Montage Health and Southwest General began with modest patient access workflows: scheduling, registration and appointment reminders. As the results accumulated, the challenge shifted from demonstrating whether automation worked to deciding what to build next and how to scale without creating another collection of disconnected tools.
During a featured session sponsored by Notable at Becker’s 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health on Sept. 14, leaders from the two health systems described how they scaled automation across different EHR environments.
The panelists were:
- Charles Gallagher, customer success team lead at Notable
- Meg Dingae, director of human experience and enterprise delivery at Montage Health in Monterey, Calif.
- Kristin Workman, clinical applications operations manager at Southwest General in Cleveland
Below are four takeaways from the discussion.
1. Start with simple
Montage Health began with a grant-funded program for children at risk of obesity. At the time, one staff member retrieved referrals from a fax machine, entered them into Epic and contacted families to schedule care. Montage automated the process from end to end, allowing that employee to move into more patient-facing work. Referral turnaround time fell from 23 days to a day and a half, providing the results needed to support broader expansion.
Southwest General started with appointment reminders, which staff had been managing through spreadsheets and paper-based follow-up. The hospital’s no-show rate declined from 11% to 4% after implementation.
“It was a good base for us because it built trust,” Ms. Workman said. “We went with something that we knew we could build upon.” Southwest General piloted the workflow, confirmed it was stable and then expanded it across its provider groups.
2. Fix the workflow before automating it
As Montage expanded referral automation, leaders discovered that neighboring departments often handled the same task differently. In one case, staff were removing fax cover sheets before indexing documents because a radiologist had requested it in 2014. No one had revisited the requirement.
“If you take a technology and you just sort of plaster it on top of an already bad workflow, that’s not great,” Ms. Dingae said.
Montage used the implementation to standardize referral processes and develop a repeatable starting point in Flow Builder, Notable’s low-code platform interface, while preserving necessary differences among specialties and referral types.
Southwest General encountered a similar challenge. Ms. Workman said five people could be brought into a room and describe six different ways of completing the same workflow. Extensive customization within Oracle had also made upgrades and integrations more difficult, creating different processes that required separate maintenance.
The health system is now pushing departments toward standardized workflows unless executives identify a clear reason to deviate.
3. AI agents are part of the strategy
Southwest General has organized its automation strategy around individual AI agents, each given a name and a defined role within patient access or administrative operations. The hospital currently uses two, Hope and Ava, which leaders informally describe as digital employees.
Ms. Workman said patient satisfaction among those interacting with Hope is approximately 96%. Patients who do not want to use the automated experience can still schedule through the hospital’s traditional process.
Ava, the authorization validation agent, works behind the scenes. It gathers CPT codes, provider information and clinical documentation so prior authorization employees do not have to search across the patient record. The workflow reduced preparation time from approximately 20 to 25 minutes per authorization to five or six minutes.
“It’s not that it’s doing the prior auth for us,” Ms. Workman said. “It’s combing the chart and getting all that information in one place.”
4. What it takes to scale
At Montage, Notable’s existing Epic integration means the health system does not need to begin a new integration project each time it introduces another workflow. The organization maintains an Epic-first strategy but uses Notable for functions the EHR cannot perform or where the platform can complement existing capabilities.
Southwest General similarly sought to keep employees from switching between Oracle and a second system. Physician orders flow directly to Hope and information moves between Notable’s Platform and the EHR without requiring additional steps from staff. Although establishing the interfaces took time initially, Ms. Workman said that foundation supports each subsequent workflow.
“It helps us be able to do things on our timeline,” Ms. Workman said. The analysts understand the hospital’s operations and can work directly with clinicians and front-desk employees before returning to the technology to build around their needs.
Staff members are submitting more requests for potential workflows than the organization has resources to pursue, making prioritization and change management increasingly important.
“The market has proven that AI works,” Mr. Gallagher said. “The next frontier and our next problem becomes how do we scale, and how do we scale without adding unnecessary complexity,”
