On Monday March 9, in an effort to address soaring patient demand in Boston, Partners HealthCare went live with a hotline for patients, clinicians, and anyone else with questions and concerns about Covid-19. The goals are to identify and reassure the people who do not need additional care (the vast majority of callers), to direct people with less serious symptoms to relevant information and virtual care options, and to direct the smaller number of high-risk and higher-acuity patients to the most appropriate resources, including testing sites, newly created respiratory illness clinics, or in certain cases, emergency departments. As the hotline became overwhelmed, the average wait time peaked at 30 minutes. Many callers gave up before they could speak with the expert team of nurses staffing the hotline. We were missing opportunities to facilitate pre-hospital triage to get the patient to the right care setting at the right time.

The Partners team, led by Lee Schwamm, Haipeng (Mark) Zhang, and Adam Landman, began considering technology options to address the growing need for patient self-triage, including interactive voice response systems and chatbots. We connected with Providence St. Joseph Health system in Seattle, which served some of the country’s first Covid-19 patients in early March. In collaboration with Microsoft, Providence built an online screening and triage tool that could rapidly differentiate between those who might really be sick with Covid-19 and those who appear to be suffering from less threatening ailments. In its first week, Providence’s tool served more than 40,000 patients, delivering care at an unprecedented scale.

Our team saw potential for this type of AI-based solution and worked to make a similar tool available to our patient population. The Partners Covid-19 Screener provides a simple, straightforward chat interface, presenting patients with a series of questions based on content from the U.S. Centers for Disease Control and Prevention (CDC) and Partners HealthCare experts. In this way, it too can screen enormous numbers of people and rapidly differentiate between those who might really be sick with Covid-19 and those who are likely to be suffering from less threatening ailments. We anticipate this AI bot will alleviate high volumes of patient traffic to the hotline, and extend and stratify the system’s care in ways that would have been unimaginable until recently. Development is now under way to facilitate triage of patients with symptoms to most appropriate care setting, including virtual urgent care, primary care providers, respiratory illness clinics, or the emergency department. Most importantly, the chatbot can also serve as a near instantaneous dissemination method for supporting our widely distributed providers, as we have seen the need for frequent clinical triage algorithm updates based on a rapidly changing landscape.

Similarly, at both Brigham and Women’s Hospital and at Massachusetts General Hospital, physician researchers are exploring the potential use of intelligent robots developed at Boston Dynamics and MIT to deploy in Covid surge clinics and inpatient wards to perform tasks (obtaining vital signs or delivering medication) that would otherwise require human contact in an effort to mitigate disease transmission.

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