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.