Healthcare Taps into mHealth Lexicon with 'Conversational Agents'

As the healthcare industry looks to mHealth to improve both the doctor and patient experience, chatbots just might be the tool that meets everyone’s needs.

Also known as conversational agents, these digital health platforms help consumers navigate their way through a healthcare experience; on the other end, they help providers gather and access information, two tasks that might otherwise ruin a perfectly good workflow.

“Appealing to both is really the sweet spot,” says Peter Antall, chief medical officer for American Well’s Amwell Medical Group, which has so far developed chatbots to aid in telehealth triage and telemental health.

But while chatbots are common in commerce and financial services – think of the “how can I help you?” bubble that pops up every time someone surfs the internet – they’re still relatively new to healthcare. That’s because they’re tricky to develop, and need a lot of careful consideration before they’re called on to replicate a doctor or nurse.

“It’s a real art, not just a science,” says Nathan Treloar, co-founder and president of Orbita, a Boston-based developer of conversational technologies used in telehealth.

Antall and Treloar were part of an online panel discussion on conversational agents and virtual visits sponsored by the American Telemedicine Association, whose week-long virtual summit kicked off on Monday. They were joined by representatives of two health systems who have used conversational agents – Jim Roxburgh, CEO of Banner Health’s Telehealth Network (BTN) and Lan Chi “Krysti” Vo, a physician with the Children’s Hospital of Philadelphia (CHOP).

Roxburgh noted that chatbots can help providers personalize the virtual waiting room that precedes almost any telehealth visit, giving providers an opportunity to collect information from a patient. They can also be used to help patients familiarize themselves with a health system before visiting it – either physically or virtually. And they can be used prior to a patient’s discharge, relaying information and preparing the patient for post-discharge care.

Vo, meanwhile, pointed out that the technology can be used by providers to capture notes or pull information from a patient’s record.

All four agreed that chatbots and other voice-activated telemedicine technologies have the potential to improve the patient experience and reduce burdensome administrative tasks for providers, but the challenge lies in getting a conversational agent to be, well, conversational.

Treloar said the challenge lies in creating a platform that asks clear, concise questions, which in turn produce responses that lead to action – what he called “snappable actions.” Open-ended questions won’t work well, as chatbots aren’t adept at long-winded answers.

On the other hand, the conversation can’t get too technical or loaded with jargon, nor can it get so informal that it sounds hokey. Some of the best health systems can develop chatbots to extend their resources out to patients and other providers, but those tools won’t work if the conversation isn’t comfortable.

As well, there are privacy and security implications to the technology. Will the interactions expose sensitive health data or create unanticipated avenues to data theft? And how can these conversations be designed to draw out actionable content without creating a HIPAA nightmare?

As with any healthcare conversation these days, the talk turned to COVID-19. Roxburgh said conversational agents have been used as gatekeepers during the ongoing coronavirus pandemic, helping providers to screen patients coming into the system and funnel them to the appropriate level of care – while also helping those patients receive faster, more appropriate care.

He stressed that providers have to plan carefully to interject these tools into the workflow. Make sure they point patients in the right direction and aren’t loaded with fancy bells and whistles.

“We have to get that foundation in place so that we can lay on top of it conversational agents,” he said.

Treloar, who noted Orbita pivoted away from the planned launch of a consumer-facing product to quickly develop a COVID-19 platform, said providers are looking for tools that can be injected into text messages or e-mails and connect with patients at home, nudging them on their journey and combining with appointment reminders or notifications.

“Expect to hear the word ‘nudge’ a lot in the next few years,” Antall added.

As for the future, both Roxburgh and Vo cited the value of conversational agents in clinical care, helping clinicians to improve workflows and efficiency. Treloar, meanwhile, said the future lies in developing chatbots that can integrate with the EHR platform and accompany the clinician into the exam room or even the operating room, acting as a virtual nurse.