September 2022 • PharmaTimes Magazine • 18-19

// AI //


Conversation starter

Conversational AI may hold the key to igniting mobile digital engagement within clinical trials

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The concept of convenience is the central driver for the movement towards decentralised clinical trials – specifically, making things as easy as possible for trial participants.

After all, there is no trial if there are not enough participants. If the hurdles are too high, recruitment targets will be missed, or worse, high patient attrition rates and non-adherence could reduce the overall sample size and compromise the study. Many trials are over before they even begin!

The concept of decentralisation is broad, but the general idea is about making things easier for participants by bringing the trial to them in their homes or neighbourhood. By removing as much inconvenience as possible, researchers have better odds of hitting their recruiting targets and keeping participants engaged throughout the trial. Decentralised trials are also helping improve trial diversity, which is a priority for most clinical research organisations (CROs).

Trial blazing

Technology is at the centre of the decentralised trial experience. Digital tools can help with recruiting, they can help with qualifying and onboarding – and they can help with execution.

Most of the patient-facing clinical trial solutions come in the form of mobile apps, which makes sense considering 86% of adults now own smartphones. By some estimates, there are now more than 150,000 different mobile apps designed for clinical trials.

The world of clinical research is embracing digital patient engagement, which is good. Still, mobile apps are not a panacea for capturing and managing a trial participant’s digital attention. What looks good on a whiteboard does not always translate into widespread adoption, especially when it involves convincing consumers to embrace new technology.

The healthcare industry suffers from an ‘if we build it, they will come’ delusion when rolling out patient-facing technology. This is why every node of the healthcare apparatus has a mobile app today, yet most are engaged with just a tiny fraction of their patient population. The apps are capable tools and will do what they were designed for, but they all suffer from a problem known as ‘friction’ – they’re too hard to use for most people.

Work of friction

Technology friction is not a new concept, especially regarding solutions that are supposed to be used by millions of people for workflows where complexity, security and administrative overhead are the norm. Consider the reality that most of the target users are sick, elderly, or disabled, and you see why digital engagement rates rarely break 15%.

The other issue is that there is no single ‘super app’ for all things healthcare. Grandma may have an iPhone 14, but will she download a portfolio of mobile apps from her various providers, set up secure accounts and become a black belt master across seven different user interfaces?

Mobile apps present a problem for healthcare because each one is created and operated by a single entity. In the world of clinical trials, it goes a level deeper with individual apps for each trial. This is one reason there are over 150,000 of them. And with each app comes a user experience that begins with a download and then a user account set up before the participant can do a single thing.

The prevailing solution to the friction problem is assigningpeople to help the patients with the mobile apps. For a trial with 50 participants, that’s maybe doable but also costly and time-consuming.

Why even have an app if you need to assign an agent to help every participant? For more extensive trials, the time and cost economics become unsustainable.
This is a challenge that all of healthcare must deal with that is getting amplified because of the worker shortages.


‘Grandma may have an iPhone 14, but will she download a portfolio of mobile apps and become a black belt master across seven different user interfaces’


Talking sense

With smartphone penetration becoming ubiquitous across all demographic and geographic segments of society, the path forward is mobile. A new class of technology is turning the smartphone into something better – a digital assistant that uses language to interact with users using the native capabilities on the device. All without the need for patients to download, set up user accounts, and learn yet another app.

Technology has reached the next major inflection point. Over the past 20 years, machines have done wonders in helping streamline interactions between people. Social networks, texting, Instagram, Twitter, TikTok are all examples.

Now, people are using language to interact with the machines themselves. The technology is called Conversational AI.

Siri and Alexa are popular examples where keyboards, buttons and menu trees have given way to words. Asking Siri for the best route to the airport is commonplace.  Alexa is very capable of handling the Nest thermostat or submitting an order for some AA batteries. Now, these capabilities are making their way into the world of business.

Conversational digital assistants use messaging to help consumers with all sorts of daily ‘business transactions,’ and healthcare is poised to be a leader in this domain. Already, chatbots are familiar tools, serving as frontline triage assistants for patients that are going to an appointment with their provider.

These solutions run using native web browsers and SMS messaging along with smartphone capabilities such as maps, wallets and calendars. By eliminating the need for patients to set up and access proprietary mobile apps, conversational digital assistants increase access, literacy and satisfaction across all aspects of healthcare.

Digital watch

Conversational AI has the potential to change how clinical trials are conducted fundamentally. Smart digital assistants can reach out to potential participants and navigate them through the recruitment process. They can collect information and provide answers at the right health literacy levels. And, they can stay with the participant throughout the trial, providing logistical support, reminders and education as well as collecting important information from every individual.

Conversational digital assistants don’t replace human care coordinators they augment them. Participants’ mobile devices become an engagement channel that handles the high volume, redundant administrative work. The human agents have the time to provide each participant with a ‘white glove’ experience because they are no longer buried chasing other patients for information, forms, reminders etc.

There are currently more than six billion smartphones out there, each of which has massive untapped potential. Someone in a marketing department may hold on to the value of having a patient captive in his or her own proprietary mobile app, but that kind of inward thinking needs to change. The digital engagement benchmark should be 80% of participants, not 20%.

Grandma’s smartphone will turn into her own digital assistant that helps her with primary care, specialists, prescriptions, physical therapy and two clinical trials she’s taking part in. It’s not science fiction. It’s already here, helping people everywhere, regardless of who they are or where they live.


Greg Kefer is CMO at Lifelink Systems.
Go to lifelinksystems.com