Patient Engagement

When is a “bot” better for patients?

There are times where technology and automation can step in and be present as helpful backups for patients, times when the human touch is not called for.

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Increasingly complex healthcare messages are having to be delivered during increasingly shorter visits in the doctor’s office. The rise of team-based care has alleviated this pressure somewhat, but there is growing recognition that patients need to be able to process this information at their own convenience, pace, and individual level of health literacy.

This is especially true of stressful situations where technology and automation can step in and be present as helpful backups.

Geri Lynn Baumblatt, executive director of patient engagement for Chicago-based Emmi said that one in four women experience post-traumatic stress disorder when they are diagnosed with breast cancer. Her company helps deliver the messages patients may miss after being overwhelmed by bad news.

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“They may not break down in tears, but — in the moment — they shut down,” Baumblatt said, adding that it helps to go home, hear the information again and process it in their own environment. “When you’re in pain or stressed out, everyone prefers simplified information.”

Baumblatt will be a speaker at MedCity’s ENGAGE conference on patient engagement being held October 18-19 in San Diego. She will appear at a panel entitled, “When is a ‘bot Better for Patients?” along with Dr. Andrew Brooks, co-founder and chief medical officer with TigerText, and Ted Smith, who recently stepped down as chief of civic innovation for the metro government of Louisville, Kentucky, to become chief executive officer of Revon Systems.

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Baumblatt and Smith took some time to reflect on the times the human touch may not be called for.

MedCity: What is the difference between patient interaction with a human clinician and automated systems?

Baumblatt: When patients see their doctor, they engage in impression management. They don’t openly disclose how much they drink or other personal information. In a virtual interaction, people are more likely to answer — or ask —embarrassing questions.

When people are scheduled to have a colonoscopy, for example, one of the reasons they don’t show is because they have a hemorrhoid and they have a fear of pain. Instead of asking about it, they don’t show. In virtual settings, you can address this and when people hear the questions, they know “It’s not just me.” We look for ways to help people self-disclose more honestly.

Smith: For patients with chronic obstructive pulmonary disease, it’s terrifying when they can’t breathe at night. But they won’t call the nurse call line — even though that’s what they’re told to. There is a huge opportunity to provide some feedback to help determine how severe the situation is.

MedCity: How do you refine messages?

Baumblatt: We’ll change one sentence in a call and see if it makes a difference. We use a lot of behavioral science to make people feel comfortable asking questions and taking action. Often, when people get an automated call, it’s not a real voice. If you get a call from us, it’s a real human voice which we work on for empathy and listenability.

It’s not just a robot dumping information in an artificial voice. We leave in breath sounds because, in real-life conversations, you take breaths. We learn if a group may prefer a man’s voice or a woman’s voice.

MedCity: How does branching help this process? (Branching is the process of how specific responses to questions lead to other questions and how the responses to those can lead to further, more detailed questions. Or, if a patient answers a question either A, B, or C, the follow-up question will be different depending on which answer the patient gave. The process can continue to “branch” out from there.)

Baumblatt: We learn what interests people. If we ask if they want to schedule a mammogram and they say “No,” we can say “You probably have some concerns. Would you like to learn more about who should receive a mammogram and when?”

Smith: The first trigger phrase can be a big problem. If you don’t know how to start the conversation, you’re done. We have to figure out the thousands of ways people may start a conversation or the thousands of thousands of ways they may describe how they’re doing.

MedCity: Can healthcare organization reduce staff with automated calls and apps?

Baumblatt: I think you have to have both. When you’re talking about hospitals discharging more and more older patients with more and more conditions, some hospitals have armies of nurses calling recently discharged patients. But we can reach more people in a day then they ever could.

We can triage people for them and let them know if a person is depressed, or confused or has some new side effects, so they can be smarter about getting to people who need extra help.

Smith: Given that 10,000 people a day are turning 65, we have an expanding population that has many chronic conditions and diseases associated with aging. We don’t have the trained population — or the economics — to provide all the needed high-touch services. We should be looking at a smarter framework. The rise of the search engine has already started the journey for us. People turn to search engines first for health information.

Is there a direction you’d like to see the technology take?

Smith: I believe that environmental monitoring will bring a pretty big shift in how we understand patient situations. We are losing the broader context in our pursuit of biometrics.

It starts as simple as measuring changes in speech and tone. There is a signature opportunity in monitoring the air and the integrity of the environment. We can measure social interaction. Does health status vary with isolation? These are things you can never figure out by taking drops of blood.

Photo: Gerard Julien, Getty Images

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