A new range of digital assistants have been launched in New Zealand with the aim of easing the workload for healthcare practices.

The digital assistants from ProCare, the largest primary healthcare organisation (PHO) for the Auckland and Northland regions with 170 general practices, aim to relieve administrative burdens for general practices and include five “robots” that focus on inbox management and cardiovascular disease risk assessments (CVDRA).

The digital assistants are integrated with a GP’s inbox utilising robotic process automation (RPA), technology that enables configuration of software to capture and interpret existing applications for processing a transaction, manipulating data, triggering responses, and communicating with other digital systems.

ProCare general manager of strategic development Paul Roseman told Pulse+IT the technology interacts with the practice management system (PMS) following a pre-determined set of criteria to emulate repetitive and routine actions from rule-based processes that would otherwise be completed manually.

“Simply put, the technology can understand what’s on a screen, complete the right keystrokes, navigate systems, identify, and extract data, and perform a wide range of defined actions,” Mr Roseman said.

“But robots, or as we call them, digital assistants, can do it faster and more consistently than people, in some cases this is up to 60 per cent faster.”

Mr Roseman said the five digital assistants are capable of CVDRA, screening FIT to help manage bowel screen results, specialist referral acknowledgement to help manage CVDRA and automatic duplicate messages for specialist referrals, and inpatient updates, for managing communications from the former DHBs for inpatient care, and Covid-19 related tasks.

According to Mr Roseman, between 2017 and 2021, there was an 81 per cent increase in clinical inbox volume, with laboratory and radiology results and the addition of patient portal messages contributing to the administrative workload for general practitioners.

“Our focus with the inbox management package is to reduce the number of items clinicians need to review for greatest impact on time savings to reduce such administrative burdens.”

Clinical governance

Mr Roseman said clinical safety and governance was “paramount” to reduce unintended consequences of automated inbox management and to ensure good clinical practice was followed.

“When piloting this service, we focused on agile development in a test and learn environment to ensure we implemented robust clinical governance processes.”

To ensure important messages are seen by a GP, ProCare had enacted a number of safeguards including:

• Digital assistants co-designed with clinicians to ensure tasks are mapped correctly and follow up-to-date clinical processes or guidelines
• An algorithm built and tested in stages, first with historic data to understand how the algorithm interacts with the patient record and how it is affected at each decision point of the automation, then in a supervised ‘test-mode’ to understand how it interacts with practice data without changing or adding to the patient record. Finally, the ‘test-mode’ output is reviewed by each practice clinical lead to confirm the results before live processing.

• Consistent monitoring of digital assistant outputs to ensure it continues to ‘behave’ as expected and remains up to date with relevant clinical guidelines
• Ideation: understanding the quality of evidence available for each step in the proposed process
• Where applicable, the digital assistant is modified to file messages following preferences specified by the practice; for example, the message may be redirected to a nurse’s inbox in the first instance.

“Essentially, we’ve built clinical oversight into every stage of development to ensure the digital assistants are clinically safe and generate reliable efficiencies for GPs, thereby allowing them to spend more time with their patients and less time on administrative requirements,” Mr Roseman said.

“The nature of RPA means the robots only do as you programme them to, and, when they’re designed well, this results in reducing the risk of errors from manual handling and unintentional human omissions.”

Working with Indici and Pinnacle

Mr Roseman said the digital assistants are currently designed for use in primary healthcare practices that use Indici as their PMS.

“This is because we have found the use of a cloud-based system is most suited to ensuring the service can be scaled sustainability,” he said.

“Additionally, browser-based PMSs have consistency across their screened interface which means we can more readily standardise processes.”

Mr Roseman acknowledged “limitations to participation” in digital assistant use and said ProCare was “interested in exploring avenues to expand the service to cater to those using alternative PMS platforms”.

ProCare has been working in partnership with Waikato PHO Pinnacle to pilot the implementation of digital assistants in the Midlands region.

“Part of this process is identifying the differences in processes across regional boundaries and what effect that has on the design of the automation,” he said. “The service is also available to our own network of GPs and we have also offered the service to other PHOs.”

In-house development

ProCare initially completed an evaluation process of different RPA platforms to determine which platform to use for the service.

“Following this we completed an RFI process to explore the opportunity to partner with a supplier in the development of automated processes for our digital assistants,” Mr Roseman said.

“This process resulted in the decision to retain development inhouse, as we saw value gains from having a developer with extensive experience using Indici and existing relationships with our clinicians to support the facilitation of design and development processes.”

In addition to the inbox assistants, ProCare clinical digital assistant CVDRAs had “demonstrable impact on equity by improving screening rates and identifying at-risk patients earlier”.

Prior to launch, the robots were tested and put through their paces to ensure they could assist with assessments accurately and safely, he said.

“Throughout the trials, our robot worked across practices and assessed CVDRA results for more than 15,000 patients over five months. This contributed to reducing the number of overdue CVDRAs by 20 per cent or more for many practices in the trial,” Mr Roseman said.

The initial trial included 14 digital assistants, so Pulse+IT was naturally interested in which ones didn’t make the final cut.

Mr Roseman said ProCare’s development pipeline included a number of digital assistant designs which were awaiting enhancements before they can be deployed into live production.

He said such enhancements were required to ensure digital assistants were designed in line with the most up-to-date clinical guidelines.

One example was the cervical screening digital assistant, which was designed to file normal result messages and generate a recall in the PMS.

“Since developing this digital assistant, the national guidelines were updated to include the ability to self-test for HPV, which caused significant changes to the clinical guidelines,” Mr Roseman said.

Another example was the mammogram digital assistant that was also designed to file normal result messages and generate a recall in the PMS, following BreastScreen Aotearoa guidelines.

“During the testing phase our clinical review processes identified a significant portion of practices follow alternative recall processes for a selected group of patients and medical exceptions.

“Therefore, these digital assistants are on hold while we review and update the process algorithms to meet the updated clinical expectations.”

Feedback

Mr Roseman said ProCare operated the service with a “collaborative approach at the forefront” and was “consistently seeking feedback from clinicians to inform the development pipeline based on their experiences in practice.”

He said feedback had been “very positive” since implementing the service, providing examples including: “I love my robots; you miss them a lot when they’re offline” and “The robot technology is great. Thank you for pushing this. This is the future of our healthcare, and I would like to see more of this in different aspects of general practice!”

Mr Roseman said practices had been calling out for additional workforce support and digital assistants were “just one way we can help them”.

He said the robots didn’t need sick leave or holidays, were accurate and “work around the clock,” helping to improve efficiency in practices as extension of a practice’s existing staff, “giving clinicians time to focus on what matters, seeing patients face to face”.

ProCare group chief executive Bindi Norwell said the PHO’s ambition was for the digital assistants to help solve the increasing problem of long patient wait times and a lack of appointment availability.

She reiterated that ProCare was currently working with other key stakeholders to help expand the service to other platforms and regions.

“However, in the recent round of funding from the government, primary health organisations got a 0% increase in management fees,” Mrs Norwell said.

“This meant that innovations like this could be at risk and if the government wanted the likes of ProCare to continue providing such innovative solutions to help support general practices, then it will need to consider increases in the future for primary health organisations.”