In a 2019 article in the Journal of Medical Internet Research, investigators presented the findings of a web-based self-report survey of 100 physicians who were asked to give their opinions about chatbots, software that simulates a conversation with human beings through voice or texts. For the most part, providers indicated that they liked the idea but are highly skeptical the technology can provide anything more than general patient education. Three-quarters of respondents doubted the ability of chatbots to provide comprehensive diagnoses and think chatbots pose a risk to patients who might use them to self-diagnose.
Chatbots, however, are not meant to replace human beings. Instead, the technology is being used successfully in some practices and hospitals to augment patient education and compliance, improve communication between healthcare providers, and to supplement ongoing professional education and training among healthcare providers.
Physicians could look to chatbots to make themselves consumer-friendly. According to a recent article in Forbes, more than 50% of Americans have interacted with this technology in some form over the past year, mainly for customer care. Among people aged 18 to 34 years, more than 70% indicated they would like to use chatbots to interact with businesses, particularly for routine tasks like updating an address or checking an account balance. In healthcare, chatbots can be used to collect data, reinforce education, provide reminders, answer questions, and walk patients through pre- and post-operative care.
“Within 10 years, chatbot digital medical assistants will be a routine part of healthcare,” said Carl Black, MD, co-founder and medical director of Provo, Utah-based TXTONOMY, which provides medical chatbot services. Medical chatbots like those provided by TXTONOMY are well-suited for practices and medical conditions that are challenged by low compliance rates, Dr Black said.
“This could be because of patients’ lack of understanding or motivation,” he said. “The sheer volume of materials some patients have to learn can be overwhelming. Chatbots give it in smaller bites and reinforce concepts the doctor wants them to understand.”
If a practitioner already has good information on a website, a chatbot can link to that content. It can also be integrated with electronic medical records (EMRs). Moreover, depending on the specific application, it can meet the requirement of a quality improvement tool under the Medicare Access and CHIP Reauthorization Act (MACRA) and Merit-Based Incentive Payment System (MIPS), he said. Some have analytics that show how patients are interacting with the tool.
Valley Women’s Health, a large obstetrics and gynecology group based in Provo, Utah, is among the medical practices that have had success using a medical chatbot. The group has more than 300 current patients using the TXTONOMY medical chatbot platform and has received positive feedback from users, said Scott Rees, DO, who helped set up the obstetrics chatbot application. Patients are provided information about the chatbot during their first obstetrics visit. Thereafter, information is sent through the chatbot at relevant times during each trimester.
The chatbot can provide information about pertinent exercises, good nutrition, or upcoming visits, such as what to expect during an ultrasound. The chatbot educates patients about important signs and symptoms, such as whether they are experiencing bleeding or headaches. Depending upon patients’ answers, the chatbot sends them down different informational pathways or directs them to call the office. Patients can also type in a keyword like “cramping” and receive additional specific information.
At Valley Women’s Health, providers can create their own program so they control the information patients receive, a feature Dr Rees appreciates because of his ability to manage patient education. “It’s like parenting,” Dr Rees said. I’d rather my kids learn things from me than their classmates. We give information we would like them to know because if they don’t get it from us, they will get it elsewhere.”
Chronic disease management
Medical chatbots can be used to facilitate care in patients with chronic, complex, and life-changing conditions such as cancer, diabetes, multiple sclerosis, rheumatoid arthritis, and inflammatory bowel diseases. They also can help patients lose weight and prepare for and recover from bariatric surgery. In orthopedic surgery, the TXTONOMY platform has been used to enhance pre-procedure education and assist in post-operative recovery. Medical chatbots can be used to help patients understand their prescribed medications. If patients are prescribed an opioid, a chatbot can provide information about the purpose and risks associated with the drug and how to decrease the likelihood of addiction.
In addition, chatbots can cut down on unnecessary patient calls to a practice. Dr Rees said his group noticed a dramatic reduction in calls to their nurses after initiating their chatbot program. Dr Black related that medical practices that use the TXTONOMY platform have experienced up to a 30% reduction in call volume to the practice from patients requesting redundant information that should have been provided during routine office visits.
“Sometimes the patients just can’t assimilate the full scope of material they are provided,” Dr Black said. “Getting a new diagnosis or managing a chronic medical condition can be dramatic and they can’t always initially process [the information]. A chatbot helps them understand over time and reduces the number of phone calls and staffing to required re-educate.”
Lighter physician workloads
Chatbots can also be used to lighten physicians’ workload. Northwell Health, a large, integrated health system in New York, has been piloting chatbot programs to understand how it can best be used in a hospital setting. Michael Oppenheim, MD, the organization’s chief medical information officer, said the biggest driver for their implementation is that EMRs have become a “very heavy, complicated tool burdened with lots of administrative functions.” The chatbot allows doctors to perform a subset of functions on a mobile device without being tethered to computers, such as information collection and passing data to other physicians.
The Northwell application allows doctors to remain focused on patients, instead of a computer screen, Dr Oppenheim said. It has taken some time to get the program up and running, and Northwell soon plans to expand its chatbot program to assist nurses and patients during hospital stays. Although chatbots have many potential uses, providers need to start small, he said.
“Pick a problem to tackle and focus on that,” he said. “You need a core problem to solve. If you try to address all user groups and user cases at once, you can end up with a program that is a mile wide and a centimeter deep.”