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

NSF I-Corps
Cornell Tech
C10 Labs

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.

01

Start with a brochure

Your team introduces Heather at discharge. Patients scan a code, share their instructions and provide the information needed for their follow-up.

02

Understand the next step

Heather follows up by phone and text, reinforcing clinician-written instructions and asking what is getting in the way.

03

Keep the team in the loop

Concerns and unresolved needs go to the designated care team with context. Clinical decisions stay with clinicians.

04

Follow through

The pilot tracks what happened after outreach, with an agreed way to measure whether clinically appropriate follow-up was completed.

Measure the next step, not just the call.

Each pilot starts with a baseline and success criteria agreed with your team. These are the outcomes we aim to improve.

Aim: improve

Follow-up completion

Did the clinically appropriate visit happen, including elsewhere when that is right for the patient?

Aim: reduce

Time to follow-up

How long did it take to get from discharge to the appropriate next step?

Aim: improve

Patient understanding

Does the patient understand the instructions and know what to do next?

Aim: reduce

Staff effort

How much time does the team spend on outreach and non-clinical coordination?

Aim: reduce

Unresolved handoffs

Which tasks still need an owner, a response or an appointment?

Aim: improve

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.

Moving into hospital pilots

A paid ED pilot is agreed with Weill Cornell. A separate heart-failure pilot is IRB-approved and awaiting launch, and a Northwell Lenox Hill ED study is preparing for IRB review. Across these three pilots, planned enrollment exceeds 100 patients; enrollment has not yet begun.

400+ discovery interviews across three NSF I-Corps programs. Cornell Tech Startup Award winner and part of Cornell Tech’s Runway and Spinout Accelerator programs.

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.

A paid pilot with a clear path forward.

Each new deployment starts with a 12-week paid pilot. We agree on the patient cohort, success criteria and ongoing-contract conversion terms upfront. Meeting those criteria triggers conversion under the agreed terms.

Patient-led enrollment lets us begin without EHR integration. The discharge team provides a brochure; patients scan a code and share their instructions. Required hospital privacy, security and legal reviews still apply.

We measure follow-up completion, patient experience and staff effort separately. Any business case uses your baseline, available appointment capacity and payment model.

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 select a specific care pathway and an accountable team for each pilot.

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 in the next pilots.

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 does the pilot work?

Each new deployment starts with a 12-week paid pilot. We agree the cohort, success criteria and ongoing-contract conversion terms upfront. Meeting those criteria triggers conversion under the agreed terms. 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 build your follow-up pilot.

Start with one care pathway, an accountable owner and clear measures. We’ll agree what success looks like before the pilot begins.

Request a 20-minute call

We'll come back with times and a short agenda.

Paid 12-week pilot No EHR integration to start Agreed success criteria