Providence expands digital assistant to 7,000-plus providers

Renton, Wash.-based Providence has expanded the use of its MedPearl digital referral assistant to more than 7,000 providers.

Integrated into the health system's Epic EHR, MedPearl generates recommended referrals for providers based on a patient's condition.

"When we see patients, we want to do what's right for them," Jessica Schlicher, MD, chief medical officer for virtual care and digital health at Providence, told Becker's. "But in family medicine I have to know, from birth to death, what's the right thing to do right now, and I have 15 minutes to do it."

MedPearl's algorithms dispense "pearls" of medical wisdom — with an average read time of two minutes or less — on more than 700 conditions. The educational tool was built by about 300 Providence clinicians with a core group that constantly updates the information.

Providence went from piloting the program to 216 clinicians two years ago to surpassing the 7,000 mark recently. "There's been no mandate in Providence to use it," Dr. Schlicher said. "Its growth has been entirely organic and viral."

She said she's tried every available healthcare AI tool on the market and hasn't encountered anything like MedPearl. She went from using the tool as a clinician to helping advance it. She's been head of content at MedPearl for the past five months.

She explained how it works: "I'm in the electronic medical record. I have a patient chart open and a patient in front of me. I open MedPearl, and MedPearl is aware of everything in that patient's chart. So it surfaces to me: 'Hey, this is the algorithm I think you should look at. Here are all the labs that have been done. Here are the things you might be missing.' It actually combs the patient's chart and surfaces the information that's needed."

She recalled a recent patient with hearing loss. In the past, she would have either sent him to the emergency department or handed him a referral to a specialist. But MedPearl advised her what the condition was called and that he needed to be treated in a matter of days or the hearing loss would be permanent.

She made sure he got in the next day to see the specialist, who told her it was the only time in his career he encountered a patient with this condition quickly enough to treat it.

Another example was a cancer patient whose diabetes was out of control. Dr. Schlicher learned via MedPearl that one of the patient's medications was causing it.

The platform is good not only for patient care but for business as well, Dr. Schlicher said.

"The core operational problem that health systems have, as they grow, is that their outpatient footprint can only grow as large as their inpatient footprint can capture the downstream from," she explained. "So the quality of a referral is core to that business need."

During the pilot stage, 72% of providers said the platform improved their clinical care plan, 20% said the tool allowed them to avoid a referral, while another 20% said it changed their referral. The program's leaders published a case study with their findings in August in the New England Journal of Medicine.

Seven in 10 users have gone on to become repeat users of the platform. The MedPearl team has received about 60,000 pieces of feedback that it has used to improve the tool.

The No. 1 algorithm has been for abnormal liver tests. "I don't know if that speaks to our country drinking a little too much alcohol, but that algorithm is beloved by GI doctors and family docs alike," Dr. Schlicher said.

The acuity of referrals has also been increasing. For instance, more patients in need of surgery are being referred to surgeons. MedPearl users have been prescribing Suboxone more often to patients with opioid addiction.

It's not just primary care providers using the software — it's also been adopted by specialists and inpatient physicians. Outside of primary and urgent care, it's been most popular among hospitalists, followed by psychiatrists and other behavioral health providers, cardiologists, pulmonologists, gastroenterologists and thoracic surgeons.

Providence plans to commercialize MedPearl in 2025. MedPearl has two other "major customers" live at this point with a couple of other potential clients in the pipeline, Dr. Schlicher said (declining to disclose their names). "Usually, the reaction we get when we demo this with physicians is, 'Make sure we have it in the budget, because if any of my physicians see this we're going to have to buy it,'" she said.

The no-code environment allows health systems to update and create their own guidelines. MedPearl has a core content library that is curated, professionally edited and peer-reviewed by Providence physicians, but clients can add supplementary or entirely new material.

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