Skip to content
unmatrixai

Patient and clinical workflow agents

AI agents for healthcare: patient and clinical workflows

AI agents for healthcare take on the administrative work around care, such as prior authorisation, referral management, documentation and patient follow-up, while clinicians keep every clinical decision. Unmatrix AI builds them inside your HIPAA programme, with PHI detected and redacted before any hosted model call, or with the whole system running on-prem.

Last updated

Workflows

What do we build for healthcare?

The workflows we usually start with, and the architecture each one is built on.

  • Prior authorisation

    Match requests to payer criteria, pull supporting notes from the EHR, and draft the determination for a nurse reviewer.

    Built as

    LangGraph workflow agents

  • Referral management

    Extract referral details from faxes and portals, check network and coverage, and schedule or route.

    Built as

    LangGraph workflow agents

  • Clinical documentation support

    Draft visit summaries and coding suggestions from the encounter for the clinician to edit and sign.

    Built as

    Autonomous agents (ReAct)

  • Patient communications

    Answer scheduling, preparation and billing questions from approved content, escalating anything clinical to a person.

    Built as

    RAG agents

Constraints

What shapes the build?

HIPAA and business associate agreements
Business associate agreements with any hosted model provider, or on-prem models. The minimum-necessary rule applies to every prompt.
Clinical safety
Agents never make clinical decisions. Every clinical output is a draft for a licensed person to review and sign.
EHR integration
FHIR and HL7 interfaces or vendor APIs, with access scoped per role and per workflow.
Audit
Every access to protected health information is logged and reviewable.

Worked example

A typical build: prior authorisation for imaging

A utilisation management team reviews thousands of imaging requests a month. Nurses spend most of each review assembling notes that already exist in the EHR.

  1. 01

    Request

    A prior authorisation request arrives from a referring clinic.

  2. 02

    Match

    The agent identifies the payer policy and the criteria that must be met.

  3. 03

    Gather

    It pulls the relevant weeks of conservative-therapy notes and coverage status from the EHR and plan systems.

  4. 04

    Draft

    It drafts the determination with each criterion marked met or not, and the evidence linked.

  5. 05

    Review

    A nurse reviewer confirms or changes the determination. Anything ambiguous is routed to a physician reviewer.

  6. 06

    Notify

    The determination is recorded and the clinic notified.

Nurse reviewers confirm instead of assemble. Turnaround falls from days to hours, and every determination carries its evidence.

Integration

Which systems do we work with?

  • Epic
  • Oracle Health
  • MEDITECH
  • athenahealth
  • Availity
  • Salesforce Health Cloud
  • Microsoft 365

Anything with an API or a file interface can be integrated. These are the systems we meet most often in healthcare.

Questions

What healthcare teams ask

Is it HIPAA compliant?

We build inside your HIPAA programme: business associate agreements, PHI redaction, encryption, audit logs, or a fully on-prem deployment. Your compliance officer signs off the design.

Will the agent give medical advice?

No. Clinical content is drafted for a licensed clinician, or patient-facing answers are restricted to approved content with escalation to a person.

Can it connect to Epic?

Yes, through FHIR APIs and the vendor's integration programmes, with access scoped to the workflow.

Can everything run on-prem?

Yes. Parsing, retrieval and open-source models can all run inside your network.

Related

Next step

Pick one workflow. We will be at your office in two weeks.

A thirty-minute call to find the right first workflow, followed by a written scoping note. No deck, no pilot.

Book a call