Providers should deploy automation as a tool to deliver on their strategic goalsbroadly rather than limiting their focus to cost reduction. Automation can improveefficiency by reducing per unit costs. But taking a problem-oriented approach –targeting point solutions to individual, inefficient workflows – guarantees that thebenefits will not extend beyond the endpoints of those problems. It constrainsboth the use case for and ultimate impact of automation.

Providers that look at automation as a means of improving user experiencebroaden their opportunity for impact. These providers are using the sametechnology to address both the process and people sides of their greatestambition: delivering high-quality, low-cost patient care. The result? A betterpatient and provider experience in addition to streamlined workflows andfinancial benefits. In other words, they get a bigger bang for their buck.

Taking a goal-oriented approach forces providers to look beyond the back officetoward improved experience for patients, staff, and clinicians.

Improved patient experience
Every provider we spoke with pointed to a service like TurboTax or online banking and said,“we should be able to offer that kind of experience.”

This user-friendly experience was Intermountain’s goal: after working for two years onEHR-based solutions to try and increase the completion rate of patient intake forms,Intermountain achieved only an 11% completion rate. Automating the patient intakeexperience – including extracting information from the EHR and auto-populating it for thepatient to sign off on, rather than manually input – increased that number to 70%.

Offering an integrated, seamless experience has multiple downstream benefits. Takingpatient registration as an example, successful registration improves patient satisfaction andretention, both of which have positive implications for clinical outcomes. It’s associated withdecreased denials, which means a healthier revenue stream and less downstreamadministrative work. And making the registration process user-friendly removes barriers topatient access. Deploying automation to improve experience yields holistic returns.

Lowell Community Health Center focuses on patient experience to improve access and health equity
Lowell Community Health Center, an independent FQHC1 serving Lowell, Mass., isusing intelligent automation to improve access to care for all patients, regardless ofdemographic or socioeconomic background. Lowell CHC serves a diverse community:40% of its patients are best served in one of over 60 languages other than English,including Spanish, Portuguese, Khmer, Swahili, Arabic, and Vietnamese. The systemrelies heavily on community health workers (CHWs) to engage patients outside thewalls of the health center. With a growing patient population,

Lowell CHC needed asolution to scale the capacity of each CHW while preserving their ability to cultivatepersonalized relationships.Lowell CHC invested in an intelligent automation solution to streamline patientregistration, from anywhere. So far, it has used the platform to facilitate patient intakeand maximize registration for COVID-19 vaccines among under-represented groups.Consistent with its commitment to health equity, Lowell CHC has deployed theplatform in multiple languages to best engage its community members, minimizelanguage- and ethnicity-based health disparities, and improve population health.

Since deploying the intelligent automation solution, Lowell CHC has seen an increasein digital patient engagement, including successful completion rates for end-to-endregistration and scheduling.

"Traditional workflowshave been one of thebiggest barriers topatient access. If wecan’t meet our diversepatient needs, we willnever deliver on ourpromise to provide anequitable health caresystem."

Brenda Rodriguez
CFO/CSO, Lowell CHC

Improved staff experience

Documentation burden is one of the primary drivers of staff dissatisfaction, burnout, andultimately turnover. Not only does it involve ample below-license work, it distracts from patientcare. Our research contacts pointed out that provider organizations regularly have over10,000 work queues in their EHR; there are hundreds of acceptable ways to denote “take onetablet by mouth daily” and over 80% of EHR data is unstructured. There are terabytes ofinformation inundating staff every day, but it’s nearly all noise and very little signal. Staff-facingintelligent automation can minimize the number of manual touchpoints required pertask across each use case. The result is staff and clinicians working at top of license.

Staff experience-driven use cases for automation

Ultimately, these are three flavors of the same thing – the same technology applied tomeet individual stakeholder needs. Taking a goal-oriented approach doesn’t mean providerorganizations forego the financial benefits of automation. Rather, it means they’re notlimited to them.

Even when providers deploy intelligent automation as a tool to improveexperience, they don’t always measure it that way. Many providers are stuck inthe mindset of “returns” referring exclusively to financial outputs.

If providers deploy automation to improve experience but exclusively measuresuccess in terms of cost savings, their efforts will meet the same fate automationinitiatives often meet of “death by pilot.” Providers need to assign metrics thatreflect the broader, more transformational ambition they set for intelligentautomation in order to quantify a true return from the get-go.

Approaches to measuring ROI when automation is deployed to achieve broad aims

Because most provider organizations are not yet deploying intelligent automation witha broad ROI in mind, there aren’t industry standards to follow for measuring impactbeyond financial return. But we’ve compiled a starter list of the kinds of metricsproviders need to track when deploying automation to meet their strategic goals.

Sample metrics to holistically evaluate impact of intelligent automation

• Patient/staff satisfaction
• Patient/staff engagement
• Patient leakage
  
• Adherence to care protocols
  
• Drug prescription fill rate
  
• Patient form fill rate
  
• Copay collection rate
• Staff turnover
  
• New patient enrollment
  
• Clinician panel capacity (e.g., care coordinators)
• Clinician hours spent on documentation
  
• Staff time spent on basic data entry
• Duplicative patient outreach
  
• Erroneous patient outreach
  
• Care gap closure
  
• Avoidable acute care use
  
• Medication errors
  
• Adverse drug event

By taking this approach, provider organizations have achieved robust outcomes to serve a range of strategic goals.

Provider leaders who ask “how many positions can I cut by using automation?”are asking the wrong labor question. The right question is, “how much morevalue can I get out of my employees?” The answer is “a lot.”

The notion that bots and humans have an either/or relationship isflawed. Automation technologies are most effective when used to enhance thequality and productivity of human labor. Most health care workflows require someelement of human involvement. But with effective intelligent automation, humansoperate only at top-of-license: that means the fewest touchpoints possible withautomatable workflows, and time spent on the tasks – or patients – that mostneed their attention.

"I need processes that can be turnkey, to beturnkey, to lift the operational burden offof staff and allow them to focus on thingsthat deliver immediate impact andoutcomes for patients."

CFO
Community-based health care provider

Beyond efficiency, this increased productivity means organizations can create and sustain volume growth without adding (human) FTEs.

RPA can be used to perform strictly repetitive tasks that don’t require humanintelligence, allowing staff to spend time on more complex tasks. AI-enabled RPA,or intelligent automation, takes it a step further by using machine learning toperform tasks that do require human intelligence. Bots trained with intelligentautomation continually learn from their “experiences” (i.e., data inputs) over time.This enables them to improve the quality and reliability of their outputs, makingthem increasingly valuable to their human counterparts. For example, bots canlearn to predict which clinical orders are most apt for a particular patient byobserving the provider’s ordering habits over thousands of comparable encounters.

How productivity gains from intelligent automation enable growth

DrFirst helps hospital increase pharmacy technician panel
Health technology solution vendor DrFirst helped a midsizehospital optimize medication reconciliation.Typically, a pharmacy technician spends 30-45 minutesper patient manually searching for and enteringmedication histories. Using intelligent automation,DrFirst’s solution parses multiple national data sources,local pharmacies, and health information exchanges tocreate more complete histories. Then, it translates thefree text, infers missing information, and adaptsterminology to match the receiving hospital’s EHR. Theresult for this hospital was more accurate medicationhistories, reduced manual transcription errors, andimproved staff satisfaction. And with the time saved,each pharmacy technician increased the number ofmedication histories performed daily by 50%.

A large regional health planincreases care manager panel
When a large, regional health plan started usingintelligent automation to support care management,nurse care managers were spending 60% of theirtime mining patient data rather than connectingwith patients themselves. Intelligent automation notonly surfaced the relevant data for the caremanagers, it prioritized which patients requiredactive outreach and which could be passivelymonitored. Care managers were able to increasetheir panel capacity by 35%.

Automation vendors echo the sentiment that good automation solutions result inFTE offset. They also acknowledge that “offset” almost always means improvedproductivity and ability for the provider to grow volumes without adding employeerequisitions – not a workforce reduction.

Get your staff on board

The first step is for leadership to get on boardwith this idea that a digital workforce shouldaugment, rather than replace, a humanworkforce. But the preconception of “humansvs. robots” doesn’t end at the c-suite. Leaderscan’t expect staff to adopt solutions they don’tunderstand without acknowledging staffmembers’ reservations. And without end useradoption, these solutions become theoretical.Specifically, leaders need to assuage theirteams’ fears of job replacement anddiminished clinician autonomy.

"It’s important to communicate benefitsof this to staff, make them feelcomfortable, part of it. There’s a lowtechnical barrier to using RPA andintelligent automation– but staff haveto feel like it’s working with or forthem, not replacing them.”

John Tippetts, Chief Architect
Intermountain

Provider organizations need to establish governance around automation in orderto fully take advantage of it as a business tool, rather than a side project of aself-identified champion. Digital capabilities underpin the majority of providers’strategic goals – as an industry, we need to move past the days of considering“digital” to be synonymous with “IT.” Digital technologies like intelligentautomation are business solutions intended to alleviate business challenges.

That’s good news, because it means intelligent automation can serve anystakeholder. (See examples of improving user experience, pages 7-9.) But thatflexibility may make it difficult for health care leaders to assign effectiveownership over and accountability for automation initiatives. A failure tocoordinate and manage projects at scale results in redundant, competing, orsiloed investments in automation solutions. As one automation vendor put it,“dabbling is not a viable path to scale.” 

Intelligent automation initiatives are often driven byindividual champions with personal interest in orexperience using AI. Champions play an importantrole. But providers need to establish cleargovernance and accountability to orchestrateeffective implementation, monitoring, and scale of thetechnology. Organizations that recognize theopportunity automation presents have done just that,with varying levels of investment.

"The most important thing for anyone that decides to embark on using automation is to have a good governance model, participation of leadership in areas you want to make an impact, and good partnership between IT and the areas where you’re trying to use it.”

Ilo Romero, VP and Assistant CIO
West Virginia University Health System

On one end of the spectrum, organizations createmultidisciplinary governance bodies to driveutilization and continued refinement of intelligentautomation solutions to meet business needs. Thiswas the case at WVU Medicine West VirginiaUniversity Health System.

West Virginia University Health System scales from champion to organized governance
At the West Virginia University Health System, automation started as achampion-driven initiative around AI. The champion (the Assistant CIO) got CEOand senior executive leadership buy in and took the helm in an expanded role todrive the use of AI and automation across the enterprise. The team includes adata scientist, an architect, machine learning engineers, and partnerships withthe business lines they support, as well as the Health System's analytics team.They were able to elevate automation – including intelligent automation – froman individual-driven pilot to an established business function being deployed tomeet both strategic and operational needs.

On the most sophisticated end of the spectrum, some organizations haveembraced the transformational potential of automation as a strategic imperativeto serve every area of the business and invested in creating a formalizedenterprise function.

Intermountain’s Center of Enablement ensures effective, enterprise-wide useof automation
Intermountain created the Center of Enablement in response to a goal establishedby the Board of Directors to expand the use of automation across the enterprise.The Center of Enablement includes architects and data scientists who workalongside staff that elevate opportunities for automation to identify whetherexisting tools can meet the business need or if they should consider investing in ordeveloping a new tool. The stated goals of deploying automation acrossIntermountain include improving quality, accuracy, productivity, and employeemorale. Not only is executive leadership unanimously in support of those goals,the Chief People Officer is personally accountable for reporting on the Center’sprogress to the Board. Intelligent automation is necessarily leveraged as a coretool to meet Intermountain’s strategic goals.