Tapping the Potential of Engagement Tech

Ohio Gastroenterology Group dives into the future of patient communications.

Like many high-volume ASCs emerging from the pandemic’s depths, Ohio Gastroenterology Group had a phone call problem… as in, way more than its staff and physicians could handle.

A Columbus-based physician-owned practice with five endoscopy centers, Ohio Gastro’s approximate monthly call volume rose in 2021 from 30,000 to 50,000.

“It became virtually impossible for us to handle,” says gastroenterologist and board member Raghuram Reddy, MD. “Patients reached out to us because of every little thing — the time or location of their appointment, clinical questions. It was impossible to have enough people to answer every call in a timely manner. Lots of voicemails means upset patients, so we had to find solutions.”

Beyond ‘legacy’ methods

Dr. Reddy and his partners viewed the problem as an opportunity to reset how they communicate with patients — particularly by moving beyond what he calls “legacy” methods like phone calls and snail mail. Forward-thinking practices over the last decade have gradually implemented text messaging, email and even smartphone apps for patient communication, while providing richer information on their websites. Some offer web-based portals through which patients can securely access personal records, providers and other info.

“We know what patients’ experiences with portals are,” says gastroenterologist and managing partner Bruce Hennessy, MD. “Patients tell us all the time, ‘Isn’t that on MyChart?’ Well, MyChart is very specific to Epic. If patients have been to a hospital and have a private primary care doctor, a gastroenterologist and a cardiologist, they might be on four different EHRs, which means they need to work with four different portals.” That includes four usernames and passwords to remember.

Dr. Hennessy says patients tell doctors when they struggle with portals — which is frustrating because their performance is dependent on the EHR vendor. Ohio Gastro wanted to fast-forward beyond portals — and the issues that arise with patients’ use of them — to provide something seamless, easier to use and more personalized to both the practice and the patient. “We want to meet patients where they are most comfortable,” says Dr. Hennessy. It also wanted to free staff and doctors for more immediate clinical work while still making patients feel appreciated, understood and cared for in a personalized, timely, convenient manner.

It’s doing so via a highly configurable patient communications platform based on artificial intelligence (AI). In the process, it’s previewing how other surgical practices could eventually improve pre- and postoperative communications while freeing providers and staff to focus more on the patients in front of them at the facility.

Directed self-service

AT YOUR SERVICE AI chat engages viewers of Ohio Gastro’s website, enabling users to access or provide information that is relevant to them personally.

After considering numerous platforms, Ohio Gastro embraced one called Orbita, which works with healthcare providers to develop and implement smart virtual assistants powered by conversational AI via web, text and voice. The platform, which addresses privacy and security standards, automates communication workflows that humans previously needed to perform. All communications are secure, with no passwords required. “You can verify who’s getting the message in a fairly simple way and provide them the information they need, which is a lot better than a portal,” notes Dr. Reddy, who says the platform furthers his vision of providing “directed self-service” to patients.

The system is rolling out in three phases. Last May, Ohio Gastro provided self-serve access to COVID-19 information, insurance coverage and billing processes. In November, to support intake workflows, it launched automated outreach programs in which interactive virtual assistants deliver pre-op instructions and post-op check-ins.

This year, it will implement referral scheduling functionality that enables patients to book recommended appointments digitally. Dr. Hennessy anticipates self-scheduling will reduce leakage and capture revenue from patients who otherwise might not have scheduled. Also coming is a visual patient assessment whose range of images will allow patients to share detailed information about where they are experiencing pain.

Both doctors say Ohio Gastro is simply catching up with how patients interact with almost everything else in life. “You can fly all around the world without talking to anyone, but in most cases, you cannot schedule a colonoscopy or endoscopy without speaking with a human,” says Dr. Reddy. Adds Dr. Hennessy, “We’re at a point in time where many people don’t really need or want to interact with a human for things they can take care of electronically. We were forcing everybody to interact with a human, and those who didn’t need to interact with a human had to spend a lot of time working through phone trees and humans just to get something simple, like the time and location of their procedure.”

Ohio Gastro wants to be virtually available to patients 24/7/365. The intent is not to eliminate human interactions, but to optimize them. “If you’re pushing somebody to one system and one system only, that’s where people get caught in corners, their questions don’t get answered, and they get frustrated,” says Dr. Hennessy. “We don’t want to eliminate the ability for somebody to have a simple old-fashioned conversation with a human being at the other end of the line.”

Dr. Hennessy believes the AI system will offset enough phone calls to free staff to spend more time with patients who truly need them. “We want to allow people to get the information they need when they need it, in the form they’d like,” he says. “For those who need to speak to a human, we’ll have enough people to handle that volume and really take care of those people well.”

Envisioning patient experiences

As a consultant practice, much of Ohio Gastro’s work involves faxed referrals from primary care and other doctors that it manually converts to data and enters into its EHR. The practice verifies insurance and patient demographics, and then the AI magic begins.

The AI engages the patient by text or email unless snail mail is requested. “We have analyzed and studied this for years and realize that if a patient has a cell phone and we have their phone number or email address, they’re more likely to come for their appointment,” says Dr. Reddy.

The virtual assistant allows the patient to schedule their appointment or contact a human. It generates appropriate consents, paperwork, questionnaires and directions to the facility, and then sends appointments and other reminders the day before the procedure. “It’s not 10 days before; it’s at the right time so the patient can remember what to do with it,” says Dr. Reddy, who believes the system will improve pre-op compliance. “For example, for a colon prep, I could send you a booklet saying, ‘At 3 p.m. do this, at 7 p.m. do this,’ but it is far better if I send a text message at 3 p.m. saying, ‘Do this,’ and another at 7 p.m. saying, ‘Now it’s time to do this.’ People seem to follow those directions a lot better than making the arrangements themselves.”

Communications go beyond words, as well. “Information is far better absorbed when it’s visual, as opposed to something you hear or read,” says Dr. Reddy. “People want pictures and videos. They seem to be far more responsive to those cues than old-fashioned cues.”

Postoperatively, the system again goes to work. “Say I order labs and X-rays for a patient,” explains Dr. Reddy. “Some patients will get them done, some won’t. For those who don’t, we are building another module where we will reach out through text message and email saying, ‘We have not received your labs and x-rays. Are you planning to get them done? If so, where are you getting them done?’”

Another example he cites is when a patient is diagnosed with colon polyps. The system allows Dr. Reddy to push out a text saying, “These are the things you can do to prevent having more polyps.” Or “We’ll plan on seeing you in three years for your follow-up colonoscopy.”

“We might send out a postoperative questionnaire to see how the patient is doing six hours after their surgery,” adds Dr. Hennessy. That feedback could prompt him or other clinicians to call the patient for a more in-depth human conversation.

You can fly all around the world without talking to anyone, but in most cases, you cannot schedule a colonoscopy or endoscopy without speaking with a human.
Raghuram Reddy, MD

The system’s conversational AI “chats” with patients through natural language processing, which enables it to understand words and phrases with which people are comfortable rather than forcing them to use clinical terms. It poses questions, guiding patients through dialogs to direct them to precise information they need. The AI is being built into the search function on Ohio Gastro’s website, as well as its new automated phone system, which is going online next month. “If you call our phone and the machine says, ‘Your wait time is four minutes, but press one to have a chat,’ it can then guide you to self-help if you don’t want to wait,” says Dr. Reddy. “If a patient is tired of chatting, keywords are built in where, when they say certain things, it automatically kicks the call to a human who will know where the chat was leading up to that, so they’re not starting the conversation new and the patient doesn’t need to explain everything all over again.”

The doctors and their vendor continuously monitor the system to ensure patient satisfaction. “The statistics it generates will tell us if people are getting frustrated, so we’ll know if we need to make changes,” says Dr. Reddy. Adds Dr. Hennessy, “The feedback we have gotten from patients has been pretty good, and we use it to try and hone the system to work for them. We want patients to say, ‘Wow, it was so easy to interact with your practice,’ or ‘Your practice was so efficient at getting me in.’”

Building targeted intelligence

QUALITY TIME The increasing use of patient communication apps and artificial intelligence platforms is being driven in part by a desire among both providers and patients to optimize the in-person time they spend together.

Ohio Gastro didn’t buy “out of the box” software. Instead, it worked directly with its vendor to implement functionality relating specifically to its operations. It requires significant work on Dr. Reddy’s end to maximize the platform’s capabilities and achieve his vision of directed self-service.

“I want my patients to hear what I think is appropriate, as opposed to whatever is out there on Google, as there’s a lot of bad information on the web,” he says. “All of this takes some intelligence in the background. We made a bank of hundreds of questions where patients can chat and interact with the AI with answers vetted and curated by us, so I know they get the right answers. We provide all the clinical content; the intelligence happens in the background via the Orbita team. We meet with them on a weekly basis and vet everything we’re doing with them.”

Adds Dr. Hennessy, “We wanted something that had intelligence in the background, so patients could ask questions and get reasonable answers instead of just having a list of FAQs.”

Dr. Reddy estimates the system’s automation of routine workflows can save 45 minutes per provider per day, allowing the practice to see more patients and potentially realize a seven-figure increase in annual revenue. “Every time we’re able to lower our no-show and cancelation rates, we add significant dollars to the bottom line,” says Dr. Hennessy. “You can fill your workdays much better if you have these tools available and don’t have barriers for patients to schedule themselves,” adds Dr. Reddy.

Dr. Hennessy says patients of all ages have largely embraced the AI system. “And if they don’t want to, we still provide an avenue for them through simple telephone,” he says. “My bias is not to push everybody to AI; you need to think of it as a tool.”

The doctors hope other GI practices can eventually benefit from their work with the vendor. “The problems we’re solving are applicable to other large GI groups,” says Dr. Hennessy. “Our patient populations have similar needs and wants. I think we’re actually at the tip of the iceberg.” OSM