Safeway stores offering health care powered by artificial intelligence

Virtual health kiosks opening up inside in Arizona Safeway stores are similar to using the self-checkout line for groceries — only in this case, the commodity is medical care.

There's no doctor or nurse inside the walk-in Akos Med Clinic. Rather, the clinics use technology powered by artificial intelligence and augmented reality to gather symptoms and vitals, as well as determine possible diagnoses.

Developers of the new health clinics are counting on the fact that patients will like the autonomy of using the kiosks, much the way some customers like the convenience of checking out their own groceries.

"What we're finding is that Millennials are definitely taking to it much sooner. They are much earlier adopters (of the concept)," said Nate Curran, general manager of Akos Med Clinic, which is a joint venture between Arizona-based companies AdviNow Medical and AkosMD. "But it is for everyone."

Patients go into exam rooms on their own and a computerized program guides them through providing key physical information using FDA-approved wireless devices that can collect medical measurements such as temperature, ear, nose and throat images; chest sounds via a stethoscope; and blood pressure and blood oxygen content.

A virtual visit with a physician, nurse practitioner, or physician assistant concludes the Akos Med Clinic appointment via telemedicine, similar to speaking with a clinician via Facetime or Skype. The clinicians, employees of AkosMD, beam into the Safeway clinics, typically from company headquarters in Glendale.

If necessary, the virtual medical staff could provide a prescription electronically.

The individual components of the Akos Med Clinic are not new. Other existing health clinics use artificial intelligence, augmented reality and telemedicine, but the combination is what makes the clinics unique, Curran said.

A 2017 survey of 1,501 U.S. adults by the research firm Accenture found that half of the respondents were interested in virtual health care, yet only 21 percent had actually received health care virtually.

"People are going to initially resist it and they are going to be hesitant, and it's healthy to have a little bit of reluctance to embrace a new idea," said Rick Hall, a senior director at Arizona State University's Edson College of Nursing and Health Innovation. 

"At the same time, I believe that technology will be one of the solutions that addresses the known doctor and nursing shortages that we are having in this country," he said.

Collecting initial information — including payment details, vitals and other medical measurement — without involving a human clinician is a big money-saver in an industry with skyrocketing costs, said James Bates, medical founder and CEO of AdviNow Medical, which provides the artificial intelligence-powered medical stations.

"Like many other things, artificial intelligence is changing how we consume health care, and our A.I. system is giving time back to providers," Bates said. "AdviNow completely automates everything around the doctor visit. Our doctors can see 10, 15 patients an hour without feeling burned out."

A.I. clinics can be profitable with 10-15 patients a day

Bates, a Phoenix-area high tech executive, came up with the idea for Akos Med Clinic after a friend asked him to invest in an urgent-care business. He looked at the urgent care financial model and was surprised by the low profits, he said. So he thought about how to improve the model and came up with using artificial intelligence.

The A.I. developed by AdviNow sorts through a massive medical database that includes medical journals. It assesses that data using information collected from the patient, including the medical measurements.

The medical provider, via telemedicine, then reviews the A.I. recommendations, as well as all the patient data.The clinician makes the final diagnosis and prescribes treatment.

"It's all about efficiency. ... Other people do pieces of what we do, but no one has the platform," Bates said.

The clinic accepts most major insurance plans, including Medicaid (AHCCCS) and Medicare. First-time visits for patients who self-pay is $75, and the routine cost is $99, which is less than an urgent care visit, Bates said.

Bates said the Akos clinic can be profitable with 10 to 15 patients per day, whereas a regular urgent care would need 20 to 30 patients per day.

"This is the next potential step in the right direction toward relieving some of the pressures that health practitioners and health organizations have to see all the patients needing help, especially in a primary care setting," ASU's Hall said, noting that computers don't get sleepy or distracted.

"This is not something that is going to quickly help for chronic diseases or emergency medicine or anything that is going to need immediate attention by a health care team. But most health-care visits are not that."

The clinics can take blood, do regular lab tests

The Akos clinics are not for emergencies, but the phlebotomist on staff will call 911 in the event that a patient needs that level of care.

The phlebotomist also cleans equipment between each patient, can help patients use the equipment, and will take blood if needed. About 30 percent of the patients want help, officials said.

The clinics can do regular lab tests, including for flu, strep, pregnancy and urinalysis.  Some lab tests, like rapid strep tests, can be shared with the patient while they are still at the clinic. Others can take up to two to three days, and clinic staff phone patients with results.

Offering telemedicine is not a new concept, but the difference with the Akos clinics is that the AdviNow technology has objective measurements and an algorithm to help with possible diagnoses, Bates said. That's different than telemedicine apps that people can currently use on their phones, he said.

"Telemedicine out there today is 'teleguess' — they can look at the person, but unless you do an exam and rapid strep test you aren't sure," Bates said.

The Akos Med Clinic concept is the only one Hall knows of that combines A.I., augmented reality and telemedicine. But it's not the only use of A.I. in health care. 

"A.I. in health care is becoming commonplace. ... You are going to see A.I. built into the wearable devices like the Apple Watches and the Fitbits," Hall said.

"Potentially someday, your car will tell you, 'Hey, you are having a heart attack,' and drive you to the hospital before you even know what's going on. All of that cool, crazy stuff is happening and is being developed right now."

Was the clinic space intended for Theranos?

The clinics — which are for patients ages five and up — are in 11 Phoenix-area Safeway stores right now, plus one in Casa Grande, and in an Albertsons store near Boise, Idaho. There are plans to expand the clinics to Safeway stores in other Arizona cities this year, including Tucson, Flagstaff and Prescott, AdviNow officials said. 

A huge advantage for Akos, officials said, is that they didn't have to build anything — the clinics were already there, waiting to be used.

Bates of AdviNow Medical said the clinics had been built for the now-disgraced Theranos blood testing company before its partnership with Safeway dissolved, though officials with Albertsons Safeway did not respond to The Arizona Republic's questions about a Theranos connection.

"Wellness centers were built into our pharmacies over the last few years with the strategy of filling them with complementary health and wellness services and clinics as it made sense for the local community," a corporate spokeswoman wrote in an e-mail.

"While we assessed the best partners for our customer needs, many wellness centers were used by our pharmacy staff to counsel patients, give immunizations, or provide private or sensitive health services."

Reach healthcare reporter Stephanie Innes at 602-444-8369, at stephanie.innes@gannett.com or follow her on Twitter: @stephanieinnes