Success story—PowerScribe Follow-up Manager improves quality and timeliness of care

Better outcomes with effective follow‑up and greater care consistency

Saint Joseph Mercy Health System creates program to promote lung cancer screening and manage patient follow‑up for lung nodules with PowerScribe Follow‑up Manager.

More effective follow‑up

Learn how PowerScribe Follow‑up Manager helps Saint Joseph Mercy Health System catch cancer at an earlier stage, resulting in better patient outcomes.


  • Only 36% of incidental lung nodules were adequately followed up.
  • Similar follow‑up baseline for other incidental findings.
  • Limited budget with tight operating margins.
  • Inconsistent follow‑up recommendations from providers.


  • PowerScribe Follow‑up Manager
  • PowerScribe Clinical Guidance


  • Doubled follow‑up recommendation identification and tracking.
  • On target to achieve full ROI in first year of 5‑year contract based solely on additional radiology revenue.
  • Decreased variability of follow‑up recommendations.


Saint Joseph Mercy Health System (St. Joe’s) is a not‑for‑profit system in southeast Michigan dedicated to offering care to everyone in the community—regardless of their ability to pay. The organization comprises five hospitals licensed for 1,548 beds and outpatient health centers, urgent care facilities, and specialty centers. St. Joe’s provides critical healthcare services and programs for chronic disease management and prevention, as well as outreach to the elderly, poor, and uninsured.

Collectively, these technologies offer us the insight and power to improve both the quality and timeliness of care.

—Alonzo Lewis, President

Saint Joseph Mercy Ann Arbor and Livingston Hospitals 

A case for early intervention

Lung cancer is the leading cause of cancer death in the U.S., with a 17% five‑year survival rate—largely because mortality is closely related to the initial stage of diagnosis, and only 15% are diagnosed early.

In some cases, an incidental lung nodule can be found during a routine CT. Unfortunately, St. Joe’s found that only 36% of patients with incidental lung nodules recommended for follow‑up ever returned for further evaluation. “We need to ensure these types of opportunities are not squandered,” said Ruth Raleigh, RN, Clinical Quality Project Specialist, Radiology. “Once we identify a potential malignancy, it’s imperative that patients receive appropriate follow‑up care.”

Lung program offers the foundation for better follow‑up care

For 2020, the American Cancer Society estimates that over 8,140 new lung cancer cases will be diagnosed in the state of Michigan alone, with another 5,220 patients dying from the disease. 

Understanding the importance of early intervention, Saint Joseph Mercy Health System created a specific program that promotes screening and manages follow‑up care for lung nodules.

Focusing on follow‑up

With Nuance PowerScribe in place, St. Joe’s was familiar with Nuance AI technology and its ability to integrate with their EHR and clinical workflows. To support the new lung nodule program, the team added Nuance PowerScribe Follow‑up Manager. “It was a logical next step for us,” said Alonzo Lewis, President, Saint Joseph Mercy Ann Arbor and Livingston Hospitals.

Automatic alerts help eliminate the communication gap between patients and physicians with reminders sent at set intervals, and every response is tracked. Since 2014, St. Joe’s has identified approximately 500 patients per month to receive follow‑up care, and now achieves over 98% closure rates, regardless of facility size.

This has allowed us to be more proactive—doubling our follow‑up recommendation identification and tracking so we can follow each patient through the process to closure.

—Alonzo Lewis, CEO

Saint Joseph Mercy Health System

Promoting care consistency

In addition to follow‑up concerns, St. Joe’s discovered differences in what their radiologists would recommend in terms of additional testing and time frames for patients with similar presentations.

To promote greater consistency and ensure follow‑up recommendations align with those of the American College of Radiology, the team activated the clinical guidance component of PowerScribe. These capabilities provide automated, in‑workflow, evidence‑based decision support in real‑time. “Collectively, these technologies offer us the insight and power to improve both the quality and timeliness of care,” said Lewis.

While radiology exams offer powerful diagnostic capabilities, the information comes with an inherent responsibility. Failure to properly track follow‑up compliance is more than just a missed opportunity; it can result in delayed care and leave providers vulnerable to malpractice.

The issues associated with failed follow‑up were not unique to lung patients. In fact, the team found failed follow‑up rates of 38%, 41%, and 48% for non‑lung cases coming from the emergency department, in‑patient, and outpatient care, respectively. Based on the success of their lung program, St. Joe’s was awarded a grant to help expand their follow‑up management program. Today, approximately 850,000 reports are run through the tracking software every year, and any finding that is noted as worrisome or urgent and requires follow‑up, is included.

St. Joe’s expects to achieve a full return on their investment in just the first year of a five‑year contract, based solely on the additional revenue generated from follow‑up radiology services. “Our business model is to invest everything we have in our community and in our ability to serve our patients,” said Lewis. “Not only is it more cost‑effective to treat cancer at an earlier stage cancer—it’s also exponentially more effective.”


follow‑up closure rate across facilities, regardless of size

Discover how proper follow‑up can lead to an earlier diagnosis, a better prognosis, and more treatment options.