisfaction measures.   With Northwell Health Chats, they are seeing a 97% patient satisfaction rate and lower post-acute care expenses in some of its hospitals. Northwell management is particularity interested in the reduced costs from fewer outreach calls since the bot engages patients and brings back needed information.

Patient Comment:

“These conversations were great and supportive emotionally as well as medically”.  

Nurse Leader Comment:   

“Conversa gives me reassurance that my patients are ok because I can see that they are responding to the health chats. It gives me piece of mind knowing that they are alright without having to always call them.”

 Clinical Leader Comment:

“Innovative technologies like Northwell Health Chats are critical assets in our journey towards providing excellent clinical care and an outstanding personalized patient experience”, explains Northwell Health physician Dr. Zenobia Brown, VP Population Health. 

Expanding Conversational Chat at Northwell Health

In addition to supporting patients through procedures such as Colonoscopies, Northwell will be using this conversational chatbot to gather social determinants of health before the patient’s annual office visit. This information will be shared with their care team for their appointment.  

Beyond population health, Northwell is expanding their Health Chats into Oncology, starting with head and neck and expanding to breast and prostate cancer patients. Northwell’s Health Chats will help patients prepare for the treatment, manage symptoms and check in once the treatment has concluded.

In the future, Northwell is planning to use their Health Chats in the areas of bundled payments for patients with Coronary Artery bypass, Acute MI, Pneumonia, Stroke and Heart Failure.

“Conversa’s conversational AI powering Northwell Health Chats enables us to improve care coordination, patient satisfaction and our ongoing patient relationship, resulting in the improved well-being of our customers while reducing costs. This high-tech, high touch, scalable approach benefits our patients, our nurses and our health system”, concludes Joseph Schulman, SVP Regional Executive Director at Northwell Health.

During the Voice.Health Summit in Boston last week, innovators gathered to explore opportunities, discuss issues and to experience different voice technology use cases.

BCH John Brownstein shares voice health use casesJohn Brownstein, Chief Innovation Officer at Boston Children’s Hospital is excited about the opportunity for healthcare to lead other verticals with this empowering technology which many of us use every day – Alexa tell me… Siri what is… ?

Since the year 2000, the health technology industry has evolved from websites (e.g. patient portals) to mobile applications (mhealth) and now to voice and conversational assistants. There are many use cases which help patients and providers in different settings.

• In hospital, the doctor asks to see the patient’s latest lab results.
• Following a hospital discharge, the patient interacts with his virtual robot to record side effects from his new medications.
• Preparing for an outpatient visit, a patient verbally responds to the pre-visit questions to share with her doctor.
• Days after a remote monitoring visit, a patient asks additional questions to help her manage her asthma.

Although voice health technology is in the early adoption stage, health innovators are convinced that these virtual voice assistants can address real problems -- the shortage of healthcare professionals, clinician burn out, inefficiencies in patient care, lack of patient engagement and the inability to personally support patients along their health journey outside of the hospital. Nuance’s Peter Durlach stresses the importance of using these technologies to free up the clinicians to take care of patients.

Voice has many unique benefits for healthcare. Dr. Rupal Patel, CEO VocalID describes the convenience (e.g. hands free), the capability to capture information and insights about the user (e.g. gender, size, bio- markers) and ability to generate trust through continuous listening and personalized responses. Other benefits include the ability to capture context (e.g. surroundings, urgency and intent) and empower the user (e.g. patient feels a sense of control). Amazon’s Emily Roberts, Sr. Marketing Manager adds the value of capturing “moments of the day” by incorporating voice into other devices (e.g. smart home/refrigerator, car).

Voice Health in Action

During the Voice.Health Summit, we saw what “voice-first” can deliver in five different care setting exhibits. Here are some interesting examples of use cases to bring value to patients and/or the care team.

1. Hospital/Patient. With the Joint Commission’s focus on “accurate screening and assessment of pain”, Dr. Samir Tulebaev, Geriatrician and the Center of Nursing Excellence at Brigham and Women’s Hospital are working with Orbita’s CEO Nate Treloar on the development of a post- operative pain management voice assistant. The patient tells her bedside teddy bear Briggie (which has a built in microphone) that she is in pain, describes where the pain is and indicates if the pain is intolerable. Her nurse immediately receives a secure text message to respond.

2. Hospital/Clinical. Cedars-Sinai uses Sopris Assistant to record, summarize, approve and place the patient care note into the EHR. The AI summons the listening technology, drives the summary and produces the intelligent note for physicians. Cedars-Sinai helped Sopris Health create an experience and workflow catered to hospitalist.

3. Senior Living & Home Health. Caregivers can engage an aging patient with the AI powered LifePod virtual assistant which serves as a personalized companion, delivers reminders, and monitors daily activities. LifePod’s CEO Stuart Patterson emphasized the importance of “proactive voice” which shares and captures essential information without relying on the person to ask (i.e. reactive voice).  

4. Consumer Home. Anne Weiler, CEO Wellpepper, the winner of the Alexa Diabetes Challenge, engages a patient who is recently diagnosed with type 2 Diabetes. She uses her voice to weigh herself, scan her feet for ulcers and track her care plan tasks. This voice assistant gives the patient an opportunity to proactively engage whenever she wants.

5. Vocal Biomarker Lab. Sonde Health is interested in capturing and using a patient’s voice samples as health measures for different physical (e.g. sinus congestion) and mental health conditions (e.g. depression, suicide risk). 

Lessons from Voice Health Innovators

As with any new technology, there is a lot to learn from the pioneers.

Real Problem Definition: Sara Holoubek, CEO Luminary Labs emphasized the importance of deciding who (e.g. newly diagnosed) and what (e.g. help with self-management) as a first step to focus the development planning process.

Patient/User Input: Deloitte's Debbie Hays, Specialist Executive discussed the patient journey research for the DeloitteASSIST voice solution which revealed the “challenges and delays” that needed to be addressed while the patient is in the hospital room.

Patient/User Feedback: Karin Beckstrom, Sr. Product Manager ERT Innovation Lab (formally PHT) described using voice to capture patient reported outcomes (PROs) on a daily basis. We ask-- how engaging was it? Are you willing to answer questions on a daily basis? How difficult was the skill? Did Alexa understand you?  

"Flu Doctor" from Seattle Children's Hospital Stacey UlaciaPersonalization: Stacey Ulacia, Sr. Communications Specialist at Seattle Children’s Hospital in partnership with Boston Children’s Hospital, developed the “Flu Doctor” voice skill. This brings more value since it is customized based on the zip code provided by the patient.

Opportunities for Voice to Solve Healthcare Problems

There are many use cases for voice technology to help drive the triple aim. 

UPMC’s Dr. Shivdev Rao believes it would be valuable to use voice to help triage a care situation, and capture information from the patient pre or post exam.

Boston Children’s Hospital Dr. Docktor shared Pediatrics Voice Hackathon examples including one which uses voice to help a patient prepare for his procedure at home with instructions and images that are tailored to his specific health issues (e.g. food problems).  

Cedars-Sinai Medical Center in Los Angeles is collaborating with Sumeet Bhalitia, Founder & CEO Avia to bring voice into the hospital room, giving the patient control over their experience and the ability to get assistance as needed (e.g. bathroom help) with the goal of increased patient satisfaction.  

Recent metrics for Answers by CignaCigna’s Laura Schuntermann, Global Head of Digital Strategy & Partnerships is excited by the growth of voice search. Gartner predicts by 2020, 30% of searches will be voice activated. Laura shared results from the voice solution Answers by Cigna which helps members get the information they need to make better health care decisions.

Novartis’s Robert Stevens, Executive Director of Digital Strategy & Medical Innovation described voice health use cases that help clinicians determine the diagnosis/clinical decision support, check guidelines, send RXs to pharmacy and order follow up patient education.   

Future Voice Health Considerations

Although there is excitement around voice health, innovators are working to remove speed bumps to accelerate adoption:

Addressing Privacy/Security. Several organizations are anxiously awaiting for HIPAA compliant voice devices. There is also a concern that the device is always listening, even without the “wake” word.  

Educating Patients about Voice. A few presenters admitted that patients do not know what they can ask. This means that either they are not using all of the voice capabilities or the patient has an unexpected experience -- Alexa says …. Hmm I do not know that one.

Mayo Clinic's Optimizing Voice Content Creating complete Patient Experiences. Mayo Clinic’s Jennifer Warner, Sr Editor Global Business Solutions explains that voice is additive and does not replace other consumer engagement methods. Therefore, it is important to provide an “omni-channel” experience to engage and support the patient through every touch point. 

Collaborating on Care Design. Maia Ottenstein, Digital Experience Design at Thomas Jefferson University Hospital (DICE/design group within the hospital) is working on the “smart patient concierge” which empowers the patient to access assistance and resources on demand.

It will take a community of patient and clinical stakeholders to define, design and deliver voice technologies that bring real value to the users. It is encouraging to see that these stakeholders are coming together in hospitals, accelerators and innovation hubs to bring these voice technologies to life.