FWIW I know of a pharmacy network that's implementing AI. Not only does the AI make egregious errors like speaking in Spanish when the conversation is in English. It also has a limited context window for ground rules of 5000 tokens or less. So correcting all the various errors goes over the instructions limit. As a result if the implementation goes through it will be of poor quality. All I can think is that people with no technical expertise are making these decisions, it is easy for any techie to predict that AI of this level won't be capable.
So - I run a company that does AI agents for pharmacy. We are at Series B now and growing well - series C in 9-12 months given growth. We just acquired a competitor of that vendor so very much an insider.
First, The technology works, and it scales, but the whole bottleneck is domain expertise and implementation. These are expensive, and hard to scale. We hire pharmacists as project managers, that's how important domain expertise and implementations are.
Second, the amount of noise of "Voice AI for <industry>" is incredible. Most of them are completely clueless about the industry & basically "YC-striver" type who can only sell to other yc companies. They fail hard the moment they touch critical functions of the real world.
We have hundreds of pharmacies with us now and they mostly successful and happy. Our biggest friction is customers being burned by vendors like this and writing off AI altogether as "not ready".
> We have hundreds of pharmacies with us now and they mostly successful and happy. Our biggest friction is customers being burned by vendors like this and writing off AI altogether as "not ready".
This is such a great graph. Your company feels successful because your customer is happy yet the rest of the world would be just happy if your company died in a fire. This seems to also be just fine for companies like yours.
Very much clueless commentary. Retail pharmacies in the US are dying dozens a day. They don't have margin to support people answering the phone like tech companies with 80% margin do. Welcome to the real world where it is survival for these pharmacies not greed or shareholder value.
They literally lose money filling your branded prescription even with no labor baked in. We are their lifeline.
I know because I am not some spoiled tech worker who stumbled into this industry. I ran these pharmacies for over a decade before ever writing a line of code.
First, most tech companies of comparable size to your customers have negative margins and survive on investment cycles, and the tech companies that are bigger haven't offered human support to anyone in decades. (And indeed, everyone already resents this practice and those tech companies. Generally, sentiment is abyssmal.)
I know you're just trying to illustrate the real plight of your customers, but it's a bad illustration that confuses the discussion.
Second, out of sincere curiosity: what was the future of the industry -- and these particular pharmacies -- if AI hadn't arrived to offer salvation? The role they fill in society is non-optional, so how the market restructuring around these infeasibly narrow margins before?
Most pharmacies are having financial issues basically due to being stuck in the middle of the battle between insurers, drug manufacturers, and PBMs over reimbursement rates, and having the weakest negotiating position of all of the parties.
AI probably will save the pharmacies some money, but IMO this will probably cause reimbursement rates to decline further, leaving the pharmacies in the same position as before.
Clueless? You sound tone deaf. If you came here thinking everyone would love your product becase AI, well, sorry about that.
Just because you think it is an amazing product does not mean the rest of us will agree with you. It's right up there with "I've never had a problem with it so anyone claiming to have a problem is wrong" mentality. It was your comment acknowledging the public does not like your product or products like yours. You just think your product is better than others. That may be true but it again does not mean it is so good that the public enjoys interacting with your product.
As someone who has worked with companies in the space more than a decade ago, I'm glad that you're doing this! Genuinely love the "embedded not installed" approach.
I suspect that applying an aerospace approach of dissimilar redundancy and root cause analysis to this will yield a much better experience for everyone (i.e. you, the pharmacies and the patients) than what would have been possible with humans alone.
I've ranted about this before, but medicine as it stands isn't a serious field. And I can say that with a straight face, because medicine has until now, been the only field of modern scientific endeavor (or rather cloaked under modern scientific endeavor) that has fought tooth and nail against gathering more data points for improving understanding.
NPS typically improves because no one stays on hold for 20+ mins anymore.
People have no ideas have pharmacies work. Pharmacies don't control how much they pay for drug, or how much they get paid. The margins are terrible and you can't hire enough techs to answer the phone at peak call volume. So - most people experience are terrible as they wait on hold for a really long time.
EVEN if the AI is a little rough around the edges with relational calls, just solving for transactional calls with no hold is a massive win.
EVEN if the AI is a little rough around the edges with relational calls, just solving for transactional calls with no hold is a massive win.
You keep saying that reducing call time is the "win." It seems like that the only metric you're measuring. If so, your product is a failure, not a success.
This is HEALTHCARE. You don't get to do "rough around the edges." You don't get to dismiss edge cases.
I also work in healthcare tech. My company doesn't permit such things because people die. I'll write it again because it's a point that tech fetishes can't get into their heads:
Do you know what NPS is? That's how the comment started. Patients like it. Because the alternative is to stay on hold for 20+ minutes, and then get it wrong. (Or have no pharmacies except Optum's and Express Scripts).
Good for you - I want in the ICU delivering care during COVID as a frontline clinician. You don't get to pull this line.
Good for you and wishing you more success. You probably going to be down voted as sentiment here in HN is going against AI due to the pressure on jobs, which is completely understandable from emotional point. People tend to compare AI to perfection for some reasons, which is not the case with humans. How many errors happened due to human phone operators? In the last few days there was an article where humans scored 66% on human evals.
I’ve been working with AI for years now and it’s not an easy task to get it right, but negative news go viral faster especially when it’s what people want to hear.
> People tend to compare AI to perfection for some reasons, which is not the case with humans.
So I mostly avoid commenting on or pontificating about the value or lack thereof of AI, but the problem I have with companies rolling out "AI for whatever" isn't that sometimes AI gets "whatever" wrong, it's that the companies simultaneous gut the processes around correcting these mistakes.
I'm currently dealing with a months-long banking error where the bank has incorrectly linked my credit card account to my wife's account and/or an account of mine in a different region, so it variously doesn't show up in my online account, shows the wrong number, shows the purchases from the wrong account, etc.
Every time I call in in a 5-minute rigamarole of:
"Please describe what you're calling about."
"Representative."
"In order to connect to a representative, please describe what you're calling about."
"There's an error with my account."
"Would you like to know your account balance?"
"No, my credit card account is not correctly configured and isn't showing up in my online banking account."
"I didn't understand. Please describe what you're calling about."
Eventually the bot reaches some failure state and then allows me to wait on hold for an hour to talk to an actual rep.
When I eventually get to talk to a rep, I get "Yes, I see that your account isn't correctly configured, I'll submit a back-end ticket and it should get fixed within 5-10 business days."
The next week I check my online banking, my credit card still isn't showing up, and I call and repeat the entire process.
So yes, it's not AI that's directly causing this Kafkaesque nightmare, but it's AI that's empowered the leaders at every utility/retailer/bank/insurer/etc. that I deal with turn their support systems into this slop.
Good to see info on how critical domain expertise is for success.
I've seen AI used well in a few support situations, and it is great - faster to get to the answer vs a human (usually faster than even getting to a human, which is another issue)
When my case can be handled by the automated system, it is great, when it is not, it is usually misery, leading to anger at the customer and whatever company sold them that automated isht.
Especially for intelligent knowledgeable users of anything, by the time we call, it is an issue likely to need escalation.
So, the one absolutely critical factor for me and everyone I know is: how fast and easy is it to get to a human when we find the automated assistance does not work for our particular issue? It should be "I need to speak to a human now", and the immediate response should be "OK, let me get you one... Hello, this is [person], how can I help?" with the prior transcript already on the human's screen.
If this works, it is good because the humans are operating a level up, not having to deal with endless monotonous minutiae, and dealing with interesting issues all day, which means they get good at it and have a better attitude — a win for all.
How, and how well do you handle that situation — how close are you to the proper response I described?
Pharmacy phone lines are a terrible first use case for voice AI. Older callers, drug names, insurance mess, zero patience. Automating "store hours" is fine. Automating refill exceptions is how you get this outcome.
We build text-based (e.g. SMS rather than voice) agents for various medical conversations (e.g. preparing people for complex appointments).
Our user base skews elderly. Going in, I was really skeptical about how much engagement and value we could provide to these older patients. I'm blown away how well it all turned out and how valuable it's been for our patients and client clinics.
For example, we were able to reduce no-shows for some high-cost appointments by 80%. Turns out that the reasons why people don't show up are a complicated and diffuse — everything form anxiety, to not speaking english, to being confused about how to get into the building — and properly configured LLM-based systems are really, really good at dealing with exactly this sort of problem.
I just don't get why we're not doing it vertically like you said here. Implement a part of the cognitive work using AI but let the hard parts be done by a person. They're still gonna be more rich, just less so.
Explain to me then why pharmacies have almost exclusively used IVR based phone systems for pharmacy refills and prescription management for the last decade?
Like they don’t even say the full name of the prescription they just tell you the first three letters and they’ll say “for the patient born on…”
Current pharmacy IT systems are currently almost 100% automated so how are you claiming it’s the first use?
Do you actually use these systems? They can’t at all handle my case where half the time the drug is on back order or there some insurance non sense in the way. I need to talk to a human every time
Correct they fail in any out of boundary condition which is like 50% of cases in my experience
Even worse is that the human is usually just as worthless because the problem is often upstream at the insurance provider or regulation
This is something I’m finding with people complaining about AI systems the AI system in this case is not any worse than the previous IVR system was it just expanded the use cases and now people say oh it doesn’t work for those expanded use cases
There’s no mention whatsoever of the current absolute devastatingly bad state of all software across the world
It’s like people are mad when there’s an application that already sucks, someone attempts to use genAI, that fails and then they blame AI
Companies will pawn off thier customers to AI at their peril.
In many ways this is a repeat of the India call center train wrecks of the 00s. On paper, letting someone in Bangalore vs onshore handle incoming customer service calls looked like a path to amazing savings. In practice the customer experience was horrendous and companies CTRL-Zed these decisions and rapidly brought customer service back onshore again. AI is just that story of shortsighted decisions by weak leadership playing out all over again.
This, I suspect, is exactly like offshoring - and a lot of companies died during the offshoring fad because their software products become full of low quality merges and feature improvements that the company couldn't afford to fix or remove by the time they realized there was a problem. That remains my primary concern with AI code generation - well established codebases might become full of slop to the point of being unusable without a clear path back to maintainability leading to company death.
LOL, pleased to read that Air Canada got smacked down.
Yeah, if I'm calling or chatting with a company, I expect them to stand by whatever commitments they make, and I will judge them harshly if they don't. This is true whether an AI or a human is speaking on the company's behalf.
my experience with AI assistants has not been that great so far, they ask for customer id numbers which are long as ... with several digits and if you group them they don't understand, for example if the number begins with two 1s and you say eleven instead of one one they don't understand you, then they are usually not trained for the local pronunciation or dialect which makes it very hard communicating, my blood pressure rises into unhealthy ranges, but if I use expletives enough I get a human on the line
if you've tried to legitimately productionize LLMs to deliver a specific repeatable outcome, rather than human editable output(text, code), you know the models still aren't there yet and the whole product experience feels hacky
Do we think that as a society there exists some meaningful lever by which we can apply force against this type of carelessness and exploitation?
I think we need to take a good hard look at what we want out of this world and ask ourselves. Do we really need to automate this? Like really. What benefit does the world receive having an AI chatbot tell grandma the wrong doage for her meds? This is the naked extraction of value from a service that's already been offshored. Companies like these are gleeful to make their service as shitty as they can because they know their users are doing so against their will. Infact, that's become the goal.
> wrong dosages, and missed prescription notifications.
BS. How is the AI touching that information?
Prescription notification is outbound communication. It’s almost a recorded message. A little text to speech if it is supposed to read the drug name.
Wrong dosages?? This must be handled by the “enroll a new scrip” functionality, right? So basically B2B doctor interaction. You let AI touch that? Aren’t the vast majority of the costs from customers not doctors? None of this makes sense.
I happened to be in Vermont last week and was unaware of this change. I heard complaints from three separate people unprompted. It was a total dumpster fire put on top of a critical service.
As someone who's been doing AI call centres for a while, I'm not surprised. It's really, really hard to build voice AI that works. There are no open source solutions that work out of the box.
But the biggest problem is ASR. WER is still atrocious even with SOTA models. When you add drug names and regional accents, it's a recipe for disaster.
Drug names are frequently BS loaded with strange consonants without singular pronunciation guidelines (sadly English isn't German) so humans already have a lot of variation in how things are pronounced - models then need to comprehend those variations, regional dialects (like those fuggin' ahs from Boston).
Wow, those names are actually real. They sound like fly-by-night compliance "brand" names on amazon sellers. How did those get approved by a multi-billion dollar marketing team?
The desired speed of AI adoption is what is hindering AI adoption. Big companies are trying to sell this as magic, and it's not. It requires proper use to get anything useful out of this system. But that takes away the magic of it and the investors can't have that as the eventual share price only works if it is magic. Frontier labs will smother their product with their timelines.
I think of this as the kiosk economy. It's like how businesses introduce kiosks even when having a human employee would be more convenient, just for the sake of greater profit.
The biggest problem with AI customer service is that a human employee would've let a minor issue slide without escalating it. But a chatbot often inflames the situation, and by the time the customer reaches a human agent, they're already furious.
Most people aren't rational or logical. Non verbal feedback, like acknowledging someone's anger and showing empathy, is incredibly important.
AI customer service doesn't fucking listen. A few years ago, I noticed that my bank had an old address on file for only one of my accounts. When I clicked edit next to the old address, it would bring me to a page that had the correct address.
At the time, they had a real person handling their support. The real person told me this was just a glitch and that my correct address was on file and everything is fine.
That wasn't actually true. A new debit card to replace my expiring one ended up being sent to the old address a couple of months ago.
So I go back to the website to try to edit it one last time. Same problem.
I call them and get their fucking stupid AI slopbot.
Still, I explain the whole situation:
> I'm trying to update my address on the website. When I click the edit link next to the old address, it shows my new address instead. I need to remove the old address.
What did the slopbot decide to say? Oh well, I should go on the website and edit my address of course! I gave it two more chances by trying to explain it a different way and how this didn't work.
Did it accept that and escalate the issue to a human? No. It kept telling me to go to the website.
I had to say
> Hey you fucking bitch, how many times do I have to tell you that doesn't fucking work? Escalate this to a fucking human before I get the attorney general involved.
to finally get a live person to fix it (I actually had to do this twice, the first set of fucks, the slopbot forgot what problem I was having and needed a refresher!). Suffice it to say, I will never trust any large amount of money with this bank again. I'm highly skeptical of any company using AI CS now, because this is one of my many experiences where the slopbot is incapable of recognizing a complex situation outside of its capabilities.
I mean look at this situation: their AI slopbot turned this one mistake into 5 mistakes instead of just allowing it to be one that another human corrects.
It's gotten to the point where whenever I see someone lauding AI customer support, I just assume they have an investment/job that hinges on people liking it and/or their only experiences are using it as a glorified refund button.
The idea, within regulated circles, is that it lacks provenance - there’s no vendor to sue. Many open source licenses also carry an explicit disclaimer of merchantability and fitness for purpose. These are taken seriously, and open-source software is viewed akin to car parts found on the side of the road. They could work but it’s better to let someone else verify.
But in the context of privacy it makes no sense though right? Open source and close source models (depending on vendor) both can be configured in a way that protects privacy of the user. The entire quote is wonky despite your point about companies preferring vendor-based system rather than raw dog oss
It will probably sound nice to laypersons but you're right, it has to have access to, at a minimum, a data extract with relevant information to perform it's tasks, although in my experience in the pharmacy IT world, a database view.
It's important to note while people are pumping the AI bubble that a near-moron with a checklist can do this job. They replaced AI with a regular old phone tree.
AI couldn't do this job with a checklist. It would forget the entire checklist after two responses, then get fixated on the words that the customer used to complain about how dumb the AI was and loop until they hung up and called back to hopefully clear the context.
edit: Unless Kinney had been sold a product that used caller ID to carry over context, then the customer's best chances would be to scream "Agent!" over and over again (to get put on hold for 45 minutes, then transferred to the most screamed-at Philippine minimum-wage gig worker on the planet), or to show up to the drugstore and start screaming at people.
FWIW I know of a pharmacy network that's implementing AI. Not only does the AI make egregious errors like speaking in Spanish when the conversation is in English. It also has a limited context window for ground rules of 5000 tokens or less. So correcting all the various errors goes over the instructions limit. As a result if the implementation goes through it will be of poor quality. All I can think is that people with no technical expertise are making these decisions, it is easy for any techie to predict that AI of this level won't be capable.
So - I run a company that does AI agents for pharmacy. We are at Series B now and growing well - series C in 9-12 months given growth. We just acquired a competitor of that vendor so very much an insider.
First, The technology works, and it scales, but the whole bottleneck is domain expertise and implementation. These are expensive, and hard to scale. We hire pharmacists as project managers, that's how important domain expertise and implementations are.
Second, the amount of noise of "Voice AI for <industry>" is incredible. Most of them are completely clueless about the industry & basically "YC-striver" type who can only sell to other yc companies. They fail hard the moment they touch critical functions of the real world.
We have hundreds of pharmacies with us now and they mostly successful and happy. Our biggest friction is customers being burned by vendors like this and writing off AI altogether as "not ready".
> We have hundreds of pharmacies with us now and they mostly successful and happy. Our biggest friction is customers being burned by vendors like this and writing off AI altogether as "not ready".
This is such a great graph. Your company feels successful because your customer is happy yet the rest of the world would be just happy if your company died in a fire. This seems to also be just fine for companies like yours.
Very much clueless commentary. Retail pharmacies in the US are dying dozens a day. They don't have margin to support people answering the phone like tech companies with 80% margin do. Welcome to the real world where it is survival for these pharmacies not greed or shareholder value.
They literally lose money filling your branded prescription even with no labor baked in. We are their lifeline.
I know because I am not some spoiled tech worker who stumbled into this industry. I ran these pharmacies for over a decade before ever writing a line of code.
First, most tech companies of comparable size to your customers have negative margins and survive on investment cycles, and the tech companies that are bigger haven't offered human support to anyone in decades. (And indeed, everyone already resents this practice and those tech companies. Generally, sentiment is abyssmal.)
I know you're just trying to illustrate the real plight of your customers, but it's a bad illustration that confuses the discussion.
Second, out of sincere curiosity: what was the future of the industry -- and these particular pharmacies -- if AI hadn't arrived to offer salvation? The role they fill in society is non-optional, so how the market restructuring around these infeasibly narrow margins before?
Why were pharmacies viable before? Presumably they didn't lose money for their whole history.
Most pharmacies are having financial issues basically due to being stuck in the middle of the battle between insurers, drug manufacturers, and PBMs over reimbursement rates, and having the weakest negotiating position of all of the parties.
AI probably will save the pharmacies some money, but IMO this will probably cause reimbursement rates to decline further, leaving the pharmacies in the same position as before.
https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2024.0...
Of the 88,930 retail pharmacies operating during 2010–20, 29.4 percent had closed by 2021.
see: https://en.wikipedia.org/wiki/Pharmacy_benefit_management
Clueless? You sound tone deaf. If you came here thinking everyone would love your product becase AI, well, sorry about that.
Just because you think it is an amazing product does not mean the rest of us will agree with you. It's right up there with "I've never had a problem with it so anyone claiming to have a problem is wrong" mentality. It was your comment acknowledging the public does not like your product or products like yours. You just think your product is better than others. That may be true but it again does not mean it is so good that the public enjoys interacting with your product.
As someone who has worked with companies in the space more than a decade ago, I'm glad that you're doing this! Genuinely love the "embedded not installed" approach.
I suspect that applying an aerospace approach of dissimilar redundancy and root cause analysis to this will yield a much better experience for everyone (i.e. you, the pharmacies and the patients) than what would have been possible with humans alone.
I've ranted about this before, but medicine as it stands isn't a serious field. And I can say that with a straight face, because medicine has until now, been the only field of modern scientific endeavor (or rather cloaked under modern scientific endeavor) that has fought tooth and nail against gathering more data points for improving understanding.
More detail here, https://news.ycombinator.com/item?id=35762650
I'm glad that you're doing this!
> We have hundreds of pharmacies with us now and they mostly successful and happy
How happy are their patients?
NPS typically improves because no one stays on hold for 20+ mins anymore.
People have no ideas have pharmacies work. Pharmacies don't control how much they pay for drug, or how much they get paid. The margins are terrible and you can't hire enough techs to answer the phone at peak call volume. So - most people experience are terrible as they wait on hold for a really long time.
EVEN if the AI is a little rough around the edges with relational calls, just solving for transactional calls with no hold is a massive win.
EVEN if the AI is a little rough around the edges with relational calls, just solving for transactional calls with no hold is a massive win.
You keep saying that reducing call time is the "win." It seems like that the only metric you're measuring. If so, your product is a failure, not a success.
This is HEALTHCARE. You don't get to do "rough around the edges." You don't get to dismiss edge cases.
I also work in healthcare tech. My company doesn't permit such things because people die. I'll write it again because it's a point that tech fetishes can't get into their heads:
People die.
Do you know what NPS is? That's how the comment started. Patients like it. Because the alternative is to stay on hold for 20+ minutes, and then get it wrong. (Or have no pharmacies except Optum's and Express Scripts).
Good for you - I want in the ICU delivering care during COVID as a frontline clinician. You don't get to pull this line.
Why would he care about that? They're not the ones paying him.
Former patients
Good for you and wishing you more success. You probably going to be down voted as sentiment here in HN is going against AI due to the pressure on jobs, which is completely understandable from emotional point. People tend to compare AI to perfection for some reasons, which is not the case with humans. How many errors happened due to human phone operators? In the last few days there was an article where humans scored 66% on human evals.
I’ve been working with AI for years now and it’s not an easy task to get it right, but negative news go viral faster especially when it’s what people want to hear.
> People tend to compare AI to perfection for some reasons, which is not the case with humans.
So I mostly avoid commenting on or pontificating about the value or lack thereof of AI, but the problem I have with companies rolling out "AI for whatever" isn't that sometimes AI gets "whatever" wrong, it's that the companies simultaneous gut the processes around correcting these mistakes.
I'm currently dealing with a months-long banking error where the bank has incorrectly linked my credit card account to my wife's account and/or an account of mine in a different region, so it variously doesn't show up in my online account, shows the wrong number, shows the purchases from the wrong account, etc.
Every time I call in in a 5-minute rigamarole of:
"Please describe what you're calling about."
"Representative."
"In order to connect to a representative, please describe what you're calling about."
"There's an error with my account."
"Would you like to know your account balance?"
"No, my credit card account is not correctly configured and isn't showing up in my online banking account."
"I didn't understand. Please describe what you're calling about."
Eventually the bot reaches some failure state and then allows me to wait on hold for an hour to talk to an actual rep.
When I eventually get to talk to a rep, I get "Yes, I see that your account isn't correctly configured, I'll submit a back-end ticket and it should get fixed within 5-10 business days."
The next week I check my online banking, my credit card still isn't showing up, and I call and repeat the entire process.
So yes, it's not AI that's directly causing this Kafkaesque nightmare, but it's AI that's empowered the leaders at every utility/retailer/bank/insurer/etc. that I deal with turn their support systems into this slop.
The pharmacies are happy because you are giving them higher profits.
Meanwhile you are royally fucking over the end user with your AI shit.
“You are absolutely right! You should indeed not give your 5 year old child 1000 milligrams of ibuprofen per hour”
Make it so the parts that are done by AI are rock solid, until then, they shouldn't be near a customer and be done by humans. Resist the greed!
So you want him to make a piece of software that models a probability distribution rock solid.
Good to see info on how critical domain expertise is for success.
I've seen AI used well in a few support situations, and it is great - faster to get to the answer vs a human (usually faster than even getting to a human, which is another issue)
When my case can be handled by the automated system, it is great, when it is not, it is usually misery, leading to anger at the customer and whatever company sold them that automated isht.
Especially for intelligent knowledgeable users of anything, by the time we call, it is an issue likely to need escalation.
So, the one absolutely critical factor for me and everyone I know is: how fast and easy is it to get to a human when we find the automated assistance does not work for our particular issue? It should be "I need to speak to a human now", and the immediate response should be "OK, let me get you one... Hello, this is [person], how can I help?" with the prior transcript already on the human's screen.
If this works, it is good because the humans are operating a level up, not having to deal with endless monotonous minutiae, and dealing with interesting issues all day, which means they get good at it and have a better attitude — a win for all.
How, and how well do you handle that situation — how close are you to the proper response I described?
We have hundreds of pharmacies with us now and they mostly successful and happy.
Is your pharmacy one of your customers? Do you use your own product regularly?
Please apologize for making the world a worse place and explain how you will close your company down.
Pharmacy phone lines are a terrible first use case for voice AI. Older callers, drug names, insurance mess, zero patience. Automating "store hours" is fine. Automating refill exceptions is how you get this outcome.
We build text-based (e.g. SMS rather than voice) agents for various medical conversations (e.g. preparing people for complex appointments).
Our user base skews elderly. Going in, I was really skeptical about how much engagement and value we could provide to these older patients. I'm blown away how well it all turned out and how valuable it's been for our patients and client clinics.
For example, we were able to reduce no-shows for some high-cost appointments by 80%. Turns out that the reasons why people don't show up are a complicated and diffuse — everything form anxiety, to not speaking english, to being confused about how to get into the building — and properly configured LLM-based systems are really, really good at dealing with exactly this sort of problem.
I just don't get why we're not doing it vertically like you said here. Implement a part of the cognitive work using AI but let the hard parts be done by a person. They're still gonna be more rich, just less so.
You figured it out, there, at the end!
Explain to me then why pharmacies have almost exclusively used IVR based phone systems for pharmacy refills and prescription management for the last decade?
Like they don’t even say the full name of the prescription they just tell you the first three letters and they’ll say “for the patient born on…”
Current pharmacy IT systems are currently almost 100% automated so how are you claiming it’s the first use?
Do you actually use these systems? They can’t at all handle my case where half the time the drug is on back order or there some insurance non sense in the way. I need to talk to a human every time
Correct they fail in any out of boundary condition which is like 50% of cases in my experience
Even worse is that the human is usually just as worthless because the problem is often upstream at the insurance provider or regulation
This is something I’m finding with people complaining about AI systems the AI system in this case is not any worse than the previous IVR system was it just expanded the use cases and now people say oh it doesn’t work for those expanded use cases
There’s no mention whatsoever of the current absolute devastatingly bad state of all software across the world
It’s like people are mad when there’s an application that already sucks, someone attempts to use genAI, that fails and then they blame AI
The whole thing is absurd
Companies will pawn off thier customers to AI at their peril.
In many ways this is a repeat of the India call center train wrecks of the 00s. On paper, letting someone in Bangalore vs onshore handle incoming customer service calls looked like a path to amazing savings. In practice the customer experience was horrendous and companies CTRL-Zed these decisions and rapidly brought customer service back onshore again. AI is just that story of shortsighted decisions by weak leadership playing out all over again.
Its still a huge and growing business and one that AI helps https://tech.yahoo.com/ai/articles/call-centres-using-ai-whi...
lol at the title
This, I suspect, is exactly like offshoring - and a lot of companies died during the offshoring fad because their software products become full of low quality merges and feature improvements that the company couldn't afford to fix or remove by the time they realized there was a problem. That remains my primary concern with AI code generation - well established codebases might become full of slop to the point of being unusable without a clear path back to maintainability leading to company death.
This is my favorite AI customer service story:
https://arstechnica.com/tech-policy/2024/02/air-canada-must-...
> Air Canada essentially argued that “the chatbot is a separate legal entity that is responsible for its own actions”
LOL, pleased to read that Air Canada got smacked down.
Yeah, if I'm calling or chatting with a company, I expect them to stand by whatever commitments they make, and I will judge them harshly if they don't. This is true whether an AI or a human is speaking on the company's behalf.
my experience with AI assistants has not been that great so far, they ask for customer id numbers which are long as ... with several digits and if you group them they don't understand, for example if the number begins with two 1s and you say eleven instead of one one they don't understand you, then they are usually not trained for the local pronunciation or dialect which makes it very hard communicating, my blood pressure rises into unhealthy ranges, but if I use expletives enough I get a human on the line
This doesn’t surprise me.
Set up whatever online portal or app you want. I’d prefer to just sign in and click a button.
If I’m picking up the phone or sending an email it’s because I have a weird problem and I need to talk to a person.
if you've tried to legitimately productionize LLMs to deliver a specific repeatable outcome, rather than human editable output(text, code), you know the models still aren't there yet and the whole product experience feels hacky
Not to mention insecure.
I guess everything is ok these days as long as the President says "We screwed up [our most basic responsibility to customers], and we own that."
It's interesting that I had to close 3 popups just to read this article, two of them were for tracking cookies
Agreed. It's horrible and stupid. I actually run a service in the EU and I don't present that nonsense even with the risk of being sued.
GDPR popups remind me of the spam popups of the 90s.
No, maliciously compliant scumbag companies did that.
You don’t need a cookie banner for functional cookies, and opt out should be a single button.
GDPR requires websites to get user consent before doing sketchy shit. You don’t need a cookie popup if you’re not a scumbag.
How open source makes it less private?!?
Do we think that as a society there exists some meaningful lever by which we can apply force against this type of carelessness and exploitation?
I think we need to take a good hard look at what we want out of this world and ask ourselves. Do we really need to automate this? Like really. What benefit does the world receive having an AI chatbot tell grandma the wrong doage for her meds? This is the naked extraction of value from a service that's already been offshored. Companies like these are gleeful to make their service as shitty as they can because they know their users are doing so against their will. Infact, that's become the goal.
> wrong dosages, and missed prescription notifications.
BS. How is the AI touching that information?
Prescription notification is outbound communication. It’s almost a recorded message. A little text to speech if it is supposed to read the drug name.
Wrong dosages?? This must be handled by the “enroll a new scrip” functionality, right? So basically B2B doctor interaction. You let AI touch that? Aren’t the vast majority of the costs from customers not doctors? None of this makes sense.
I happened to be in Vermont last week and was unaware of this change. I heard complaints from three separate people unprompted. It was a total dumpster fire put on top of a critical service.
Related: A pharmacy chain in Vermont implemented AI for efficiency (11 days ago, 40 points) https://news.ycombinator.com/item?id=49105190
Wow, it lasted over a week.
As someone who's been doing AI call centres for a while, I'm not surprised. It's really, really hard to build voice AI that works. There are no open source solutions that work out of the box.
But the biggest problem is ASR. WER is still atrocious even with SOTA models. When you add drug names and regional accents, it's a recipe for disaster.
ASR = Automatic Speech Recognition
WER = Word Error Rate
Too many acronyms; not everybody is in your field.
Just curious, why are drug names such a disaster? Do LLMs not understand pronunciation keys?
Trademarks.
And the patients generally don't have a pronunciation key. Doctors prescribing might not, either.
Drug names are frequently BS loaded with strange consonants without singular pronunciation guidelines (sadly English isn't German) so humans already have a lot of variation in how things are pronounced - models then need to comprehend those variations, regional dialects (like those fuggin' ahs from Boston).
It ends up being quite a lot of variation.
As some examples: Wegovy, Ixempra, Qvar, Keflex
Wow, those names are actually real. They sound like fly-by-night compliance "brand" names on amazon sellers. How did those get approved by a multi-billion dollar marketing team?
People pronounce drug names all sorts of ways, and there's a lot of them (with a steady trickle of new ones)
The desired speed of AI adoption is what is hindering AI adoption. Big companies are trying to sell this as magic, and it's not. It requires proper use to get anything useful out of this system. But that takes away the magic of it and the investors can't have that as the eventual share price only works if it is magic. Frontier labs will smother their product with their timelines.
I think of this as the kiosk economy. It's like how businesses introduce kiosks even when having a human employee would be more convenient, just for the sake of greater profit.
The biggest problem with AI customer service is that a human employee would've let a minor issue slide without escalating it. But a chatbot often inflames the situation, and by the time the customer reaches a human agent, they're already furious.
Most people aren't rational or logical. Non verbal feedback, like acknowledging someone's anger and showing empathy, is incredibly important.
AI customer service doesn't fucking listen. A few years ago, I noticed that my bank had an old address on file for only one of my accounts. When I clicked edit next to the old address, it would bring me to a page that had the correct address.
At the time, they had a real person handling their support. The real person told me this was just a glitch and that my correct address was on file and everything is fine.
That wasn't actually true. A new debit card to replace my expiring one ended up being sent to the old address a couple of months ago.
So I go back to the website to try to edit it one last time. Same problem.
I call them and get their fucking stupid AI slopbot.
Still, I explain the whole situation:
> I'm trying to update my address on the website. When I click the edit link next to the old address, it shows my new address instead. I need to remove the old address.
What did the slopbot decide to say? Oh well, I should go on the website and edit my address of course! I gave it two more chances by trying to explain it a different way and how this didn't work.
Did it accept that and escalate the issue to a human? No. It kept telling me to go to the website.
I had to say
> Hey you fucking bitch, how many times do I have to tell you that doesn't fucking work? Escalate this to a fucking human before I get the attorney general involved.
to finally get a live person to fix it (I actually had to do this twice, the first set of fucks, the slopbot forgot what problem I was having and needed a refresher!). Suffice it to say, I will never trust any large amount of money with this bank again. I'm highly skeptical of any company using AI CS now, because this is one of my many experiences where the slopbot is incapable of recognizing a complex situation outside of its capabilities.
I mean look at this situation: their AI slopbot turned this one mistake into 5 mistakes instead of just allowing it to be one that another human corrects.
It's gotten to the point where whenever I see someone lauding AI customer support, I just assume they have an investment/job that hinges on people liking it and/or their only experiences are using it as a glorified refund button.
> Marraffa says Burt is fully HIPAA compliant and that the AI is not open-source and does not generate or manipulate data.
We need to fight the talking point that open source is bad!
How could something like open source ever be perceived as bad?
The idea, within regulated circles, is that it lacks provenance - there’s no vendor to sue. Many open source licenses also carry an explicit disclaimer of merchantability and fitness for purpose. These are taken seriously, and open-source software is viewed akin to car parts found on the side of the road. They could work but it’s better to let someone else verify.
But in the context of privacy it makes no sense though right? Open source and close source models (depending on vendor) both can be configured in a way that protects privacy of the user. The entire quote is wonky despite your point about companies preferring vendor-based system rather than raw dog oss
how can it not manipulate data and still work? does it do it by magic? absolute L quote by the spokesperson
It will probably sound nice to laypersons but you're right, it has to have access to, at a minimum, a data extract with relevant information to perform it's tasks, although in my experience in the pharmacy IT world, a database view.
but if the source is open, the ay-eyes can find the zero days! /s
It's important to note while people are pumping the AI bubble that a near-moron with a checklist can do this job. They replaced AI with a regular old phone tree.
AI couldn't do this job with a checklist. It would forget the entire checklist after two responses, then get fixated on the words that the customer used to complain about how dumb the AI was and loop until they hung up and called back to hopefully clear the context.
edit: Unless Kinney had been sold a product that used caller ID to carry over context, then the customer's best chances would be to scream "Agent!" over and over again (to get put on hold for 45 minutes, then transferred to the most screamed-at Philippine minimum-wage gig worker on the planet), or to show up to the drugstore and start screaming at people.