Move over chatbots! It’s time to recognize that the smartest person in the room may not be the robot, rather patient experience creating a new type of dialogue through conversational AI. Conversational AI is a cutting-edge form of artificial intelligence enabling consumers to interact with computer applications the way they would with other humans.
Greg Johnsen, chief executive officer of Lifelink Systems, a technology company focusing on addressing people’s health concerns using conversational AI solutions, puts patients first. Greg is drawing on his more than 30 years of software, technology and health expertise to keep the patient at the center of innovation and the care conversation. Medika Life spoke with Greg about his vision for putting technology to work to improve people’s health experience and access to care.
Gil Bashe: Tell me a bit of your vision, why this suite of technologies, and what problem did you want to leap into and solve for people who have pressing health needs?
Greg Johnsen: There’s an emerging class of technology that’s explicitly focused on patient and consumer experience. Conversational AI (artificial intelligence) has two sides; one side of that technology is all about consumers’ huge problems engaging with healthcare organizations in the digital space, whether it’s waiting for somebody online while on hold or trying to download a specific kind of app that is needed for this particular kind of visit and learning how to use it, finding it, and remembering to set up a username and a password, and not knowing how to do that.
The other side is that healthcare organizations have a massive problem delivering that kind of technology. It’s hard. It’s a complex technology and many of these organizations are very strapped for the resources and the capital to spin up these kinds of elegant modern, patient experience technology layers.
Bashe: This nation’s health system is incredibly fragmented. Navigating between a physician, a payer, and a pharmacy. How do you begin to navigate such a fragmented system? How do you make those connections? And what’s your thought about making the pathway easier for the consumer?
Johnsen: Some of it is the modality itself. Suppose you think about the things that frustrate consumers when dealing with or engaging digitally. Things like setting up an account and getting a username and password. These chunky sorts of frustrating things make the log-on process simple if you just took them and went horizontally. That would be a huge win or just making the download experience disappear.
However, the other side is just the healthcare system or the organization side. They don’t have the people and human brains at scale to have the conversations to connect in real-time with people. We have to find a way to make the rules, smarts, understanding referrals and prescription pickups and questions that a consumer might have about dosing and make those kinds of conversations asynchronous. They can happen anytime; they don’t have to be real-time with them and driven by artificial intelligence. I’ll say automated, and that’s key because there’s no way you’ll get the coverage to give immediate, easy, convenient access to consumers unless you find a way to multiply the workforce by 10, even 100 times.
Bashe: When we deal with something so critical as our health needs, the process should be easy. Why is it so hard for patients who are, in theory, the customer of the system? Why is it that the system is the customer of itself?
Johnsen: Let’s face the music here a bit. That kind of experience is not new in the consumer world. There are industries where, whether it is entertainment, travel, finance, or banking, you are starting to see 24/7 available digital conversations. It can be as easy as chatting or texting with a friend. One of the barriers to the massive change in the patient experience is the healthcare organizations beginning to realize just how strategic and game-changing it can be.
The technology is around. It’s not like we have to spend a decade inventing the technology. There are companies, we are one of them, that have the infrastructure, tooling, services, know-how, and patterns to make big chunks of this work. Healthcare systems, health providers, and healthcare organizations have to get to where they see this as a strategic imperative. I believe that if you aren’t focusing your treasure and your strategic intent on creating this seamless digital experience for your consumer or patients, you are going to lose.
Bashe: I have to say the health system is a system and a culture; that culture crushes innovation. The health system is resistant to change. You just said that all the technologies exist. Can you talk about some of the technologies you are harnessing to work with the more progressive-minded clients in your portfolio? What are the tools of technology that Lifelink Systems deploy that make a difference in this interaction between the consumer, their wellbeing, and the help and care and information they seek?
Johnsen: The first thing I’ll say about some of this infrastructure is that in our case, we made a significant commitment that the place to land to the consumer is the mobile phone. That supercomputer that we all have in our pockets, that we are on 3 to 5 hours a day. What we are doing on that thing is texting and chatting. The time a consumer spends on a messaging app is now more than they spend on a social network, so it’s language based.
The technology is language-based conversation engagement on a mobile phone with little to no friction in terms of how you get there. That technology is super helpful in pre-visit prep, appointment reminders, and intake cases. We are doing this at scale, and we are doing this with health care systems and life sciences companies. We have millions of patients who get a text message with a link they click on three days before their appointment, the conversation starts, and it can happen any time they are ready. Instead of getting to a clinic or waiting room where you sit and get a clipboard with papers that you fill out, all this can be done ahead of time virtually with digital assistance.
The mobile phone becomes the worker, and it’s not like the healthcare system gave the patient a bunch of work to do; they sent out a digital worker to help do the job. That technology is conversational, mobile, workflow-based and straightforward, meaning the system knows what’s next. All that knowledge must be in the system to feel like intelligence, but it delivers value to the consumer.
Bashe: The whole vision around consumer experience with medicine is going through a bit of a shift. We are talking about diversity and inclusion. We are talking about senior disparities. We are talking about the future of drug development. Conversational AI has tremendous potential. Do you see conversational AI making remote participation in clinical trials more feasible? How do you see diversity and inclusion cascading? Even more concern for many is senior care. Where do you see this going in the future and making medicine friendlier and more accessible?
Johnsen: You just described another zone of medicine and healthcare where friction is the biggest enemy. You think about drug development and clinical trials, the tens of thousands of people that need to be relocated for a clinical trial not just for one moment, but for many moments over many years in some cases. One of the most telling statistics for clinical trials is the cost that manufacturers and CROs ensure between enrolling a subject into a clinical trial and that subject’s first office visit; sometimes, 50% or more drop out.
Somebody takes the time to find out about a clinical trial, fills an enrollment form, and nobody talks to them for the next 5, 7, or 10 days. It’s all about how you connect with the patient. How do you onboard them? How do you give them this modern experience to feel connected, held, graduated, and guided through this process. Today it’s primarily people, and it’s people calling on phones trying to catch these participants and find them. The answer is digital – mobile and conversational.
We see many opportunities for conversational AI and mobile phones in clinical trials, and in rare drug specialty patient services, hubs where connecting with the patient is critical.
Bashe: During the high of the COVID era, many clinical trials collapsed. Neurology trials and oncology trials did continue but at a significantly reduced rate. Clinical sites have felt concerned or confused about decentralization and remote patient participation. The drug development system was based upon sites and contract research organizations having special agreements with sites. Does conversational AI again expand the influence of set sites to be set and remote? What’s your perspective on that in terms of decentralization and the future of hybrid?
Johnsen: Any interaction, conversation, or protocol that is defined and can be executed by a human is a candidate for a digital equivalent. That goes from scheduling to answering questions to informing consent and collecting data. All these interactions should have a shadow digital equivalent story. The degree to which a site takes advantage of this infrastructure or not depends on the protocol, timing, and sponsor; there are two giant gears at play here: humans and physical sites.
The digital shadow that can handle most of those conversations and those flows can go to the patients wherever that subject is, and then the in-between is humans going to the home. Nurses are deployed to do the blood draw or make it super convenient when the clinic comes to the home, but why not do the intake before the nurse gets to the home? Why not deliver the test result with a digital conversation after the nurse has been at the home? Hybrid is the right concept, but you need the right conversational infrastructure to properly adjust the various digital dials along the care spectrum.
Bashe: Who sets the dial? Is it the site, is it the participant, is it mutual, or is it the trial’s sponsor?
Johnsen: I imagine that at the end of the day, the sponsor is driving and is on the hook, for ensuring that the clinical trial is executed correctly and that it does move through the approval process, and one of the significant inputs to that successful execution is a burden on the site, patient, speed, getting through there and getting high-quality relevant data. Not just the data on the clinical trial itself, but patient experience data so your subsequent clinical trial is better informed and more efficient. Sponsors need to go through their evolution because it’s about to get more complicated. The opportunity is enormous to get super-efficient and great at data collection so that you can transform clinical trials.
Bashe: Many people think of chatbots or conversational AI as the perfection of the voice instead of the epitome of the interaction. When you say conversation, you also mean connection. Is that correct?
Johnsen: Once you know where you are headed, you can begin to test what kinds of interactions and dialogues are most effective for the patient in getting to that outcome. It is open, fascinating stuff, and all these little things that feel stylistic add up to make a difference, and we have seen these things make a difference.
We found out that it is more effective in digital conversion than giving somebody the complete form where you ask all the questions at once. People stay engaged in that dialogue form longer and complete the workflow, even if it takes longer than in a platform where they see everything at once. That flexibility is critical, and it’s hard to do with a portal, an app, or even by a human.
Bashe: There seems to be a real differentiator here. The emphasis is on technology supporting the journey, not technology as the offer. Can you share a brief story about a customer saying, “I get the fact that the experience the consumer will have through this journey is a reflection on me; it speaks to what our brand and our corporate image is about?” Can you share any insight where a customer says, “we need this because this truly reflects who we aspire to be in the healthcare system?”
Johnsen: We have a customer in the specialty pharma space, and they are a leader. Every time a patient is prescribed one of these costly therapies somewhere along the way, the manufacturer will invest a fair amount to ensure that the consumer gets the support they need.
To get through all the financial hurdles, get to therapy, and start getting well again. This customer took our technology and gave it a persona that reflected the values of their call-center team, like another agent. They gave her a name. She is the one that meets the patient on their mobile phone when that patient gets prescribed medication, and she lets the patient know all the work she is going to do for them, all the work she can perform, what she is available for, she understands how they want to be engaged. I think that persona found a way to create the essence, and the language, and the feel of the service in the way they wanted.
That would be tricky in traditional digital approaches because the technology has to have enough skills to make adjustments. Still, also, she is evolving; she is getting new skills, she started doing a particular set of things, and now she is doing more things. She is front and center for the company because she exudes the brand, feeling, and personality.
Bashe: Let’s look a little bit into the future, but not too far. Six to twelve months down the road, conversational AI is making such a significant headway, and we talked about some of the places where you and your community are helping the health system make those advances. We spoke about provider systems, specialty medication groups, decentralized clinical trials, and pharmaceutical industry sponsors and where this is going. What is the next segment, the next innovation advance you see down the road?
Johnsen: it is less about creating something new. There is a lot of innovation in tech available, and even today, the healthcare systems, pharma sponsors, and CROs, are just on the first pinning. We will see a new set of metrics arrive: what percentage of your total interactions with patients, customers and subjects are digital? How many digital conversations did you launch this year? And what you need to see is a universe in which you are getting a massive scale in which 80% of your interactions are digital, but your total number of interactions is 10 times what they were before.
We see innovation already. Healthcare systems, pharma companies, insurance, employers, and all these sectors that deal with consumers in healthcare need to amplify their digital conversation envelope by orders of magnitude.
Conversational AI is transforming many industries into customer friendly conversations and connections – travel, finance, consumer sales and finally health. Face it. It is still easier to order a pizza online than make a doctor’s appointment. Through conversational AI, Greg and LifeLink Systems are helping patients describe their symptoms through a series of questions meant to navigate around wait times obstacles. Will the health ecosystem suddenly become easier to engage? Will patients be directed to the right medical experts to resolve their concerns? That is exactly what Greg and his colleagues are working to achieve.