Care automation — Hype or a healthcare delivery revolution?


In recent years, consumer expectations have changed dramatically across industries, healthcare included. Unfortunately, when it comes to meeting these new expectations, the healthcare sector has lagged other sectors, like retail and e-commerce. Some might say that healthcare is better at telling patients what they should do than engaging with them in a consumer-friendly way to improve their health. The good news is that human-centered technology has the potential to bring a consumer-centric experience to healthcare.

Becker's Hospital Review recently spoke with Ray Costantini, MD, CEO and co-founder of, about care automation and artificial intelligence. He shared how these technologies can improve patient access to care, help healthcare systems compete for new patients (and retain existing ones), reduce physician burnout and generate cost savings for health systems.

Shifting patient expectations are forcing health systems to rethink care delivery.

Whether consumers are buying products or services, they expect the process to be convenient, accessible and easy. This has not always been the case in healthcare, but in recent years, patients' options have broadened. In the past, people relied solely on physician’s offices and hospitals for their healthcare needs. Today, however, healthcare is no longer sequestered to traditional providers. Retailers like Walgreens, Rite Aid, Walmart and Amazon are all offering medical care to customers, as are direct-to-consumer healthcare apps.

"For the first time in my professional life, healthcare delivery systems are being forced to think differently about their competitive landscape," Dr. Costantini said. "New competitors are pushing healthcare systems to look beyond traditional approaches to care delivery. The healthcare sector is starting to think about the digital tools that are available, and the types of experiences consumers expect."

Healthcare can learn from ineffective digital transformations is other industries.

Historically, healthcare has been strongly anchored in its bricks and mortar infrastructure. The shift to a more progressive mindset is an interesting one. "It's kind of like watching Blockbuster evolve into the digital future," said Dr. Costantini. Blockbuster Online tried to use its bricks and mortar stores to position itself against Netflix. Consumers could reserve movies online and then pick them up at the stores.

"Blockbuster thought that process would be more appealing to customers than waiting for Netflix to mail movies to them," Dr. Costantini said. "I think, in some ways, healthcare is doing the same thing. Patients can register for their appointments online, but then they need to be seen in an in-person setting. Healthcare systems have a tendency to try and use the assets they have, rather than reinventing the care-delivery process."

Clinicians will adopt care automation and AI solutions when they are deployed thoughtfully.

Although healthcare has a reputation of being a lagging industry in terms of technology adoption, Dr. Costantini feels that assessment is unfair. "I think the issue is the way technology has been introduced into healthcare. Doctors aren't averse to technology…technology is accepted when it makes clinicians' lives better and simplifies the care delivery process," he said.

However, to date, many of the artificial intelligence solutions in healthcare have been built in ways that increase the burden on clinicians. For example, the data entry process for all patient visits has become onerous, yet the benefits are evident for only a small number of patient visits.

Dr. Costantini observed, "When I was a resident, there was an expression, 'When you hear hoof beats, think horses first, not zebras.' AI has been built in healthcare to identify, diagnose and treat zebras. Yet, 99 percent of care delivery is for horses. If a solution creates a burden for 99 percent of the cases and can potentially help 1 percent of the cases, clinicians aren’t likely to adopt it."

All clinicians want to deliver better care, but they're also drowning in work. They need to see far more patients each day than in years past. In this environment, the answer to driving technology adoption and user engagement is to use AI in ways that can streamline clinicians' workflow and make their jobs easier. This means organizing and displaying the information that providers need and making it actionable.

Artificial intelligence has tremendous promise for aiding medical decision making, but the technology isn't mature enough yet. "Before AI can be trusted with actual decision making, we need to prove that AI platforms perform consistently better than providers in the complex, real-world environment of patients," Dr. Costantini said.

He added, "Automation and AI are most valuable for repetitive, predictable tasks. There are many places in healthcare where automation can deliver information into the hands of highly trained providers, so they can make complex cognitive decisions and apply clinical judgment in the highest-value, most efficient way possible."

Ultimately, technology will increase access to care, while saving money and reducing physician burnout.

Most physicians enter the field of medicine because they care about patients and want to help them. Dr. Costantini shared that when he was a practicing physician, he wanted meaningful interactions with patients. However, he spent most of his time on charting, orders, prescriptions, referrals and other types of paperwork.

"When I started practicing medicine, none of the paperwork was digitized yet," he said. "When healthcare systems introduced electronic medical record systems, we actually saw a reduction in efficiency. This is unlike every other industry that has seen productivity improvements as a result of digitization."

Care automation and AI have the potential to liberate an ocean of clinician capacity. Dr. Costantini said that clinicians spend a significant percent of time on paperwork, data entry and administrative tasks, which isn't value creating. Automating that work offers a huge opportunity to improve access to care. This is the principal that's SmartExam virtual care platform is built around.

Dr. Costantini explained, "We have a significant shortfall of clinician capacity relative to patient demand in the United States today. This isn't just an American problem, however. Great Britain wanted to expand from a five-day-a-week primary care model to a seven-day-a-week model.
They couldn't because they didn't have enough clinician capacity."

The mismatch between patient demand and clinician capacity means that providers must be paid more in certain markets. Care automation and AI-based solutions could help address this supply/demand imbalance and reduce healthcare costs.

"Doctors and clinicians sell 20-minute increments of time, especially in primary care," Dr. Costantini said. "Patients who come in with a common cold get the same 20-minute block of time as patients with complicated medical conditions like diabetes or congestive heart failure. It's terribly inefficient. With care automation and AI, we can treat patients more quickly for common problems like the flu, a rash or a urinary tract infection. We can also speed up and improve the care for more complex patients. It's all about introducing efficiency and passing reduced costs on to the patients who really need and deserve that most.”

In addition, care automation and AI offer opportunities to reduce physician burnout because these solutions can reduce the technological and administrative burdens that clinicians face. They also can make it easier to care for patients with complex health conditions.

"If technology can reduce the time spent on patients with low-acuity conditions and reduce the administrative burden, clinicians will have more time and emotional capacity to spend with patients who really need it," noted Dr. Costantini.

Healthcare leaders recognize that automation delivers competitive advantage.

As hospital and health system leaders confront the new reality of nontraditional competitors and changing patient expectations, many are recognizing that their organizations can no longer stay the course with a "business as usual" approach.

One reason health systems have trouble capturing additional market share — by acquiring new patients and keeping the ones they already have — is because existing patients have to wait as long as eight weeks to get appointments. This has created opportunities for new market entrants to inject themselves into the relationship between providers and patients. Care automation represents a potential solution to this challenge.

Dr. Costantini sees a future for the healthcare sector where care automation becomes the norm. He observed, "Healthcare systems that can improve their efficiency 10-fold and also improve outcomes will enjoy a competitive edge and increased capacity. They will also provide better patient experiences. If we don't increase the efficiency of healthcare, we'll see a lot more care being delivered in places like Walmart. I'm not sure that's where our highly trained medical providers think the best level of care is going to happen."

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