There is no way around it — health systems are facing an ongoing shortage of clinicians to meet the needs of patients who require longitudinal care management. “You can never hire enough clinicians or providers today to do outreach and connect with people,” says Mark E. Schario, MS, RN, FACHE, president of University Hospitals Coordinated Care Organization in Cleveland.
Also, care managers might fail to reach patients despite making tons of phone calls. “It’s very satisfying when you talk to somebody and help them. But it’s very frustrating when you can’t make a connection, especially when you are first engaging with somebody,” Schario laments.
Chatbot technology turned out to be at least a partial solution to all these problems. Patients now receive a text message every day, or every few days, from chatbots after they are discharged from the hospital with specific chronic conditions (e.g., stroke, asthma, congestive heart failure). The chatbots ask about the patient’s weight, blood pressure, and self-care behaviors.
At first, the mere mention of chatbots sparked multiple concerns among staff. “Not all the staff were big fans of the idea,” Schario reports.
In actual practice, the situation turned out positively. The care managers ended up freed from trying to reach patients, often unsuccessfully, which led to more quality time on high-value interactions that required clinical judgment. In several cases, chatbots made all the difference in a patient’s care. “The technology provided the right assistance at the right time to really change the course of their illness,” Schario says.
With chatbots, patients answer important questions at any time. If everything is OK, the electronic medical record documents the interaction as “green.” If the situation is concerning, it is coded as “yellow.” In that case, a care manager is alerted to follow up right away. If the chatbot is coded as “red” (or if the patient clicks on a phone icon), it immediately transfers the call to a 24-hour nurse advice line.
Previously, ED visits and readmissions were happening specifically because patients were lost to follow-up. “We are not going to be able to hire enough people to meet the demand. We really need technology to help with that,” Schario says.
At first, some staff made comments like, “No one’s going to want to talk to a machine.” That concern was unwarranted.
“We need to give the older generation credit for being tech-savvy. We have such a variety of patients who you might not think would be engaging with a chatbot, but they do,” says Carol A. Bahner, BSN, RN, CCM, manager of care management in Population Health at University Hospitals.
It turned out patients appreciated receiving these daily check-in texts. “An 80-year-old might not be as tech-savvy as a 20-year-old, but is certainly comfortable emailing and texting,” Bahner says. “Society is so much more comfortable using AI than in the past. It will be the norm in the near future.”
Care managers can intervene faster, which helps morale. “If staff are not feeling they are making a difference in the patient’s clinical outcome, that can lead to burnout,” Bahner says. Previously, care managers would finally reach a patient and everything was fine, but then the patient needed help the following day when staff did not call. “In a busy day, the chatbot helps bring people to your attention who need help,” Bahner says. The department is planning to expand the use of chatbots to include transitions of care for people moving from an acute to ambulatory environments.
“This is where people are at today. They want short, crisp interactions,” Schario says. “The possibilities of using a chatbot to assist with care are limitless.”
REFERENCE
- Schario ME, Bahner CA, Widenhofer TV, et al. Chatbot-assisted care management. Prof Case Manag 2022;27:19-25.
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