How MUSC’s Digital Initiatives Are Reducing No-Show Rates and Boosting Patient Satisfaction

In the heart of South Carolina, a healthcare transformation is underway that challenges preconceptions about innovation in the American South. The Medical University of South Carolina (MUSC University), celebrating its 200-year anniversary, has emerged as a surprising leader in health tech adoption. Under the guidance of Crystal Broj, CPDHTS, Chief Digital Transformation Officer, MUSC has implemented a series of digital health solutions that are significantly reducing no-show rates, enhancing patient satisfaction, and improving clinical workflows.

A Tech Leader in the South

MUSC University has positioned itself at the forefront of healthcare innovation and eHealth solutions. As the only comprehensive academic health center in South Carolina, MUSC serves 2.4 million patients annually across 16 hospitals, 2,700 beds, and 750 locations in all 46 counties of the state. It’s also one of only two telehealth national centers of excellence in the country, showcasing its commitment to AI in healthcare and cutting-edge health technology solutions.

The Digital Transformation Office, led by Broj, is relatively new – just over two years old. What started as a one-person team has grown to ten members, including a fellow and three interns. “We’re definitely into teaching innovation to the younger generations who are coming up through digital health and getting them involved early,” Broj explained during a recent interview with the American Journal of Health Care Strategy.

Broj’s background in computer science has proven invaluable in her current role. “Having that IT background lets me bridge the gap,” she notes. “My sweet spot is taking business problems and finding technical solutions.” This perspective has allowed her to bring fresh approaches to healthcare challenges, supported by strong leadership backing from the organization. MUSC’s innovative work is often showcased at leading industry events like the HIMSS conference and VIVE Health conference.

Digital Check-In: Farewell to the Clipboard

One of MUSC’s most successful initiatives involves robotic process automation (RPA) for patient check-ins through a partnership with Notable platform. This workflow automation system reaches out to patients before appointments, allowing them to confirm or cancel, while collecting demographic information digitally instead of using the traditional clipboard at the front desk. This digital front door approach has revolutionized patient engagement.

“We started with a very small project,” Broj explains. “We wanted to outreach to our patients when they have an appointment and say, ‘Hey Cole, you have an appointment in three days. Would you like to confirm it or cancel it?'”

The process began as a pilot in just five locations before expanding throughout the organization. The team continuously refined the system based on direct patient feedback, achieving a remarkable 98% patient satisfaction rate. Improvements included consolidating check-ins when patients have multiple appointments in one week and adding Spanish language capability.

The results have been impressive:

• No-show rates decreased by nearly 4%
• Pre-visit check-in rates increased by almost 67%
• Copay collections at time of service rose by approximately 20%
• Front desk staff saved 3-5 minutes per patient, totaling about 500 hours monthly across the system

This time savings allows front desk personnel to focus more on patient interaction rather than paperwork. “That lets Sally actually be able to look up and go, ‘Hello, Cole, how are you today?’ Or be able to, when you get out of the office, schedule a referral or your next appointment,” Broj says.

“Emily” the Voice Bot: Reimagining Phone Systems

Moving beyond the frustration of traditional phone menus, MUSC introduced “Emily,” a natural language processing voice AI for their patient access center. Unlike conventional systems that require callers to navigate through numbered options, Emily engages in conversational AI interactions.

“When you call, her name is Emily, you call and it says, ‘Hi, I’m Emily. I’m your digital assistant. How can I help you?'” Broj explains. “It says, ‘Well, I’d like to check on my appointment.’ ‘Sure. No problem.'”

After gathering necessary identifiers to access electronic health record (EHR) records, Emily can provide appointment information and help patients confirm, cancel, or reschedule. The team started small with just a few phone lines before expanding, and they’re currently teaching Emily to handle more complex interactions like appointment rescheduling and Spanish language requests.

Ambient Scribing: Giving Doctors Their Focus Back

Perhaps the most transformative technology for provider experience has been the implementation of ambient scribing technology through Nuance Communications DAX. This artificial intelligence-powered solution records doctor-patient conversations and automatically generates clinical documentation, showcasing one of the most promising AI solutions in healthcare.

“No provider ever went to school to become a doctor, a nurse, or whatever and said, ‘I can’t wait to type into the EHR,'” Broj points out. “They wanted to help people.”

The technology allows clinicians to maintain eye contact and focus on patients rather than typing into Epic during visits. After a year-long pilot that started with just a few providers, MUSC found that patients actually embraced the technology. More importantly, providers using the system effectively experienced:

• 33% less time outside scheduled hours completing charts
• 25% reduction in “pajama time” (nights and weekends spent on documentation)
• 35% drop in chart lag, improving revenue cycle operations

While not ideal for all providers—particularly those highly proficient with Epic‘s smart phrases or those with established human scribes—the ambient scribes technology has proven valuable enough that MUSC is now rolling it out system-wide to all interested providers.

Automating Prior Authorizations: From Hours to Minutes

Building on their RPA success, MUSC has expanded intelligent automation to tackle prior authorizations. Previously, staff would need to manually enter information from Epic into payer portals, wait for authorization codes, and then enter them back into Epic—a process taking 15-30 minutes per authorization.

With automation, this has been reduced to approximately one minute. Currently, about 40% of authorizations flow through the system without human intervention, allowing staff to focus on managing denials and exceptions rather than routine data entry. The result is faster patient care—patients can get their MRIs and other services much more quickly without waiting for administrative processes.

Implementation Challenges: Building Trust and Managing Change

MUSC’s digital transformation journey hasn’t been without challenges. One significant hurdle was change management, particularly with front desk staff. “We found that they, that our front desk people were telling people not to use the software,” Broj admits. This resistance, combined with high turnover rates, required developing comprehensive training programs and continuous reinforcement to improve AI literacy and facilitate AI integration.

Getting physician buy-in for new technologies like ambient scribing required understanding provider concerns about looking incompetent with new systems. “Nobody wants to go in, no matter what system it is, you don’t want to go in in front of other people and not look smart,” Broj explains. “I mean, they went to school for 12 years, for Pete’s sakes.”

Her strategy involved:

1. Ensuring immediate technical support was available
2. Clearly explaining the benefits in terms of time savings and work-life balance
3. Leveraging physician champions who were early technology adopters
4. Building relationships and trust over time

Another significant challenge has been reconciling IT’s traditional waterfall project management approach with innovation’s more agile methodology. While IT teams typically work with precise timelines for Epic updates, innovation projects often require frequent pivots as new technologies are refined. “It’s sort of the gift that keeps on giving—smaller, like, ‘I need an API guy for like two hours this week and then to validate for an hour next week,'” Broj explains.

Looking Forward: Building on Success

With these initial successes, MUSC continues to expand its AI initiatives and health technology solutions. Current projects include:

• Developing a chatbot for the website that mirrors Emily’s phone capabilities
• Working on referral automation to replace fax-based processes
• Expanding ambient scribing to all interested providers
• Further enhancing prior authorization automation

The organization is also developing an innovation district that aims to become a tech hub combining technology and healthcare. “Our innovation district that’s coming that you’ll keep hearing more and more about at MUSC, we’re really building out to be a tech hub to do really cool things with combining technology and healthcare,” Broj shared. This initiative explores cutting-edge concepts like generative AI in healthcare, LLMs, and AI agents to further enhance patient care and operational efficiency.

The Human Element Remains Central

Despite all the technological innovation, Broj emphasizes that the goal isn’t to replace human interaction but to enhance it. The time saved through automation allows staff to focus more on patient needs rather than administrative tasks. Front desk personnel can engage more meaningfully with patients, providers can concentrate on clinical conversations rather than documentation, and the entire care process moves more quickly.

As Broj puts it, “I think at the end of the day, the relationship game is one of the biggest pieces that you can have—being trustworthy and showing that trust and earning the trust of people.”