How Chatbots can Aid Value-based Care Initiatives

After a year of running his own practice, it became clear to Brett Swenson, MD, a primary-care physician, that a traditional outpatient clinic wasn't for him.

"I was seeing 25 patients per day - which is pretty typical for a doctor in a primary-care practice…my visits were down to 15 minutes per patient, [and] half of the time [I was documenting]. I wasn't getting to know patients like [I wanted to]…my practice continued to grow and it was successful based on the definition of a traditional primary-care practice, but it had become factory medicine," Swenson said at the annual Healthcare Information and Management Systems Society (HIMSS) Conference, held recently in Las Vegas. 

Swenson says he hadn't gone to medical school to practice medicine like this. So he set out to open a concierge practice, which would allow him to focus on quality and value-based care.

"Value, for me, was achieved with happy and healthy patients, that's the value I wanted to deliver," he said.

Once he left behind factory medicine for value, he needed to adopt tech solutions that would help him adjust to a patient-focused practice, especially when it came to communication. One of the draws of concierge medicine is constant interaction between practice and patient. That's where chatbot came into play.

"Chatbot is a computer program designed to simulate conversation with human users, especially over the internet. The goal of the chatbot was to meet the criteria set by the patients - responsiveness, communication, and better outcomes. That's what the chatbot could deliver," he said.

Three Phases

Swenson's concierge practice, Swenson Premier Care in Scottsdale, Ariz., rolled out the chatbot technology in three phases. The first phase was patient-initiated communication, whereby they used the technology to schedule appointments and get medication refills. Instead of calling the clinic, patients could securely text through the chatbot system and make those arrangements.

Usage in this phase was low, said Swenson, who noted behavior change can be hard and most patients still called the clinic for those services. Also, because it was not yet integrated with the EHR, there was still manual work to be done in the back end by his staff.

Instead of having patients use the chatbot service on their own, phase two involved the clinic initiating communication with the patient. The clinic focused on patients receiving preventive care, such as a flu vaccine. In this phase, the tech was still not integrated into the EHR and the process of finding patients eligible for the vaccine had to be done manually.

"We had to generate two files….the first was a list of phone numbers for patients who needed flu shots, the second was a file with timeslots available for [them] to get the flu vaccination. Once we compiled those files, we sent out a text [inviting them to get the shot]," he said. While the response rate was much higher, the lack of integration forced a lot of extra work on the staff.

The final phase, which started in February, aims to solve that problem, as Swenson's concierge practice recently rolled out the chatbot with EHR integration. Meaning every appointment made through the technology goes right into the EHR's practice management suite. Moreover, it's easier to identify patients who may need those shots. They've expanded this capability to focus on patients who need their annual physical.

Swenson's advises other practices looking to adopt this tech that EHR integration will make life much easier. Also ensure the process is compliant with HIPAA regulations. On the operations side, he recommends reaching out to patients in manageable chunks, starting with 500 per physician. As health care goes from volume to value, Swenson sees chatbot as a viable way to help practices make this move. 

"The systems we've been using are better designed for factory-designed medicine. They're designed for the convenience of the clinic rather than the patient," he said, noting the failures of portals and phone calls. "That's where chatbot can be beneficial. It gives the patient 24/7 access. They use a text interface, which they use for everything else in life, so why not health care? And it's interactive with the patient. And it can be designed to provide those nudges we need for preventive care."