This article covers:
FAQs
What is the Smart Inbox AI Navigator?
The tool sits in the Smart Inbox signposting section and for every eConsult, excluding long term condition reviews and eConsult Lites, it will suggest 3 triage fields: team, urgency and mode:
Team: The most appropriate team member to respond
Urgency: The suggested time frame for response
Mode: The suggested mode of consultation (SMS, telephone, video, face to face ['F2F'])
The aim of the AI Navigator is to quickly and easily fill in the signposting section on the eConsult report, moving it through to the most relevant team member to pick up and respond. However, this is not intended to support admin-first triage - each ‘quick suggestion’ must be reviewed by a clinician before acceptance.
The tool speeds up your team’s eConsult triage process: where the quick suggestion is judged correct on the clinician’s assessment of the eConsult, no further selection is required.
How does the AI Navigator Work?
Once an eConsult report has landed in the Smart Inbox the AI will apply a ‘Quick Suggestion’. The user needs to review the eConsult in the usual way first and make their decision about the appropriateness or otherwise of the suggestion, and then save to automatically move the eConsult into the triaged folder.
Should the ‘Quick Suggestion’ not be correct or not be the most appropriate selection following your review, it is easy to override. You can either fill in the signposting section manually, or if you only want to change one of the triage suggestions you can press on the 'Quick Suggestion' to fill in the fields and then just change the one you want.
How was the Smart Inbox AI developed and how were the rules built?
A large group of clinicians working with eConsult created a structured logic table to determine the appropriate initial ‘Quick Suggestion’ output based on a number of variables, including patient age, sex, flagged responses and other clinically relevant factors.
In partnership with Deloitte following an award from NHS England, technical capabilities were added to the logic - including natural language processing and lemmatisation - to take forward to clinical testing and ensure that the AI Navigator outputs were appropriate and catching relevant higher risk free text entries.
This innovative AI triage tool is being independently evaluated by Swansea University as of late 2023.
What do the different triage urgencies mean?
We know that different practices and sites work in different ways, and we have received feedback that some prefer to define timings for urgency more flexibly. We have therefore moved away from specific language on urgency: practices should define these categories at their specific response times at a local level.
Urgent - today or tomorrow
Soon - Ideally by the end of the next working day
Routine - within 2 weeks
If you have previously been using the signposting feature, you might notice that these are new options. However, you still have access to all of the old urgencies if you want to continue with more granular triage timing detail.
How do I turn on the Smart Inbox AI Navigator?
If you want access to the Smart Inbox AI Navigator, please get in touch with our Operations Team at practice.support@econsult.health or contact your Account Manager.
FAQs.
Features and Functionality
Why doesn't it offer a ‘Quick Suggestion’ for eConsult Lites and long-term condition reviews?
eConsult Lites do not contain enough structured information, and long-term condition reviews contain too many variables, to work with our initial version of AI Navigator. As a result, they are excluded from the AI Navigator and will need to be processed manually, they will show the following message instead:
Does the AI feature work with different clinical systems?
It does. As the tool is housed in the Smart Inbox and does not rely on the clinical system; it can be used by all Smart Inbox users.
Can I use it just for clinical or administrative eConsults?
The AI Navigator will process both administrative and clinical eConsult, it cannot be enabled for just one of the queues. However, you may decide to only save the suggestions from one queue.
Will I still have to process eConsults?
The AI Navigator tool within Smart Inbox is intended to offer a suggested triage (mode / team / urgency) to assist clinicians in efficient triage of eConsult reports. It is a decision support tool and is not intended as a stand-alone automated triage tool - it is expected that a full clinical assessment of the eConsult report by a clinician with access to the full clinical record should still take place for every eConsult.
Will I be able to turn it off?
Yes of course, just reach out to practice.support@econsult.health for support with this.
Does the Smart Inbox AI include Machine learning?
Not at the moment. We want to gather some initial data on how different users are using the tool, and assess the common overrides before we explore introducing machine learning.
Can I amend the Team categories in the signposting section?
Not at the moment. During the trial the options currently provided need to remain the same for all practices testing the AI functionality.
Safety and Accuracy
How do I know the AI feature is safe?
The AI Navigator tool within Smart Inbox is intended to offer a suggested triage (mode / team / urgency) to assist clinicians in efficient triage of eConsult reports. It is a decision support tool and is not intended as a stand-alone automated triage tool - it is expected that a full clinical assessment of the eConsult report by a clinician with access to the full clinical record should still take place for every eConsult.
Is the AI Navigator accurate?
The AI Navigator algorithm is based on consensus of 19 GPs on clinical rules derived from the red flag system which has been part of eConsult since its inception. Our internal testing suggests that it offers the ‘quick suggestions’ we would expect, but we will not be able to fully judge its accuracy until it is in real world use. In practice, it is very likely that there will be instances where clinicians disagree with the ‘quick suggestion’. As we all know, even outside the context of digital health, there is considerable variation in opinion between clinicians on any given clinical question. This is supported by research which has shown wide variation in accuracy of telephone triage across studies (69-97%). It is likely that AI Navigator may sometimes seem ‘over-cautious’ in terms of recommendations. This would be in line with most digital tools developed for healthcare, which seek to balance risks of ‘under-triage’ with inconvenience of ‘over-triage’. However, we believe that in a large proportion of cases the ‘quick suggestion’ will align with clinician assessment, allowing single-click acceptance following clinical review. During and after the Swansea University independent evaluation we have a process of continual monitoring and surveillance in place to ensure we can evaluate the ongoing accuracy and appropriateness of quick suggestions, with alterations to the algorithm where necessary.
If you have any questions or you feel that this article could be improved, please feel free to give us some feedback by emailing us, pressing the emojis below or using the chat button on the bottom right-hand side of this page to speak to one of the eConsult team.