Electronic Health Reporter

By Chinmay Singh, co-founder and president, Asparia.

Every medical group today is expected to demonstrate competence and results in population management. Increasingly, pay-for-performance contracts demand that groups utilize data, clinical coordination, and connected technology to improve patient care and patient outcomes. Information in the electronic health records (EHR) is often the glue that binds these initiatives together, enabling the dashboard for what individual patients need and a repository of data that can be analyzed for an entire group.

However, there is a notable gap in EHR capabilities that has been overlooked, up until now. The individual patient’s clinical data should be tapped and used to manage patients when they are not in the doctor’s office – to ensure adherence to manage treatment for chronic illness, for preventive tests and screenings, and for ongoing medical care.

Often called “patient access” functions, these communications today are fragmented, one-way, and for the most part, ineffective. How does the medical group notify the patients who need a particular vaccine? And how do they know that these patients may have actually received the vaccine elsewhere? What happens when preventive tests are due, and the patient doesn’t schedule or maybe doesn’t keep the appointment?  What happens when patients are supposed to come back for a follow up in a year, and they don’t?

It’s not for lack of trying that these situations occur. Patient access departments use telephone calls, reminders by mail, e-mail and even texts, with no appreciable increase in consistency in the reduction of no-shows or patient compliance. Patients have good intentions of keeping their appointments, but life intervenes. It’s an inconvenience to them to have to call to re-schedule, and often they just let it go. Staff spending time calling each patient is tedious, time-consuming and expensive – and without a means to keep patients on track, quality of care suffers. Conditions that could have been detected early, may be only found when they are much more serious and expensive to treat. Illnesses that are preventable happen because the test or vaccine wasn’t received. The group’s costs of care go up, and outcomes go down.

Additionally, operational expenses rise.  Staff time is wasted in trying to connect with patients by “old school” methods, and each no-show costs the office an average of $200. At a 7-20% no-show rate, a 100-provider health system has revenue leakage of about $10 million a year.

The solution is to adapt new technology like chatbots for example as a way to enable two-way automated communication with patients that taps the data in the EHR, and then communicates with the patient to ensure that the required actions are taken. Intelligent chatbots have modernized the doctor’s office and make convenience equal to that of dealing with the bank or online travel. This is what consumers expect today, and this is what they should be able to experience in health care.

Electronic health record companies such as Epic, NextGen, Athenahealth, AllScripts, Centricity, DrChrono and others have already incorporated these chatbots into their systems. Although awareness of this capability may be low, it is easy and inexpensive to integrate and use. This integration enables “zero friction” implementation and operations; staff do not have to undergo training to learn a new system and can continue to work within the EHR. With no data duplication, the EHR remains the single source of truth for patient data and interactions.

Here’s an example. Say today, a doctor’s office texts a patient and reminds them of an appointment or tells them that they are due for a screening or re-check. If the patient can’t keep the appointment, they usually have to call the office to re-schedule. It’s an inconvenience and they are likely to forget, especially if they can only call after work and the doctor’s office is closed for the day. Even if they receive a text, they cannot re-schedule by text if their schedule is complicated. With new chatbot capabilities, patients are offered times that they can choose from, and the “conversation” continues until the situation is resolved. No human interaction is required.

Also of benefit to today’s multilingual population, the chatbots can conduct interactive communication in more than 100 different languages.

This new automated system closes the crucial gap that exists today in patient management – the disconnect between recommended care as documented in the EHR, and the patient outside of the exam room. It gives a voice to those care needs and health systems can effectively manage patient adherence using this automated technology.

Automating these activities with smart technology is a major step forward in improving patient care and alleviating the ongoing issues in patient access. With the link between patient compliance and health outcomes, this kind of automation will enable health care delivery organizations to achieve higher efficiency and reach quality and population health goals.

Health care delivery organizations, such as health and hospital systems, medical groups, and federally qualified health centers (FQHC) using chatbots report dramatic increases in patient response and engagement, significantly lower no-show rates and higher consistency and adherence to preventive care check-ups. For example, compliance with vaccines rose from five percent to 70 percent while no-show appointments were reduced.

The next step in automation means that providers are delivering better and more proactive care. Patients love being able to conduct these transactions on their cell phones, at any time, without having to make phone calls or go back and forth in communicating with the office.