Novel approach utilizes RPA, AI, and Apple Watches to unite multiple functions onto one platform to improve the patient experience and create administrative efficiencies for provider practices.
Is it possible for a single technology platform to improve the patient experience from check-in to checkout, while simultaneously reducing the administrative burden for physicians and front office staff?
CommonSpirit Health, a nonprofit, Catholic health system operating in 21 states, is engaged in an endeavor to find out. An end-to-end solution from San Mateo, California-based Notable Health aims to automate many of the processes involved in an office visit through a digital assistant that feeds relevant information into the electronic medical record (EMR). The technology involves Robotic Process Automation (RPA), artificial intelligence (AI), Natural Language Processing (NLP), and physician-worn Apple Watches.
The health system is partnering with the company to automate multiple tasks for physician offices and clinics, including patient check-in, insurance verification, and patient input of current history and symptoms, as well as provider dictation and ordering tests.
While there are other products on the market that address these activities individually, this approach is unusual because it packages all these functions together, says Marijka Grey, MD, MBA, FACP, executive leader of transformation implementation—physician enterprise at CommonSpirit Health.
"In healthcare, we're used to having a Frankenstein monster of different tech products to get us to where we need to be," Grey says. "Notable seamlessly pulls it all together with one product."
Administrative costs account for about 25% of healthcare spending in U.S. hospitals and are a significant contributor to physician burnout, according to CommonSpirit. As hospitals and healthcare systems explore ways to address these issues, this technology platform provides another method to manage these concerns.
Last November, CommonSpirit began testing the solution, slowly rolling it out to five primary care clinics through the early months of this year. As the coronavirus pandemic hit the United States, the process was accelerated to quickly onboard an additional 600 physicians and advanced practice providers. The system had been adapted to help screen for and triage patients with scheduled visits to direct them to appropriate resources for care and ensure they didn't show up for appointments with symptoms that could contribute to the spread of the disease.
Behind the technology
Notable Health's approach uses a single set of application programming interfaces that sit on top of existing legacy systems to interface with the EMR. This approach eliminates the need for complex integrations involving multiple point solutions, explains Pranay Kapadia, MBA, CEO, and co-founder of Notable Health.
"The road to purgatory in healthcare is driven by integration," Kapadia says. "It takes too darn long to actually integrate any of those point solutions, so we're making sure that the entire encounter is as seamless as it can possibly be given current technology."
Kapadia was inspired to start the company because his physician wife complained that "she was the highest paid data collector in the world" and spent too much time on administrative functions. He decided to apply his financial technology experience, which includes seven years at Intuit leading initiatives for Mint, TurboTax, and QuickBooks, to help automate processes in physician practices. His goal was to enable providers to focus on patients, rather than perform as "click monkeys."
According to a description provided by CommonSpirit, Notable’s platform "uses RPA to understand data from electronic health records and deploys AI models that anticipate and support providers’ needs so they spend less time on administrative tasks. Using AI, machine learning, and natural language processing, the sophisticated algorithms also learn physicians’ behaviors and work patterns to proactively assist them with related administrative tasks."
How the technology works at CommonSpirit
Grey, who has spearheaded the initiative for CommonSpirit and describes herself as a "relentless tweaker of workflows," formerly served national faculty for the Center for Medicare & Medicaid Innovation and still serves as a national learning facilitator for the Transforming Clinical Practice Initiative. She describes how CommonSpirit uses Notable's solution.
On the surface, the digital assistant's check-in process appears to be similar to some other products on the market. However, information entered by the patient feeds into the EMR and physician workflow, and it comprises only one component of a broader solution.
- Before an appointment, a patient receives a text reminder on their smartphone with a link that takes them to a series of user-friendly screens with a simple interface, Grey says. It walks the patient through the process that would normally occur when they arrive at the office.
- The patient confirms demographic and insurance information, acknowledges receipt of Health Insurance Portability and Accountability Act notification, and has an opportunity to describe health issues and symptoms. Patients also answer any routine questions the provider wants to ask. Photos of the patient and insurance cards can be uploaded as part of the process.
- There are no apps to download or websites to visit. "All that information is actually uploaded from your phone to the electronic health record," explains Grey.
- Because the intake process is completely automated, it frees front desk staff of time-consuming responsibilities, she says. When the patient enters the office, they simply acknowledge that they have arrived.
Apple Watch used for dictation and reminders
The solution also expedites processes for providers. "As the physician, I have all that information uploaded in the chart already in front of me," Grey says. "When I walk in the room, we can go directly into the visit."
By using an Apple Watch that's connected to Notable's platform, the physician can dictate notes directly into the EMR and order tests. The digital assistant uses natural language processing to generate the note into the patient's record, while simultaneously assigning the appropriate codes to streamline the billing process.
"All I have to do for the rest of my documentation is go to the computer, review it, and sign it," she says. Rather than addressing these tasks later, "This all happens at the time of the visit," Grey says. The provider is required to dictate the notes and it does not employ ambient clinical intelligence, which listens and transcribes while the visit takes place, she says.
"What we hope to see is increased cycle times for our physicians, and most importantly, less pajama time—less time that they're spending [working] after hours."
The Apple Watch performs other functions as well. For example, it vibrates to alert a provider that the next patient is ready.
"Instead of being in the exam room and having that knock on the door, or having someone hurry you out of the room, you have just the subtle vibration on your watch to tell you that you should be wrapping up the visit. It's a way to keep physicians on track, but without interrupting that good patient-physician flow," Grey says.
Notable also has the ability to help with insurance verification and authorization. "That's one area that [CommonSpirit] hasn't brought life as yet," she says. "We have not done that phase of our testing, but that's another area that will be a huge part of stopping the bottleneck of the front desk."
Early results appear promising
Customers measure their return on investment in different ways, Kapadia says. Some focus on improved patient experience scores. Others seek gains in efficiency. Physicians who use the digital assistant for dictation and charting save between 30 minutes to two hours a day, he says. Another approach is to measure enhanced collections due to cleaner claims.
While CommonSpirit is examining patient satisfaction scores to determine whether using the digital assistant improves the patient experience, it is too early to report results, Grey says.
Patient and physician usage also is being tracked. During the pilot phase, nearly 40% of patients used the system to check in, a figure Grey pronounces as "amazing; four in 10 patients are no longer at the front desk." She expects that number to rise as more patients become familiar with the process.
"We understand that this will never be a 100% check-in solution for us," Grey says. "Some patients purposely budget their time to come and chat to the receptionist, and some just don't have the time to think ahead. As we live our lives more on our phones, and we're in the digital world, we want to have options for those patients who want to do it this way."
Physicians have expressed satisfaction with the digital assistant, but use is not mandatory. About a third of the physicians who had access to the technology during the pilot used it for pre-visit planning and to order tests and procedures. In the early stages, Grey says that physicians who were satisfied with their current method of dictation were hesitant to transition to the new method featuring the Apple Watch. The health system plans to examine how use of the dictation function varies with physicians who are not happy with their current dictation technology.
Once the coronavirus crisis abates, CommonSpirit will continue to roll out the platform and have more precise metrics regarding the value it delivers to the organization. Meanwhile, Grey says, "As a physician, this speaks to the future of where we want to go to in medicine, which is really putting the focus back on the physician-patient relationship and using technology to augment and support that. In the past, we've used technology to support billing, documentation, and coding. This is one of the few products that has gone back to really supporting the physician and the patient."
“This speaks to the future of where we want to go to in medicine.”
Marijka Grey, MD, MBA, FACP, executive leader of transformation implementation—physician enterprise, CommonSpirit Health
Mandy Roth is the innovations editor at HealthLeaders.
The health system is partnering with Notable Health to automate multiple tasks for physician offices and clinics, from patient check-in to checkout, as well as provider dictation and ordering tests.
The solution involves Robotic Process Automation, artificial intelligence, Natural Language Processing (NLP), and physician-worn Apple Watches.
ROI may include improved patient experience scores, greater physician efficiency, and cleaner claims.