Yolande Pengetnze, MD, MS: How Chatbots Can Help Patients with COVID-19 Symptoms

Yolande Pengetnze, MD, MS

Given the current health climate, many patients have expressed feelings of anxiety due to self-isolation and the spread of novel coronavirus (COVID-19). Many emergency departments and hospitals are at capacity and patients who may be experiencing symptoms might not want to put themselves in a high-risk environment. That's where artificial intelligence (AI) can be leveraged. Personalized and tailored messages can be sent to individuals in their homes to educate themselves on the symptoms of the virus and steps to take.

Yolande Pengetnze, MD, MS, senior medical director at Parkland Center for Clinical Innovation (PCCI) spoke to HCPLive® about how the technology can be leveraged, overlapping symptoms of COVID-19 with allergies and asthma, and how education is key during high-stress health crises.

Editor's note: The following interview has been lightly edited for style and clarity.

HCPLive: Given the current health pandemic, how can chatbots be leveraged during a time where most people are quarantined due to COVID-19?

Pengetnze: That's a great question and we've been working on a few proposals at PCCI to bring up to speed a program. With the current COVID-19 pandemic, there are 2 sets of behaviors that need to be managed. One, of course, is to educate everyone about preventive activities— handwashing, social distancing, and everything that we should be doing—but also categorizing patients by risk group. We know the high-risk groups, those with chronic conditions—poorly controlled hypertension, diabetes, coronary diseases, immune suppression—all those patients are in 1 category. Of course, there’s the elderly category as well.

Then we have those patients for who represent 80-90% of the population. That population would probably not have too many symptoms or have minor symptoms and be okay.

There are 2 sets of behaviors that we want to encourage here. One is to educate the high-risk group about preventive measures and symptoms that should drive them to seek care as early as possible because of the disease to ensure that we know about them and we can intervene in a timely manner to prevent them from ending up with a complication, or at least to monitor them and treat them early on if a complication should arise.

On the other hand, we have the low-risk groups, who are patients that will have very mild symptoms. We don't want them to be overwhelming the health system with test-seeking or doctor's office visits or emergency department. Those groups of patients should be targeted for education that gives them information about preventive measures and how to manage the symptoms at home and encouraging them to avoid seeking care unless specific symptoms start arising—a high fever or worsening respiratory symptoms. Those subgroups should be encouraged to stay home and self-isolate, but not to directly reach out to providers.

A chatbot platform can be helpful in that we have already demonstrated impact with risk-driven interventions that are tailored to this profile. And, more than ever, that is needed for COVID-19 pandemic so that we can encourage early outreach for health provider evaluation for the higher-risk group while we decrease unnecessary doctor's visits for those with mild symptoms.

HCPLive: How can chatbots and telehealth tools in general be effective in addressing concerns before a patient presents in a high-risk environment?

Pengetnze: Patients who show up to an emergency department probably have a reason to be concerned. But again, those constraints can be managed and tamed if patients are educated and know what to expect and when to reach out. For the most part, people will rush to the healthcare system or emergency department when they see all these talks about people being infected and dying and they're not quite sure what to do and where to go. And doctors’ offices are overwhelmed and may not be available to respond to their questions. That's when they end up in the emergency room.

That’s why chatbot are important. We can tailor some messages and educate everyone about the symptoms that should drive you to the doctor; symptoms that you can manage at home; what you should be doing; how you should you be behaving in your community to prevent disease spread while remaining socially connected. That's important.

On the other hand, those high-risk patients, you sure don’t want to keep them home and end up with someone who actually stepped into the emergency room in a situation that would have a hard time managing, whereas we could have been ahead of the complication if doctors had known ahead of time that the patient had been infected.

So, we have to balance these 2 approaches. And again, it's a matter of proper re-segmentation, identifying those high-risk groups, targeting them with specific messages to take them to the doctors early for evaluation, whereas the low-risk groups should be educated and hopefully provided with enough comfort that they can take care of themselves at home, but yet, be aware of the symptoms that should bring them to the doctor or to the emergency room.

I think the telehealth platforms are going to be extremely helpful here because you can imagine the chatbot identifying someone whose symptoms are worsening and connecting them with a telehealth provider for quick evaluation before they present for an in-person evaluation.

HCPLive: COVID-19 presents symptoms that could be similar for patients with allergies or respiratory diseases like asthma. Can you discuss those overlapping symptoms?

Pengetnze: Cough, sneezing, and runny nose are typical symptoms of allergies that we share with common cold and now we share with coronavirus. However, once you have a fever it’s no longer allergies and has to be some viral infection. If you start having flu-like symptoms such as body aches and fatigue, then we're getting away from your common cold and it's more likely something closer to the flu. At that point, you have to be thinking, given the current situation, that it could be coronavirus. If you have flu-like symptoms, fatigue, coughing, shortness of breath, you should get evaluated by a doctor.

On the other hand, if you only have sneezing and coughing and you know you have allergies, certain medications can help you feel better and there's no point in going to the doctor to be evaluated. The only caution I put here is that if you live in the same household with an elderly person, I would say if you have fever, cough, and cold, then you probably need to be evaluated because we want to make sure you’re fine. If you're younger than 60 years old, you probably are going to be okay. But if you’re living with someone who's elderly or someone who has an immunosuppressive condition, a cancer patient with autoimmune disease, someone who has had an organ transplant, or someone with a severe respiratory condition, then it might be worthwhile to be evaluated if you have a fever along with these other symptoms. If not for you, at least for the sake of the person that you are taking care of or that you're in contact with, so we know if they have been exposed and if they need to be monitored differently.

Allergies would get better with allergy medications. A cold probably won't get better with allergy medications but shouldn't give you a high fever. As soon as you have a high fever, you have body aches, headaches, and shortness of breath, then at that point, you probably need to be evaluated.

It is the same time with asthma. Patients with asthma typically will have a cough, wheezing, and increased work of breathing, but again, asthma symptoms do not cause fever. So, if you don't have fever, then you know you can take care of yourself as usual. If you do have fever, though, within the current context, you need to be tested first for the flu because we still have the flu around. If your flu test is negative, at that point it would make sense for you to be tested for COVID-19. However, if you have your asthma symptoms and you can manage them at home, do that. If you have asthma symptoms and you have a fever on top of it, I think it's about time to see your doctor.

HCPLive: What can patients educate themselves on COVID-19?

Pengetnze: There's been a lot of information in the news, and I know that there are plenty of websites. I'm not going to refer you to any particular 1, but the CDC website has plenty of education about what are the symptoms that are fairly specific to coronavirus that should drive you to seek medical advice or at least get yourself evaluated.

Again, in terms of asthma patients, typically, the routine asthma education programs will certainly teach patients about the symptoms that are routine for them that they can take care of at home and those other symptoms that should take them to the doctor. And

Currently there is CDC outreach and local health departments that are providing a lot of information and I definitely recommend for everyone to reach out and look up their local health department website for additional information to get better educated about this pandemic and how to manage at home. Reach out to your doctor's office by phone of course and see if they can provide additional educational materials.

HCPLive: There is an overall feeling of anxiety, paranoia, and stress with a pandemic of this magnitude. Aside from chatbots helping patients who are experiencing symptoms of COVID-19, how might the technology be used to address mental health issues caused by the virus and self-isolation?

Pengetnze: We would have to use a chatbot specifically for handling mental health education, monitoring, and targeted screening. Chatbots are going to be extremely useful here to educate patients in mass to give them information about what to do, what are the symptoms that we're looking for that should take them to the doctor, and how to manage at home. That is important.

To bring the overall anxiety down, giving people access to resources when they have specific questions that are not answered through what’s available would certainly be a way of bringing down the anxiety level and making sure that people should know that most people are going to be okay. We're mostly wanting to focus on those 20% that may not be okay to take them to be evaluated by medical professionals.

Patients are truly the best partners for the health system in the way we want to educate patients in a way that is meaningful to them. Chatbots are definitely the way to go because when you overlay machine learning and artificial intelligence to claim all the messages to patients’ specific needs and risk profiles, you end up with patients who are more engaged and more educated and can make some decisions for themselves. These patients are going to optimally use the health system in 1 way or another and hopefully bring the overall anxiety down when we have a situation like what we have right now. Folks are empowered when they know what to do when things go 1 way or another, and also have access to the resources that they need to support them when they need to.