Why Your AI Should Be Talking to Patients You Don't See

WellSpan Health has launched an AI agent named Ana, who's connecting with at-risk patients for screenings that might otherwise be forgotten or ignored.

Healthcare organizations are now using AI to have conversations with patients that doctors and nurses might not have time for—and closing critical population health care gaps that could save lives.

WellSpan Health launched an AI platform roughly one month ago that calls selected at-risk patients to schedule colorectal cancer screenings. The AI agent, called Ana and developed by digital health startup Hippocratic AI, asks patients if they would agree to take the test and, if they agree, arranges to mail a testing kit to their homes.

The so-called AI “agent” is designed to replace either a mailing, a cold-call program often launched out of a health system’s call center or—if the health system doesn’t have those resources—the conversation that a doctor would have with a patient during an annual checkup.

None of those tactics has a high level of success. And as a result, at-risk patients often don’t have those screenings when they should, if at all, increasing the chances of a serious health issue down the road.

WellSpan Health executives decided to use the program to reach out to patients at risk of developing colorectal cancer, identified by their birthdate and family history. Of particular concern were Spanish-speaking patients, who might miss the mailer or the conversation with a doctor because of language issues.

“It’s an opportunity for us to reach out to people in their homes, in their own time, and have a conversation with them that we maybe couldn't staff with a human,” says R. Hal Baker, WellSpan’s SVP and chief digital and innovation officer. “But [with] the right AI, that conversation could be had.”

R. Hal Baker, SVP and chief digital and innovation officer at WellSpan Health. Photo courtesy WellSpan Health.

Baker, a primary care physician, says the program takes pressure off of doctors to fit that task into an already busy care visit and gives them more time to make that visit meaningful.

“Most of my visits are 20 minutes,” he notes. “And while it may take only 30 seconds to have a conversation about colorectal cancer screening, … if I can take any of these things like mammograms and colorectal cancer screening and COVID shots and flu shots out of the visit, and they can happen reliably outside of coming to the office, that gives me more time to discuss what can only be discussed in the exam room.”

Kasey Paulus, MBA, RN, CENP, WellSpan’s SVP and chief nursing executive, says Ana works because she’s designed to be empathetic and engaging. And she can speak Spanish, in which not many doctors or nurses are fluent.

“A sensitive AI that speaks your language [is better than] a well-meaning human who can’t speak Spanish,” Baker says.

And it works. Of the first 455 Spanish-speaking patients contacted by Ana, 15% agreed to screening, Baker says, and the net promoter score was higher than that of English-speaking patients (of which 6% agreed to a screening).

“Not bad for an automated reach-out cold call to people who weren’t expecting it,” he says.

Kasey Paulus, MBA, RN, CENP, SVP and chief nursing executive at WellSpan Health. Photo courtesy WellSpan Health.

Eventually, the health system will see results in clinical outcomes. More screenings will lead to more cancers detected and treated early, improving the quality of life for patients and reducing deaths. Financially, more screenings might boost initial costs but lead to less expensive medical treatments and long-term care later on.

Baker and Paulus say WellSpan worked closely with Hippocratic AI to develop Ana, going through every scenario that the AI agent would face and every question that a patient might ask. Baker says he even tried to confuse Ana during a test by announcing that his birthday was on New Year’s Day.

“We have a very creative and collaborative multidisciplinary team, and those individuals do their best to try to break it before we launch it,” he says. “So we're looking for ways [in which] somebody might trip it up that we didn't even think of, because inevitably that will happen.”

For example, Baker says, “We had to very quickly realize we had needed to add the ability for somebody to say, ‘Please don't call me again.’ “

In launching Ana, Baker says the health system was very careful to make sure that patients know they’re talking to an AI agent. For the first 100 phone calls, a nurse was also on the line to make sure things ran smoothly.

“What we found out was that [the nurse] didn’t have to” be in on the call, he says. “What is novel here is that we have now moved the human in the loop to the human on the tail for our next thousand calls,” meaning a nurse will review the call within a few hours.

With the platform now up and running, Baker and Paulus say they’re giving Ana another task: connecting with patients who are coming into WellSpan for a colonoscopy. Ana will call them ahead of that appointment and go through everything the patient needs to do before the procedure. Again, that task would have been handled by a nurse or call center, if at all.

“The last 48 hours of coaching are really critical,” Paulus says. “And AI can help us where we can't always have somebody on call 24/7 365.”

She says the health system will see the benefits in reduced cancellations and procedures that are started and cut short or unsuccessful.

Baker says the platform may scale up in time as WellSpan explores how Ana can effectively interact with patients and support their healthcare journey. They may use the platform for more population health outreach, or to help patients prepare for other procedures, or even to check up on them and coordinate care after a procedure.

“We recognize that we're boldly going into some uncharted territory and that our AI is not replacing our clinical staff but augmenting the work that they just don't have the capacity to do,” he says.