How Spanish-speaking patient portal AI promotes health equity

Epic introduces AI to draft patient portal messages

Mount Sinai is no stranger to automated patient portal messages. The medical center was an early adopter of Epic's augmented response technology (Art) tool  within the MyChart patient portal to streamline messaging with patients.

"It generates a draft response for inbound messages that patients are sending our doctors, and it helps them respond faster and better, so patients get a much better experience," Gillette described during a recent interview.

That's been a boon for Mount Sinai providers, who saw a nearly 500% increase in patient portal messaging as a result of the pandemic. When patients couldn't come into the clinic to chat with their clinicians, they turned to the technology to create a digital connection. It was good that patients were able to do that, Gillette acknowledged, but it created significant burden for the providers who were "buried alive with messages," he said.

"The AI came along a couple years after that," Gillette recounted. "With Epic's original version of the generated draft response, we implemented that on the English language side in 2023, so we were one of the first to use that there."

The medical center saw a near-immediate improvement in clinical workloads and patient experiences on the patient portal. Doctors were spending less time responding to messages, while patients got their answers up to a half day faster than before.

But fast forward to 2024, and Mount Sinai Medical Center started to identify some equity issues. Although the AI was a net benefit for the healthcare organization, it mostly benefitted patients whose preferred language was English.

Enter Spanish-language Art.

Art responds to Spanish-speaking patients

Gillette said Mount Sinai has been a long-time customer of Epic, and since it was an early adopter of Art, it made it easy for the organization to collaborate with the vendor to create Spanish-language options.

"Epic wanted to get into the multi-language space, starting with Spanish," Gillette explained. "We raised our hand and said we wanted to be an early adopter. We were really pounding the table for this from the very first days when this came out. 'Whenever we get Spanish, please choose us. We want to be a champion of this.'"

Mount Sinai adopted a similar partnership approach with Epic that it used when it first adopted the English-language version of Art. By diligently fine-tuning its prompting, working specialty by specialty, the organization was able to ensure the technology could fulfill both patient and provider needs. After all, a draft response is useless if it doesn't capture the nuances of a good patient-provider digital interaction.

Gillette and his team focused on their relationships with the technology developers as well as the Spanish-speaking physicians within the medical center. By having physicians review the sample draft responses and provide their feedback, Mount Sinai was able to iterate with Epic.

Now, Mount Sinai has a tool that automatically sets a draft response to Spanish when appropriate. Because the medical center's EHR asks patients to document their preferred language, the system is able to automatically generate responses in either Spanish or English, depending on the documentation.

There are still some hiccups, of course. For one thing, documentation of preferred language is not a given. Health systems must be diligent in querying and documenting preferred language in order to have multi-language Art work appropriately.

Likewise, it's not a given that a Spanish-speaking patient will be meeting with a Spanish-speaking provider. In these cases, the clinician will receive a message in Spanish, and the draft response will be in Spanish. Right now, Gillette said those providers will need to consult with another clinician who can translate for them.

Still, adoption of AI tools for the patient portal has made a marked difference on provider workflows.

"The digital side of the portal has exploded in recent years, certainly since COVID," Gillette noted. "So, to arm our clinicians with tools to deal with that side of it was important."

Now, with Spanish-language options for patient portal AI, the medical center can serve more patients, regardless of their English language proficiency, helping to quell some health equity concerns with AI.

Sara Heath as reported news related to patient engagement and health equity since 2015.