Digital care has become a powerful tool for transforming access to care and outcomes over the past two years, with the potential to eliminate billions in unnecessary costs without impacting quality. Now, as provider organizations reimagine how care is initiated, delivered and managed with digital at the center, new use cases for automated care programs are coming into sharper focus.
Across the country, leading healthcare organizations are leaning into chat-based automated care programs to improve clinical and financial outcomes, including better allocating strained resources and increasing efficiency. It’s an approach that holds strong potential to reduce readmissions for patients with chronic conditions, such as patients with chronic obstructive pulmonary disease or heart failure. It also can create more personalized care and communication, even in the face of healthcare workforce shortages, such as by enabling earlier communications and support when data suggest a patient’s condition requires intervention.
Key to success: deploying automated care programs with intention by designing initiatives to solve the pain points provider organizations are experiencing with their patient and clinician communities. Two leading health systems recently shared examples of ways automated care programs are making a difference at Nemours Children’s Health and the University of California, San Francisco (UCSF) and the lessons learned that could help other organizations define and refine their approach.
Virtual Companions for Pediatric Patients
At Nemours, one of the largest integrated pediatric health systems in the country, automated care programs for children with moderate and complex health needs are successfully closing gaps in care, reducing no-show rates, decreasing readmissions and reducing unnecessary emergency department (ED) visits.
The programs bolster compliance with post-procedure care protocols and give parents vital peace of mind as they navigate their child’s medical needs. Parents also gain critical education via the Nemours KidsHealth library of online content, patient instructions following medical procedures, and videos on a variety of health topics.
In 2021, leaders for Nemours identified priorities for automated care, including decreasing no-show rates and supporting parents and caregivers whose child was undergoing a surgical procedure or recently discharged. Nemours discovered that no-show rates for virtual care visits trended higher than no-shows for in-person visits. It’s a challenge leaders uncovered while determining how to build capacity for physicians to see more patients while providing the types of experiences patients and physicians most desired, including digitally. Additionally, Nemours wanted to ensure families of children undergoing surgery understood what to expect before, during, and after the procedure. This included clearly conveying the child’s discharge instructions and facilitating easy access to the resources needed to manage their child’s condition and optimize health.
In November 2021, Nemours deployed a “telehealth preparation chat” with the goal of addressing the high no-show rate for virtual visits. The chat is automatically triggered at a predetermined interval before the scheduled visit to parents in the form of an email or SMS that requires no download or login. It reminds families of the upcoming appointment, conveys device requirements for a successful virtual visit, walks families through what to expect during the visit, and provides an avenue for rescheduling the appointment, if needed.
Shortly after, Nemours rolled out an automated care program for children with complex care needs and those who have just undergone surgery. These digital chat-based interactions collect social determinants of health data to give clinicians a clearer view into family challenges and obtain self-reported answers that give clinicians a window into a crucial question: “How do you feel about how you feel?” When the patient’s health data or self-reported answers point to challenges in managing a child’s condition, the program uses behavioral science to nudge the family to make the appropriate changes and alerts in-house staff when live intervention is needed. The chat can even assist with scheduling an in-person appointment, when appropriate.
The results have been extremely promising. Today, three out of four families participating in this program report satisfaction with automated care programs. Families who do not participate in a chat are more than twice as likely to miss a scheduled telehealth visit compared with families who participate in at least one chat. Furthermore, participation in the appendectomy and tonsillectomy chats is high, at 76% and 65%, respectively. Nemours continues to deploy new use cases, with automated chats for ED discharge, urgent care telemedicine, and hospital discharge.
Automated Monitoring for Complex Conditions
In May 2020, after the pandemic hit, UCSF launched an automated care program for lung transplant patients that helped this highly vulnerable population avoid unnecessary exposure to COVID-19.
Lung transplant patients require frequent pulmonary function testing—every three months—to monitor for rejection. It’s a process that is expensive, time-intensive, and typically involves a lab visit, which would not have been ideal for this population during the pandemic.
As part of the automated care program, UCSF mailed spirometers to more than 550 lung transplant patients to serve as an effective and accurate replacement for some components of in-lab testing. With sustained engagement, UCSF has been able to replace six in-person visits for lung transplant patients with telehealth visits in the first two years after transplant, saving patients time and money. One best practice that helped sustain engagement with lung transplant patients in automated care programs: sharing trend lines to show health status over time.
Today, virtual and automated care programs at UCSF include programs for symptomatic irritable bowel disorder, kidney treatment, organ donor education, symptom triage, and peri-procedural care for interventional cardiovascular and orthopedic care. A pilot program for automated and virtual care for breast cancer patients, meanwhile, is in its early stages.
Lessons Learned
Automated care programs will play a vital role in digital health’s evolution but optimizing its impact for patients and provider organizations alike depends on a strategic approach. Following are three lessons that can be learned from the experiences of Nemours and UCSF to ensure the success of automated care programs:
- Integrate automated care programs with existing workflows and data, where possible. For example, integrating data and insights from automated care program interactions with the EHR enables all those involved in the patient’s care to access the most up-to-date information regarding trends in the patient’s health and recent interventions. Such information ensures continuity of care and avoids redundancies in care that can dampen patient satisfaction and increase costs. It also improves efficiency and demonstrates an understanding of how people work.
- Build close operational partnerships to support change management. Lean into clinician expertise in developing your organization’s approach to automated care, and look for clinician champions who will engage their peers in rolling out new programs and sustaining momentum.
- Focus on the patient experience. Look for opportunities to improve the patient experience at each stage of the care encounter and make it easier to receive high-quality care. For instance, parents of children who have just undergone a tonsillectomy want to know how to best care for their child after surgery. When they are assured that they can gain live access to a specialist via a chat-based interaction when they have questions regarding their child’s condition, this delivers a level of value that instills confidence in parents and helps avoid unnecessary emergency department visits. Also important: Provide regular feedback to families who participate in automated care programs. This rewards engagement.
With careful planning and an eye toward strengthening the patient and provider experience, health systems can effectively leverage automated care programs where they are needed most.
Carey Officer
Carey Officer is vice president, service delivery innovation for Nemours Children’s Health.
Anobel Y. Odisho, MD, MPH
Anobel Y. Odisho, MD, MPH, is associate professor, urology and epidemiology/biostatistics, clinical informatics, for the Center for Digital Health Innovation at the University of California, San Francisco.
