Meeting patients where they are
How MUSC is using AI to transform access for patients and eliminate manual work for staff
Annual value
of all copays collected touchless
no-shows avoided
reallocated staff hours per month
Introduction
Founded 200 years ago in 1824 in Charleston, South Carolina, MUSC is the oldest medical school in the South and the state's only comprehensive academic health system. Its journey mirrors the evolution of healthcare itself, from the rudimentary practices of its early days to the complex, technology-driven discipline it has become today. MUSC has stood the test of time, not merely surviving but thriving, by adapting to change and embracing innovation.
Today, MUSC Health, the integrated clinical arm of MUSC, serves patients through 16 hospitals, 350 telehealth sites, and nearly more than 750 care locations across all regions of South Carolina. At its core, MUSC is driven by a singular, notable purpose: to preserve and optimize human life in South Carolina and beyond. This is a commitment to excellence, compassion, and innovation, aims to heal and enhance the quality of life for every patient it serves.
Meeting patients where they are
Transforming patient access
MUSC’s 200-year legacy is one of innovation. From pioneering lifesaving cardiac procedures to leading the nation in telehealth, the organization has consistently pushed to change what is possible. Under the leadership of enterprise chief digital transformation officer, Crystal Broj, MUSC Health is executing its digital transformation vision to integrate cutting-edge technology seamlessly into the core of the institution, revolutionizing and enhancing business functions along the way.
That vision addresses three key challenges.
The first is patient access. This is an ongoing area of focus for MUSC Health, as it serves a diverse patient population over a large geographic footprint. The organization works daily to provide patients with simple, convenient and modern tools to access the care they need, when and where it is most convenient. Navigating patients to the right care at the right time across more than 750 care locations is no small undertaking. When you consider the need to personalize each of these interactions, such as using a patient’s preferred mode of communication or communicating in his or her preferred language, the challenge greatly increases. Accomplishing this for a single patient is extremely difficult, and scaling it to a patient population that spans the entire state is even more daunting.
Because healthcare has historically been an analog and manual industry, despite ongoing technological advances, the second challenge lies in identifying processes that currently depend on human engagement and deploying technology to automate them. This includes patient intake and registration, appointment scheduling and more. MUSC Health specifically sought strategic partners that offered integrated solutions built on a flexible, unified platform to improve cost-effectiveness and efficiency across all operations.
The third challenge is reducing the burden on healthcare providers and staff. By leveraging technology to ease documentation and data management on providers and automate administrative tasks for staff, significant time can be saved daily. MUSC Health is committed to enabling providers and staff to dedicate more time and energy to patient care.
“We must exceed patient and family expectations along their care journey. Expectations are rising in an age where many of our daily activities can be done seamlessly from our phones. Consumers expect the same from health care,” said Caroline Brown, chief strategy and external affairs officer at MUSC. “We continue to focus on making access easier for our patients. The bottom line is that convenient technology enables patient access, which leads to improved health outcomes.”
In late 2021, a partnership with Notable was born from a shared vision to use the power of artificial intelligence (AI) and automation to transform patient access and care experiences. This collaboration set out to reimagine patient care, starting with access, by using automation and modern engagement tools to meet patients where they are.
Meeting patients where they are
Improving patient outcomes
The state of South Carolina has traditionally had high rates of breast cancer among women. To increase access to quality care, MUSC Health identified more than 30,000 women across the state who were overdue for a mammogram.
After identifying care gaps, an initial wave of outreach targeted women in the Charleston area. To personalize the experience, outreach was carried out in the patient’s preferred language and using her preferred method of communication (email or text message).
From the emails or text messages, patients were able to schedule mammograms directly at their nearest clinics without picking up the phone or talking to a scheduler. This highly personalized, fully automated process allowed MUSC Health to meet its patients where they are, making scheduling simple and improving access to care.
On the first evening after implementation, 147 mammogram appointments were scheduled by women without the involvement of any staff. Charts were automatically updated for patients who went through the experience and indicated they had already gotten their mammograms.
As the program rolled out to additional patients across the state, more than 5,100 women completed the experience, and upward of 1,100 women scheduled mammograms without staff involvement. Of those, 122 were found to have abnormal mammogram results, which may not have otherwise been discovered.
“This initiative has an obvious impact on the lives of our patient population,” said Broj. “Out of everything we’ve done on our digital transformation journey, this is the work I am most proud of.”
MUSC Health is committed to addressing health care disparities in South Carolina by improving access and ensuring that people can get the care they need when they need it. Automated care gap outreach and completion are powerful examples of that, allowing MUSC Health to transition seamlessly from identifying an open care gap to delivering patient outreach that results in staff-less action, ultimately closing the care gap through additional documentation or self-scheduled visits. Without robust automation technology, this end-to-end process typically would require significant staffing and hours of manual labor, instead, it requires none. The organization plans to continue to improve patient outcomes by expanding this program with Notable statewide to include screenings for colon cancer, diabetes and heart disease.
Feedback from patients who were part of the initial program has been overwhelmingly positive:
An improved experience for patients and staff
With a patient population that spans urban and rural areas across the state, MUSC Health is focused on directing patients from all backgrounds to the right care at the right time to provide a personalized experience. This means investing in and optimizing its digital front door, which includes referrals, scheduling, authorizations, registration, intake, payments and more.
The objective is to create a patient-centered platform that eliminates the need for patients to wait on hold to make an appointment, fill out paper forms, pay a bill or repeatedly provide redundant information. Initially, MUSC Health focused on optimizing the digital registration and intake experience.
Notable automatically sends personalized registration instructions to patients with upcoming appointments, based on whether they’re new or returning patients, using their preferred method (emails or text messages). This is not a digital version of the dreaded clipboard. Instead, patients truly feel recognized and valued. Returning patients experience an efficient process with pre-populated form fields based on information from past encounters, ensuring that they never have to answer the same question twice. Patients can quickly review their information, confirm its accuracy and complete registration when it is most convenient for them. The workflows and data created are tightly integrated into MUSC Health’s electronic health record (EHR) and user workflows to create a seamless operational experience.
With the digital registration and intake solution deployed enterprise-wide, across 760 departments and 3,000-plus providers within the MUSC network, the organization is averaging 110,000 monthly digital registrations completed. Each digital registration saves an estimated three to five minutes of staff time per appointment. By augmenting the workforce with automation, Notable has allowed MUSC caregivers to reallocate over 1,300 hours per week to higher-value patient care tasks, including addressing advanced questions, referrals and additional face-to-face engagement. This has helped to drive 98% patient satisfaction since the initial go-live in May 2022.
“We’ve had an extremely positive response from patients to our digital intake and registration experience,” said Broj. “Based on patient feedback, we continue to make changes and updates to the workflow to make the experience as frictionless as possible.”
For example, MUSC Health quickly took feedback and made changes for patients with multiple appointments scheduled for the same week. Rather than send individual registration messages for each appointment, MUSC Health worked with Notable on a consolidated multi-appointment experience. Through single text messages or emails, patients can review and complete their check-ins for all upcoming appointments for the week, streamlining communications and greatly simplifying the overall experience.
“When patients complete everything through Notable, it’s so much easier for the front desk,” said one practice manager. “All the documents are signed, and the [insurance] cards are scanned in. It makes check-in faster for patients so they can see the doctor more quickly.”
For MUSC Health team members, this journey is about eliminating hours of time-consuming tasks.
Explaining the change management aspect for staff with the touchless digital check-in process, Broj said, “Front desk staff were used to handing every patient a clipboard. We retrained them, and now they determine if the patient has checked in via Notable.”
Improving health equity
There is a concern that digital technologies could worsen health inequities in health care. Spanish-speaking households in South Carolina represent a significant segment of the population that might not receive effective communication unless it is delivered in their native language. MUSC Health saw an opportunity to use a digital experience to meet patients where they are by personalizing interactions to each person’s individual needs.
In just six weeks, the organization identified all patients who preferred communicating in Spanish and began delivering digital touchpoints to them in their preferred language. As a result, MUSC Health increased digital intake completion rates by 30% for its Spanish-speaking patients.
“Our goal is to be able to use our digital experience to create small ‘wow’ moments for our patients,” said Broj. “Our Spanish-patient experience is one example where we’ve been able to do just that.”
Improved financial performance
Using the same unified digital intake experience, MUSC Health enables patients to confirm or cancel their appointments without sending a message or making a phone call. This reduces staff outreach efforts, captures visit revenue and, ultimately, drives provider utilization.
“When we can engage patients throughout the registration process, they’re more likely to stay engaged in their overall care journey,” said Todd Leach, chief information officer at MUSC.
As part of the registration workflow, patients are presented with copay information upfront, increasing MUSC Health’s propensity to collect. Notable helped the organization to collect $1.7 million in copays during the pre-visit registration process, meaning 15% of MUSC Health’s total copay collection happened without human intervention. This has reduced staff effort and cost to collect while driving cash acceleration.
Engaged patients are also more likely to come to their scheduled appointments. In 2023, no-show rates were reduced by 7.6% which equates to 14,500 no-shows avoided each year. These appointments resulted in what otherwise would have been lost revenue.
The MUSC Health and Notable partnership delivers over $3.3 million in annual value to MUSC Health per the Joint Operating Committee-approved attribution model.
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Building from a foundation of partnership
What true partnership looks and feels like
When seeking partners to advance its digital transformation, MUSC Health identifies those who strongly align with its mission and values. Any successful partnership goes well beyond technology; it also requires a deep understanding of health care operations and the ability to facilitate change management to drive the desired outcomes. MUSC also requires shared risk and shared reward in its strategic partnerships, with a focus on driving innovation and health transformation.
“A partner walks down the road with you,” said Broj. “They are invested in making every project successful, and they have skin in the game.”
Broj notes that it is important for vendors to empathize with the challenges their executive champions are dealing with. Health care is complex, but when there is alignment on the North Star, a mutual investment and the ability to push and challenge one another toward the ultimate goal, real progress and change can happen.
“If you can’t disagree for the sake of a better outcome,” said Broj, “then you don’t have a partnership.”
MUSC Health engages a set of partners, each of whom it expects to provide platform capabilities solving multiple challenges, and the ability to integrate seamlessly. These include, but are not limited to, its foundational EHR from Epic, telehealth services, Microsoft cloud capabilities and AI and automation software from Notable. By engaging an ecosystem of integrated partners, MUSC Health harnesses a wealth of knowledge, skills and technologies that it can weave into the fabric of its operations.
How the partnership with Notable has evolved
MUSC Health initially partnered with Notable to deploy a personalized digital front door experience to improve patient access outcomes. Today, regardless of where they engage with MUSC Health, patients receive personalized interactions that make them feel recognized throughout their care journeys.
One critical early decision was to set up joint executive stewardship, governing how the two organizations would make agile prioritization decisions to focus on the highest-impact opportunities, while collectively marching toward the North Star that is preserving and optimizing life in South Carolina and beyond.
“Being able to learn and grow with one another is a big part of partnership,” said Broj.
MUSC Health has improved patient experience and engagement without growing staffing costs. To do this, the organization has made strides in fulfilling its commitment to make life easier for its providers and staff by digitizing and fully automating key workflows.
Notable’s integration and implementation capabilities allow for swifter deployments, unlocking faster results and happier patients, providers, and staff.
Embracing a culture of innovation and agility
MUSC Health is committed to a culture that fosters new ideas and values impact. The organization believes innovation can and should occur everywhere: in its renowned research labs, within physical and digital classrooms, in clinical spaces as care teams meet patient needs and through the processes and services that keep MUSC running.
This approach aligns with a specific core value of Notable’s: iterate with zeal. The two organizations’ bias toward action was evident in how they deployed the automated registration and intake experience.
Where other health care information technology (IT) deployments can take several months or even years to implement, and in an industry that refers to “pilotitis” as the affliction of pilot programs that never lead to impact at scale, MUSC Health moved from a go-live at its first site with Notable to being deployed enterprisewide in just six months. The registration, intake and payment solutions have data and user workflows tightly integrated into Epic, consistently achieving high engagement rates and reducing work for staff.
Driving transformation: future projects
MUSC’s efforts to support the people of South Carolina as a trusted health care provider do not stop. In the coming months, the organization plans to scale its breast cancer screening care gap outreach, launching versions in English and Spanish, to reach more than 80,000 patients currently marked as having an open breast cancer screening care gap.
In addition, MUSC Health will expand its work on outreach to close care gaps and improve quality performance, engaging more and more people across South Carolina for needed care that could otherwise be missed. The organization will introduce automated chart review through Notable, providing the ability to identify proactively patients who need care.
Another area ripe for innovation is the expansion of clinical pre-appointment intake, where MUSC Health is working to identify and build additional automated experiences related to women’s health, mental and behavioral health and more. By gathering relevant medical information about patients before their appointments, providers and clinic care teams can save time and more readily take action on essential care.
Additionally, members of the MUSC Health team will be trained and certified to use Notable’s Flow Studio. This no-code interface enables them to build, configure, deploy and monitor custom automations for clinical and patient experience use cases.
Finally, MUSC Health is working to automate additional burdensome processes, such as referral intake and prior authorizations. With these automations, the organization aims to continue improving productivity and the business outcomes that these processes drive, such as referral to appointment conversion, new patient visits and denials rates.
“At the end of the day, digital transformation is a journey, not a destination,” said Broj. “There is so much more to come.”
