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On-demand 24/7 access to care. . . Will AI make it possible?

Tess is an AI chatbot that provides timely and personalized mental health care for everyone. Saint Elizabeth & Elizz are working with Tess to explore new ways to support patients and family caregivers

Artificial intelligence (AI) is an exponential technology poised to revolutionize health care as we know it. A 2016 study by Frost & Sullivan predicts the market for AI in health care will grow to $6.6 billion by 2021, with the potential to enhance care delivery, improve outcomes and reduce costs.

Tess™ is an AI ‘chatbot’ that provides timely and personalized mental health care for everyone. Created by X2, Tess has been recognized as a breakthrough innovation by Singularity University.  Saint Elizabeth’s head of public affairs Madonna Gallo recently caught up with Michiel Rauws, the CEO of X2, to learn more about Tess and how the two companies are collaborating to improve mental health care.

SE: When you created Tess, what was the tough problem you wanted to solve?  

MR: There are millions of people globally who struggle with anxiety and depression, and simply not enough psychologists to take care of everyone. Mental health professionals are often limited in their capacity to provide treatment, and there are other barriers like wait times, cost and social stigma that can prevent people from getting the support they need. In some areas of the world, mental health services are practically nonexistent. We created Tess to bridge these gaps and provide people with quick access to high quality mental health services and supports. Tess is powered by AI, and can therefore support many patients at the same time, which makes it a very scalable and affordable solution.

SE: How does it work?

MR: Tess holds conversations with the patient, which simply start with “How are you?” and continue in a similar way as a coach or psychologist would. With the oversight of a therapist, Tess provides people with mental health education, coping mechanisms, and supports for self-care and emotional wellbeing.  Over time, Tess gets to know the patient – what they love and why, what scares them, what calms them down, and the best way to help them cope through a period of depression. Emotions are core to helping people, and these regular exchanges help Tess to form an emotional bond with the patient and offer a personalized experience. 

SE: There’s a lot of buzz around the use of AI in health care. What are your thoughts on this?

MR: AI is a broad term that encompasses many different methods and technologies that essentially make a system behave in a ‘smart’ way – everything from predicting to analyzing and correcting. It’s great to have these self-learning elements in health care because it helps us to customize the experience for each individual, as well as figure out and replicate the most effective practices. One feature that makes Tess unique from other AI systems is that everything Tess can say is checked by a licensed psychologist. This ensures the ongoing safety and quality of the system. In severe crisis situations, the system will automatically alert a psychologist, who can take over the conversation without the user noticing.

SE: It sounds like Tess is a built-in friend, therapist and knowledgeable companion, all rolled into one. What kind of feedback have you heard from people who use Tess?

MR: People like talking with Tess because she is always there and ready to chat. There’s no judgement or bias, which helps people open up about topics they might otherwise avoid. If someone is experiencing a panic attack at work, for example, they can connect with Tess and get support in that moment. It’s quick and discrete. Sometimes people just need to vent and they worry about burdening their friends and families with their negative emotions. Tess helps create that time and space for self-reflection. We have patients who chat with Tess every night before they go to sleep as a way of processing their day and letting go of their worries.

SE: When and how did you get connected with Saint Elizabeth? MR: I met Shirlee Sharkey [Saint Elizabeth’s CEO] in 2015 at Exponential Medicine, which is a Singularity event focused on the future of health and medicine. Shirlee was really intrigued by Tess as a potential solution to a big societal need. Saint Elizabeth has the largest home care innovation team in Canada, and we agreed that we had to find a way to work together.

SE: Fast-forward to 2017 – we’ve teamed up to explore how Tess can be used to support family caregivers, a population that is dealing with significant stress and burden, and needs more support. Tell me about that process and what we are learning.

MR:  The first step was to learn about the needs and journey of family caregivers – their emotional needs, common problems, concerns and interventions. The team at Saint Elizabeth and Elizz has a deep understanding of family caregivers and was able to share some incredible insights with us. From there, we began to customize the scripts and conversations for the caregiver population. Saint Elizabeth is now introducing Tess to its living lab environment, where employees who are family caregivers will be working with Tess to help her learn and grow. This is a great opportunity to customize Tess for a new population, and it’s also allowing nurses, home care workers and therapists to gain experience with AI technology. Using Tess enables you to see the benefits of AI firsthand and understand how it can impact people in a very positive way.

Tess is available on HIPAA-compliant messaging apps, instant messaging apps such as Facebook Messenger, and without internet connection by simply texting a phone number. To learn more, visit

About Saint Elizabeth

Saint Elizabeth is a national social enterprise providing home care, health solutions and education to people where they are and when they need it. With Canadian roots and more than 100 years of expertise, the not-for-profit charitable organization is accelerating health care innovation to support healthy lives globally. Through its team of 9,000 health leaders, Saint Elizabeth delivers 20,000 care exchanges daily, totalling 50 million in the last decade alone. Learn more at or find us on social media.