Abridge built its name on a specific, difficult problem: turning the conversation between a clinician and patient into a finished clinical note. That ambient documentation across inpatient and outpatient settings, spanning numerous specialties and languages, made it one of healthcare’s most widely adopted AI companies, live in more than 300 health systems.
But the finished note was only ever a starting point — a trajectory the company signaled early on. Care Signals, which Abridge is naming publicly for the first time as it launches, is its clearest move yet beyond the visit to before and after it.
Co-designed, built and first deployed at Kaiser Permanente, Care Signals is a capability within the Abridge platform that spans the whole arc of a clinical visit. Before the visit begins, Care Signals flags a patient’s most relevant health conditions, including chronic conditions. During the visit, it tracks whether a condition is discussed with the patient and cues the physician if there isn’t an appropriate assessment and plan, rather than simply transcribing the conversation. At the end of the visit, it turns the result into industry-standard documentation and the associated ICD-10 codes that match.
Care Signals took 15 months to build, with multidisciplinary teams within Kaiser Permanente pressure-testing each round, toward a shared goal: more complete, personalized treatment. “This has really taken our ability to more accurately report diagnoses and the patient’s care plan to a very, very different level,” Paul Minardi, MD, executive vice president of enterprise clinical integration and growth at Kaiser Permanente, said.
Abridge shares that clinical aim, and has built something larger around it. In June, before an audience of partners and investors, the company sketched its vision for a healthcare intelligence platform that reaches well beyond the exam room. Less a passive scribe, more an active partner working alongside the clinician.
Shiv Rao, MD, the practicing cardiologist who co-founded Abridge in 2018 and leads it as CEO, knows that work firsthand. On Sunday nights before a day in clinic, he used to review patient charts.
“On any given weekly clinic day, I might’ve had a dozen patients lined up, and maybe half of those patients were really complicated, with multiple chronic diseases all interacting with each other,” he said. “The night before, I’d sit in front of Sunday night football and I’d just prep my charts. I would read up on those patients. I’d think about them. I’d look up journals related to their conditions. I’d also think about what care gaps I need to close.”
Primary care clinicians, Dr. Rao estimates, face roughly 10 times that load — complex patient cases with their own set of care gaps. It is more preparation than any clinician can realistically do by hand, for every patient, every day. “We’re now at a moment with AI where we have this opportunity to help those clinicians walk in feeling like they have all the context on who this patient is,” Dr. Rao said.
Care Signals is the machinery meant to deliver that context and, on the other side of the visit, to extend this important clinical information to the subsequent treating care teams and to the administrative teams that account for the care given.
‘A team of assistants’
Matt Troup came to expect a particular sense of disappointment. A physician assistant for about 13 years before he joined Abridge, he would walk into a room, address the primary concern the patient brought, and realize only after they had gone that he had missed what he meant to raise.
“All of a sudden I realize after the patient has left, my goodness, I’ve forgotten the things that I was planning to talk about, because you really want to make sure you feel like that patient is seen and heard for their concerns at the top of the visit,” Mr. Troup, Abridge’s clinical strategy principal, said. The worry followed him home, becoming what he said was a source of his own burnout.
Mr. Troup’s worry was clinical, with an administrative shadow. Capturing chronic conditions completely and specifically enough to withstand an audit is largely retrospective work, disconnected from the exam room and reaching clinicians days or weeks after the patient has gone home.
Care Signals moves that work into the visit and, when it can, into the background — that Sunday-night chart prep, now delivered as a cue card. The conditions it surfaces arrive with the evidence and relevant history associated with them, so the clinician walks in oriented rather than uncovering the history mid-visit. That evidence is also what supports a more precise diagnosis when the patient history warrants one: not Type 2 diabetes, but Type 2 diabetes with diabetic polyneuropathy, where the neuropathy is documented.
Care Signals identifies and surfaces relevant diagnoses for a patient, which may also support coverage decisions and risk-adjustment reporting. The conditions it surfaces in some instances map to Hierarchical Condition Categories, the groupings CMS and commercial payers may use to set payments for patients covered by governmental programs as well as specific risk-based commercial groups. When documentation lacks enough specificity to place a condition in the right category, the payment often reflects a healthier patient than the one actually treated.
“Having a fellow in a clinic or a resident sometimes can feel like this incredible boon,” Dr. Rao said. “You have someone who can chase those charts or summarize those records or just be a backstop for you as you’re thinking through a really complicated patient. Now we can deliver to every single clinician out there a team of assistants like that.”
In the background, on purpose
The hardest part of Care Signals was not surfacing information. It was surfacing it without getting in the clinician’s or patient’s way.
Clinical technology and interventions have a long history of promising to help clinicians and falling far short. Past solutions were piecemeal, Dr. Rao said, and entirely in the foreground: revenue-cycle queries waiting in the EMR or inbox, requests for a clinician to fix or clarify something long after the visit; pop-up alerts mid-exam; documentation-integrity requests that surfaced weeks later, about patients the clinician no longer remembered. “All of those different point solutions end up feeling like paper cuts when they’re not coherently working together,” Dr. Rao said.
At Kaiser Permanente, Trina Davis, MD, a family medicine physician in Seattle and medical director of innovation at the KP Medical Foundation, helped make sure Care Signals was built differently. She was the first clinician at Kaiser Permanente to use Care Signals. Early on, she and more than a dozen others tested each iteration and sent feedback to Abridge, round after round. She likens the collaboration to a long marriage, comfortable enough now to be blunt. “This required a level of trust and relationship building to get to the point where we could candidly give each other feedback,” she said.
The result, Dr. Davis said, is a tool elegant enough to stay in the background. She offered an example from her own clinic. A visit was wrapping up and she was already at the door when a patient mentioned, almost in passing, that she’d been having reflux. It was the kind of parting detail that arrives after the formal part of a visit — an aside that’s easy for clinicians to note aloud but lose before it reaches the chart. Care Signals caught it, folded it into the draft note and flagged the treatment and potential diagnosis Dr. Davis had recommended on the spot for review.
“I think having that information in the record, in a searchable, easy-to-find format, helps me communicate with my future self and my colleagues,” she said. “The consistency it brings to documentation and diagnosis coding creates a more complete medical record and strengthens our ability to deliver integrated care and makes a real difference for patients and providers.”
Unlike the foreground tools that came before it, Care Signals never pushes. “It’s not forcing me to do anything,” Dr. Davis said. “It’s just surfacing it so that I can do the thing I wanted to do all along, which is take care of the whole person in front of me.”
Dr. Minardi is equally firm on this point. Care Signals never independently finalizes a diagnosis. Instead, it tees up potential diagnoses for clinicians to evaluate, using their clinical judgment to determine what should be entered into the medical record. Freed from entering everything by hand while clinically reasoning through a visit in real time, he said, clinicians can turn that attention to the patient instead.
The tougher test, Dr. Minardi said, came not from the technology but from inside Kaiser Permanente. “It was in our own internal evaluation of the product and its related output and outcomes,” he said. “We are our own harshest critics.”
A governance team spanning clinical, legal, compliance, certified coding experts, Medicare representation, and IT met monthly; independent external coding experts audited the model, and Kaiser layered its own quality review on top of this intensive evaluation. The rollout is phased first for the next 100 to 200 clinicians across Colorado and Washington, then California and Georgia, then Kaiser’s Risant Health affiliates.
For all the machinery underneath — the ICD-10s, the audits, the models retrained to federal specifications — Dr. Rao keeps returning to the same destination. “Ultimately, the North Star for us is clinical outcomes,” he said. And even now, with Care Signals launching and spreading, he sounds like someone at the start: “It still also feels like we’re just scratching the surface of where we can go.”
Editor’s note: Kaiser Permanente Ventures is an investor in Abridge.
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