A successful startup-hospital partnership requires a lot of elements to work. On the startup side, a company has to be willing to listen to a health system’s problems and craft their offering to really address them. On the hospital side, enthusiastic executive buy-in and a strong champion are musts.

For Northern California’s Sutter Health and triage chatbot startup Ada Health, all these pieces came together. Ada Health Chief Commercial Officer Jeff Cutler sat down with HIMSS Media onstage at the Connected Health Conference in Boston last week to talk about his company’s technology and the lessons learned from the collaboration.

Starting with the problem

Sutter Health didn’t merely deploy a chatbot because it seemed like interesting technology, nor was it aimed at a vague goal like freeing up physician time. They were facing a highly specific problem with how patients were utilizing the health system.

“Sutter was finding that people just did not understand the difference between emergency rooms, urgent care centers, and walk-in centers,” Cutler said.

Ada Health’s chatbot uses artificial intelligence to have a dynamic conversation with patients, asking them about symptoms and generating different questions based on their answers, until it eventually produces a list of possible causes with associated probabilities.

The company worked with Sutter to build a version of its technology that users could access from Sutter’s website or patient portal that would ultimately send them to the appropriate venue for care.

“What we’ve done is we’ve mapped our triage options to Sutter Health’s healthcare options, and we then geolocate a patient, show them the closest facilities, we map it for them, and then we allow them to go into MyChart and book that appointment,” Cutler said.

In the five months since the deployment begun they’ve done 20,000 assessments, averaging 100 per day. Two-thirds of those are done between 6 p.m. and 9 a.m., and half of them end up directing users to non-emergency care. How that translates to savings for Sutter is an important question that Sutter and Ada are still working out.

“We want to get the roadmap right, we want to get the integration with the industry tools right, and we want to prove the ROI,” Cutler said. “So we’re literally defining the value of moving someone from a high-priced or potentially unnecessary venue of care like an emergency room to a lower-cost more relevant service, and once we define that value we’re going to define some metrics around it and make sure we move the relationship in that direction.”

Since the project began, the mandate to help patients choose between emergency, urgent and walk-in care is starting to be broadened: Cutler says they’re working on adapting the program to include primary care and telemedicine as recommendations where appropriate.

Buy-in is a two-way street

In order to accommodate Sutter’s needs, Ada Health created a web app version of what they normally offered as a mobile app, and tailored their software to work well with Sutter's website and patient portal.

But Sutter also contributed a lot to make the deployment work. For one thing, Cutler said, their leadership was involved early, widely and intensely.

‘Dr. Albert Chan, who’s our executive sponsor and champion at Sutter Health, he’s their chief of digital patient experience. He’s been a tremendous proponent and a major reason for this success, going out there and really driving home the importance of providing 24-7 care across the community,” Cutler said. “[Additionally,] when Sutter was launching this, they really took a very unique approach from the beginning. They created an interdepartmental governing board that oversaw the decision process when they were selecting different partners, and then going forward was continually involved.”

And the health system really shined when it came to promoting the offering, featuring it as the centerpiece of the website for five months, and aggressively marketing it with email and social media campaigns.

Ada and Sutter are planning to continue their relationship and keep making improvements, including a Spanish language version and the aforementioned integration with telemedicine. They’ve recently updated the app to let patients download and print the assessment reports after an outcry of public demand, and are working on ways to get that data to physicians directly in a useful form.

Cutler attributed some of the success to the fact that Ada has been very focused in its early sales strategy, looking for a few stalwart partners rather than risking biting off more than it can chew.

“It’s a marathon,” he said. “It’s more about collaborating and being co-development lighthouse partners. That’s really what you’re looking for.”