AI Use Cases for the Smart Clinic

Verify coverage at arrival; collect payment if uninsured. Layer in prior authorization pre-checks for likely orders (MRI, referrals). Add self-pay fee schedule and sliding scale logic for underserved populations.

Capture chief complaint with structured symptom severity scoring (ESI, PHQ-2) — not keyword matching. Emergency flags must account for age and context. The tagged chief complaint also drives downstream ambient scribe template selection.

Predict wait time with live updates. Conservative estimates with uncertainty outperform stale precise ones. Car waiting requires SMS opt-in captured at registration. Honest, dynamic communication reduces patient frustration.

Three-way reconciliation: chart vs. pharmacy dispensing (Surescripts) vs. patient report. Structured capture of why medications were stopped (side effects, cost, felt better). Discrepancies flagged for physician review — not free text only.

USPSTF-driven alerts for due screenings and vaccines. Pre-populate orders but require physician sign-off. "Standing order" model (physician pre-authorizes vaccine for all adults) enables nurse execution without real-time order.

Speaker diarization in noisy exam rooms. Patient consent workflow required. Sensitive disclosures (mental health, substance use) may need exclusion from verbatim transcription. Physician amendment UX is the key differentiator — easy correction drives adoption.

ICD-10, CPT, and E&M level assignment (99213 vs. 99214). Confidence score + rationale for each code. Conservative-by-default posture to avoid overcoding liability. Full audit trail required. Pipeline shared with ambient scribe for note quality dependency.

Disambiguate order types (PA/lateral vs. portable x-ray). Duplicate order checking. Contraindication flags (e.g., no gadolinium if eGFR < 30). Automate requisition generation and fax dispatch to imaging centers — high value in independent clinic settings.

Accurate current medication list with <30-day renewal flags. Interaction checking via DrFirst/Surescripts API. Deprescribing flags for polypharmacy (Beers Criteria for elderly patients). Proactive refill anticipation reduces inbox volume.

Problem-specific narrative summaries over time ("trajectory of diabetes management over 6 months") rather than raw last-N-notes. Physician-parameterized by problem, date range, or provider. Context-aware framing outperforms simple summarization.

Point-of-care complement to backend population health tools. Shares the same rules engine to ensure consistency. Flags active deficiencies at time of visit when the patient is in front of the physician and action is most likely.

Suggests additions, removals, and updates with confidence scores and evidence citations ("Suggest adding T2DM — supported by HbA1c 7.4 on [date]"). One-click acceptance workflow. Addresses the real-world problem of chronically stale problem lists.

RAG interface over the patient chart. Answers must cite source note and date. Never hallucinate lab values. Flag unanswerable questions explicitly. Structured response format ("Based on note dated X, Dr. Y stopped lisinopril due to cough") preferred over open-ended generation.

Extracts key chart data to answer form fields (disability, insurance letters, school/work notes). Chains to Chart QA module. Flags unanswerable fields rather than leaving blanks or guessing. Physician review before printing — legal implications for many form types.

Agent-initiated scheduling based on physician return interval. Aware of scheduling rules: physician availability, visit type durations, insurance limits. Pre-selects appointment type from reason context (e.g., diabetes recheck).

Pending tasks (vaccines, in-office tests) displayed by room at the nurse's station. Priority logic: pre-departure tasks vs. deferrable tasks. Integrates with room assignment and rooming workflow for real-time operational clarity.

Captures physician promises to patients (article review, deferred form completion). Default 48-hour due date with escalation logic. Tasks appear in physician's inbox — closes the loop on commitments that otherwise fall through the cracks.

Priority logic: urgent flags, abnormal labs, imaging findings, expiring medications. Deduplication across fax/HL7/portal. Sender classification. Administrative vs. clinical inbox split. OCR + patient matching (name, DOB, PHN) with human-review queue for low-confidence matches on misfiled documents.

Phone booking, cancellation, and identity verification. Multi-language support (patient safety issue, not optional). Concern triage per validated protocols (chest pain → 911). No-show prediction drives reminder channel selection (call vs. text vs. nothing).

Configurable database queries by non-technical staff (e.g., "CKD stage 3+ missing ACR in 12 months"). Tiered outreach: portal message → SMS → automated call → staff call. Track response rates per channel. Requires the cleanest data foundation — build last, benefits from all prior modules.