eBook: The Legal Considerations of Using an Intelligent Virtual Agent in Hospital Call Centers

Intelligent virtual agents (IVAs) can significantly enhance efficiencies within a hospital call center, facilitate communication between staff, and improve patient experiences. However, the use of artificial intelligence (AI) in healthcare introduces complex legal considerations. Health organizations should be aware of potential liabilities arising from what IVAs say.

Hospital managers can be proactive in addressing the risks associated with AI technology, including the use of IVAs. This e-book attempts to provide guidance to healthcare leadership who are deciding if using an IVA is right for their organization. The benefits of using an IVA, as well as areas of concern, are included in the following pages.

It is best to consult with legal counsel to ensure compliance with all applicable laws and regulations. However, this e-book draws upon Amtelco’s decades of experience in the communications industry to offer tips, guidance, and examples of how hospitals can minimize liabilities and ensure patient safety when using an IVA by implementing appropriate safeguards and protocols.

Hospital call centers can improve efficiency, reduce costs, and enhance the overall patient experience. IVA’s offer enhanced capabilities in handling detailed interactions because they are powered by natural language processing (NLP) and machine learning (ML). They seamlessly integrate with electronic health record (EHR) or electronic medical record (EMR) systems for accurate and efficient information sharing.

These advanced AI technologies can understand nuanced language and context that require a deeper understanding. IVAs can navigate complicated interactions that are considered routine in the health industry and provide immediate assistance to patients who may otherwise have to wait on hold for a human agent.

The voice tones used by IVAs are friendly and offer a multitude of different-sounding voices to make calls more engaging. They also have multilingual abilities and can assist callers right away instead of waiting for an interpreter service, improving access for diverse patient populations.

Some examples of how IVAs benefit hospital call centers: 

Appointment Management

Automated Scheduling: IVAs handle appointment scheduling, rescheduling, and cancellations, freeing up staff for more sophisticated tasks. They can access and update patient records and provider schedules in real time. 

Appointment Reminders: Automated reminders can be sent via voice, text, or email, reducing no-show rates.

Patient Information and Inquiries

Answering FAQs: Answers to common patient questions about hospital services, directions, visiting hours, and insurance info.

Medication Refills: Processing prescription refill requests, verifying patient information, and pharmacy communication.  

Test Results and Information: With proper security protocols, IVAs can provide patients with access to certain test results or information to improve patient access.  

Emergency and Urgent Care

Triage and Routing: Assess the urgency of patient calls and route them to the appropriate department or medical professional. In emergency situations, IVAs can quickly gather essential information and connect patients to emergency services.

Patient Support and Communication

Provide Pre-Procedure Instructions: Deliver standardized instructions to patients before medical procedures.

Post-Discharge Follow-Up: Post-discharge follow-up calls reduce patient readmission rates. Follow-up calls to patients after discharge are automated with IVAs, to ensure patients understand their discharge instructions.  

Sentiment Analysis: IVAs can analyze the emotional tone of patients, allowing call center staff to prioritize calls from patients who are distressed, require extra support, should be transferred to a human agent, or to indicate when a call should be recorded.  

While adoption of AI and IVA technology is growing, patient comfort levels can vary significantly, and some trends are revealing how people feel about interacting with AI technology.

There are common factors that influence a patient’s comfort level when using an IVA. Patients tend to be more willing to let IVAs help with routine tasks like appointment scheduling, prescription refills, and basic information retrieval.

Understandably, they prefer human interaction for sensitive medical inquiries or emotionally charged situations. However, the quality of the IVA matters in these scenarios. Advanced IVAs with natural language processing (NLP) and human-like voices create a more positive patient experience. Also, patients are more trustful with IVAs when they know their personal and medical information is secure. Clear communication about data privacy and HIPAA compliance is essential.

Most people appreciate that IVAs offer 24/7 availability and reduce wait times, which can improve patient satisfaction, especially for routine inquiries. This can be a major factor in patient comfort, as long wait times are a large point of frustration in healthcare. Also, IVAs that are able to personalize the interaction, by accessing patient records, and using that information to make the interaction more efficient, tend to be more positively received.

There’s a growing acceptance of AI in healthcare, particularly for administrative tasks. Healthcare providers are increasingly focused on improving the patient experience, and IVAs are seen as a tool to achieve this. However, it’s crucial to maintain a balance between automation and human interaction.

Patient comfort with IVAs is evolving. This technology has the potential to improve efficiency and access to healthcare. However, it’s crucial to prioritize patient needs and ensure that IVAs are used responsibly. Healthcare organizations can continue to prioritize patient comfort and ensure that clear communication, robust security measures, and seamless escalation to human agents are available when using IVAs.

Healthcare systems should be concerned about potential liabilities arising from what IVAs communicate. The use of AI in healthcare, while offering numerous benefits, introduces complex lawful scenarios.

If an IVA provides inaccurate or misleading information that leads to patient harm, the hospital could face medical malpractice lawsuits. Determining liability in such cases can be tricky, as it may involve questions about the IVA’s programming, the hospital’s oversight, and the standard of care.

Hospitals could be held liable for negligence if they fail to properly implement, monitor, or maintain their IVA systems. This could include issues such as data breaches, system malfunctions, or inadequate training of staff who interact with the IVA. Organizations must ensure their IVA systems comply with HIPAA regulations to protect patient privacy. Any breach of patient confidentiality could result in significant legal and financial penalties.

Even with advanced IVAs, human oversight is essential to ensure accuracy and patient safety. The lawful framework surrounding AI in healthcare is still evolving, which creates uncertainty and potential for new challenges.

Hospitals can proactively address the risks associated with IVAs and carefully evaluate IVA systems before implementation to ensure they are accurate, reliable, and secure.

Establishing clear guidelines and protocols for the use of IVAs, including when human intervention is required, and implementing regular monitoring and audits of IVA systems to ensure accuracy and compliance is paramount.

It is best to consult with legal counsel to ensure compliance with all applicable laws and regulations. However, below are some examples of how implementing appropriate safeguards and protocols can minimize a hospital’s liability and ensure patient safety.

Using a multi-layered approach offers the best protection when using an IVA:

Rigorous System Validation and Testing

Pre-Implementation Testing: Conduct extensive testing of the IVA system in simulated environments to identify potential errors or biases. Test various scenarios, including intricate medical inquiries and emergency situations. Be certain to involve medical professionals in the testing process to ensure accuracy and safety.

Regular Audits and Updates: Implement a system for regular audits of the IVA’s performance and accuracy, and establish a process for promptly updating the IVA’s knowledge base and algorithms to reflect the latest medical guidelines. Keep a detailed log of all system updates and audits.

Clear Disclaimers and Limitations

Explicit Disclaimers: Include clear disclaimers in all IVA interactions, stating that the IVA is not a substitute for professional medical advice. Emphasize that the IVA is intended for informational purposes only and that patients should consult with a healthcare provider for diagnosis and treatment.

Limitations on Medical Advice: When scripting for the IVA is programmed, avoid providing specific medical diagnoses or treatment recommendations, and limit the IVA’s responses to general information and guidance to prevent the IVA from providing potentially harmful or incorrect information.

Robust Data Security and Privacy Measures

HIPAA Compliance: Implement strict access controls and encryption to protect patient data, and ensure the IVA system complies with all HIPAA regulations regarding data privacy and security. Conduct regular security audits to identify and address potential vulnerabilities.

Data Minimization: Limit the amount of patient data collected and stored by the IVA system, and implement data retention policies to delete patient data when it is no longer needed.

Consent and Transparency: Obtain informed consent from patients before collecting or using their data. Provide clear and transparent information about how patient data is used and protected.

Set Clear Protocols for Human Intervention

Escalation Procedures: Establish protocols for when and how the IVA should escalate calls to human agents, and implement a system for seamless transfer of patient information to live agents. Train operators to effectively handle escalated calls and provide appropriate assistance.

Human Oversight: Implement a system for monitoring and reviewing IVA interactions.

Documentation and Record-Keeping

Detailed Interaction Logs: Maintain detailed logs of all IVA interactions, including patient inquiries, responses, and actions taken. This information can serve as evidence in case of lawful disputes.

Version Control: Maintain version control of the IVA’s programming, and data sets. This will allow for the ability to backtrack changes.

Policy and Procedure Documentation: Thoroughly document all policies and procedures related to IVA implementation and use.

By implementing these safeguards, hospitals can minimize their legal risks and ensure that IVAs are used safely and responsibly.

Call center software vendors can and should incorporate features and programming that curtail liability risks. Built-in tools and security automatically provide safeguards, and regular training and resources provided by the vendor help hospital call center staff stay updated with the latest information.

Integrated features that ensure HIPAA compliance, such as data encryption, access controls, and audit trails, are critical to helping healthcare organizations comply with relevant patient safety and data security regulations.

Filters can prevent IVAs from providing potentially inaccurate information, and the system can integrate with updated databases and knowledge sources to ensure accuracy. Escalation protocols that automatically transfer complicated or urgent calls to human agents can be triggered if the call is too complex for the IVA to handle or the patient requests a live agent.

Robust encryption keeps patient data protected both while in transit and at rest, and granular access controls limit access to private patient information. Detailed reporting and auditing tools keep records of all interactions with the IVA.

Vendors can regularly provide comprehensive documentation on the IVA’s capabilities, limitations, and safety features, and offer training resources to help healthcare organizations effectively use the IVA and minimize risks.

Below is a basic example of a policy that healthcare organizations can use as a guide when establishing protocols about their use of IVAs.

Disclaimer: This is a basic example and should be adapted to the specific needs and circumstances of each healthcare organization. Legal counsel should be consulted to ensure compliance with all applicable laws and regulations.

Policy: Use of Intelligent Virtual Agents (IVAs) in Patient Communication

1. Purpose

This policy outlines the guidelines and protocols for the responsible and ethical use of Intelligent Virtual Agents (IVAs) in patient communication, ensuring patient safety, privacy, and satisfaction.

2. Scope

This policy applies to all employees, contractors, and affiliates of [Healthcare Organization Name] who utilize IVAs for patient communication.

3. Principles

Patient-Centered Care: IVAs will be used to enhance patient access and convenience while maintaining a focus on patient needs.

Transparency and Choice: Patients will be informed about the use of IVAs and offered the choice to interact with a human agent.

Data Privacy and Security: All patient data will be handled in compliance with HIPAA and other applicable regulations.

Accuracy and Safety: IVAs will be programmed and maintained to provide accurate and safe information.

Human Oversight: Human agents will be available to handle complex or sensitive interactions.

4. Procedures

4.1. Patient Notification

• Patients will be informed about the use of IVAs at the beginning of interactions.
• Clear and concise information will be provided about the IVA’s capabilities and limitations.
• Patients will be offered the option to speak with a human agent at any time.

4.2. Data Handling

• IVAs will be programmed to comply with HIPAA regulations regarding patient data privacy and security.
• Access to patient data will be restricted to authorized personnel.
• Data encryption and secure storage protocols will be implemented.
• Data minimization principles will be followed.

4.3. Information Accuracy

• IVAs will be programmed with accurate and up-to-date information.
• Regular audits will be conducted to ensure the accuracy of the IVA’s responses.
• Medical information provided by IVAs will be limited to general guidance, and disclaimers will be provided.

4.4. Human Agent Escalation

• Clear protocols will be established for escalating calls to human agents.
• Human agents will be trained to handle complicated or delicate patient interactions.
• Seamless transfer of patient information will be ensured during escalation.

4.5. System Monitoring and Maintenance

• Regular monitoring of IVA performance will be conducted.
• System updates and maintenance will be performed to ensure optimal functionality.
• Detailed logs of IVA interactions will be maintained.
• Version control will be implemented on all software and data sets.

4.6. Training

• All staff members who interact with IVAs will receive comprehensive training on their use.
• Training will cover patient communication, data privacy, and escalation protocols.

4.7. Bias Mitigation

• Regular testing for AI bias will be conducted.
• Steps will be taken to mitigate bias in the AI’s responses.
• Data used to train the AI will be logged.

5. Compliance

Failure to comply with this policy may result in disciplinary action. This policy will be reviewed and updated regularly to reflect changes in technology and regulations.

6. Review and Updates

This policy will be reviewed and updated annually or more frequently as needed.

7. Responsible Parties

[Department or Individual Responsible for Implementation and Oversight]

Please click below to download the full PDF version of the eBook, and contact us if you would like to discuss using an IVA in your organization’s call center.