Voice assistants are quickly becoming a popular consumer tool that allows users to access libraries of skills, including games, news, and reminders. Last month, Los Angeles-based Frontive Health launched its smart personal health platform to help patients more easily adhere to their care regimens by leveraging Amazon Echo’s voice assistant. Utilizing a “less is more” approach to collating medication instructions, pre-, and post-procedure protocols, and lifestyle modifications, Frontive’s artificial intelligence (AI) enabled technology prioritizes daily actions that lead to optimal patient outcomes.
According to Anthony “Tony” Jones, Co-Founder, and CEO of Frontive Health, “Today, too much patient information is organized and presented to reduce liability instead of supporting patients the way they actually experience recovery and health management. We’re aiming to change this so that patients always feel supported and in control.”
The launch comes at the conclusion of Frontive Health’s first pilot at Lowell General Hospital (LGH), a not-for-profit community hospital in Lowell, Massachusetts. Pilot patients used Frontive two weeks before surgery and two months post-discharge. Patients received information about their prescription medications and daily guidance curated to their individual care plan.
According to 78-year old pilot participant Jean Greico, “Even though I read through the binder of information I got at my pre-op session, I didn’t need to go back to it after my surgery because I could just ask Frontive. I asked personal questions about my health – from what medications I should take and when, to where I should be in my recovery – and it told me everything I needed to know.”
A second pilot at LGH is now underway incorporating a mobile app to keep family and caregivers engaged in how their patients are doing and where they are in their care journey.
To learn more about Frontive’s technology and the initial pilot program, Medgadget heard from Tony Jones and Cecelia Lynch, Vice President of Patient Care Services and Chief Nurse Executive at LGH.
Medgadget: Thank you for taking the time to speak with us. First off, what differentiates Frontive from other digital health solutions using technology-driven approaches to improve care management outside the hospital or clinic?
Anthony “Tony” Jones: Despite the number of digital care management solutions on the market, the costs of medical non-adherence increase each year. The logical conclusion is that the current solutions are failing to adequately help patients adhere to their care regimens.
With that in mind, we made a basic assumption: most patients intend to follow their doctors’ instructions. That begged the question: how do we make it easier for patients and families to do what they intend to do? This question led us to develop four key design principles that differentiate Frontive Health from other solutions:
- Organize information and instructions as a personal project plan, reflecting the way patients actually experience the day-to-day tasks of care management
- Automate the uploading and maintenance of users’ health information
- Leverage both voice and mobile app interfaces
- Focus on highly personalized and relevant information because less is more
Medgadget: Can you describe the patient experience with Frontive? How do setup, training, and ongoing usage work?
Jones: For patients using Frontive Health for perioperative support, they are introduced to the solution typically four to six weeks prior to surgery at the education class conducted by the hospital. Eligible patients are provided with a short introduction to Frontive Health, an Echo Dot, and setup instructions. As part of the setup process, patients must enable the Frontive Health skill through the Amazon Echo device. The skill is not publicly available in the general Amazon skill repository and access is protected by a 4-digit PIN that users customize during setup. Once the skill is enabled, we link the patient’s health profile and data to their account and notify them that their account is ready to use.
We provide users with a quick reference guide that includes most of the available commands, so they don’t have to guess what phrases to say, access to online support, and toll-free telephone support. We also have users complete a short, 10-question survey that provides us with baseline information on each user’s attitudes about health engagement. Once they’re set up, patients can access personalized responses to over 100 frequently asked questions about the surgery, both pre-op and post-op, get a personalized daily flash briefing, and provide daily updates regarding their level of pain and how they’re feeling.
Medgadget: What is the basis for the AI technology powering Frontive Health?
Jones: AI is a fairly broad set of cognitive technology tools and we utilize some more than others. At this stage, we use natural language processing and rules/expert systems technology to convert generic care instructions into more personalized actions that patients should do or avoid at any given time in their care plan. We’ve also designed our platform to leverage machine learning algorithms that will further personalize the user experience as utilization increases and we have sufficient data to actually drive those algorithms.
Medgadget: Turning to Cecelia, What initially led you and your organization to implement a pilot with Frontive? Has LGH previously piloted digital health solutions providing care support outside the hospital?
Cecelia Lynch: We are deeply invested in improving the continuum of care to make transitions in care as seamless as possible for our patients. We are a forward-thinking organization that has shown a commitment to using technology to improve the continuum of care, reduce readmissions and improve the overall health of the communities we serve. This is a tool that one day may be able to help some of our most vulnerable patients get their questions answered when they need it so they can recover safely at home. If we reduce some of these readmissions, we will bring down healthcare costs for the entire system, and this has the potential to be a valuable tool in that effort.
Medgadget: What was the scope of the pilot LGH conducted with Frontive Health? Are there any outcomes to share as of yet?
Lynch: We had 40 patients in our pilot, all knee replacement patients treated by one of our orthopedic surgeons. We chose knee replacements because the post-surgical plans are relatively standardized.
Medgadget: Are there specific clinical areas or medical use cases you think have the best opportunity to benefit from voice-activated technologies like Frontive?
Lynch: We see the greatest potential for this type of technology with patients coping with chronic conditions like COPD and CHF who can significantly benefit from this kind of interactive technology. These are patients whose outcomes depend on compliance with their medical instructions, and where gaps in that compliance often lead to unnecessary hospital readmissions.
Medgadget: Going back to Frontive, while the company’s technology is still nascent today, what is the long-term plan in terms of who pays for Frontive (i.e. patient, provider, payer, etc)?
Jones: Long term, who pays for Frontive Health depends on the use case and who stands to benefit the most from patients being more adherent. For perioperative support, the paying entity is the hospital. For chronic disease management, the paying entity may be the health plan. Finally, for a late-stage clinical trial, the pharma or device company would support the costs. The current model does not anticipate patients paying for the service for the primary use cases.
Medgadget: Given the need to use a voice-activated device, what are the limitations to who can use and benefit from Frontive?
Jones: Today, Frontive Health users must have access to Wi-Fi at home and a smartphone to set up and use Alexa. We started with English as the default language but will add other languages as needed in the coming months. Note that 70% of people in the U.S. have smartphones while 76% of people have Wi-Fi, these figures continue to grow each year. Therefore, we see the few barriers to use or adoption diminishing quickly for most of our target users. Of course, we also recognize there are patient segments with issues that make voice or mobile app interfaces impractical.
Medgadget: What are Frontive’s main clinical use cases today? Are there other voice-activated technologies with which your technology will be compatible?
Jones: Going back to our first design principle — reflect the way patients actually experience care — requires a horizontal view of healthcare tasks across multiple conditions. Patients in need of support rarely have a single issue, so, for example, providing help with someone’s asthma, but ignoring their diabetes and sleep apnea is an incomplete solution at best. As a result, we target three use cases, regardless of the underlying clinical conditions:
- Perioperative support (pre- and post-op instructions & FAQs)
- Complex chronic condition management
- Late-stage clinical trials
Frontive Health is designed to be portable across other voice assistants. We intend to add support for other platforms as needed to reach our target segments.
Medgadget: Finally, given the recent pilot at Lowell General Hospital, what’s next for Frontive Health?
Jones: We expect a Q4 2019 commercial rollout for perioperative support, focused initially on joint replacement patients, but expanding to other surgeries as well. We’re also close to kicking off additional pilots for the other use cases mentioned above: complex chronic condition management and late-stage clinical trials. Of course, we’ll continue to improve the user experience and take advantage of new capabilities being added to the Alexa platform where appropriate.
Link: Frontive homepage…