Case studies / Monarch Health
Case study · Internal medicine
Every patient walks in with their story already on screen.
Every night, medscrub syncs Monarch Health's eClinicalWorks charts and works through them with four skills the practice wrote itself. The day is read before anyone's in the building.
Monarch HealtheClinicalWorksSandpoint, IdahoRAN LAST NIGHT
Marv Murchins
68y · MRN-MARV-0001
3 open plans · A1c 8.2% (07/10/2026)
Kee Beverly
2 open plans · A1c 6.2%
Marv Murchins Follow-up
↗ Push to eCWLAST 3 MD VISITS
07/10/2026 provider, Monarch Health
T2DM — metformin 1000mg BID; A1c 8.2% (07/10), up from 7.8% (04/02)
HTN — lisinopril 20mg daily; BP 148/92 in office
HLD — atorvastatin 40mg qHS; LDL 138 (07/10); eGFR 58 — CKD 3a
OPEN PLANS · 3 OF 5 PLANS UNRESOLVED
Type 2 diabetes — suboptimal control
PLAN Recheck A1c in 3 months; discuss SGLT2i if above goal · 04/02/2026
07/10/2026 A1c 8.2% — above goal, no follow-up scheduled
~2 hrs
saved per clinic day
4 skills
written by the practice, in production
3 plans
open plans caught per patient, avg
5:00 AM
every chart prepped before
Open plans
Did the plan actually happen?
Every visit ends with a plan: recheck the A1c in three months, start a home blood-pressure log, get the shoulder imaged. Then the next patient is roomed, and nobody looks back at that plan until the patient returns. If they return. Monarch's follow-up skill reads each chart the night before and answers four plain questions: what was the last primary complaint, what plan did the clinician and patient agree on, was it followed, and what happened. A plan that never happened shows up as an open plan, flagged before the patient is in the room.
A copy of the record, outside the EMR.
The nightly sync leaves Monarch with their own FHIR copy of the practice's records, on their own machine. Skills, chat and briefings all run against that copy — any AI tool can, not just the ones their EMR vendor decides to sell them. The chart stays in eClinicalWorks; the leverage doesn't.
Custom skills
Four skills, written in the practice's own words.
A skill is a page of plain-English instructions the AI follows for every chart. Monarch wrote theirs the way you'd brief a new hire: what to include, what to skip, how the note should read. They run every night against the synced charts.
Follow Up Visit Summary
Runs for every scheduled patient. Last 3 MD visits, problem-based summary, lab trends with source dates — and the open-plan check on every prior plan.
150 charts / night
New Patient History
Any new patient who hits the clinic gets a full historical build: active conditions grouped with their meds and monitoring data, plus health maintenance gaps.
Runs on arrival
Wound Care Visit Note
Compares the last two wound visits: measurements, tissue composition, procedures performed, treatment plan — documented findings only, never inferred.
10 charts / night
Sick Visit Prep
When a patient books an acute visit, the relevant history is pulled and digested so the MD walks in current — not scrolling.
On schedule change
Writing one takes a paragraph, not a project.
The skill builder takes a plain description — written the way you'd explain it to a colleague — and sets up the data, prompt, output and guardrails itself. Monarch's wound care skill started as a few sentences about what their RN wanted in the note.
✦ Just describe what you want
Write it the way you'd explain it to a colleague. No settings required.
Compare the last two wound visits and summarize progression — measurements, tissue, drainage, procedures performed. Documented findings only; if it isn't in the chart, say so.
✓ Here's what this skill will do
✓ Read the relevant information from each patient's chart, de-identified before any AI sees it
✓ Use the AI to produce a written summary
✓ Show you the result to copy or share by hand
⛨ Nothing is sent or written to a chart until you review and approve it.
WOUND CARE VISIT NOTE · MARV MURCHINS
Clinical Progression
L plantar forefoot DFU: 2.1 x 1.4 x 0.3 cm (07/17) → 1.6 x 1.1 x 0.2 cm (07/31). Granulation increased ~60→80%; slough decreased. Scant serous drainage, no odor. Periwound intact, no maceration. Offloading adherence documented both visits.
Status Assessment
Improving — decreasing depth, increasing epithelialization.
Procedures Performed
Conservative sharp debridement (07/17); callus reduction (07/31).
Wound Treatment
Cleansing, collagen contact layer, foam secondary; offloading boot continued.
NEW PATIENT HISTORY · MARV MURCHINS
Active Conditions and Clinical Management (Historical)
T2DM — metformin 1000mg BID. A1c 8.2% (07/10/2026), 7.8% (04/02/2026). HTN — lisinopril 20mg daily. HLD + CKD 3a — atorvastatin 40mg qHS; LDL 138, eGFR 58 (07/10/2026).
Health Maintenance and Prevention
Diabetic eye exam not documented in records reviewed. Pneumococcal due per age + DM. CRC screening current (2023 colonoscopy, outside record).
Ad-hoc chat
Ask the chart anything. The chart never leaves.
Some questions don't fit a skill. The doctor can pull up any patient and just ask — how should we plan the next visit, what changed since March, am I missing anything on this med list. The answer comes from the record itself, pulled straight from the EMR, and he can put the question to whichever LLM he prefers. Names, dates and record numbers are swapped for tokens on the office computer first, so the model — Anthropic, OpenAI, Google, or one running locally — never learns who Marv is.
Marv's name never leaves the computer.
How should we plan for the patient's next visit?
Next Visit Planning
Suboptimal control across all three cardiometabolic conditions, plus early CKD (Stage 3a):
1. Medication intensification — add SGLT2i (renal protection given eGFR 58) or GLP-1 RA (BMI 31.4); suboptimal A1c on metformin monotherapy.
“The open plans are the part we can't give up. It remembers the plans we made and tells us whether they actually happened.”
Monarch Health · Sandpoint, ID
Walk in tomorrow with every chart already prepped.
Set up is self-service: sign up, download the app, follow the connectivity guide for your EMR, connect the LLM you prefer, and run your first sync — the insights start with it. eCW syncs nightly; Epic, Cerner and athenahealth refresh sub-hourly.
Works with your EMR
