The U.S. health care delivery system is undergoing rapid and far-reaching transformation driven largely by emerging technologies that are reshaping nearly every aspect of care in a short span of time. This pace of change accelerated dramatically in the wake of the COVID-19 pandemic, which served as a catalyst for major shifts such as widespread telemedicine adoption, remote patient monitoring, and digital health innovations. Today, advancements in artificial intelligence (AI), machine learning, wearable technology, electronic health records, and digital therapeutics are further revolutionizing clinical diagnostics, treatment approaches, and patient engagement. These developments are prompting health systems to adopt new policies, management practices, and institutional strategies related to rapid innovation. This, in turn, has led a growing number of health systems to establish dedicated transformation offices, officers, centers and departments to manage this evolving dynamic at the core of hospital operations.

The University of Pennsylvania Health System was one of the earliest pioneers in this field of health care transformational management.

Penn’s initiatives and this new trend in health care transformational management were the subject of LDI’s March 21, 2025, Annual Charles C. Leighton, MD Memorial Lecture. The featured speaker was LDI Senior Fellow Raina M. Merchant, MD, MSHP, Vice President and Chief Transformation Officer at the Perelman School of Medicine and Executive Director of Penn Medicine’s Center for Health Care Transformation & Innovation (CHTI).

Speaking in the Wharton School’s Huntsman Hall, Merchant, a Professor of Emergency Medicine, noted that Penn Medicine’s transformation strategy was driven by a few key ideas: embrace change, align with top priorities, center on people, measure impact, and blend technology with human connection. At its core, the goal is to move fast, work collaboratively, and turn research into real, scalable care improvements.

“The challenge and work involved in this kind of transformation is hard, but essential for us in terms of growth and imagining what the future of health care will look like,” said Merchant. “We need a strategic alignment with our leadership, and we also have to prioritize with purpose. There are about a thousand different things that we could be working on. And what’s really important is making sure that we are prioritizing the most important things.”

To demonstrate how Penn is doing that, Merchant took the audience through ten of Penn Medicine’s current transformation projects. They are:

Care at Home

Most hospitals are at capacity or beyond it with situations that require emergency department patients to often wait in the hallway for long periods of time. In collaboration with LDI Senior Fellows Austin Kilaru, MD, MSHP, and Anna Morgan, MD, MSc, CHTI has partnered with Penn Medicine at Home and the Emergency Department in a new program called PATH, an evidence-based model for shifting the delivery of acute care into the home. Instead of being admitted for conditions like pneumonia, patients receive IV meds, therapy, and virtual doctor check-ins at home. PATH is already the second largest such program of its kind in the Northeast and has enrolled over 128 patients in the last six months. So far, it has also reduced boarding and reported high patient satisfaction and fewer hospital returns.

Patient/Provider Interface

One of the most challenging aspects of modern medical visits is the sense of disconnection that can arise when physicians are focused more on their computer screens than on their patients. To address this, Penn Medicine is adopting “ambient listening” technology. In this approach, a smartphone is placed on the desk between the doctor and patient, where it uses artificial intelligence to automatically transcribe the conversation and generate clinical notes in real time, directly into the patient’s medical record. This not only fosters more meaningful face-to-face interactions but also reduces physicians’ after-hours work—often referred to as “pajama time”—spent completing notes and replying to messages.

Guide Program for Dementia Patients

Given the dramatic demographic age shift in the U.S., CHTI has focused on transformational projects to improve care for the aging population. Its GUIDE Program is a package of services in what Merchant characterized as a long-overdue, holistic approach to dementia care designed to improve the life of individuals with dementia and reduce the strain on their caregivers. A collaboration with LDI Senior Fellow Kyra O’Brien, MD, the program includes a comprehensive assessment, 24/7 access to support for the patient and their family members, navigator-like care coordination, medications management, and assistance with respite care.

Switchboard Automated Appointment Management

Expanding a telemedicine tool originally created during the COVID-19 pandemic to connect with patients remotely, the CHTI team has launched Switchboard, a comprehensive automated logistical system for managing appointments as well as telemedicine visits. The text message system now fills thousands of extra appointments and reduces staff workload by sending texts, reminders, and post-visit surveys—saving time and boosting revenue. The post-visit surveys query patients about their visit experience, gleaning information that can be used to further streamline the system. Merchant pointed out that Switchboard has significantly reduced no show rates and overall workforce burden at the same time it has generated $6.75 million in additional revenue.

Refill Express

Another area being transformed by technology is the filling of prescriptions, which has often been time-consuming, labor intensive, and complicated for physicians, pharmacists, and patients. Penn Medicine’s new Refill Express powered by the WaytoHealth uses a texting platform to confirm refills, track missed doses, catch side effect concerns, and log everything into the medical record. It cut manual work for pharmacists and hospital staff by nearly 90% and ensures patients get critical meds faster, especially in high-demand areas like weight loss treatments. It has enabled pharmacists refill significantly more prescriptions at the same time it has reduced the cost of doing that.

Coordn8

Despite the advanced state of digital technologies, many hospital departments still use fax machines to acquire and exchange medical information about patients with other hospitals and physician practices. This despite the widespread recognition that this hard copy-to-digital entry work is a multiple step, labor-intensive process prone to errors and long delays. Penn Medicine’s new Coordn8 program replaces that with smart forms, AI, and e-consent tools that cut wait times, boost staff satisfaction, and streamline the document transfer process—saving thousands of staff hours and reducing delays in care. To date, it has saved almost 5,000 hours of manual labor and freed up staffers to pursue other top-of-license tasks.

High-Risk Follow Through

It’s a widespread reality that significant numbers of patients fail to follow through on crucial clinical recommendations, even though this can dramatically impact their health. Sometimes this involves a needed screening or something like a small nodule detected on a scan that requires a follow-up appointment that never happens. Penn Medicine’s new High Risk Follow Through program supported by LDI Senior Fellow Shivan Mehta, MD, MSHP, uses technology to detect missed follow-ups and helps with the completion of those—for both the patient and the clinician. Currently, the program is focused on pulmonary nodule follow-ups but will soon be expanding into keeping lab visits, procedures, consults, and prescriptions on track.

Operating Room Scheduling Efficiency

Efficiently scheduling hospital surgeries is a complicated process that requires a lot of highly coordinated steps and careful time management. Managing multiple operating suites in large and very busy hospitals inevitably involves not only scheduling but the ability to accurately predict of how long a procedure will tie up any given operating room. In the past, this task has been a manual affair that hasn’t always gotten it right. But Penn Medicine’s new ORACLE program driven by LDI Senior Fellow Rachel Kelz, MD, MSCE, has automated the process with AI that outperforms the existing operating time model and reduces scheduling errors by 55%.

Speeding Up Science

One of the greatest frustration of researchers and clinicians alike has been the length of time it has taken for new evidence-based methodologies and procedures to move from journal pages into actual clinical practice. The commonly cited lag time is 17 years. Changing that has been a major goal of Penn Medicine’s CHTI transformation science team. One of its recent AI-powered successes led by LDI Senior Fellow Anna Morgan, MD, MSc, was a pharmacist-led intervention that boosted statin prescriptions among at-risk patients from 43% to 66%. The time from research publication to real-world care was less than seven months—improving outcomes and lowering costs.

Health Care Workforce Wellbeing

While the general sense is that health care delivery is a service tightly focused on patients, the COVID-19 pandemic showed us as never before how much the care-delivering clinicians themselves sometimes need care. Penn Medicine’s COBALT platform asks the user if he or she needs peer support resilience coaching, or a psychotherapist, or psychiatrist and, based on the user’s answer, displays a screen listing available resources. Cobalt + was then developed by the CHTI team (supported by LDI Senior Fellow Anish Agarwal, MD, MPH). It “pushed” well-being content via text message to health care workers rather than requiring them to seek out the resources and “pull” them. Through a large, randomized control trial, Cobalt + demonstrated significantly reduced anxiety and depression in this high-risk health care workforce population and these effects were sustained over time.

In closing, Merchant emphasized that, “The future of healthcare is not something that will simply happen to us. It’s something that we must create. And as we look ahead, we need to challenge ourselves to not just embrace change, but to drive it, to shape it and ensure it leads to a world where healthcare is more accessible, more intelligent, and deeply human.”

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