A Physician-Created Platform to Speed Clinical Decision-Making and Referral Workflow

Abstract

A core problem for busy primary care physicians (PCPs) and advanced practice providers (also referred to, collectively, as clinicians) is making the best possible evaluation and management decisions for multiple problems within the space of a short office visit. When a specialty referral is necessary, it is difficult to rapidly determine what laboratory tests, imaging, first-line medications, and other interventions should occur until the patient is seen. Health care organizations need medically appropriate access, reducing the number of referrals that could be managed by a PCP empowered with next-best specialty care actions, and increasing the number of referrals for the sickest patients most in need of timely specialty and procedural care. From the perspective of medical specialists, there is little capacity to provide automated support for PCP-based, first-line subspecialty care for lower-acuity problems in order to create the required space for the sickest patients to be seen quickly. To address these issues, Providence developed MedPearl, an electronic medical record (EMR)-integrated digital assistant and clinical knowledge platform for primary and urgent care clinicians. Frontline clinicians now consult MedPearl during patient visits to answer complex clinical questions, determine if specialty care is necessary, and, if so, determine the next-best action to optimize the referral. The product provides concise, human-authored, algorithmic primary and subspecialty guidance on more than 700 conditions, with an average read time of 2 minutes or less. When a referral is needed, MedPearl supports a precise workup tailored to a specific patient’s medical conditions. Fidelity to human-centered design is the key to the effectiveness of MedPearl. Clinicians wanted an automated specialty e-consult for their most pressing clinician concerns. The tool needed to be tailored to the patient’s specific concerns and informed by the patient’s data from the EMR. Using a jobs to be done framework, a no-code platform was created. Clinician-driven design, thousands of hours of clinician-to-engineer feedback, and direct observations of the use of the tool in the clinical workflow were integrated throughout the development process. All content and algorithms were built in a proprietary no-code environment by clinicians. As of June 2024, MedPearl has been used by 6,967 Providence physicians, advanced practice providers, and other care team members who have conducted more than 189,000 point-of-care searches.