The reimagineers of Penn Medicine

By Christina Hernandez Sherwood 

Six million digital messages arrive in the inboxes of Penn Medicine clinicians each year. That’s more than 16,400 inquiries daily about everything from where to park to referral requests to pain management. 

While patients value the ease and convenience of being able to ask their questions through a portal any time, any day, the resulting tidal wave in the volume of messages adds to the pressures driving clinician burnout, said Jeffrey Moon, MD, MPH, an emergency physician and assistant chief medical informatics officer at Penn Medicine. “Ten years ago, there were zero,” he said. “This is a burden that no one really saw coming.”  

The specific problem may have been unexpected, but the pattern is a persistent one. As new technologies emerge in medicine that can improve or even revolutionize treatment, they also often bring new challenges for people working on the front lines of health care. 

And that’s a pattern that Kevin B. Mahoney, CEO of the University of Pennsylvania Health System, has set his sights on changing. 

“Everything that is not working [in our systems and processes] is taking away from time at the bedside; it’s taking away from you being able to do your jobs,” Mahoney said in a town hall discussion with the Penn Medicine workforce last fall. In the case of 24/7 messages, the onslaught makes it feel impossible to step away from the job after hours. 

So, since 2023, Penn Medicine has been developing a solution to streamline replies to patient messages with help from artificial intelligence (AI)—working with the electronic health record platform Epic to refine a tool that is now available to users of the system across the country.  

The AI patient messaging pilot is a prime example of how Penn Medicine is addressing a massive problem by zeroing in on technological innovation to help keep health care encounters more human-centered.  

Technology and innovative changes in practice are driving progress toward several key goals in Penn Medicine’s most recent strategic plan—including not only a goal to become the most clinician-friendly health system, but also to expand patients’ ability to access all of Penn Medicine, from telehealth to advanced, research-driven care.  

Clinician-friendly and patient-centered care 

The AI patient messaging pilot is the health system’s largest project putting artificial intelligence into clinical practice to date, as part of the push to make work easier for front-line clinicians.  

“We’re not just pursuing AI for AI’s sake,” Moon said. “We’re deliberately targeting pain points.”   

Penn Medicine partnered with Epic to test an artificial intelligence-enabled patient message response module, in which messages drafted by AI must first be reviewed and modified as needed by a clinician before they are sent. More than 100 Penn Medicine primary care and specialty providers gave feedback on the responses to patient questions that were generated by the AI module, Moon said. The clinicians helped make the module’s responses less verbose and more authentic, as well as determine how to deploy the tool among staff to ensure sent messages were clinically sound, and to make sure it didn’t perpetuate bias. The module became available to Epic users nationwide only after these refinements. 

While it’s tough to quantify how much this project has eased physician burnout overall, Moon said, the AI-generated messages are used in some form by Penn Medicine providers roughly 35 percent of the time. “In five years, maybe even sooner,” he said, “I could see this being a true game changer.” 

Other solutions driven by technology and process streamlining include: the expansion of an AI-driven ambient listening pilot to turn provider-patient conversations into clinical notes; a pilot program to eliminate prior authorization for certain imaging studies; Penn-developed software that reduces the time to input faxes received from outside the health system; and an automated system for streamlining specialty prescription refills. 

Repairing, refocusing, and reimagining  

While technologies like these are often the right answer to the challenge of making health care more meaningful and accessible for clinicians and patients alike, sometimes the solution is more about when and where to use them. A growing number of innovations at Penn Medicine are harnessing the concept of “anytime, anywhere” and connecting care across settings. The COVID-19 pandemic dramatically accelerated the expansion of home care services, including telehealth offerings and home-based post-operative care. Today, for instance, about half of Penn Medicine’s chemotherapy and other infusion treatments are now delivered at home. These efforts free up space in hospitals and outpatient clinics, which provides much-needed capacity relief to care for the sickest patients. 

These are just some of the ways Penn Medicine is making both subtle changes and big swings—spotting and repairing dysfunction, refocusing on the institution’s patient-centered mission, and ultimately reimagining how an academic health institution can make the world a healthier place for all of the people in it, including within the workforce. 

Physicians at the helm of technology and innovation  

Two longtime Penn Medicine doctors who bring creativity and a collaborative spirit, along with a deep understanding of the health care system, are key to driving these approaches forward. Together, Raina Merchant, MD, MSHP, an emergency physician who ran Penn Medicine’s Center for Digital Health, and Mitchell Schnall, MD, PhD, the health system’s longtime Radiology chair, totaled more than half a century of experience at Penn Medicine before they were recently tapped for newly created roles. Merchant became the health system’s inaugural vice president and chief transformation officer in 2022, and Schnall was named its first senior vice president for data and technology solutions in 2024. 

They are, together and separately, tasked with such aspirational projects as moving health care out of the hospital and into the home when appropriate, building more robust systems for online scheduling and accessibility, and leveraging artificial intelligence to ease the burden on health care providers. In the meantime, both continue to regularly provide patient care—Merchant in the Emergency Department at the Hospital of the University of Pennsylvania and Schnall performing magnetic resonance imaging-guided breast biopsies.  

While executive-level leaders at Penn Medicine, like most health systems across the country, have often come from business-related backgrounds, it was important to choose doctors from the Perelman School of Medicine faculty for these two roles in particular, Mahoney said. That’s because, as doctors, Merchant and Schnall bring a physician’s perspective to today’s health care problems, providing a complementary set of skills that are crucial to the modern health care C suite. 

“Raina and Mitch are doctors first,” Mahoney said. “We need to make it easier for doctors to take care of patients, and one of the ways is to have physicians leading.” 

Physicians bring a different perspective to the leadership team, Merchant said, because of their proximity to the challenges of practicing medicine and providing patient care. And as physician-scientists who do academic research, she said, they're trained to weigh and evaluate limited evidence. “We, as physicians, are very focused on keeping the patient and the health care workforce at the center of everything we do,” Merchant said. “We’re comfortable with uncertainty, with not having all the information sometimes when you make a decision. Particularly in emergency medicine, that’s what the field is about.” 

Physicians have an innate creativity, Schnall added, that has been stripped away from them as the field of medicine has evolved from a science-informed art into a business-informed science. He said one of his aims is to challenge faculty to rediscover their creativity to explore how they can reimagine, transform, and innovate within their specialty areas. “I want to unleash the technology and let our faculty have at it,” Schnall said. 

From pilot projects to large-scale organizational change  

Both Merchant and Schnall have experience building and implementing successful pilot projects within Penn Medicine. While that model has allowed for rapid innovation, it has not always been an integrated approach across the health system, Merchant said. And as a result, many technological systems remain fragmented, duplicative, or inefficient. 

“Often there are five or six different ways of doing something,” Merchant said. “Where can we be more efficient by thinking about programs that connect across the system, as opposed to having 20 different pilots in different settings?” 

That aim—scaling with efficiency—is exactly what Mahoney has tasked Merchant and Schnall to do in their complementary areas. This involves unifying the fragmented health system into a single, strong system of operations and culture, commonly described with the shorthand term “One Penn Medicine.”  

Schnall said he and Merchant speak every day in service of that goal. “Leadership is not about writing papers and showing how smart we are,” he said. “It’s about our organization showing how we can take care of patients better as an entire system.” 

It’s also an important reminder that Penn Medicine fosters the upward mobility of talent, encouraging employees to grow their careers within the health system, said Cindy Morgan, Penn Medicine’s vice president for learning and organizational development. “As the organization evolves, opportunities can be made available to people who have been great employees, faculty, staff here at Penn Medicine,” she said. “They know the best of Penn and can keep pushing from within to make great change.” 

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This article is part of a collection that will be published in the spring 2025 issue of Penn Medicine magazine. See related articles including: