Maximizing the Value of Investments in Automation

Leveraging intelligent automation to deliver on strategic goals

Intelligent automation combines two powerful tools – artificial intelligence (AI) and simple process automation – to create a digital “workforce” capable of removing the friction from health care delivery. AI technologies are increasingly capable of replicating human brain functions while performing them much faster – and more accurately – than humans themselves. But in today’s lexicon, “automation” is nearly synonymous with robotic process automation (RPA). And by and large, the ambition for automation in health care starts and ends with point solution efficiency.

This thinking limits the impact automation can have. Other industries have successfully embraced intelligent automation beyond streamlining business functions to help them achieve their strategic goals. Here’s our take on four shifts health care leaders need to make in order to do the same.

What is intelligent automation

AI-enabled process automation.

Intelligent automation combines adaptive elements of AI like predictive classifiers, natural language processing, and computer vision with execution-focused capabilities of RPA to perform repetitive, logic-based tasks.

It uses AI capabilities to take in and act on structured and unstructured data in a human-like manner and learns from historic data to improve accuracy and efficiency.

The conventional wisdom

When providers think about automation, they think narrowly. They think about revenue cycle—as a single siloed function to be streamlined and accelerated. They think about other fundamental business functions like supply chain—because of the obvious ROI. They may think more broadly about robotic process automation (RPA)—but often only in terms of labor arbitrage.

This thinking isn’t necessarily wrong. Automation can and should make back office functions more efficient, and RPA can produce real financial rewards for
low-margin provider businesses. And most providers have plenty of running room for improvement.

Health care leaders’ conservative approach to using automation is also easy to understand. Unfulfilled promises of previous technologies—including but not limited to the EHR—make providers hesitant to wade into advanced automation solutions. When they do, it’s usually in the form of small pilots that are easily measurable but have limited impact (and may even exacerbate pain points in
adjacent workflows). In other words, some health care leaders are choosing to hold off on investing in automation, and some are investing in point solutions. Neither approach solves the problem of enterprise-wide efficiency or, consequently, experience in health care.

Our take

By focusing automation efforts solely on improving targeted efficiencies and reducingcost, provider organizations are inadvertently blinding themselves to thetransformational potential intelligent automation holds to help them execute againsttheir core organizational goals. AI-enabled automation, or intelligent automation, hasthe potential to alleviate administrative burden and achieve financial wins while alsooptimizing the care delivery experience.

Other industries have already turned to intelligent automation to ensure that theirconsumers are able to effectively access and navigate their services. Think aboutmanaging your investment portfolio, checking in for a flight, or filing your taxes. Thoseexperiences are setting, meeting, and even elevating consumer expectations aroundhow to interact with those organizations. And their consumers are your patients.

Health care is often behind the curve when it comes to adopting technology—and that's not surprising given that providers' margins are so thin, and their existingtech infrastructure is often cumbersome. But this is a gap that must close. Without aclear focus on the end user, the endemic problems of clinician burnout and turnoverwill persist unaffected at best and accelerated at worst. Patients will disengage, seekcare elsewhere, or avoid care altogether if they can’t interact meaningfully andconveniently with their providers.

Automation must be more than a series of disconnected IT point solutions. As AItechnologies improve, they have made automation nimbler and more productive.Intelligent automation can now learn from its “experiences” to more effectivelyenhance provider operations. It is more robust and adaptive than legacy processautomation solutions.

This presents a new opportunity in health care. Making the most of it requires a newpoint of view: providers need to look upon automation as a lever to improve thehealth care experience at all stages of the journey for both patients and staff.

Four approaches to maximize the value of investments in automation 

Changing mindsets is easier said than done, but it’s a non-negotiable first step towardinnovative transformation—and that’s what the move toward intelligent automation is.Providers don't need a new strategy around automation. They need to thinkdifferently about how automation can help them achieve their existing strategic goals.

We’ve identified four specific ways health care leaders need to push their thinking inorder to maximize the value of their investments in automation – and the first stepsthey should take to turn thought into action.

Providers should deploy automation as a tool to deliver on their strategic goalsbroadly rather than limiting their focus to cost reduction. Automation can improveefficiency by reducing per unit costs. But taking a problem-oriented approach –targeting point solutions to individual, inefficient workflows – guarantees that thebenefits will not extend beyond the endpoints of those problems. It constrainsboth the use case for and ultimate impact of automation.

Providers that look at automation as a means of improving user experiencebroaden their opportunity for impact. These providers are using the sametechnology to address both the process and people sides of their greatestambition: delivering high-quality, low-cost patient care. The result? A betterpatient and provider experience in addition to streamlined workflows andfinancial benefits. In other words, they get a bigger bang for their buck.

Taking a goal-oriented approach forces providers to look beyond the back officetoward improved experience for patients, staff, and clinicians.


Improved patient experience
Every provider we spoke with pointed to a service like TurboTax or online banking and said,“we should be able to offer that kind of experience.”

This user-friendly experience was Intermountain’s goal: after working for two years onEHR-based solutions to try and increase the completion rate of patient intake forms,Intermountain achieved only an 11% completion rate. Automating the patient intakeexperience – including extracting information from the EHR and auto-populating it for thepatient to sign off on, rather than manually input – increased that number to 70%.

Offering an integrated, seamless experience has multiple downstream benefits. Takingpatient registration as an example, successful registration improves patient satisfaction andretention, both of which have positive implications for clinical outcomes. It’s associated withdecreased denials, which means a healthier revenue stream and less downstreamadministrative work. And making the registration process user-friendly removes barriers topatient access. Deploying automation to improve experience yields holistic returns.


Lowell Community Health Center focuses on patient experience to improve access and health equity
Lowell Community Health Center, an independent FQHC1 serving Lowell, Mass., isusing intelligent automation to improve access to care for all patients, regardless ofdemographic or socioeconomic background. Lowell CHC serves a diverse community:40% of its patients are best served in one of over 60 languages other than English,including Spanish, Portuguese, Khmer, Swahili, Arabic, and Vietnamese. The systemrelies heavily on community health workers (CHWs) to engage patients outside thewalls of the health center. With a growing patient population,

Lowell CHC needed asolution to scale the capacity of each CHW while preserving their ability to cultivatepersonalized relationships.Lowell CHC invested in an intelligent automation solution to streamline patientregistration, from anywhere. So far, it has used the platform to facilitate patient intakeand maximize registration for COVID-19 vaccines among under-represented groups.Consistent with its commitment to health equity, Lowell CHC has deployed theplatform in multiple languages to best engage its community members, minimizelanguage- and ethnicity-based health disparities, and improve population health.

Since deploying the intelligent automation solution, Lowell CHC has seen an increasein digital patient engagement, including successful completion rates for end-to-endregistration and scheduling.

"Traditional workflowshave been one of thebiggest barriers topatient access. If wecan’t meet our diversepatient needs, we willnever deliver on ourpromise to provide anequitable health caresystem."

Brenda Rodriguez


Improved staff experience

Documentation burden is one of the primary drivers of staff dissatisfaction, burnout, andultimately turnover. Not only does it involve ample below-license work, it distracts from patientcare. Our research contacts pointed out that provider organizations regularly have over10,000 work queues in their EHR; there are hundreds of acceptable ways to denote “take onetablet by mouth daily” and over 80% of EHR data is unstructured. There are terabytes ofinformation inundating staff every day, but it’s nearly all noise and very little signal. Staff-facingintelligent automation can minimize the number of manual touchpoints required pertask across each use case. The result is staff and clinicians working at top of license.


Staff experience-driven use cases for automation


Ultimately, these are three flavors of the same thing – the same technology applied tomeet individual stakeholder needs. Taking a goal-oriented approach doesn’t mean providerorganizations forego the financial benefits of automation. Rather, it means they’re notlimited to them.

Even when providers deploy intelligent automation as a tool to improveexperience, they don’t always measure it that way. Many providers are stuck inthe mindset of “returns” referring exclusively to financial outputs.

If providers deploy automation to improve experience but exclusively measuresuccess in terms of cost savings, their efforts will meet the same fate automationinitiatives often meet of “death by pilot.” Providers need to assign metrics thatreflect the broader, more transformational ambition they set for intelligentautomation in order to quantify a true return from the get-go.


Approaches to measuring ROI when automation is deployed to achieve broad aims


Because most provider organizations are not yet deploying intelligent automation witha broad ROI in mind, there aren’t industry standards to follow for measuring impactbeyond financial return. But we’ve compiled a starter list of the kinds of metricsproviders need to track when deploying automation to meet their strategic goals.

Sample metrics to holistically evaluate impact of intelligent automation

  • Patient/staff satisfaction
  • Patient/staff engagement
  • Patient leakage
  • Adherence to care protocols
  • Drug prescription fill rate
  • Patient form fill rate
  • Copay collection rate
  • Staff turnover
  • New patient enrollment
  • Clinician panel capacity (e.g., care coordinators)
  • Clinician hours spent on documentation
  • Staff time spent on basic data entry
  • Duplicative patient outreach
  • Erroneous patient outreach
  • Care gap closure
  • Avoidable acute care use
  • Medication errors
  • Adverse drug event

By taking this approach, provider organizations have achieved robust outcomes to serve a range of strategic goals.


Provider leaders who ask “how many positions can I cut by using automation?”are asking the wrong labor question. The right question is, “how much morevalue can I get out of my employees?” The answer is “a lot.”

The notion that bots and humans have an either/or relationship isflawed. Automation technologies are most effective when used to enhance thequality and productivity of human labor. Most health care workflows require someelement of human involvement. But with effective intelligent automation, humansoperate only at top-of-license: that means the fewest touchpoints possible withautomatable workflows, and time spent on the tasks – or patients – that mostneed their attention.

"I need processes that can be turnkey, to beturnkey, to lift the operational burden offof staff and allow them to focus on thingsthat deliver immediate impact andoutcomes for patients."

Community-based health care provider

Beyond efficiency, this increased productivity means organizations can create and sustain volume growth without adding (human) FTEs.

RPA can be used to perform strictly repetitive tasks that don’t require humanintelligence, allowing staff to spend time on more complex tasks. AI-enabled RPA,or intelligent automation, takes it a step further by using machine learning toperform tasks that do require human intelligence. Bots trained with intelligentautomation continually learn from their “experiences” (i.e., data inputs) over time.This enables them to improve the quality and reliability of their outputs, makingthem increasingly valuable to their human counterparts. For example, bots canlearn to predict which clinical orders are most apt for a particular patient byobserving the provider’s ordering habits over thousands of comparable encounters.


How productivity gains from intelligent automation enable growth

DrFirst helps hospital increase pharmacy technician panel
Health technology solution vendor DrFirst helped a midsizehospital optimize medication reconciliation.Typically, a pharmacy technician spends 30-45 minutesper patient manually searching for and enteringmedication histories. Using intelligent automation,DrFirst’s solution parses multiple national data sources,local pharmacies, and health information exchanges tocreate more complete histories. Then, it translates thefree text, infers missing information, and adaptsterminology to match the receiving hospital’s EHR. Theresult for this hospital was more accurate medicationhistories, reduced manual transcription errors, andimproved staff satisfaction. And with the time saved,each pharmacy technician increased the number ofmedication histories performed daily by 50%.

A large regional health planincreases care manager panel
When a large, regional health plan started usingintelligent automation to support care management,nurse care managers were spending 60% of theirtime mining patient data rather than connectingwith patients themselves. Intelligent automation notonly surfaced the relevant data for the caremanagers, it prioritized which patients requiredactive outreach and which could be passivelymonitored. Care managers were able to increasetheir panel capacity by 35%.

Automation vendors echo the sentiment that good automation solutions result inFTE offset. They also acknowledge that “offset” almost always means improvedproductivity and ability for the provider to grow volumes without adding employeerequisitions – not a workforce reduction.


Get your staff on board

The first step is for leadership to get on boardwith this idea that a digital workforce shouldaugment, rather than replace, a humanworkforce. But the preconception of “humansvs. robots” doesn’t end at the c-suite. Leaderscan’t expect staff to adopt solutions they don’tunderstand without acknowledging staffmembers’ reservations. And without end useradoption, these solutions become theoretical.Specifically, leaders need to assuage theirteams’ fears of job replacement anddiminished clinician autonomy.

"It’s important to communicate benefitsof this to staff, make them feelcomfortable, part of it. There’s a lowtechnical barrier to using RPA andintelligent automation– but staff haveto feel like it’s working with or forthem, not replacing them.”

John Tippetts, Chief Architect

Provider organizations need to establish governance around automation in orderto fully take advantage of it as a business tool, rather than a side project of aself-identified champion. Digital capabilities underpin the majority of providers’strategic goals – as an industry, we need to move past the days of considering“digital” to be synonymous with “IT.” Digital technologies like intelligentautomation are business solutions intended to alleviate business challenges.

That’s good news, because it means intelligent automation can serve anystakeholder. (See examples of improving user experience, pages 7-9.) But thatflexibility may make it difficult for health care leaders to assign effectiveownership over and accountability for automation initiatives. A failure tocoordinate and manage projects at scale results in redundant, competing, orsiloed investments in automation solutions. As one automation vendor put it,“dabbling is not a viable path to scale.” 

Intelligent automation initiatives are often driven byindividual champions with personal interest in orexperience using AI. Champions play an importantrole. But providers need to establish cleargovernance and accountability to orchestrateeffective implementation, monitoring, and scale of thetechnology. Organizations that recognize theopportunity automation presents have done just that,with varying levels of investment.

"The most important thing for anyone that decides to embark on using automation is to have a good governance model, participation of leadership in areas you want to make an impact, and good partnership between IT and the areas where you’re trying to use it.”

Ilo Romero, VP and Assistant CIO
West Virginia University Health System


On one end of the spectrum, organizations createmultidisciplinary governance bodies to driveutilization and continued refinement of intelligentautomation solutions to meet business needs. Thiswas the case at WVU Medicine West VirginiaUniversity Health System.


West Virginia University Health System scales from champion to organized governance
At the West Virginia University Health System, automation started as achampion-driven initiative around AI. The champion (the Assistant CIO) got CEOand senior executive leadership buy in and took the helm in an expanded role todrive the use of AI and automation across the enterprise. The team includes adata scientist, an architect, machine learning engineers, and partnerships withthe business lines they support, as well as the Health System's analytics team.They were able to elevate automation – including intelligent automation – froman individual-driven pilot to an established business function being deployed tomeet both strategic and operational needs.


On the most sophisticated end of the spectrum, some organizations haveembraced the transformational potential of automation as a strategic imperativeto serve every area of the business and invested in creating a formalizedenterprise function.


Intermountain’s Center of Enablement ensures effective, enterprise-wide useof automation
Intermountain created the Center of Enablement in response to a goal establishedby the Board of Directors to expand the use of automation across the enterprise.The Center of Enablement includes architects and data scientists who workalongside staff that elevate opportunities for automation to identify whetherexisting tools can meet the business need or if they should consider investing in ordeveloping a new tool. The stated goals of deploying automation acrossIntermountain include improving quality, accuracy, productivity, and employeemorale. Not only is executive leadership unanimously in support of those goals,the Chief People Officer is personally accountable for reporting on the Center’sprogress to the Board. Intelligent automation is necessarily leveraged as a coretool to meet Intermountain’s strategic goals.

Parting Thoughts

Automation can improve backend efficiency to achieve cost savings, but it cando so much more than that when deployed to improve patient and providerexperience. Health care leaders have been thinking too narrowly about the roleautomation can play in helping them meet their strategic goals. As automationtechnologies improve and become more prevalent, providers need to broadentheir thinking about how to leverage intelligent automation.

Health care leaders are afraid to be the “tip of the spear” when it comes todeploying intelligent automation in patient and staff-facing ways. But that thinkingmay soon be outdated: the number of providers using automation more thantripled in the past year alone. Investment in automation on some level isinevitable; the question is no longer whether to invest in automation, it’s how toguarantee your investment has the broadest possible impact.

Focusing on improving the health care experience is a good place to start.Consumers expect a more seamless experience: paper-based processes justwon’t cut it anymore. And every point of friction in the experience is anopportunity for a patient to fall through the cracks. When the goal is to simplifythe experience for the end user, health care leaders are forced to considerprocesses holistically. In doing so, they can realize benefits beyond just the costsavings for which they usually aim.

The past year has seen providers innovate in shoots and starts, out of necessity.Several used intelligent automation to stand up emergency Covid-19 outreachcenters to field patient calls and orchestrate Covid-19 testing and vaccination.Leaders need to take advantage of this spirit of innovation and build on it.Intelligent automation shouldn’t just be employed when crisis strikes – it shouldbe woven into the fabric of doing business in health care.

About the sponsor

Notable is the leading intelligent automation company for healthcare. Three of the top 15 US health systems, including Intermountain Healthcare and CommonSpirit Health, use Notable to identify and engage more patients in need of care by automating hundreds of repetitive workflows like patient intake, care outreach, registration, documentation, and billing. With Notable, staff and clinicians report saving 700+ hours of administrative work per provider per year; increased patient visit volume; a provider NPS score of 74; and patient satisfaction ratings of 98%.

Learn more about notable

This report is sponsored by Notable Health, an Advisory Board member organization. Representatives of Notable Health helped select the topics and issues addressed. Advisory Board experts wrote the report, maintained final editorial approval, and conducted the underlying research independently and objectively. Advisory Board does not endorse any company, organization, product or brand mentioned herein.

View Advisory Board's editorial guidelines


Sponsored By

This report is sponsored by Notable. Advisory Board experts wrote the report, conducting the underlying research independently and objectively. Notable had the opportunity to review the report.

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1. You'll understand what makes intellignet automation unique.

2. You'll learn how to leverage AI and robotic process automation (RPA) for process efficiency.

3. You'll discover strategies for improving performance and reducing cost.

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