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.