The Problem
A 7-clinic multi-specialty network with 240 staff in the Toronto area was struggling with two adjacent problems. Physicians were spending 90+ minutes a day on documentation. particularly discharge summaries that had to satisfy clinical, billing, and provincial reporting requirements. Insurance claims were taking 14 days on average from service to submission, and denial rates were running at 22%. most denials traced back to documentation issues that could have been caught earlier.
The board wanted physicians seeing patients, not typing notes. The CFO wanted denial rates cut in half.
What I Built
A clinically-careful automation stack that integrates with the existing Epic-based EHR via FHIR APIs:
1. Discharge summary draft assistant. After each patient encounter, the physician reviews the AI-drafted summary built from: visit notes, prior history, lab results, medications, and the procedure record. The AI produces a structurally-compliant draft (provincial reporting format, billing codes, plain-language patient version). Physician edits typically take 3-5 minutes vs 25-40 minutes for a from-scratch summary.
2. Claim pre-flight check. Before any claim is submitted, an automation runs the documentation through a denial-prediction layer: missing modifiers, unclear medical necessity language, code combinations that historically denied, signature/sign-off gaps. Issues are flagged to the relevant physician with one-click resolution suggestions.
3. Appointment routing intelligence. New patient referrals are auto-triaged by Claude. extracting symptoms, urgency, and suggested specialty from the referral letter. and routed to the right clinic + practitioner, with suggested visit duration. Reduced 14-day average referral-to-booking to 3 days.
4. Patient-facing automation. Pre-visit instructions, post-visit care summaries, and follow-up appointment scheduling all run through automated patient communications respecting Ontario's PHIPA regulations.
Outcome
Physicians reclaimed roughly 70 minutes a day each. the network is now seeing more patients per day with the same physician roster, and clinical satisfaction scores have climbed. The CFO's denial rate target was beaten (−58% vs target −50%). The provincial reporting compliance rate hit 100% for two consecutive quarters for the first time in the network's history.