Entries in Health Experience Design (3)
Providence Health Supercharges Primary Care with AI for Specialist Care Decisions
September 11, 2024 
During the HIMSS AI for Healthcare Forum in Boston, Dr. Eve Cunningham, MD, MBA, GVP, Chief of Virtual Care and Digital Health at Providence Health presented a few AI use cases including an impactful example which empowers PCPs for better care decisions.
Today primary care doctors are pressured to address patient health concerns in an average of 18 minutes with an average of 220,000 data points in the patient’s electronic medical record. With over one in 3 patients referred to a specialist each year, PCPs are tasked with diagnosing the health issue to and making decisions about the need for a specialist.
Barriers to Specialist Care Decision
With vast amounts of patient data that is not clinically organized around context within the patient’s chart, PCPs must spend time pulling together and reviewing relevant information to support the patient’s health problem. Then the PCP must determine if a specialist is needed, and if so which type of specialist.
Given the shortage of primary care doctors and specialists, optimization of the referral process is critical to access to care. However, the referral process today is both inefficient and ineffective causing problems:
- Patient did not need to go to a specialist. (Note: About 20% of patients referred to specialists do not need to see a specialist at all)
- Patient is sent to wrong specialist and/or at inappropriate level of urgency.
- Patient arrives to specialist without any prereferral work-up such as lab, imaging and first-line therapy for a condition.
- Patient has delayed care until there is a specialist appointment
Accelerating Primary Care Referrals
The September issue of NEJM Catalyst’s article on “A Physician-Created Platform to Speed Clinical Decision-Making and Referral Workflow” describes the problem and process that Providence Health has undertaken to conceptualize and build their MedPearl Platform.
“As primary care clinicians struggle to access the expanding base of specialized knowledge and experiences, they attempt to refer patients to specialists, often without the advantage of usable tools at the point of care.”
Developing this needed platform entailed using a “Human- Centered Design approach with a Jobs to Be Done framework, working closely with our clinicians and UX designers”, explains Dr. Cunningham. “We began by asking clinicians how this platform needed to work and look, and got input from 270 clinicians in the design process, which was essential for gaining buy-in”.
MedPearl Platform Built by & for Clinical Care Decisions
Based on clinician’s requirements, Providence built MedPearl as an application within their Epic electronic medical record (EMR) to integrate a digital assistant with clinical knowledge to support primary and urgent care clinicians. MedPearl has “concise, human-authored algorithmic primary and subspecialty care next best actions on over 700 conditions”.
Clinicians utilize MedPearl’s AI algorithms to pull up and review essential clinical information alongside contextualized patient data to see next best actions with what has/hasn’t been done for the patient, empowering clinicians to optimize the “work up” while reducing redundant diagnostics.
Since it can take weeks to months for the patient to get in to see the specialist, the MedPearl platform enables PCPs and urgent care providers to take care of the diagnostics in the interim to optimize the care referral decision. With MedPearl, clinicians can see the testing stream, make sure tests do not need a referral, find the most appropriate specialists and triage the urgency of the specialist appointment based on patient history and diagnostics. Think about what this means for rural health where accessing a specialist is even more challenging.
Providence has designed MedPearl with icons to reduce the clinicians cognitive reading load and provides links to guidelines and QR codes to scan for evidence -based applications.
Clinician Experience with MedPearl
Providence Health has deployed MedPearl across their health system which is available in Epic’s Marketplace.
Dr Cunningham as MedPearl founder comments “Our clinicians tell us that with MedPearl they are spending less time in the EMR, fewer outside work hours and are more productive. To date, we have 7,000 clinician users, making 30,000 searches per month on the MedPearl platform”.
During the initial pilot with 216 participants conducting 14,000 searches, clinicians reported the clinical content helped with clinical decision support: they did not need to refer the patient 20% of time, improved care plan and work-up 72% of the time and changed referral specialty and/or level of urgency 20% of the time.
With MedPearl, clinicians are also realizing better resource efficiency. “We had a challenge with some of our more newly onboarding clinicians overwhelming our Medical Directors with clinical questions and curbside phone calls. The call volume decreased significantly when these clinicians were advised to reference MedPearl first for answers”, shares Dr. Cunningham.
Clinicians often walk through the MedPearl tool with their patients. They review educational content together, discuss the algorithms and use the decision support tools.
Feedback from Clinicans Using MedPearl
After using the MedPearl tool, clinicians commented about the ease of use, quick access to the most essential patient data and benefits of leveraging this patient data for the physician, practice and patient.
“MedPearl provides concise and focused clinical evidence -based summaries, making it easier to quickly access the most relevant information. Its streamlined format saves time and effort, ensuring health professionals can find information without being overwhelmed by unnecessary details”. Medical Director Urgent Care
“The cognitive offloading and reassurance that knowing the Prov approved standard of care has been helpful for me, and I love being able to share it with newer clinicians”. Urgent Care Physician
“The Headache algorithm – perfect example of how to reduce variation in our urgent care practice.” Urgent Care Physician
“With the demand for neurology consultation greatly exceeding the supply of neurologists for the foreseeable future, MedPearl improves access when it has never been more vital.” Chief of Neurology
“MedPearl is a point of care tool we need to augment our clinical acumen and to help drive uniformity of patient care path the best -practice level. This allows primary care physicians to provide more care value, improving diagnostic testing, treatment, and referrals and in opening more specialist access.” Medical Group Director
“Recommendations re: referrals and specific imaging with and without contrast very helpful. Truly has improved physician satisfaction and flow for the day”. Family Medicine Physician
“Contextualization is pretty cool. Makes Pearl useful in multiple ways.. Quick way to see all relevant data about a work up for a particular topic.” Internal Medicine Specialist
“Love the patient experience, engagement and shared decision-making components of this tool.” Practice Senior Director of Operations
“I love the headache algorithm. During a recent appointment, I had a patient point to each symptom that applied to her.” Physician
Future Direction of MedPearl for Health Systems
Dr. Cunningham describes Providence Health’s approach with “feedback and iteration as a core principle by which we drive our MedPearl features roadmap and design. We also push our end users to think beyond the workflow of today, and envision workflow of tomorrow.”
The MedPearl team continues to collaborate with users to gain insight into future enhancements. Specifically, they are focused on these platform innovations:
1. "Expanding contextualization beyond labs, imaging and procedures to further enrich the context aware data aggregation experience"
2. "Adding documentation support features to expedite documentation workflow"
3. "Further refine home page to create a more dynamic experience to delight end users"
4. “Since we believe all workflows will converge on ambient technology, we are preparing ourselves to integrate into ambient workflows. We don’t plan to be the ambient provider, rather we envision ourselves as a clinical intelligence plug-in to further enrich that experience.”
Dr. Cunningham confirms plans to begin “deploying MedPearl to other health systems using EPIC and then Oracle EMRs. We see ourselves as ‘headless’ clinical decision support system that is EMR agnostic and application agnostic. We want to permeate and spread the goodness of MedPearl in a seamless fashion, and meet clinicians and patients where they are“, Dr. Cunningham concludes.
New England Baptist Hospital Hip Replacement- Patient & Caregiver Experience
June 9, 2021 
Beginning Surgery ExperienceTwo weeks ago, Sam had hip replacement surgery at New England Baptist Hospital, a top nationally recognized orthopedic facility in Boston. - Orientation Timing: The virtual meeting was within a few weeks prior, so this gave us ample time to prepare in the days leading up to his surgery date.
- Orientation Content: The hip surgery nurse specialist reviewed pertinent information about what to expect before, during and after the surgery. The follow up emails including “Planning for your Recovery” provided essential information to get Sam’s home ready for his return post-surgery, addressing fall risks.
- Individual Patient & Caregiver Consultation: Since we had some questions that were specific to Sam’s situation, I wish that we had the option to schedule a virtual visit with the nurse to address our concerns in the days leading up to surgery. This would have reduced our anxiety around what to expect Sam to be able to do at different points of recovery.
Discharge Medication informationDue to Covid, I dropped Sam off for pre-op with his crutches and cinch sack filled with paperwork and personal items for his stay. Several hours later, I was contacted by his nurse liaison about his status and about coming to his recovery room for a two- hour visit. It was not communicated to me or Sam if he would be staying over or being discharged. As 4pm neared, I asked about his discharge and the nurse moved quickly to get another PT session in to help Sam master stairs. The nurse went carefully through all discharge materials, answered all of our questions and then handed us the folder. - Nurse Liaison: As Sam went through pre-op, he texted me a contact card for the nurse liaison, which gave me reassurance that I had someone to connect with about his surgery status.
- What to Expect Next Discussion: Instead of just telling us what we needed to do at home, the nurse walked us through the folder at discharge, reviewing each patient education insert so we understood what to do and where to go to re-read the information. This took the pressure off of us to remember everything that was mentioned during the discharge meeting.
- What to Expect Packet/Medication: As a caregiver, I was disappointed that there were several different inserts related to medication (Med List, Medication Guide). Although it was quickly mentioned at discharge, it was not documented which medications are to be taken together (i.e. laxative with pain management meds). This would have helped us follow protocol. There also wasn’t a "medication tracking form", so as the caregiver, I had to create my own to record the times that each medication was given and indicate when medications were stopped. There is an opportunity for the provider to gather templates like this from other caregivers and provide them within the discharge packet.
Post surgery emails tied to surgery date As promised at discharge, Sam received a call from VNA Care to schedule nurse and PT appointments. During these visits, Sam learned how he was doing, what was normal and required a call to the surgeon’s office. These visits have continued over the past few weeks, with the PT providing additional exercises for Sam to do in home. - Care Coordination: Sam felt relieved that his care was continuous and the instructions consistent from the hospital to home, the discharge nurse to VNA Care nurse.
- Recovery perspective: Sam learned from his VNA Care nurse how he was healing relative to other patients. He felt relieved when he was able to master the PT exercises and he was off pain meds “much earlier than other patients” like him.
- Home Health Patient Education and Education Workbook: During the first VNA Care visit, the nurse handed us a 94-page book and pointed out pertinent pages for Sam and for me such as medication categorization and fall preventiion information. This helped us to not feel overwhelmed by the big workbook of information, especailly in the first few days when we are trying to address everything we need to do.
- Patient Education Journey: Sam and I find New England Baptist's post emails informative and relevent since they are tied to his surgery date and recovery milestones.
- Caregiver Post-Surgery Communication: With Sam on pain meds following surgery, it would have been helpful to have all patient communications also pushed to me/caregiver. After he was off of the pain meds and cognizant of what needed to be addressed, Sam forwarded the emails to me. I realized that several would have really been helpful such as what to look for and what to do in the first few days following surgery.
- VNA Visit Alerts: Although the nurse and PT mentioned that they were coming next Monday in the afternoon, it would have been helpful and expected for the patient and caregiver to receive a text reminder with the time range for their visit. Given that Sam is on crutches and often sitting with ice packs on his hip, I need to be available to answer the door for these visits.
- VNA Virtual Visit: As a caregiver, I had questions that needed to be addressed in between the VNA nurse visits. Although I was encouraged to call VNA Care at any time of day or night, I wished that I had the option of a virtual visit to show the nurse Sam’s swelling and bruising. This would have made me feel relieved since the nurse could have seen his hip and leg to make the best care decision instead of relying on my words to convey what I saw.
Kaiser Permanente’s Reimagining Health Promotion & Behavior Change with Patients
April 26, 2021 
As one of the largest metabolic and bariatric surgery centers in the world, Kaiser Permanente Southern California sought to reimagine how it prepared and supported its patients every step of their journey. Kelly Dumke, DrPH, Senior Learning Consultant from Kaiser Permanente’s Center for Healthy Living presented their Human Centered Design process insights at MadPow’s Health Experience Design Conference HxD 2021 within the Person- Centered Care Experiences track.