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Q&A: Healthcare is using machine learning to improve clarity (Includes interview)

In November 2019 the U.S. government released proposed rules requiring price transparency by having hospitals openly make available information about all charges and negotiated fees. A part of the rules that didn’t get a lot of attention was the requirement to make the text understandable, with “plain language” descriptions.

To comply with the rules, many healthcare organizations are employing machine learning to make their billing and fee information more understandable to consumers.

To gain an insight into these developments, Digital Journal spoke with the CMO of language analysis company VisibleThread, Evelyn Wolf.

Digital Journal: How confusing is healthcare information for the typical person and what are the consequences?

Evelyn Wolf: Simply put, very confusing. Let me explain by looking at health literacy levels. These give us a sense of how hard healthcare information is to grasp for a typical person.

Health literacy isn’t only about being able to understand medical jargon. It’s the ability to obtain, process, and understand basic health information and services to make appropriate health decisions. Here are some stats from the National Center for Education Statistics in the US:

36% of the population have basic or below basic health literacy levels
75% of patients who were in poor health also fall into the below basic health literacy category
51% of 65-75 year olds are at the basic or below health literacy reading level.

At intermediate level, you are able to read an instruction on a prescription label, and determine at what time a person can take the medication. None of the above cohort can confidently do this.

You asked about the consequences for the typical person. The above statistics include typical people. 75% of people in poor health have poor health literacy. These people have difficulty understanding basic medical instructions that are vital to their wellbeing.

DJ: What is behind the current drive to make healthcare information more understandable to the average person?

Wolf: This is tied into a cultural shift in society. People are used to easy access to information across all sectors. They expect instant feedback. They expect to be able to instantly book holidays, pay taxes and buy insurance. In short, people now expect to easily engage with organizations when dealing with day to day life tasks. And they don’t get that from some healthcare providers.

So, patients are fed up. Patient advocate groups are speaking up. If other industries can communicate clearly, then why not healthcare? At VisibleThread, we see clarity as a basic human right.

Some visionary healthcare providers and payers are addressing the issue. They want to deliver a better experience to their patients and members. And this has a positive effect on staff and budgets as well. Let me give you an example:

A healthcare insurer sends a complex membership letter. The recipient is confused about her insurance status. She must dial the call center to double check. Don’t forget she has a busy day, making the call is a nuisance. The call center agent already answered the same question 10 times today. Here the customer experience is broken. The agent unintentionally irritates the caller. The organization is paying for a call that could have been avoided if only they had communicated clearly in the first place. And the brand experience is poor.

We solved this scenario with one of our customers by simplifying overly complex letters. The result: 19% fewer help desk calls, $325k annual call center cost savings and a better customer experience. All because of clear membership letters.

DJ: What is meant by ‘plain language’ descriptions?

Wolf:Don’t confuse ‘Plain language’ with ‘dumbing things down’. Think of is as simplifying instead.

Using plain language means that people can easily understand what you are asking them to do. Whether that’s completing a form, taking medication or coming to an appointment on time.

Consider these statements:

1. The patient is required to notify us.
2. The patient needs to tell us.
3. You need to tell us.

Option 3 is the most clear.

Let’s look at two medical terms: sub-therapeutic and hypertension. One means low-level, the other high blood pressure. Do patients know for certain which one is which?

So what can a healthcare provider do to communicate in plain language?

1. Reduce sentence length
2. Eliminate passive voice
3. Choose less complex words
4. Stop using industry jargon, or if required for compliance reasons, explain it
5. Measure written content for clarity using well known readability scores

DJ: What is the basis of the VisibleThread technology? How does it work?

Wolf:VisibleThread makes words matter. Our technology drives operational savings and better customer experience by supporting clear, compliant communications, across all business functions. From operations, to HR to marketing/communications. It analyzes the written word, and scores it for complexity and jargon.

Communications originate from all parts of the business, and across all channels, both online and offline. Organizations struggle to maintain oversight. From marketing materials to manuals, invoices to terms of service. Jargon laden content. Different writing styles, different tone of voice.

VisibleThread’s solutions cater to all stakeholders, from non-professional writers to executive management who need to measure the effectiveness of their ‘customer first’ and ‘plain language’ programs. When you get objective metrics across all written content, you now have a repeatable way to make it all more accessible and understandable. Recent advances in NLP (Natural Language Processing) and AI (Artificial Intelligence) facilitate the technology.

VT Insights Platform uses AI and NLP technology. It includes two components:

VT Readability – Supporting Content Creators to score their own content as they write
VT Insights – Providing Executive Oversight. Ensuring Single Tone of Voice.

DJ: How did you develop and test the technology?

Wolf:VisibleThread has been working with global organizations for over 10 years. We set out to use technology to help simplify & de-risk business communications and drive better business outcomes. Good writing is an art; however, we knew technology could help identify complexity.

Customers used our early products in 2011 and 2012 to simplify, and de-risk large scale content. This included Supplier contracts, large RFP (Request for Proposals) responses and large IT specifications. We numbered 9 of the top 15 US government contractors as customers. Many of our customers were in the healthcare field. And we had a continuous feedback loop with them.

This helped us identify different components of our technology that could be used for more general content analysis. In 2017, we launched our light-weight self-scoring component “VT Readability”. And followed that with our executive oversight dashboard solution “VT Insights”. The whole platform now provides end to end oversight across thousands of users in larger organizations.

DJ: Does medical jargon pose any special challenges?

Wolf:To me, jargon means jargon. Regardless of the sector. And you can trace most of the issue back to an overuse of ‘industry-speak’. External audiences will not understand this institutionalized language. Be it in financial services or healthcare. Sometimes, we hear this kind of thing ‘ah yes, but my industry is different, it has such and such compliance regulations, and we couldn’t possibly simplify the language’. This is a cop-out.

We find it’s largely the same issues across sectors:

1. Changing the writer’s mindset

Writers should avoid jargon. But, the writer may not even realize she’s using jargon. It’s so engrained. She needs to make an effort to avoid it. Here technology like ours can really help support writers in their efforts, as they’re writing and editing.

2. Putting in place a commitment from senior leadership

Clarity and commitment to plain language must come from the top. It must feed into every corner of your organization. Once executives realize the profound business benefits (deep operational savings and better brand experience), they sponsor a change program. Then others follow more easily. Executives need to see the business impact plain language has. Our technology offers this out of the box.

Finally, it’s important to remember, there are simple translations of most jargon terms (echocardiogram = heart ultrasound). If you can’t get around jargon, explain it simply: “During your appointment, you will undergo an echocardiogram. This is a heart ultrasound.” .

Written By

Dr. Tim Sandle is Digital Journal's Editor-at-Large for science news. Tim specializes in science, technology, environmental, and health journalism. He is additionally a practising microbiologist; and an author. He is also interested in history, politics and current affairs.

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