Banner Health is using “chatbots” in some of its EDs to help guide patients through the care process and improve satisfaction. Patients can interact with the chatbot in a conversational style on their cellphones to ask questions and stay informed about schedules, lab statuses, and other aspects of their experience.

The chatbot can communicate in English and Spanish. (Editor’s Note: Banner Health uses text-based chatbot technology provided by LifeLink in Oakland, CA. Similar chatbot technology is available from other companies, including LivePerson in New York City and Ada in Toronto.)

The health system tested the technology in a pilot project at one ED and expanded the program after receiving a good reaction from patients, says Jeffrey Johnson, vice president of innovation and digital business with Banner Health, based in Phoenix.

At a Banner Health ED, patients are offered the opportunity to receive updates on their cellphones at check-in, Johnson says. Those who accept receive a one-click activation text message that establishes a secure HIPAA-compliant connection to the chatbot, which then automatically provides updates and information to patients through conversational messaging that appears similar to texting.

“The initial testing with our customers yielded a very positive response, so we were optimistic about rolling it out more in our system. We were excited to see that we immediately were getting the same gains we had achieved in the pilot project in terms of engagement and customer satisfaction,” Johnson says.

“We’ve now rolled it out to all 28 of our hospitals,” Johnson adds. “It’s become a normal course of business for our emergency rooms and how we engage patients when they come in.”

Integrated With Medical Record

The chatbot usually interacts about eight times with each patient during their ED visit, Johnson reports. The chatbot is integrated with Banner’s electronic medical record (EMR), which provides the chatbot with real-time updates that are personalized to the patient.

The conversations include the opportunity for the patient to provide feedback, which is used to monitor patient satisfaction and identify opportunities for improvement, Johnson says.

Banner has seen improvements in its Net Promoter Scores (NPS) since adopting the chatbot technology, and Johnson says hospital leaders are optimistic they will see improvements in HCAHPS, ED-CAHPS, and other benchmarks.

“We do a survey after every interaction with patients and measure the satisfaction with that. It’s all trending very positive, and we anticipate that our scores will align well with what we’re seeing in the surveys post-engagement,” Johnson predicts.

“We will start doing some comparative analysis among hospitals and better understand whether we’re having higher impact on some of the busier urban hospitals,” he adds.

Johnson says the most promising part of the project is the chatbot gives Banner Health something to build on for improving customer satisfaction. Providing a chatbot option for emergency patients is only part of what Banner Health leaders plan for improving the patient experience, he says.

“We’re looking to extend [patient engagement] by looking at how patients first start searching for an ED online, and our option to start the registration process online before you arrive,” Johnson explains.

“We have that option available at about half of our hospitals, and we’re getting very good feedback from patients on that,” Johnson continues. “People like to tell us they’re coming in. The next step might be to use the chatbot technology before they even arrive, providing them with a map to get to the hospital, information on wait times, a picture of the entrance to the ED, where to park, how to get to registration.”

Extending to Post-Discharge

Banner Health also wants to extend the idea to the post-discharge period, with the chat technology helping patients obtain prescriptions, lab results, follow-up appointments, and other information after leaving the hospital.

“We want to connect the entire journey with this digital assistant that is there with you at the right times, telling you the next steps in your care journey,” Johnson says.

One challenge for Banner Health was the integration of the chatbot technology with the health system’s Cerner EMR. Banner Health had never integrated a customer-centric technology with the EMR. However, the integration was key to making the chatbot useful and providing patient-specific information rather than just general updates and advice, she says.

“Part of the value of the chatbot is giving you personalized information by connecting right to orders and statuses that are relevant specifically for you. That makes the conversation relevant to your personal experience and far more helpful than generalized information,” Johnson explains.

“It has far more impact on the patient experience to tell them their next step and how to get to that department, rather than a general announcement to everyone in the waiting room about the wait time or how the process works,” he continues. “People respond to information that is about them personally and makes their experience easier.”

The other challenge involved how to socialize the technology with ED staff, Johnson says. The chatbot represents a new way of interacting with patients. Although the effects are positive, any change in such established routines can be difficult for staff.

“There was change management training that had to go on with the front desk and with clinicians so that they were aware of what the customer was experiencing with the chatbot,” Johnson says. “It wasn’t overwhelming, but it has to be anticipated as part of introducing a technology like this that changes how people interact with one another.”

Ask Patients for Design Input

Johnson says the chatbots are not intended to replace any personal interaction with staff. The technology actually improves the value of interaction with staff by helping keep patients informed and lowering anxiety about the ED visit, he says.

Hospitals should work with patients to help design a chatbot program, Johnson suggests. Banner Health solicited patient input on the design of their ED chatbot.

“Verify that the technology is going to do what you want it to do and have the positive impact you’re seeking. Model out the prototypes, and ask the customer if this input is helpful or not, whether it improves the patient experience,” Johnson says. “Don’t assume it will just because you think so. Any new technology like this has the potential to be really valuable to the customer, or it can potentially be annoying if it’s not giving them what they need.”

Banner Health also is in the early stages of implementing a chatbot that helps with annual health risk assessments for Medicare. The early experience with that pilot has been positive, Johnson notes.

“I really think digital assistants and conversational bots can have a huge impact on the customer experience. We look at them as expanding and reinforcing the face-to-face interaction with our staff,” he says. “As confusing as healthcare can be, we see that patients appreciate this second level of support and guidance. We’re just tapping the potential of these conversational bots in healthcare.”