Victor Morrison, vice president of healthcare markets, Next IT
Who would have thought that intelligent virtual assistants could be used as patient engagement tools? The same virtual assistants that live on websites you might traffic that help you find site details, search the site or ask more detailed questions about information contained on the site.
Apparently this is the exact line of thinking of the folks at Next IT, a company that develops virtual assistant technology. According to Victor Morrison, vice president of healthcare markets, virtual assistants are the “silver bullet” to the patient engagement quandary.
The Washington state-based technology firm currently supports several major companies including United and Alaska airlines, Gonzaga University, Amtrak and Aetna. Though it’s only current healthcare experience is on the payer side, the company entered into a partnership with a major pharmaceutical company a few weeks ago and is expected to bring a new virtual assistant “personality” to market in a few months, said Morrison.
Next IT has partnered with Aetna for three years, creating for the company through its Human Emulation Software, “Agent Ann,” a virtual assistant that lives on Aetna’s registration page of its website. There, Ann provides immediate assistance to new members visiting the site for the first time. Ann debuted in early 2010 when many new members were first beginning to use their plans, and “she” is available to members 24/7, making it easier to do business over the web.
Members are able to type in their questions, using their own natural language and get the information they need to continue registration. Results show that she’s having an impact.
According to Next IT’s website, more than half of people registering on the website for the first time engage with Ann, “Because Ann does such a good job walking members through registration, Aetna reported that during the fifth month after implementation, they saw a 29 percent reduction in calls to their member-service technical help desk.”
Because of Ann, Aetna is seeing a reduction in operating expenses while still providing the service that members expect.
Most impressive, though, is that half of all people registering on the Aetna site engage Ann. Even Aetna’s covered members using the member’s only site are able to use Ann to view claims, look up physicians for services and even estimate the amount a service will cost with a specific physician.
According to Morrison, the system used by Aetna will be considered somewhat light in relation to what Next IT has planned for the clinical setting. Specifically, it will be more proactive depending on a patient’s needs, he said.
“Interactive virtual assistants are the magic bullet for patient engagement,” Morrison said. “What we can do is create and interface with smart phone and smart devices.”
With the right interface, which can be created to incorporate voice activation, like what’s found in Siri, tools like virtual assistants that are employed by large and enterprise health systems may be able to create a link with a patient, to interact with and monitor activity on a regular basis and to engage them through a protected portal such as a patient portal.
Ultimately, tools like Aetna’s Ann, and the one used by the U.S. Army, which have personalities and back stories built into their profiles (designed to create trust with users, Morrison said) will be able to push information, reminders and updates to patients who sign up with the service to help them stay engaged with their caregivers.
“Once we understand the patient and we begin to engage, we can push information to them to push engagement,” said Morrison. “We’ll be able to ping them with a text message, and push medication reminders. We’ll even be able to ask them questions like ‘How are you feeling today.’”
Depending on the patient’s response, if after a certain number of non-positive responses, the assistant will be able to automatically schedule an appointment with a physician or manage some other pre-established message to the patient’s care provider to ensure the patient is being contacted to ensure proper care continuum.
But, the assistants’ interaction can be set up to be much more than pushing information; they can actually engage individual with medication reminders, for example, and provide guidance for recommended doses, where to take an injection (in situations where that is appropriate), and improve patient understanding of a procedure or medication.
Patients can set up reminders through their smart devices, schedule appointments and can rate their health experience and how they feel, which can help physicians begin to create a comprehensive patient case history.
Based on this, virtual assistants may contribute to a more engage patient population, especially if people are able to so easily interact with them as is showcased in the video. Where patient portals and other engagement strategies, like social media, may be lacking, this technology may, in fact, be the magic bullet Next IT believes it to be.
From her hospital bed, the little old woman gathered herself beneath her tissue-paper thick blankets and wondered about many of the things she’d face in her future. Though the room wasn’t cold, wringing her hands through the folds of the cheap cloth were all she could do to keep herself calm.
The television blared above her prone body; it made the only noise except for the rasp of her short breath. Occasionally, an orderly passed by but made no effort to breach the curtain door, and made her way down the hall.
A newspaper lay unopened at her side, not a word of it read, mostly because of the glaucoma in her right eye. Thus, the television called out, it being the only thing to steer her thoughts back from the darkness and confusion that seemed to take hold.
A relatively healthy 95-year-old women prior to the automobile accident (that consequently was not her fault), she seemed to suffer the unimaginable at her age and come out alive. Though doctors wouldn’t guarantee her recovery during the first few days, they were more optimistic now that her broken leg, broken arm, fractured wrist, broken shoulder and cracked ribs had not killed her.
She’d made it this far, they reasoned; and if the whole experience didn’t kill her then certainly it would make her stronger.
So alone she sat, except for when the occasional visitor stopped by, much of the time scared and most of it confused.
In came the food, out went the plates. In came a doctor, what was left were his orders. The occasional nurse checked her machines and gave her a pill; conversation was limited to, “How are you feeling today?” or “Are you in pain?”
There’s no surprise she feels out of place. Clearly, thoughts of giving up come to mind and she wonders if she’ll be able to survive the three or four months of required physical therapy for her to recover.
Even worse off, without any real family to guide her through, she sat quietly trapped in her own thoughts.
Finally, at one point, randomly looking at the computers in the room, she said softly, “Everything is mechanical now.” It was a statement, like something said in fear and loathing. She wrung her hands some more and closed here eyes.
When the nurse came in, the old lady requested a pain pill and the nurse left to retrieve it. Upon her return, the nurse handed over the small white pill and a shot of water and said she’d stay until she was sure it had been swallowed.
Thirty seconds later she was gone, again. Alone, the old woman tried to remember her home and its warmth and did her best to recall a lifetime – nearly a full century – in which she’d been engaged lovingly by family and friend.
It’s all mechanical, now, she said again, wondering in silence as her companion, the television, blared on.
After a detailed conversation recently with a practicing physician, my long-held suspicions about meaningful use may be coming to fruition.
You see, though I’m a believer in meaningful use from a data collection perspective and for the benefits it provides the healthcare community in being better able to track outcomes and measure results, I’m also concerned with the amount of regulation and oversight required of the reform. Additionally, I’m concerned about how the overbearing amount of added reform is affecting the thousands of small businesses that are private practices.
With the added mandates and with the continual burdening requirements of the physician as educator to patients, there’s only so much room left for them to take on their tasks as caregiver.
All of that said there is some growing resentment in the healthcare community that suggests physicians are growing resentful of their educational assignment.
“Our job is not patient education,” the physician I spoke with said, asking that his name be withheld. “We’re on the precipice, teeter tottering on the verge of collapse and the system is going to fall down. We’re being pushed to the extreme with patients. We need to see more patients per hour just to cover our expenses because the margins have disappeared.
“We’re forced to focus on getting more patients through the door; we don’t have time to focus even more on patient care,” he said.
Besides meaningful use, there are other issues to address in healthcare, he said, like 5010, ICD-10, Medicare and Medicaid changes and insurance hurdles.
On top of these issues, physicians struggle with internal operations because of the financial cuts to their practices. With ever-changing reimbursement rates affecting the amount of money they can bring into their practices, practice leaders also have to worry about making payroll. Certainly, physician salaries are declining. Gone are the days when physicians were guaranteed lucrative careers.
The more likely model now will become the one where physicians become employees.
“Healthcare reform essentially is putting the private practice out of business,” he said.
In the long run, the only successful private practice model will likely come down to where large practices dominate the landscape. Anything less than a 300-physician group probably won’t survive, he said.
“This is the reality of what we’re seeing in the outside world.”
Add all of this to a physician shortage that’s only getting worse, and the healthcare community is indeed embarking on a tumultuous road ahead.
Perhaps one of the easiest ways to engage patients in the patient engagement process, especially as it relates to meaningful use Stage 2, is to let them know that you are trying to engage them.
Since CMS announced the patient engagement requirement as part of meaningful use, physicians and practice leaders who hope to attest and receive federal incentives have voiced their concern over the requirement since it’s the one element beyond their control.
“The push back from providers is because it’s the one thing they can’t control; they can’t make patients ask for a patient summary and force them to download it,” said Amit Trivedi, healthcare program manager at ICSA Labs, which is a vendor-neutral testing and certification firm that works with EHR vendors. “Originally, I thought it would be upheld. I still don’t think they’ll drop it, but it’s possible they (CMS) may modify it or choose not to audit it.”
Essentially, the patient engagement portion of Stage 2 most likely won’t be dropped, but, according to Trivedi, enforcement of the mandate may not happen right away.
Still, Trivedi says the healthcare community shouldn’t walk away from the patient engagement debate simply because patients don’t seem interested in or accessing their health record. On the contrary, now is the time to begin moving in the direction of creating more awareness with the consuming public.
By taking the approach that if patients don’t ask for something because they don’t want it is faulty, Trivedi said. The same arguments were made by technology vendors prior to meaningful use who he said claimed certain enhancements just were not important to physicians and their patients. However, once incentives were announced and mandates issued, vendors quickly jumped on board to upgrade their systems to meet the new need.
Patient portals are an example of one such tool. Prior to meaningful use, they were considered Cadillac-like add ons that were wanted only by a few practitioners. With meaningful use, they are necessary and required component of the systems.
“You may never be able to make patients download their records, but you have to advertise and make the data available” said Trivedi.
Healthcare is entering the age of a new demographic and though there may be little desire to engage with the current generation, upcoming users are not going to be so patient in seeking their health information. For many, having access to their records will be a right, Trivedi said. Making data available to the public and encouraging patients to access and use it is nothing more than a cost of business.
Other than advertising to patients about the capabilities, Trivedi suggests taking the message to those who truly need access to it, for example, parents of young children and caretakers of the elderly. Though there’s simply no way that a majority of consumer patients will be engaged patients, at least in the short term, it’s much more likely that targeting specific population sets, like those mentioned, will help move the population forward and get people to take greater ownership of their care (or at least the care of those they are caring for).
After all, even with all the data collection and its analysis, its potential for improving greater health outcomes across the population and the move toward structured and transportable data, it ultimately we won’t find the results we’re looking for if the patients are not engaged.
Help me understand, if you will, where the soul of meaningful use lies. I’ve seen the rules that have been made final and I’ve heard the stories of folks in the field that have had their lives and practices changed because of it.
But all of this just doesn’t seem to lead to a very innovative end.
Sure, the technology is needed in healthcare as the antiquated use of paper continues to overwhelm, but what’s the real proposition here? As far as I’m concerned, some of the real questions remain unanswered, and I am slightly suspicious as to why the feds are so heavily involved.
Granted, I shouldn’t be surprised given all the money that’s been spent in numerous non-government areas (like cars, banking and solar), but let’s peel back here a little and ask why the industry really needs the incentives. Let’s agree that on its own, the healthcare industry would have adopted the technology and was doing so; the incentives just moved adoption along much more quickly. So, why are the feds involved? Agree with me or not, they want our data.
This is the coup d’état. Collected data leads to predictive analysis and evidence-based treatment protocols. This leads to the dissolution of independent care protocols and removes independent will and turns healthcare into committee care.
Getting care is going to be similar to applying to government grants and scholarships. I’m oversimplifying the matter here, but please, let’s admit that there is a price that’s going to be paid for the federal incentives.
That said, my soap boxing out of the way, I’m back to my original question: Where is the soul of meaningful use?
Let’s take a look at the upcoming Stage 3. In large part it’s a lot of increased measures and new “patient engagement” provisions such as: giving patient the opportunity to request amendments to their records online, requiring electronic health records to receive, generate or access appropriate immunization recommendations, and requiring EHRs to be able to query other entities for outside records.
(Yawn.) (Wipe my eyes.)
These are valiant efforts and worthy of exploring, certainly. But, where is the real innovation that we’re supposed to be seeking? Where’s the game-changing approach to healthcare information that blows our minds? This is a technology based process after all and I think we need to begin demanding more of the technology we employ.
The technology is not holding us back, either. It’s us and our continually lowered expectations. If we’re going to take some risks then those risks need to be real risks and not some marketing speak for a data grab slight of hand.
From my perspective, about 90 percent of the technology vendors in the space do just enough and nothing more. Their investments are in sales teams, not in research and development.
But how can you blame them when the one leading body of the mandated changes is asking so little of the community.
What this is beginning to feel like a bunch of self-appointed “decision” makers trying to affect change of a program that’s been in place for decades, in the end, no matter the tinkering, may be nothing but waste having been accomplished.
The meaningful use of data collected in an electronic health record continues to be the stump speech of Farzad Mostashari, National Coordinator for Health Information Technology.
He’s been pushing the message for months: those achieving or working toward meaningful use attestation need to get beyond just the financial incentives of the program, he says.
Physicians and their healthcare systems need to dig deeper and realize the importance of the data that they have at their hands. They need to realize just how to leverage the data to improve their patient’s health outcomes and lead those in their care down an educational path about the importance of their involvement in their care and how electronic systems can help improve their interaction with their care providers.
For meaningful use to work, those in the community need to make sure they’re using the data collected meaningfully. Meaningful use is a tool and it should be used as one; but unlike a simple jack knife, it’s a multi-purpose, multi-blade, do-it-all Swiss Army knife.
If used correctly, as a means for change rather than a singular solution for incentives, Mostashari believes that meaningful use can actually lead to population health management (the real reason behind meaningful use), more patient engagement (this is yet to be determined) and the creation of health information exchanges (yes, but we need interoperable systems before we see wide spread use of data outside their silos).
His ambitions are correct, and collectively, there is a fundamental agreement that meaningfully using EHRs will help accomplish all of these goals (though patient engagement may remain the stickiest of wickets). The problem here, though, seems to be that even though most physicians want to dive into the deep pool of big data, but they just don’t seem to be able to catch their breath.
In all walks of life we face the day-to-day grind of ongoing and seemingly never ending tasks that drive us further away from our goals. However, it’s different in healthcare. I just can’t seem to think of any other professional group (other than members of the military and police forces) under so much constant pressure to produce positive, long-term results for the people they serve.
In addition to making life and death decisions, our physicians and healthcare leaders are constantly facing the deluge of regulation and reform (meaningful use, ICD-10, HIPAA and even to a certain extend malpractice and 5010).
Healthcare professionals are overrun by details that have taken them into the weeds. Their days are long and their time is short. We can argue if electronic health records actually save them time and money. Depending with whom you speak, each person has an opinion as to its effect. Add everything I previously mentioned and it’s simply overwhelming.
I firmly believe that in a best case scenario, we’d be able to meet all of Mostashari’s proposed goals. Big data would (and can) lead to a changed system and provide real and personal stories of improved health outcomes. I believe that if we could clear away the clutter, we could begin building upon the foundation and create the best, most comprehensive, patient-serving healthcare system that produces results and actually changes lives.
But, for now, we live in a database world where no matter how meaningful we use them there’s still much left to be desired.
Healthcare big data is a big story, and it’s only going to continue being one. It’s a story I like and am intrigued by, but it’s not very sexy. Because of this, the only pieces of information about it seems to be very technical.
Until we actually see how big data changes lives, there’s just not going to be warm and fuzzy stories about it. So, cold and technical it is; nonetheless, I’m still fascinated.
In searching information about the subject, because I too want to know more from a ground floor level, it was nice to come across a nice piece about big data on the Cleveland Clinic’s website.
So, getting right into it, here’s an interesting piece of trivia about healthcare big data directly from the Clinic: “The amount of data collected each day dwarfs human comprehension and even brings most computing programs to a quick standstill. It is estimated that 2.5 quintillion bytes of data are created daily, so much that 90 percent of the data in the world has been created in the last two years.”
Healthcare big data is essentially large amounts of data that’s difficult to manipulate using standard, typical databases. Essentially, big data is very large pieces of information that ultimately, when captured can analyzed, dissected and used to monitor segments within a given sect.
Healthcare big data, it is thought, is what will drive change in care outcomes. What’s interesting, though, is that even though there’s a tremendous amount of data available for use, it’s just not being collected in a structured manner.
Collecting structured data is a must if we are going to begin putting some muscle to the bone of the new healthcare ecosphere we’re putting in place. You don’t have to take my word for it; IDC Health Insights research director Judy Hanover spoke of the same subject recently here.
But, to prove my position, I’ll let Cleveland Clinic make the point: “Unfortunately, not enough of this deluge of big data sets has been systematically collected and stored, and therefore this valuable information has not been aggregated, analyzed or made available in a format to be readily accessed to improve healthcare.”
Also according to the Clinic, if all of the data currently available were used and analyzed, it would be worth about $300 billion a year, reducing “healthcare expenditures by almost 8 percent.”
At the heart of healthcare big data is the hope that it can eventually help providers become predictors. Essentially, big data is like a big crystal ball, or so it’s been said.
According to Cleveland Clinic: “In this way, analytics can be applied to better hospital operations, track outcomes for clinical and surgical procedures, including length of stay, re-admission rates, infection rates, mortality, and co-morbidity prevention. It can also be used to benchmark effectiveness-to-cost models.”
Predictive analytics: That’s what it’s all about.
With all of the attention being given big data and warnings about being prepared for big data so it doesn’t sneak up on you – like meaningful use and ICD-10 – are valid and should be taken seriously.
Efforts are currently underway and available for big data processing and by managing data, “This dynamic data management technology makes data analysis more efficient and useful. Access to these data can also significantly shorten the time needed to track patterns of care and outcomes, and generate new knowledge. By leveraging this knowledge, leaders can dramatically improve safety, research, quality, and cost efficiency, all of which are critical factors necessary to facilitate healthcare reform,” writes Cleveland Clinic.
Big data is a catalyst for change, and without sounding caustic, will be a bigger deal than electronic health records currently are. Without a commitment to it, practices and healthcare systems will be left behind.
The misconceptions about healthcare information technology, specifically electronic health records, are rampant even as the technology matures and begins to saturate the market.
More of the technology’s capabilities are known now by the average healthcare insider (physician, practice or hospital leader, for example) than even two years ago (before meaningful use). That’s understandable; however, those darned misconceptions continue to fly.
No matter where you look, there’s a top five or a top four and even a top three list of the biggest misconceptions about the technology.
So, today I thought I’d take a look at some of the “best” misconceptions about EHRs floating about the health IT stratosphere.
Electronic health records won’t save a practice any money: Though they alone may not save money from the moment go, over time and if implemented properly, they can help a practice save money in the long term. Ultimately, they create internal efficiencies such as reduced paper, easier and safer transfer of records to patients and specialists, reductions in the number of tests that need to be ordered, greater coordination of care. Plus, for some practices utilizing EHRs they’ve been able to increase the number of patients seen because of improved administrative functions.
Using technology in the exam room distracts patients and reduces the quality of the visit: Frankly, this is nothing more than a statement made without substance, and there’s really no difference between taking notes on paper or through a piece of technology from the patient’s perspective. Additionally, we all live in a technology filled world and patients are accepting of technology in their lives. In many cases, patients see technology in the exam room as a way to engage their physicians in their care. Physicians should see it the same way.
Electronic health records are not as safe and can be hacked: Never say never, and yes, there’s a bit of truth to that statement, but the fact is that paper records are simply easier to access than their electronic counter parts. And, since most data breeches are inside jobs, at least electronic health records allow for electronic auditing which can determine who, when and how often a record has been accessed.
EHRs are hard than paper to use: Perhaps depending on your comfort with your system, this may be the case, but clear investment in learning the system will pay long-term dividends. Electronic health records allow for searchable records with data that can be viewed, shared, downloaded and “filed” without having to print, manually scan, review and file the documents.
Electronic health records were created to facilitate meaningful use: Quite frankly, this is false. Clearly, EHRs have been available long, long before meaningful use was even a concept. They do facilitate meaningful use now that the process has been put in place for the program to thrive.
An electronic health record assures a practice of meaningful use: Not so. An EHR is the first step in the process. Meaningful use is about the process of using the technology and about using the data gained to improve patient health outcomes. Seeing the patient populations’ data allows physicians to begin to make changes to their approach to care, especially as it relates to chronic conditions.
Electronic health records are not available for every practice: There’s no way to objectively respond to this misconception. Truth is, there are hundreds, maybe even thousands of systems on the market, some of them designed for specialty specific practices. If you have been dutiful in your research and still determine that nothing meets your needs, either you aren’t ready or willing to make the switch or you are impossible to please.
