At Banner Health, a massive health system headquartered in Arizona, a key purpose of its Digital and Innovation programs is to transform the patient healthcare experience. In one initiative, the health system assessed all aspects of the Banner Health network and uncovered a significant opportunity across the 28 Banner emergency departments, which see more than 1 million patients each year.

THE PROBLEM

Like most health systems, the ED poses many challenges from a patient experience perspective due to the operational realities of managing supply and demand in a very dynamic, complex environment. Oftentimes, the result is a less than ideal patient experience.

“We believed if we could improve patient communications as part of the ED experience, it would have a significant impact on Net Promoter Scores as well as our care teams, who were often the ones dealing with frustrated patients,” said Jeff Johnson, vice president, innovation and digital business, at Banner Health.

“We also believed if we could be successful in the ED, the solution could be applied across Banner Health,” he said. The path forward was with technology, but we had to find the right solution – something patients would actually use and understand.”

PROPOSAL

Banner Health staff concluded any patient-facing technology had to be mobile. Most patients now carry a smartphone, and if Banner Health was to be more consumer-centric, it needed to match the digital experiences people get when they bank, shop or travel, Johnson said.

“To engage our customers in the ED quickly and easily during their visit, we knew that we had to provide a tool that was simple to use,” he explained. So Banner turned to chatbot technology vendor LifeLink. “LifeLink offered us an alternative to a traditional app download with a solution that uses a modality that consumers prefer – messaging.”

"One of the reasons we were able to deliver this big project in such a short amount of time was the simplicity of the technology."

Jeff Johnson, Banner Health

LifeLink conversational chatbots use text messaging to interact with patients and help them navigate healthcare workflows. Rather than asking patients to download an app, remember their passwords, and then learn a new tool, LifeLink bots use a one-click authentication process and then interact through a standard web browser.

“We felt this engagement approach would help us reach and interact with a significant percentage of our ED patient population and establish the mobile communication channel we were looking for,” Johnson said.

MARKETPLACE

Vendors that offer chatbot technology and services include Care Sherpa, Element Blue, Kore.ai, Lifelink, LivePerson, Orbita, Phase2, Podium, Sensely and SymphonyRM.

MEETING THE CHALLENGE

Banner Health first piloted the bots at one of its high-volume EDs in Phoenix. The chatbot served as a virtual concierge that interacted with the patients from the moment they checked in through discharge. At check-in, patients could opt in by providing their mobile number. The minute they sat down in the waiting room, they would get a text link to begin the conversation. A simple two-question authentication process would launch the chatbot engagement.

“The bots would first orient patients to the ED, providing information about the facility, answering FAQs and setting expectations,” Johnson explained. “As the visit progressed, the bots would provide status on wait times, labs and next steps. After discharge, the bot would collect patient satisfaction feedback. This whole experience was a fully automated, crafted interactive conversation, which could run at scale across our large ED network.”

The pilot was successful. 46% of patients engaged in conversations with the chatbots, and there was a 41% increase in Net Promoter Scores for patients that used the bots. And Banner Health clinical teams experienced workload relief because they were getting fewer duplicate questions and dealing with less frustrated patients. So Banner Health moved quickly from the pilot to a full, systemwide rollout of the ED chatbot.

In June 2019, the project to roll out the LifeLink chatbots across all 28 Banner EDs was initiated. It was completed four months later. The bots are integrated into Banner’s Cerner EHR, which allows them to collect and present patient data (such as lab ETAs) directly from the system of record. The partnership between the digital, innovation, IT and program management teams to deliver and scale so quickly a patient engagement product with this type of impact was significant, Johnson said.

“One of the reasons we were able to deliver this big project in such a short amount of time was the simplicity of the technology,” he noted. “There is zero training required for patients because the interactions are all natural conversations. The change management for our teams was also somewhat basic because we only needed to add the step of confirming the patient mobile number with a brief explanation of what to expect as part of the ED check-in process.”

RESULTS

After the first quarter of full deployment, the chatbots have conducted more than 900,000 specific conversations with more than 80,000 ED patients. But one begins to get a sense of the scale on an annualized basis.

“Imagine taking just a small percentage of all those automated chatbot conversations and consider each as a few minutes of precious time that our human teams didn’t need to spend and the time savings really adds up,” Johnson explained.

Banner Health also tracked engagement rates, which is essentially the percentage of eligible patients that authenticate and “converse” with the chatbot, and conversations per patient as a measure of stickiness with the solution. Currently the bots are conducting about seven conversations per patient. While the chatbot satisfaction is high, Banner Health has not yet done a Net Promoter Score assessment on the full rollout but does expect it to mirror the results it saw in the pilot stage.

“The ED project was the first phase of a broader engagement with chatbots,” Johnson noted. “Based on the success we have seen in the ED, Banner is rolling chatbots out across the organization, in multiple functional areas.”

For example, Banner Health ran a successful pilot with Medicare patients that automated the Health Risk Assessment (HRA) prior to their Annual Wellness Visits and saw high engagement levels – 50% of seniors engaged the bots and 97% completed their HRAs through chatbot conversations a week before their appointment.

“Those numbers are impressive on their own as we really didn’t expect many seniors to engage with advanced mobile conversational technology,” he said. “But the best part of the story is that we saw a 70% drop in appointment cancellations, which has really helped our providers with their scheduling and asset utilization. The HRA bot is now being rolled out across the entire Banner Medicare population.”

The health system also has projects in the queue with LifeLink to use the bots for periop processes, ED discharge and the inpatient experience.

“We’re now very committed to conversational chatbots as part of our patient engagement strategy,” he said. “They can augment our Cerner EHR and other system investments by wrapping those platforms with an engagement layer to connect the patients with a mobile, conversational modality.”

ADVICE FOR OTHERS

“It is really important to understand what the patients want as the foundation of any digital or patient engagement product,” Johnson advised. “When dealing with consumers, you must strive to eliminate barriers to adoption and use. Tap into your organization’s consumer insights data, but most importantly design and iterate your products with your customers directly, and then use pilots to validate that you are delivering what the customer is asking for and finds value in.”

Start with the customer experience first and then identify the technologies secondarily that can support it, he added.

“With the chatbot solution, we have been successful getting patients to use the technology because it’s based on a low-friction, simple experience,” he said. “Nowadays, healthcare patients are already forced to navigate a complex array of care programs, insurance, pharmaceutical programs, labs and so on. The last thing they are interested in is adding a new piece of complex technology to the list.”

This is why Johnson believes conversational technology can be an important part of the future of consumer healthcare technologies.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com
Healthcare IT News is a HIMSS Media publication.