Technology and Care Delivery

New technologies, including the advance of artificial intelligence (AI), hold great promise for helping providers and health systems manage the care they deliver, but have not always lived up to their potential. Differences in how organizations approach care integration, medical records, and patient engagement limit the ability of these technologies to catalyze systemic improvements in care access, effectiveness, and efficiency.

RAND Health researchers leverage their expertise across medicine, statistics, and health policy disciplines to sort hype from reality. Our teams devise and evaluate new approaches and technologies including AI, telehealth, and interventions that use medical records and mobile applications.

Examining the Use of AI in Clinical Care

AI could be a great help in clinical care—by streamlining administrative tasks or speeding image analysis, for instance—allowing providers to focus on tasks requiring human discernment. Yet the removal of human input could also lead to unacceptable trade-offs, including misdiagnoses, missed diagnoses, and medical errors.

A multi-faceted approach: RAND teams help policymakers understand the risks and benefits across a wide swath of health care uses, as well as considerations for future applications. Recent work includes

• an examination of how well chatbots respond to suicide-related questions, compared with humans
• an exploration of how AI might enhance the accuracy of a mechanism to screen EHRs for markers of frailty
• systematic studies and an evidence map of AI's role in clinical care and the COVID-19 response
• strategies to mitigate challenges that emerge from the use of machine learning in public policy
• the use of infant mortality data to predict risks and identify the most effective interventions to keep babies and mothers healthy.

Evaluating the Effects of Telehealth

The role of telehealth surged during the COVID-19 pandemic and has continued to expand. Despite its popularity, there is no one-size-fits-all guideline on whether it is as effective and appropriate as in-person care across all conditions. Further, state-based regulation of health care delivery leads to uneven access to telehealth and complicated rules to navigate, especially for patients and providers who live near state boundaries.

Treatment flexibility: Through dozens of projects, RAND researchers have investigated telehealth’s role in adapting to emergencies, enabling treatment for behavioral health, lowering barriers to care, and addressing differences in health care access. Post-pandemic, researchers continue to analyze how telehealth could affect

• lactation services
• outpatient palliative care
• group therapy for families of people with opiod use disorder.

Cost vs. value: Unfettered increased access to telehealth would undoubtedly lead to increased overall costs. RAND experts on telehealth, however, encourage policymakers to shift from worrying about spending to thinking of telehealth as a potential tool to gain access to highly valuable services.

Using Health Apps to Improve Care

Technology alone cannot cure the fragmentation of health care: medical records often can’t sync across health systems, and siloed care can lead to conflicting medical advice, prescriptions, and errors in care.

Trials of new interventions: Within randomized controlled trials, RAND researchers have designed and implemented clever uses of health data to improve clinical outcomes.

• Researchers examined an app for patients to report on and rate their asthma symptoms between provider visits. The app integrates with their medical records and alerts providers to changes in patients’ health status. Researchers measured changes in app users’ asthma-related quality of life scores. The scores improved, but the changes were not clinically significant for this pilot test.
• Apps that aim to reduce alcohol consumption have been widely available, but little data has been collected on their effectiveness. RAND deployed a nationally representative study and paired the results with interviews, finding that alcohol-reduction apps could be powerful tools to introduce users to health care services and support groups.