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 After analyzing data from more than 150,000 encounters between
patients and the Buoy Health triage tool, researchers found that
nearly a third of users concluded after using the tool that their
situation was less dire and their need for care less urgent than
originally assumed. In 4% of cases, patients decided their situation
was more serious than they initially thought, according to the
results published in JAMA Network Open.
The researchers also found a reduction in the proportion of patients
who were uncertain about the seriousness of their health problem,
from 34% before using the tool to 21% afterward.
The new findings show the "chatbot can impact the care patients
intend to receive," said the study's lead author, Aaron Winn, from
the school of pharmacy at the Medical College of Wisconsin, in
Milwaukee.
Patients interested in learning more about their symptoms are led
through a series of questions by a chatbot that is designed to
home-in on possible causes. Along with the symptom questions, users
are asked to provide only their age and gender.
The developers were cognizant of the dangers of having the chatbot
dispense medical advice, which is why certain safeguards were
programmed in, said coauthor Dr. Bradley Crotty, also from Medical
College of Wisconsin. Crotty has served as an advisor to Buoy
Health.
"For 75-plus conditions that are too dangerous for a person to be
chatting with a computer for, Buoy automatically routes them to the
ER," Crotty said in an email. "For example, for someone coming in
with crushing chest pain, Buoy immediately suggests the ER as
opposed to asking more questions. These conditions are consistently
being monitored by Buoy's internal clinical team."
Currently a version of the chatbot is sold to health insurers and
self-insured employees, Crotty said. "Investors include Optum,
Cigna, Humana and F-Prime," he added.
To get a quick look at how the chatbot might be impacting people's
care-seeking intentions, the researchers combed through 158,083
encounters between the program and patients. The average patient age
was 40, and 78% were women.
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The most common organ system with queries from patients was the
reproductive system. That was followed by general symptoms and
gastrointestinal issues, the researchers found.
The most common symptom types were pain, abnormal functioning and
discharge. Most patients, 47%, using the chatbot initially thought
they should see a primary care physician, while 34% said they were
uncertain, 9% thought they should be seeking urgent care and another
9% thought they should be heading to the emergency room.
The researchers couldn't determine what the patients did after
getting an analysis of their symptoms. "That would be something for
a follow-up study," Winn said.
Dr. Gabe Kelen was both "excited" and "concerned," about the new
tool.
"I wonder, what is the business model for the company," said Kelen,
a professor and chair of the department of emergency medicine at
Johns Hopkins Medicine in Baltimore, Maryland. "Are they selling
this data to somebody? I wonder if patients are unwittingly putting
their health status out there on the internet."
On the other hand, "the exciting part is this technology probably
not only can't be stopped but also if properly developed and used
could be a disrupter in healthcare delivery," said Kelen, who wasn't
involved in the study. "I really like that and think it is the
future. In our department we have developed an electronic triage
tool. We looked at hundreds of thousands of cases and tested it in a
number of settings."
The idea behind the Hopkins tool is to ferret out the patients with
the most urgent needs for care, Kelen said.
SOURCE: https://bit.ly/2sf0met JAMA Network Open, online December
27, 2019.
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