Health systems today are facing a perfect storm with increasing demand from an aging and sicker population and decreasing supply of physicians to support these patients.

AAMC’s (Association of American Medical Colleges) latest report (2024) projects the United States will “face a physician shortage of up to 86,000 physicians by 2036.” In some specialties, like behavioral health and dermatology, the wait for a new patient to see a physician can be weeks to months, depending on the system, type of problem and expertise needed.

To address this care access problem, Ochsner has been investing in AI tools to drive patient access with intelligent triaging to connect them with providers at the right care setting. For every patient, it is critical to get to the right provider 100% of the time.

Recently, Ochsner incorporated AI guided eConsults to empower the patient’s Primary Care Physician with insights from the specialist until the patient can be seen.

Ochsner’s two AI- driven tools for better patient care:

1.  Intelligent triaging uses the Clearstep Smart Access chatbot to guide patient navigation. 

Since Q2 2024, Ochsner’s use of Chatbots and Large Language Models (LLMs) has offered an excellent way to guide patients to the right level of care, while also enabling the healthcare system to dynamically meet the demand.  

When a patient goes to Ochsner’s website and types into the Clearstep Smart Access chatbot, ‘I have a headache,’  Ochsner seeks to understand the acuity of the condition to know when a patient needs to see a neurologist. To drive the matching algorithms, Clearstep starts with a clinically trusted triage protocol (built in partnership with Dr. Barton Schmitt, co-author of the Schmitt-Thompson protocols) and follows with a series of conversational questions to present patients with clinically appropriate, timely and convenient Ochsner care options based on their specific symptoms and location.  

“The use of Chatbots/LLM is a fantastic way to get patients to go through a decision tree and help them feel supported. When a patient types in ‘I have a headache’, the chatbot generates intelligent prompts to continue to triage, such as ‘Let’s get more information about your headache.’ ‘Does it seem like a migraine?’  ‘Have you had a longstanding headache for years?’  ‘Have you used medications without success?’  It is not just about a triaging protocol. It is about getting the information needed to match the patient with the right provider and care setting,” explains Dr. Jason Hill, Innovation Officer at Ochsner Health. 

While Ochsner recognizes that some patients may know where to go for care, many patient conditions can be appropriately managed by low-acuity care services. An 2024 Clearstep analysis on user intent found that 73% of users had an incorrect intent of where to find care, the majority of which were de-escalated to a lower acuity. Ochsner’s data supports this finding. Out of 7,500 completed chatbot interactions, 77% benefitted from a low-acuity care modality (e.g. Virtual Urgent Care, Primary Care) for their symptoms.

“At Ochsner, like other health systems, we don’t just have neurologists, we have movement disorder specialists. We don’t just have ophthalmologists, we have neuro-ophthalmologists. These people are super- specialized. Anytime you put them with a patient that is not in their field, you are delaying care for someone with an urgent need for that specialist’s expertise – in a way, wasting that expert’s value,” explains Dr Hill. “As a large health system, it is our challenge to create a funnel which accounts for that level of complexity to the individual patient/provider interaction.” 

The first step of creating the triage match is to set up the list of providers on the supply side. “We ask our super specialists to share common symptoms, complaints and situations. Then we try to figure out a way to get the patient to match those. We determine the questions that we need to ask to gather information that will enable us to make the right match,” says Dr. Hill.  

“We work on identifying the right destination of care and sorting out whether a problem is acute or chronic. We do this using existing structures, as the patient moves through a protocol. As these decision-making tools become more sophisticated, we can then determine the provider type, and then, the sub-provider type,” Hill says. “At first, we are using decision trees, but the ultimate goal is to use AI to understand the patient and provider scope, as well as provide dynamic questions that allow us to establish the patient’s ultimate destination.”

“We need to train a model about what patients are asking us for each type of specialist -- and with that information we can create different models which have access to different aspects of these complex algorithms (e.g. payor coverage, specialist expertise). The AI will learn from our data to help sort the patient to the right match. Of course, the patient has the right to go wherever they wish, but the models can help to direct them to the most appropriate provider,” says Hill. “Once the patient matches, the specialist has access to that patient’s record to provide needed care. We can say to the specialist, ‘This is the right patient for you.’” 

“The biggest value that the Clearstep Smart Access tool provides for Ochsner is getting the patient to the right place at the right time. So many patients end up in the ER for a simple rash. That is a waste of resources. Everyone wins when the patient ends up at the right level of care,” explains Ted Hudspeth, MD, Associate CMIO, Ochsner Health. 

Of the users that complete a Clearstep conversation and receive a care recommendation, 56% engage with one of the three presented options that is determined to be the right level of care. This far exceeded Ochsner’s outset benchmark goal of 35%.  

Clearstep regularly reviews user feedback to monitor and improve product performance of the core product. Ochsner also closely monitors the CSAT scores for the Ochsner instance to ensure that feature enhancements (e.g., displaying additional location services or appointment availability) enhance the user experience.  Ochsner patients who have used this intelligent triaging chatbot have shared their positive experiences, noting that the chatbot was "easy to navigate" and offered "excellent service."  

2. Supercharging PCPs with Specialist eConsults using Epic.

Since a patient might not be able to see a particular specialist quickly, Ochsner is empowering the Primary Care Doctor to tee up patient questions to gather needed information from the specialist eConsult. “We are working with Epic to develop these templates designed to capture patient information to support specialist clinical responses and are feeding them into an LLM,” shares Dr. Hill. 

“We started by capturing the ‘pearls’ or questions that each specialist needs the PCP to capture upfront and we built these pearls into each template,” Dr. Hudspeth explains. “This is valuable, since the PCP may not know all the questions to ask the patient for some conditions. Since this eConsult is asynchronous, it is essential to capture this information for the specialist to give the best response.”

The PCP fills in the template about the patient’s current health issue and receives the specialist’s protocol (e.g., do this, then this) response. If that does not work, the patient sets up a specialist appointment. The eConsult enables PCPs and patients to get answers quickly and reduces the number of patients needing the specialist referral.   

“We have learned that this supercharged eConsult educates PCPs, who are really becoming triage experts. The next time a patient has a similar problem, the PCP knows what to do and is more empowered with back up information so they feel like they can do it,” Dr. Hill explains.  

Ochsner has been building the specialist eConsult for their PCP network and has over 20 specialty areas covered. Dr. Hill explains, “There are certain specialties that are ripe for this workflow, like endocrinology, ID, and dermatology since they do not require as much of an in-person exam to render recommendations as some other specialties do.  We started with these specialties, and as the project has grown, we have learned of others where the PCP can manage patients in place instead of sending them for a specialist appointment. The templates are being developed to help these departments with high numbers of eConsults to perform them easier.”

Ochsner is evaluating success factors including:

• Percentage of patients who needed to see a specialist (after the eConsult)
• Turnaround time for eConsult vs in- person appointment 
• Care access for patients in regions without specialists

“We are doing over a thousand eConsults per month. Our PCPs feel they are delivering a higher level of care instead of sending the patient to wait for a specialist appointment, and getting a faster turnaround time on response. We request a 72-hour/3-day response for the eConsult, and we are seeing an average eConsult response of 1 ½ days across our specialty areas,” shares Dr. Hudspeth. “For the Ochsner system, 85% of patients have not needed an in-person visit within 90 days of eConsult and only 7% of eConsult requests converted into an in person and/or virtual appointment. eConsults help us free up capacity for our patients.”

Future AI- Driven Patient Care 

Ochsner is analyzing the data from these AI tools to gain insights into the distribution of recommended care and patient preferences enabling them to understand service demand, evaluate system capacity, and dynamically promote the services that offer the best access for that patient. Ochsner is also envisioning how AI bots can help guide patients through the clinical maze, not only assisting with care navigation but also supporting patients through their care journey.

On the eConsult front, Dr. Hudspeth explains: “We are excited by the future of AI and our work with Epic. AI is designed to get answers, but it does not know the questions. We have the questions that specialists want answered.”

Ochsner views the responsible use of AI tools as critical differentiators and catalysts to help drive better patient care, and that starts with access and communication.

“These tools are evolving at a rapid pace, but without collaboration with patients and clinicians, and thoughtful workflows which take advantage of our network of skilled providers, they are useless. AI technology has the potential to transform care for the better. We must consider how these technologies might impact our patients and providers and carefully decide how to use them to evolve our care model. With each iterative step, these tools are guided by our clinical and connected health teams to make sure they are providing value,” Dr. Hill concludes.

Since 2023, Sutter has been addressing the provider burnout epidemic and the burdensome administrative tasks detracting from the time and focus clinicians dedicate to patients. Dr. Veena Jones, Chief Medial Information Officer, Sutter Health explains "by leveraging generative AI, we’re reducing these burdens, allowing clinicians to focus on meaningful, personalized interactions with their patients while enhancing the overall care experience and the clinicians’ joy of work. It’s truly a win-win for both providers and patients.”

Sutter Health, a non-profit integrated delivery health system providing comprehensive care to nearly 3.5 million patients throughout California, is one of the early health systems thoughtfully exploring ways to test AI-driven solutions to support patient and provider needs.  With a focus on responsible implementation, Sutter is committed to leveraging AI in a way that enhances care while maintaining the highest standards of security and trust.

Specifically, Sutter has invested in AI & GenAI for two key initiatives as “tools for our providers tool kits”:

     1) Supporting Patient Messaging within Epic, Augmented Response Technology (ART) – The ART tool analyzes patient messages, gathers relevant information and drafts a response for the clinician to review, edit and approve, before sending to patients.  Integrated within Epic, ART uses a large language model (LLM) to generate a contextually relevant response for clinician review.

       In Q4 2023, Sutter was one of the first handful of health systems that began piloting this tool.“Our early work with Epic and other leading health systems to pilot the ART tool was instrumental in advancing its development,” said Dr. Jones. “Since October 2023, ART has been in production within the Sutter EHR, following a collaborative effort with primary care clinician champions and patient advisors to help validate and refine its capabilities.”

       Sutter started testing ART with about 70 physicians and advanced practice clinicians to gather feedback on messages generated from the LLM and adjust the prompts before the March 2024 launch. Beyond clinician feedback, the team collaborated with patients for feedback on GenAI generated message response.

      "It was vital to include perspectives from patients in our Patient Family Advisory Council (PFAC) program," said Dr. Jones. "By reviewing message responses with patients, we gained invaluable insights—ensuring that the technology supports clear, compassionate, and meaningful communication. Patients are at the heart of our mission and it’s essential to align AI advancements with the human-centered care we strive to deliver.”

       In March 2024, Sutter launched ART to all primary care clinicians in Internal Medicine and Family Medicine, since they were on the receiving end of the most patient inbox messages. Soon after, ART was made available to all pediatricians and then was expanded to OB/Gyn and geriatric clinicians across the organization.

       Sutter recognized the need to adjust the LLM prompt to ensure relevance and benefit with each specialty rollout, working closely to test ART before making it more widely available. By the end of 2024, all Sutter clinicians receiving patient messages in their in basket had ART-generated draft replies available for their use.  

     AI PATIENT MESSAGING SUCCESS:

     “We started the ART project with the goal of saving providers time when responding to patient emails. What we heard overwhelmingly was that providers want to keep using it because it significantly reduces their cognitive burden”, shares Laura Wilt, Sutter’s Chief Digital Officer. “Think about the level of effort required for a doctor to create a patient response email from scratch versus simply reviewing and editing a pre-drafted message.”

·        To date, 3,000+ Sutter clinicians have used ART to assist with responding to medical advice requests from patients.

·        With over 217,000 messages sent, feedback from Sutter clinicians has been invaluable in refining the prompt engineering process to enhance the quality of draft responses.

·        Clinicians are reporting an average time savings of up to 20 percent when using ART to help manage their patient communications, along with a noticeable reduction in cognitive load and mental fatigue.

Qualitative Provider Feedback:

“I like the empathy and the AI component that reviews the chart and gathers information like last labs, or pending labs. That is very helpful.”

“I like that the responses are often more thorough and considerate than I would have time to write.”

“Includes empathy statements and acknowledgement of patient's symptoms. Really good for quick and straightforward questions.”

“Appreciate the ART-generated responses to long patient messages. Reduces mental workload by having a template initially started.”

2) Ambient Listening for Visit & Follow- up with Patient Friendly Summaries. Sutter has been working closely with Abridge which has a generative artificial intelligence (AI) platform for clinical documentation. It records and transcribes a visit and generates components of the clinical note. In addition it creates a patient-friendly summary of the visit which the provider can paste into their After Visit Summary.  

To date, most clinicians using Abridge have seen a reduction in documentation time and cognitive burden associated with their work. The ambient listening technology allows for more personal connection and focus on the patient interaction, rather than on the computer, thus strengthening the care relationship.    

“Another benefit we are seeing with Abridge’s ambient listening technology to personalize care is enabling providers to conduct the visit in the patient’s native language, while the English documentation is created in real-time. We have patients and clinicians who speak a variety of languages, from Spanish to Cantonese. The mental load is high for these clinicians having to translate everything they discuss into English for the note. Abridge takes care of the translation and puts the note directly into the EMR”, explains Wilt.

From April- December, Sutter enabled 1,000+ ambulatory physicians and advanced pratice clincian users with the ambient technology. Sutter learned about the importance of physicians being able to directly access Abridge through Epic’s Haiku app, having it fully integrated to make it easier to have their work all in one place. Wilt adds “we took a thoughtful approach to implementation, aiming for a smooth adoption. Our Digital Academy Team played a key role in supporting the rollout and ensuring physicians had the resources they needed. It went smoothly, with minimal training needed— just a brief eLearning video to watch. From a physician adoption perspective, it took off like a rocket ship… maybe because it takes tasks away and lets providers focus more on connecting with patients.”

AI AMBIENT LISTENING SUCCESS:

“Again, we initially focused on time savings, and for many clinicians it’s a significant time saver. But we’ve found that —it also helps reduce cognitive burden”, Wilt adds.

      Qualitative Provider Feedback: 

“Abridge has been a life-changing experience. It alleviates 50% of the charting work for me,” said Alice Woo, M.D., a plastic surgeon with Sutter West Bay Medical Group. “[Now] I feel like my conversations with patients are much more intimate and therapeutic.”

“Abridge has changed how I feel at the end of the day,“ said Kevin Chen, M.D., a family medicine physician with Palo Alto Foundation Medical Group. “If you have balance in your life, you can do other things. It makes you a better doctor when you’re in the clinic seeing patients—you’re better centered.”

EXPANDING AI USE CASES:

“We see the patient message response/ART in Epic and Abridge Ambient listening platform as examples of how generative AI technology can help Sutter personalize medicine”, Wilt shares. 

Patient Message in EPIC/ART. Sutter is interested in moving beyond the patient generated messages into other message types such as “results” (i.e. normal results) and “medication” (i.e. medication refill requests). Sutter is also planning a pilot with Epic for another feature to help further streamline physician workflows with “Chart Summarization”, which provides a summary of key patient information within their electronic medical record. 

Ambient Listening/Abridge: Sutter is extending use of the ambient listening tool in a pilot with emergency and inpatient physicians across all Sutter hospitals. They see opportunities with other types of clinical staff, such as with nurses and physical therapists, and look forward to exploring these as the technology evolves. 

Sutter is excited about the continued evolution of Abridge which will "go beyond capturing the conversation and generating a note, to queuing up clinical orders that were discussed. Wilt explains, “so if your doctor mentions getting an Xray, the order would be put in for the physician to just accept, instead of having to type in the order.” 

“AI is all about continuous improvement—what was implemented a few months ago has already evolved, and it will continue to improve over time," said Dr. Jones. She encourages Sutter teams and other health systems to approach these tools with curiosity. "When implemented thoughtfully, AI has the potential to not only reduce administrative burdens but also strengthen the connection between providers and patients, enabling more meaningful care experiences."

MY TAKE: AI INNOVATION BEST PRACTICES

Sutter has invested in the right practices and processes to drive success:

1. Collaborated closely and early with vendors (e.g. Epic, Abridge) to define and pilot AI and GenAI capabilities.
2. Co-created with key clinical and patient stakeholders to ensure a strong experience.
3. Integrated with exisiting workflows spanning development, training, care delviery and support. 
4. Focused on both qualitative and quantitative success measures including the voice of the clinician and patient (e.g. feedback) and user trial/usage/traction. 

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. 

During the recent Home & Hybrid Care Virtual Summit 2024, St Lukes Health shared how they have expanded virtual access to support patient care journeys over the past three plus years. It is refreshing to see how St Lukes views virtual as a big front door to their care network, how they have personalized the entrance and experience across more than a half dozen patient programs and how they have invested in an integrated data platform and tools for better care experiences.

Like other health systems, Idaho- based St Lukes Health is addressing today’s healthcare headwinds including staffing challenges, provider burnout, the consumers increased expectations for their healthcare experience, all within the regulatory and reimbursement landscape.

In September 2021, St Lukes Health launched a telehealth program to patients with one of seven low acuity conditions.  Since then, their virtual program has expanded to provide patients with immediate care access until they can schedule and see their providers, which may take up to a few months.

“Our team value is that we (virtual care) will be the quickest access to a provider”, explains Abby Losinski, MHA, Director of Telehealth at St Lukes. Abby’s group is part of the Consumer access and experience team.

St Luke Virtual & Hybrid Model

Since late 2021, St Lukes has developed needed processes and infrastructure to successfully expand their virtual program with a centralized virtual support team, virtual command center platform to address incoming patient demand and virtual care patient data integration to support care collaboration and a superior patient experience.

While many health systems launch separate virtual programs to support urgent care, mental health,  and chronic conditions, St Lukes centralized team supports many patient populations with virtual care access. They view this virtual interaction as an opportunity to begin a patient relationship.

Several patients targeted by St Lukes for their virtual care program:

• New Patients (December 2021) St Lukes promoted virtual services to welcome patients without a doctor but with an immediate need. During the virtual visit, patients can refill a prescription, get scheduling help and access care support until their appointment. Patients needing a higher level of care are quickly connected with a clinician. 

• Urgent Care (May 2022) Patients at St Lukes’ Urgent Care Centers with high wait times are offered a virtual appointment when they meet certain criteria. Patients use their mobile phones for the visit and are urged to stay nearby if point of care testing is required. This gives patients a chance to be seen when there are no available rooms. 

• Service Line Extension (January 2023) “We are an extension of any department where patients need same day access” (e.g.  primary care, urology, oncology, pediatrics) explains Losinski. “We work with the Medical Directors to build clinical guidelines so that patients are treated the same way whether they are coming in to see a specialist or meeting with our virtual clinician”.  Losinski is proud that St Lukes “can offer multi-specialty care from one centralized team”. 

• Maternity/New Pregnancy (April 2023) After learning about their pregnancy, patients often have questions and concerns. Instead of waiting for their first appointment which may take 8-10 weeks, patients can meet with a clinician virtually and set up notifications in MyChart to immediately receive information about their maternity care and growing baby. During the virtual visit, patients can get scheduling help and care can be escalated if required. 

• Home & Community Access (Sept – December 2023) St Lukes has set up “virtual hubs” enabling patients to connect virtually using digital health tools from a partnership with TytoCare. “We wanted to expand what we can treat virtually because we have new tools. If we can’t see into the ear, we can’t treat it” and the revenue is lost, Losinski explains. St Lukes now offers TytoCare Home devices (e.g. otoscope, stethoscope, throat camera, skin camera) to patients at home and TytoCare Clinic to patients at schools, libraries and workplaces, to capture data for the virtual care team decision support.

St Lukes Virtual Care Access Experience Success 

Their virtual program success is achieved through continuous focus on the patient experience. St Lukes has designed their virtual experience from the outside- in and offers patients the bridge into their health system care network.

Here are several success elements that I have noticed to deliver care continuity:

Designed Patient Experience to fit care scenario. Newly pregnant patients are set on the Maternity path, supported by the virtual team with education, testing and virtual visits until their OB appointment. Service Line Extension patients such as oncology may have access to digital tools for remote monitoring with condition education and support until their specialty appointment.

Partnered for Patient Care Coordination. St Lukes’ Consumer access & experience team has built partnerships with different service lines and settings across their network. Patients accessing virtual care at St Lukes needing more care are escalated to these clinical partners within the St Lukes network. St Lukes ensures patient care quality is maintained by using the same clinical guidelines for virtual and in- person care.

Built Integrated Patient Data & Tech Infrastructure. “St Lukes has decided that virtual care can not be this thing that lives outside of the health system”, Losinski emphasizes. St Lukes has invested to integrate and augment patient data (TytoCare devices) enabling clinicians to access information from all clinical interactions and from patients from beyond the walls to deliver better patient care and experiences.

St Lukes Virtual Care Feedback

Through marketing research, St Lukes has learned: 

Consumers: The “brand” offering virtual care services really matters. Consumers like that the doctors conducting the virtual visits work for St Lukes and live in the community and appreciate that their PCP can view their virtual visit notes.  

Patients: After participating in St Lukes’ virtual services, patients rated the experience an equivalent of 4.9 stars (out of 5). “Thank you for being there when no one else was” shares a patient.

Providers: Clinicians delivering virtual services have a strong provider experience; “appreciate the increased location and schedule flexibility”, “being in the moment for patients” and “getting to work from home”.

St Lukes Virtual Care Direction

Earlier this year, St Lukes launched eVisits, an asynchronous virtual care option. For $29/visit, patients can message a clinician about one of seven symptoms. eVisits are viewed as a virtual care “entry point which affordable and convenient for patients”.

St Lukes will continue expand virtual care access for their patients. “Currently, we are 8am-8pm but we are looking to extend our hours to 24x7” Losinski shared.

It is impressive to see how St Lukes brings patients into their care system through a larger virtual care front door, leverages care partnerships and protocols for consistent patient care quality and empowers care collaboration with integrated data and tools. St Lukes’ virtual care investments and vision enable them to effectively address staffing and consumer expectation challenges while delivering a superior patient and provider care experience.

Navigation Bar for Stanford Health Care Patients“Healthcare today is changing and we need to be a catalyst for change with our patients,” explains Alpa Vyas, Stanford Health Care’s Chief Patient Experience & Operational Performance Officer.  “In order to create a superior experience for our patients, we have expanded our understanding of patient needs through empathy, incorporating design thinking into our clinical and operational processes."

As part of Stanford Medicine, Stanford Health Care has a long history with patient experience and is committed to continuous improvement by collaborating with patients on products, programs and processes. Patient Experience is one of Stanford Health Care’s four main pillars, demonstrating the importance to their organization.

At the PX Symposium in Boston, Alpa will be presenting Design Thinking Rx: A Prescription for Innovative Healthcare Solutions. Join me at the Symposium to learn more about Stanford Health Care and other truly patient- centered organizations. I will be leading a round table discussion to exchange best practices and processes for a superior patient experience. 

5 Questions in 5 mins, Interview by Sherri Dorfman, MBA, CEO Stepping Stone Partners

1. How do you define Design Thinking at Stanford Health Care? How does this fit with Human- Centered Design and Co-creation?

“We view Design Thinking as the ‘How’ we problem solve. We start with the end user/patient and use empathy to gain insight into needs to define the problem. Then we move through the Design Thinking process with ideating, prototyping and testing solutions.

We see Human Centered Design as the ‘What,’ our philosophy of engaging with the patient at the center of our process. Co-creation is the ‘Who’. We collaborate internally with our physicians and staff and externally with our patients.”

2. Tell me how Stanford Health Care gathers and leverages insights during the Design Thinking process.

“We use a ‘Collaboration Model’ where we define the problem statement and then refine it with insights collected from internal (e.g. clinical, operational, technical) and external (e.g. patients, family caregivers) stakeholders. We use surveys, discussions and observations. Depending on the project, our internal discussions may point us to others with specific expertise or experience interacting with patients. For patients, we may observe them (with their permission) in the hospital or their home to understand their needs for care and support.”

3. Can you share an example of how Stanford Health Care has successfully used the Design Thinking process to define a better patient experience?

“We are in the process of enhancing the service that our ground navigation team delivers and are excited about what we have discovered. We want to move beyond typical wayfinding services and hospitality approach. Through discussions with our operational leaders interacting with patients who are looking for information and guidance, and via patient surveys and interviews, we learned about the need for improved communication support and better coordination support. We are defining a new, higher level navigation role which will allow us to expand and enhyance our level of patient support. This may include scheduling appointments post discharge from an inpatient unit or emergency department, arranging transportation, securing lodging for family members and providing care updates on for patients – For example, ‘I spoke with the nursing team and they will be bringing you back in 20 minutes’.”

4. Thank you for that specific use case. Tell me how Stanford Health Care is using Design Thinking to address a broader patient problem.

“During the pandemic, we had to pivot on how we provided care ‘Access’ to our patients, from in -person to virtual visits. Looking forward, we want to start thinking about ‘Access’ differently. We are engaging staff and patients in the process of defining the next generation of care, including asynchronous care. We are learning that patients see care ‘Access’ as much more expansive. Based on insights from staff and patients, we are exploring some ideas including PCP eConsults (curbside) with specialists to determine the need and urgency for the appointment and virtual nurse triage.”

5.  How does Stanford Health Care measure success for PX initiatives?

“Back in 2022, I contributed to a PX Journal article called ‘Measuring what matters: A proposal for reframing how we evaluate and improve experience in healthcare’. Through extensive discussions with industry experts, the journal article concluded that in order to design experiences that are meaningful, we need to understand what really mattered to patients, families and care partners. At Stanford Health Care, we have looked at our surveys where we ask the same questions and engaged with staff and patients for their feedback. With those insights, we have added questions including those to get feedback on new process enhancements.

We are bringing these survey and discussion insights (including open ended comments) to our operational team members in real- time to translate into immediate changes for our patients.”

With planning underway for 2024, Alpa and her team are interested in further utilizing Design Thinking to develop better programming for Stanford Health Care. “We are working on the next generation of care- exploring ways we can use the insights we have gained to create more personalized experiences for our patients.  The Design Thinking process will guide our exploration on how to leverage data and feedback that may be buried within our systems to hone in on specific challenges and solutions – this is where we hope to invest”, Alpa concludes.