Help patients complete follow-up after discharge
Meet Heather, your AI care navigator. She helps patients understand their discharge instructions, work through barriers to follow-up, and bring unresolved needs back to your care team. Starting with ED patients going home.
Built with clinicians. Supported by
The call is only one step in the care journey.
A patient can understand the instructions and still never get the care they need.
Booking
The patient knows they need follow-up, but still needs an appointment.
Barriers
Transport, confusion or a missed visit can interrupt the plan.
Handoffs
An unanswered referral or unresolved task leaves the next step unclear.
More information only helps if someone can act on it. Heather helps move the next step forward. Your team gets the context to address what remains unresolved.
From discharge to the next visit.
Start without EHR integration. Build the workflow around your patients and the team responsible for their follow-up.
Start with a brochure
Understand the next step
Keep the team in the loop
Follow through
Measure the next step, not just the call.
The outcomes Heather is built to improve, measured against your own baseline.
Follow-up completion
Did the clinically appropriate visit happen, including elsewhere when that is right for the patient?
Time to follow-up
How long did it take to get from discharge to the appropriate next step?
Patient understanding
Does the patient understand the instructions and know what to do next?
Staff effort
How much time does the team spend on outreach and non-clinical coordination?
Unresolved handoffs
Which tasks still need an owner, a response or an appointment?
Patient experience
Is the support useful, understandable and respectful of the patient’s choices?
Early feedback. A clear next test.
An earlier NewYork-Presbyterian study involved 12 patients and 12 clinicians. Results are being submitted for publication.
92%
of patients reported understanding their care better.
95%
of clinicians said Heather was accurate and saved them time.
Early study feedback; follow-up completion and clinical outcomes remain to be evaluated.
Built around your care plan.
Heather supports patients between visits. Your clinical team defines the pathway, the boundaries and who handles each handoff.
Clinician-defined instructions
Heather reinforces the discharge plan. She does not diagnose, prescribe or change treatment.
An accountable care team
Before launch, we agree who receives concerns, how they are routed and what requires human review.
Patient-centered follow-up
Success means clinically appropriate care, including outside your system when that is the right choice.
Questions clinical buyers ask.
Is Heather a replacement for our nurses?
Heather handles protocol-based outreach and non-clinical coordination so the care team can focus on needs requiring human judgment. Clinical decisions remain with clinicians.
Does Heather give medical advice?
Heather reinforces clinician-written discharge instructions. She does not diagnose, prescribe or change treatment. In an emergency, patients should call 911.
What happens when a patient reports a concern?
Concerns and unresolved needs are routed to the designated care team with context. Before launch, we agree the escalation protocol, responsible owner and response process.
Which patients do you start with?
Our initial focus is patients discharged home from the emergency department who need outpatient follow-up. We start each hospital with a specific care pathway and an accountable team.
What does the evidence say?
An earlier NewYork-Presbyterian study involved 12 patients and 12 clinicians, with positive feedback on understanding and clinician usefulness. Results are being submitted for publication. Follow-up completion and clinical outcomes remain to be evaluated.
Do we need EHR integration to start?
No EHR integration is needed to start. The discharge team provides a brochure; patients scan a code, share their discharge instructions and provide the information needed for follow-up. Hospital privacy, security and legal reviews still apply.
How do we get started?
We start with one care pathway and an accountable team. Before launch, we agree the patient group, the baseline and how success is measured. Launch timing depends on the required hospital approvals.
How is patient data handled?
We define the information needed for the selected pathway and agree data handling, access and contractual requirements with your hospital before launch. Patients provide information for their follow-up, and clinical concerns stay within the agreed care-team workflow.
Let’s improve follow-up after discharge.
Start with one care pathway, an accountable owner and clear measures. We’ll agree what success looks like before launch.