ChristianaCare, a Delaware based healthcare organization, is making some big bets that digital transformation will remake existing models and create one that revolves around the patient.
We caught up with Randall Gaboriault, chief digital and information officer at ChristianaCare, to talk about the intersection of digitization and healthcare.
Voice and Amazon's Alexa as a gateway to healthcare. ChristianaCare has built out Alexa Skills for patients so they can recover at home. The bet is that voice communications with digital assistants will be critical to patient care. Gaboriault explained:
We know voice is going to become the most common pathway for interaction with patients. And the reason is obviously it's the most natural way to interact. And as we think about how we can use voice to allow the patient to communicate in ways that are natural from a process perspective and even using the language that's natural for them. Then you start factoring in things like the percentage of search each year, that's gone up in terms of mobile and then voice-driven search. Sort of the trade winds are moving that direction. So as we thought about sort of the portfolio of capabilities that we want to start introducing for patient-level interaction and even clinical interaction, we've directed a lot of that energy around voice capability.
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Is Alexa natural enough right now for patient care? Gaboriault said:
Let's say the trajectory with which things are moving and the accuracy level that we're at today, it is really close. Over the next three to five years, we're going to have an accuracy level that is so high that, we'll have, the clinical language and it knows things about measurements, different therapeutic regimen names and things like that. For what we're doing, yes, voice is good enough. It's adequate and it's sophisticated enough, but it's also familiar enough for people to be able to sort of naturally interact in a way that feels so comfortable with them.
HIPAA. Gaboriault said ChristianaCare started its Alexa Skill journey before Amazon was able to do a business associate agreement, which is a HIPAA rule set. Once Amazon was able to support information in a HIPAA compliant way, Alexa Skills became a good option.
Use cases and Alexa as a home care coach. Gaboriault said a common use case for Alexa in healthcare is one as a home care coach. For instance, a knee replacement patient can go home to rehab and Alexa serves as a caregiver and assistant. Gaboriault said:
Envision you're sent home and day one, a home health nurse shows up and they're doing physical rehab. They're getting you started, they're getting trained on your exercises. They're doing those exercises with you. And under the normal course of action, you would do some exercises. And that home health nurse doing the PT work would return perhaps the next day, depending on the acuity level and what your needs were, maybe at 48 hours. But instead, we now supplement that nurse, that PT therapist with Alexa. And Alexa, you can engage with and say, "Hey, Alexa, what are my exercises today?" And Alexa can begin to say, "Well, your care plan specifically calls for day one. We want you doing 25 steps." And then it's day two, "Hey, Alexa, what are my exercises?" "Oh, we need you to do a right flection," or this sort of therapeutic move.
And it can explain to you how to actually do those exercises. Raise your arm, move your knee, do this sort of thing. Oh, it's day three. "Alexa, what am I exercises?" "Today, we want you doing one flight up, one flight down." And then envision the ability to say, did you successfully do that flight of steps? Did it hurt that it hurt the inside of your knee, the outside? We can begin this conversation, this dialogue. So we're what we define sort of, I'll say, just we're really just scratching the surface in terms of the capability that we can bring.
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All care will be digital care in the home. Gaboriault said:
All care will be digital, except that which cannot be, and all care will be in the home, except that which cannot be. That drives our thesis to build these capabilities into a scenario where it matches the life flow and the location where the patient wants to be.
Gen one is that the care plan is loaded in kind of a push fashion. Gen two begins to capture this concept of taking feedback. Gen three is where we actually do things like say, "Now it's time to change the dressing around the wound."
Now here's what your wound should look like at day three. And you know what, let's undress your wound and take a picture of it. And then it gets sent up into our environment and AI will look at it and determine, is there something risky here and then hand off to the patient.
Today, Alexa and digital assistants are first generation when it comes to healthcare, but Gaboriault said there's progress in building a "digital care pathway" that sets up the future and natural discussion between digital assistant and patient.
How digital changes the healthcare model. Gaboriault said digital transformation in healthcare is accelerating. He said:
We know that the economics of care already don't work. When we look at our unit costs to produce care, and we look at the model under which we're building physical real estate to push patients through into that model it's clear that once you build four walls, you've actually created a constraint. And so our view is, as you build virtually and digitally, you have the sort of unlimited sort of capacity in terms of, and then the cost to add a marginal sort of patient into that model is extremely low. So by going virtual and digital, you unlock capacity, you then don't require patients to necessarily move and orchestrate around the care system.
He said healthcare today is orchestrated around the reimbursement flow and then the provider flow. The patient is last.
"Our thesis is we can change the access model. We can align it with the life flow of the patient. We can deliver care where it needs to be done, and we can do it in what we believe is a high tech, high touch fashion by doing this work digitally and reducing the unit cost to produce a healthy outcome," he said.