Background: Patient navigators, whose value has become increasingly apparent, still face significant challenges, including a lack of support, funding, and recognition. These challenges have been exacerbated in the wake of the COVID‐19 pandemic.
Methods: This study explored the potential use of artificial intelligence (AI) in patient navigation. Data were collected through structured surveys and individual interviews with patient navigators from a variety of institutions and professional backgrounds. The data were analyzed to understand the current state of patient navigation, identify existing gaps, and suggest best practices for the future.
Results: The findings showed that patient navigators (a) have diverse backgrounds and responsibilities, (b) lack technology support for their work, (c) are at risk for burnout, with the extent varying based on the level of technical support received, and (d) report significant overlap between current barriers and those that could potentially be addressed with AI‐driven technologies.
Conclusion: A novel intervention, that is enabled by AI and other technologies and tailored to individual needs, has the potential to reduce burnout, increase capacity, and help ensure the sustainability of patient navigation and other areas of healthcare. By addressing the specific needs of individual patients, this type of intervention could help improve the overall effectiveness of patient navigation and support the long‐term sustainability of the role.
Keywords AI, care access, health equity, patient navigation
Abbreviations: AI, artificial intelligence; EHR, electronic health records; EMR, electronic medical records.
This is an open-access article under the terms of the Creative Commons Attribution‐NonCommercial‐ NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is noncommercial and no modifications or adaptations are made.
© 2024 The Author(s). Medicine Advances published by John Wiley & Sons Ltd on behalf of Tsinghua University Press.
The healthcare system in the United States is widely regarded as one of the most advanced in the world, yet it is also incredibly complex and fragmented. Navigating this system can be challenging, and it is common for patients to experience uncoordinated care, leading to gaps in care, outcomes, and quality.1 Patient navigation, although it has various definitions, was developed to address the barriers that prevent patients from accessing optimal, equitable, and affordable healthcare.2
The healthcare system in the United States is widely regarded as one of the most advanced in the world, yet it is also incredibly complex and fragmented. Navigating this system can be challenging.
Patient navigation is a relatively new addition to the healthcare system that helps address barriers to quality care by providing individualized assistance to patients, survivors, and families.3 Although the concept of patient navigation may be new to modern medicine, its roots can be traced back to President Richard Nixon's declaration of the “War on Cancer” in the National Cancer Act of 1971.4,5 At this time, medical advances had been made, but cancer care delivery was found to be plagued by disparities in underserved populations. There was a significant disconnect between medical discovery and care delivery.2,6-8
In the early 1990s, Dr Harold Freeman, a surgical oncologist at Harlem Hospital in New York, pioneered this field, establishing the principles and launching the first known patient navigation program. Since then, patient navigation has evolved from originally addressing barriers to care to also addressing prevention, detection, diagnosis, treatment, survivorship, and end-of-life care.2
Since its inception, the efficacy of patient navigation has been demonstrated through real-world practice and research. Studies have shown that patient navigators are effective interventions in removing barriers to cancer screening and follow up on diagnoses, leading to better outcomes and increased satisfaction for patients, as well as financial benefits for healthcare institutions.9-11
Patient navigation has been specifically targeted towards reducing cancer disparities in underserved populations since the inception of the first patient navigator program. The value of patient navigation as a tool to narrow health disparities has been recognized in the current era of US healthcare reform.2,12,13
Patient navigation gained increasing attention in the first few years of the new millennium. A series of studies or reports brought this prominent healthcare challenge to the public and policymakers, including the Unequal Burden of Cancer,14 The National Cancer Program: Assessing the Past, Charting the Future,15 Voices of a Broken System: Real People, Real Problems,16 and the Unequal Treatment: Confronting Racial and Ethnic Disparity in Healthcare.17 This led to a legislative move in 2005, when the Patient Navigator Outreach and Chronic Disease Act passed.18 Furthermore, the Patient Protection and Affordable Care Act was signed by President Obama to mandate patient navigation as a component of healthcare.19,20 In 2021, Centers for Medicare & Medicaid Services launched the Enhancing Oncology Model to improve cancer care for Medicare patients and lower healthcare costs, which includes patient navigation as an integral part: $80 million in grants was made available to navigators in states with a federally facilitated marketplace for the fiscal year of 2022 to approximately 70 institutions or programs nationwide.21
Several standard-setting organizations are devoted to the development and adaptation of patient navigation. In 2005, the American Cancer Society launched its first Patient Navigator Program; the program had helped over 500,000 patients by 2016. A 9-site National Cancer Institute Patient Navigation Research Program was initiated to evaluate interventions and obtain clearer definitions of navigation.22 The Academy of Oncology Nurse & Patient Navigators (AONN+) was formed in 2009 and has now become the largest national organization for oncology nurses and patient navigators.23 In 2010, Oncology Nursing Society, the Association of Oncology Social Workers, and the National Association of Social Workers came together to define the Role of Oncology Nursing and Oncology Social Work in Patient Navigation.24 A few competencies or certification programs have been gradually established by the American College of Surgeons’ Commission on Cancer in 2012, the Oncology Nursing Society Nurse Navigator program in 2013, The George Washington Cancer Institute in 2015,3,25 and AONN+ in 2016.26 In 2017, the National Navigation Roundtable, a national coalition of over 50 member organizations and invited individuals, was launched with the goal of “achieving health equity and improving access to quality care across the cancer continuum through effective patient navigation.”27
The Academy of Oncology Nurse & Patient Navigators (AONN+) was formed in 2009 and has now become the largest national organization for oncology nurses and patient navigators.
Despite their value being more and more explicitly demonstrated, patient navigators and their affiliated programs are still “undersupported,” “underfunded,” and “undervalued.”12 Our healthcare system is further stressed by dire challenges in the wake of the COVID pandemic, such as the aging population, labor shortage, and burnout in professionals. Patient navigators and their affiliated programs are at higher risk of failing to fulfill their mission to remove the barriers to care, close gaps in health disparity and inequality, and improve quality of life.
While numerous studies have been devoted to investigating the role, effectiveness, and impact of patient navigation at the individual, institutional, community, legislature level, and industry-standard setting, little research has been conducted on the technology factors, especially about how the latest technologies (eg, artificial intelligence [AI], big data, and more) may support the patient navigators to reach their full potential. It remains a challenge for many health institutions to leverage advanced technologies to design and operate patient navigation programs. The purpose of the present study is to explore the potential of the latest technologies (eg, big data, and more) to better support patient navigators in their line of work, identify the gap, and inform the future navigators, program managers/directors, and other healthcare professionals in response to the healthcare challenges in the post-pandemic world.
The survey, “AI for Patient Navigation”, is a novel study to explore the potential of the latest technologies (eg, AI, big data, and more) to better support patient navigators in response to the healthcare challenges in the post-pandemic world. Patient navigators, program managers/directors, and other healthcare professionals involved in patient navigation are invited to express their opinions.
A 9-question questionnaire has been developed for this purpose. Responders were mainly solicited for their opinions from 3 modules: (1) About their role, practice, and work responsibilities; (2) How they feel in the line of work, extent of burnout; and (3) How is the technology empowerment currently, and how much and in what way they’d like technology to help (Table 1).
The questionnaire is embedded as an online survey form (https://forms.gle/ttKffmnD2X8hegrAA) to be sent to patient navigators, program managers/directors, and other healthcare professionals. Responders may choose to volunteer to disclose their affiliation and contact for further interviews if possible.
The survey was sent to 383 patient navigation professionals from 128 cities from 51 states and territories. In total, 47 respondents responded to this anonymous survey (Table 2).
According to the survey, there is a variety in the affiliation of navigators. Most navigators are institutional, affiliated with health institutions or navigation programs. But there are also navigators in private practices. In addition, it is not always navigators who are navigating patients; health professionals from other responsibilities are also assigned to patient navigation, such as post-anesthesia care units and clinical trial research. Professionals from other industry sectors, such as social workers, are also involved (Figure 1).
Navigators are responsible for different lines of work. Over half of responders are involved in medical care navigation (53.7%), followed by oncology navigation (14.6%) and financial navigation (12.2%) (Figure 2). These high-ranking responsibilities indicating navigator’ role to support care practice also reveal diversity of patient navigation beyond clinical encounters in the continuum of care.
Most responders (80%) reported no use of software or tools in their line of work (Figure 3). Moreover, non-tech users report higher burnout index (3.3/5.0 vs 3.0/5.0) and have higher demand for tech empowerment (4.2/5.0 vs 3.3/5.0)—the burnout index is indexed by averaging an individual’s reported score (least concerned–1; deeply concerned–5). Overall, the respondents reported a burnout index of 3.2 out of 5.0 and a demand for technology to be 3.9 (Table 3).
Most navigators are responsible for multiple barriers, despite their self-reported line of work. On average, one patient navigator is helping their clients with 4.53 main barriers. Financial, transportation and educational are among the most reported—each by over half of the responders. The top barrier reported included lack of health insurance or concerns about cost (81.5%), followed by lack of knowledge about diseases, transportation, and medical literacy—each reported by 66.7% of responders (Table 4).
When asked about barriers that may be helped most by technology, over half of the responders chose scheduling and educational barriers. The top barrier reported included difficulty with scheduling appointments—reported by 63.0% of responders, followed by lack of knowledge about diseases (59.3%) and limited medical/health literacy (51.9%). Language barriers and lack of health insurance or concerns about cost are slightly less than half (44.4%) (Table 4).
In addition to the primary results of the survey, we further investigated barriers using a scatter plot with 2 attributes: the percentage of respondents who identified a particular barrier as a main challenge in helping their patients and the percentage of respondents who believed that technology could be effective in addressing that barrier.
The scatter plot shows that these 2 attributes are generally correlated, with barriers aligned along the diagonal line. Language barriers are seen as the most typical challenge, with nearly half of the responders indicating that it is both a main barrier and a barrier that could be helped by technology (Figure 4). The scatter plot can be further divided into 4 quadrants using language barriers as a reference line.
The leading quadrant of the scatter plot represents barriers that are both important and technologically feasible to address. These barriers turn out to be more informative or educational in nature, such as a lack of knowledge about diseases or limited medical/health literacy. The highest-ranking main barrier, financial barriers (such as a lack of health insurance or concern about cost), is located on the borderline of technological feasibility, suggesting that innovators will need to be creative to effectively address this challenge.
The lagging quadrant of the scatter plot includes cultural barriers, emotional barriers, and difficulty choosing hospitals/providers, which are among the least relevant barriers for navigators and their clients. Few navigators believe that technology may be effective in addressing these challenges for their current base of clients.
There are a couple of exceptions to the general pattern observed in the scatter plot. For example, 66.7% of responders reported that a lack of transportation is a main barrier, but only 33.3% believe that technology could be effective in addressing it. Similarly, 40.7% of responders reported that difficulty with scheduling appointments is a main barrier, but 62.96% (the highest percentage for any barrier) believe that technology could be effective in addressing it. These exceptions highlight the importance of considering the specific needs and challenges of patient navigators and their clients when developing technological solutions.
There is no consensus among respondents regarding their preferred navigation tools. The options provided in the survey included: direct patient advocate (serving as a patient advocate to directly interface and help patients), virtual assistant (serving as a virtual assistant to support the navigator’s work, like a clinical decision system for physicians), software as a service (a platform offering digital visualization to help manage patients), and software plug-in (software that integrates with electronic health record [EHR]/electronic medical records [EMR] systems). Responders were also given the option to provide self-defined answers.
According to the survey results, SaaS platforms were the most popular choice among respondents, with 29.3% selecting this option. The next most popular choices were EHR/EMR plug-ins (24.4%), direct patient advocates (22%), and virtual assistants (9.8%), respectively (Figure 5).
The survey, which collected responses from a variety of sectors including major health institutions, community organizations, the public service sector, private practice, and local navigation networks, has a wide geographic and industry coverage and provides a balanced view of the state of patient navigation. Structured interviews with volunteers who provided their contact information and affiliations also contributed to the in-depth insights gathered.
The results of the survey reveal a concerning lack of tech support for patient navigators, with more than 80% of navigators not using any digital tools for their work. Further interviews revealed that many of the technology users were healthcare professionals who utilized EHR software for patient navigation. The results also indicated a correlation between burnout and the demand for technology in the field. Burnout is a common issue in the healthcare sector, and patient navigation is no exception. The lack of tech support can be a significant burden on the workforce.
There are several possible reasons for the absence of technology in patient navigation, including the fact that the scope of the role is not yet well defined, non-affordability or lack of financial resources, and/or a lack of systemic or institutional support. These findings highlight the urgent need for technological empowerment in this field.
The results of the barrier investigation, both primary and advanced analysis, show that technology has the potential to address the unmet navigation needs of patient navigators and their clients. However, the survey results reveal a diverse range of needs for technology, as responders have different preferences for the tools they use. These needs can vary from individual to individual and change over time, presenting a challenge for conventional software development. To effectively meet these needs, next-generation patient navigators must be smarter, more adaptable, and more holistic in their approach. This gap further raises questions about the programs for training next-generation navigators and supporting their practice.
Further interviews with patient navigators revealed even more individualized perspectives on their needs. The heterogeneity of a typical day for a navigator and the specific challenges they faced were evident in the responses. For example, a Texas-based program manager reported spending “2 to 3 hours” driving to visit rural clients, while major hospital-affiliated counterparts emphasized the importance of communication with leadership. Some director-level responders use programs instead of one-on-one approaches to better support survivors, while private navigators struggle with revenue cycle management. These varied experiences highlight the importance of considering the specific needs and challenges of patient navigators and their clients when developing technological solutions.
To effectively adapt technology to meet the needs of patient navigators, it will require sophistication, instrumentation, and orchestration. By developing tools that are adaptable, flexible, and tailored to the specific needs of individual navigators and their clients, it is possible to create technology that can effectively support and empower patient navigators in their important work.
Chen et al27 provide a compelling case study on how cutting-edge technological solutions can address professional burnout in patient navigation. During the COVID-19 pandemic, the development of Ask Dr. Haiel, an AI-enhanced patient navigation platform powered by a large language model and a specialized search engine, expanded access to a suite of healthcare resources, facilitating online diagnosis and symptom checking, introducing users to medical resources specific to COVID-19, and mapping out hospitals equipped to treat COVID-19 patients, federally supported healthcare service establishment clinics, COVID-19 testing locations, county health departments, as well as clinical trials for vaccines and treatments. The deployment of Ask Dr. Haiel not only provided patients with a clearer understanding of their care options and the overall pandemic scenario but also streamlined communication with healthcare providers, potentially contributing to more successful patient outcomes. Crucially, this advanced navigation tool also alleviated the workload of human patient navigators, enhancing their operational efficiency and reducing their exposure to COVID-19.
The data provide only a snapshot of the current state of patient navigation. Longitudinal studies are necessary to track the rapidly evolving field and understand the impact of interventions over time.
The study has several limitations: it features a small number of respondents, limiting the generalizability of the results. Additionally, the lack of detailed demographic and geographical information caused by privacy concerns restricts analysis based on location or other factors. Moreover, the data provide only a snapshot of the current state of patient navigation. Longitudinal studies are necessary to track the rapidly evolving field and understand the impact of interventions over time.
The AI for Patient Navigation survey is a unique study that investigates the potential of emerging technologies, including AI and big data, to enhance the work of patient navigators in the post-pandemic world.
This study provides unprecedented insights from a technological perspective, and its results confirm the current state of patient navigation, identify gaps, and propose solutions to support the next generation of patient navigation in this new era.
A novel intervention, that is enabled by AI and other technologies and tailored to individual needs, has the potential to reduce burnout, increase capacity, and help ensure the sustainability of patient navigation and other areas of healthcare. By addressing the specific needs of individual patients, this type of intervention could help improve the overall effectiveness of patient navigation and support the long-term sustainability of the role.
These findings provide valuable insights into the current state of this field and can help address the healthcare challenges providers and patients face today and in the future.
Fenghao Chen: Conceptualization (lead); data curation (lead); formal analysis (lead); funding acquisition (lead); investigation (lead); methodology (lead); project administration (lead); writing—original draft (equal). Tu Lan: Validation (supporting); visualization (supporting); writing—review & editing (equal). Jie Liang: Validation (supporting); writing—review & editing (supporting). Ronghui Zhang: Resources (supporting); software (supporting).
This research was supported by COVID-19 Crisis Relief Program, initiated by the Hopkins Club for Innovation and Entrepreneurship, an alumni- and faculty-led 501(c)3 organization in Baltimore, Maryland. The authors are grateful for the communication with the Academy of Oncology Nurse & Patient Navigators (AONN+). The authors would also like to thank Dr Harry Quon from the Johns Hopkins School of Medicine, and Ms Zheying Mao, from the Hopkins Club for Innovation and Entrepreneurship for the insightful discussion.
The authors declare no conflict of interest.
Data sharing is not applicable to this article as no data sets were generated or analyzed during the current study.
Not applicable.
Fenghao Chen
https://orcid.org/000000015703578X
Reprinted with permission. © John Wiley & Sons, Inc.
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