Rush University System for Heath is an academic medical system, caring for patients in the Chicago area since the 1880s. Throughout time, Rush has continued to evolve to meet their patients’ growing needs by expanding care settings, services and technologies for better patient care.

Over the past few years, Rush has focused on their digital transformation, which is a “consumerism strategy to create healthcare services that meets patients’ elevated expectations”.  Rush has been investing in ways to meet those expectations through simplicity, convenience, personalized care and differentiated care services.

Eighteen months ago post- pandemic, Ben Wolfe, Rush’s Senior Director Digital Transformation shared that Rush set out to understand how patient expectations for care were changing and to capture the voice of the patient around what they wanted those changes to be.

Through a survey with 25,000+ patients and potential patients, Rush discovered there was a segment of younger healthier patients who wanted a different type of relationship with their health system. “About 40% of the patients that we surveyed said they were interested in a virtual care offering that ‘allows me to solve my most common problems’ (e.g. low acuity conditions) at any time. They also wanted a ‘hotel-like concierge service’ where they can go when they did not know what to do next (e.g. help me understand this bill, tell me what do I need to do to get a referral). They wanted a ‘personal assistant’, ‘one place to go to simplify the way healthcare works’. And they did not want this is be expensive”.

From other research they have done, Rush learned there was some resistance to a fully automated digital experience with healthcare and that maintaining the ‘human touch’ is an important part of the digital experience.

Ben shared that “we have a chatbot that patients can use to check a symptom for example. But for the new subscription service that we were developing, we decided to put a ‘live human into this navigation role’ where patients in the program can text 7 days per week to get answers and guidance for what they needed to do”.  

Rush Connect+ Subscription Program

“There are many options for virtual care these days, but none is as comprehensive or connected into the fabric of the top-quality health system as what we have created on our Rush Connect platform,” explains Paul Casey, MD, MBA, senior vice president and chief medical officer at Rush. “Rush Connect+ is a natural extension of that platform to create a seamless, concierge-level care navigation experience and access to 24/7 virtual urgent care anywhere in the country.”

On July 10th, Rush launched their Rush Connect+ digital subscription model charging patients $19/month. Rush partnered with Fabric to develop the program, providing patients with both high tech and high touch services. The Fabric platform enables patients to chat with a live human assistant within the Rush Access Center who provides concierge-like customer service, addressing needs and questions, 7 days per week. Fabric also provides clinical staffing services—advanced practitioners who are available 24x7, nationwide, to treat a host of 40+ virtual urgent care conditions. These benefits are accessible to Rush Connect+ subscribers through their My Rush mobile app, and are tightly integrated with other Rush services that live outside the subscription, such as primary and specialty care.

How is Rush Connect+ different that other subscription programs on the market today? Ben explains “we are focused on delivering the comprehensiveness of care. Other telehealth subscription programs may address the patient’s specific problem at that time. However, we view the patient more holistically. Beyond the virtual care session, the Fabric care team will refer the patient to a Rush PCP or specialist to uncover the underlying causes if needed. Since Rush Connect+ is part of the larger Rush Connect portfolio of digital care offerings, these referrals can often be completed as soon as today or tomorrow via the Rush Connect Primary Care and Rush Connect Virtual Specialty Care offerings.

AI- Driven Patient Care & Experience

Within the My Rush mobile app, patients click to learn more about the Connect+ Program. After seeing a program description, interested patients can schedule a concierge onboarding visit with a Rush Connect+ personal assistant who welcomes the patient into the program and completes their signup.

These patients can access the Rush Connect+ features within their My Rush mobile app. They can live chat with the Rush personal navigator or access the Fabric-delivered 24x7 virtual urgent care. Patients that need virtual care begin by entering information in Fabric’s “adaptive”, asynchronous AI-guided questionnaire. The questions dynamically change based on the patient’s specific responses to capture needed patient information. Rush sees this as “an intelligent questionnaire which helps uncover what is really going on and ensure they are routing the patient to the right care for their needs.”

After the patient identifies their problem  ("My eye is bothering me," "I need a prescription refill”, "Do I need to see a doctor for ____?"), they are presented with a structured interview and answer multiple choice/multi-select and free text questions. The questions adapt as the user provides more information, and Fabric’s clinical logic determines if the problem can be solved asynchronously ("This is pink eye, our provider will write you a prescription and route it to the pharmacy you have selected"),  or if the patient needs to be seen via a video visit, in which case they are transferred to a live provider via a video visit in real-time. These clinical-built protocols are personalizing the patient’s path through this part of their care journey while ensuring a safe, clinically-validated experience.

Rush along with other health systems have joined Fabric’s nationwide Clinical Quality Advisory Council to design and review these protocols which are standardized and evidence- based. Each protocol contains relevant content, diagnostics, appropriate prescription(s) and patient education, all under the oversight of Rush and Fabric’s panel of clinical experts.

Connect+ Subscription Program Success

Aside from concierge medicine programs being offered by some health systems today, RUSH is one of only few health systems offering this type of “subscription” program model.

Ben notes that Rush has a lot to learn as more patients sign up and provide early feedback on the service. Rush is creating awareness for the program through both social media and Chicago-based “out of home” marketing, such as billboards and signage.  As subscriptions increase and feedback comes in, Rush will continuously improve the service over time.

Early patient feedback has been positive, and some of the first subscribers note how convenient the Rush personal assistants were in helping them quickly solve a problem. Ben noted how, as a subscriber himself, he was able to have a prescription refill processed and a primary care visit scheduled after just a 2-minute text message exchange with his Rush Connect+ assistant.

Beyond patient satisfaction scores and new member signups, Rush is closely monitoring the data and metrics to understand how often patients are utilizing the virtual urgent care platform, which types of follow- up care and referrals are being generated, and how effective Rush is in helping those patients complete those follow ups to ensure the best health outcomes.

“Rush Connect is all about creating unparalleled convenient access,” Casey said. “We want our patients to be able to get care where and when they need it. For many, that may mean in-person visits with their providers. While for others, it means opening their smartphone at 3 a.m. However patients choose to seek care, we want them to have a seamless experience and know that they are receiving Rush-quality care in every setting.”

How do Rush providers feel about outsourcing care for program subscribers? Rush made it a point to ensure that Rush primary care and specialty care providers have full access to the information that is generated from the Fabric-delivered visits, directly within the Rush EHR, which helps with continuity of care. Rush also worked closely with its medical group leadership team to ensure that a robust communication plan was in place, so that providers could ask questions and provide feedback on the service.  To date, feedback on the program has been very positive. Many providers have viewed this as an innovative tool for bringing new patients into their primary and specialty care practices that otherwise may not have come to Rush.

Future Connect+ Subscription Program

Rush has plans to continue to grow their subscription program. They want to offer the abililty to deliver at home lab testing and prescription deliveries to the patient’s doorstep following the virtual visit.

In addition to offering new services, Rush plans to extend the subscription program to new patient segments. “We are interested in launching a subscription tier for families, meeting the needs of the parent(s) and their children, who often need care outside of usual business hours”, Ben shares.  

Beyond these enhancements, Rush will be working closely with its clinical and business leaders to expand the program over time, including new use cases such as direct-to-employer models, and even as a potential benefit for Rush employees. “We think this first release of Rush Connect and Rush Connect+ really provides a platform that we can innovate on to deliver even better patient experiences. We’re excited about the possibilities our partnership with Fabric offers as we grow this program together,” Ben 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.