HWI is designed to help close care gaps, empower people in their health journeys, and help care teams learn how to improve care.
Why follow-through matters
34.8%Documented completed appointment
65.2%No documented completed appointment
In one large health system, nearly two in three specialty referral scheduling attempts had no documented completed appointment.
103,737 scheduling attempts · Patel et al., 2018
Single-system study using 2015–2016 records. Undocumented care may still have occurred.
Patel MP, Schettini P, O’Leary CP, Bosworth HB, Anderson JB, Shah KP. Closing the Referral Loop: an Analysis of Primary Care Referrals to Specialists in a Large Health System. Journal of General Internal Medicine. 2018;33(5):715–721.
Referrals from 24 primary care sites to 20 high-volume specialties, July 2015 to June 2016. This describes one health system. It is not a national rate, a current benchmark or an HWI result.
HWI’s approach
HWI connects each person’s health information, choices and care updates across participating organizations.
Pending steps stay visible to the responsible team.
HWI is built as neutral continuity and learning infrastructure. A consistent identity connects a person’s journey across participating organizations, each update retains its source, time and status, and access and use follow agreed permissions. Existing systems stay in place.
The aim is continuity as people move between care teams and organizations. This approach is designed to support a learning health system: connecting people’s experiences with care, using what happens to inform action, and evaluating whether changes improve care.
HWI aims to connect real-world health information with people’s choices, care and progress over time—supporting the generation of real-world evidence to inform action and evaluate improvements in care.
Meet Jordan · A fictional example
Watch Jordan’s choices and what HWI records.
Demo · About 85 secondsWhat HWI records
What this means
Journey overview complete
Jordan’s choices stay connected with care updates over time.
At HLTH · Screening
Your results
Your clinician will go through them with you next.
Recorded by HWI
At HLTH · Clinical review
Clinical review
Top next steps
Recorded by HWI
At HLTH · Jordan chooses
Your plan
Saved to your plan
Up next
Recorded by HWI
Day 7 · Check-in
Messages
Recorded by HWI
Day 7 · Help reaches the right team
Help
Your request has been sent to care navigation.
Recorded by HWI
Day 30 · Progress check
Day 30 check-in
Anything blocking your plan?
Check-in saved
Recorded by HWI
Later · Practice update
Your dental practice has added your evaluation record.
A practice update, not a reply from Jordan.
Recorded by HWI
Event Gum evaluation completed
Source Dental practice record
Earlier update Jordan reported completion at Day 30
Day 90 · Repeat screening
Repeat saliva test · Synthetic example
Most notable
Change since baseline does not show what caused it.
Recorded by HWI
Where Jordan’s record stands
History
Recorded by HWI
What was found. What Jordan chose. What happened next.
Event Gum evaluation completed
Source Dental practice record
Earlier update Jordan reported completion at Day 30
More of Jordan’s portal
What changed? · Synthetic example
At HLTH → Day 90
Classified by Oral Genome. Review changes with your dentist or doctor.
My preferences
Change these anytime. Saving a preference is not a care event.
Help
Requested, routed and resolved are recorded as separate steps. Having a serious medical problem? Call 911.
Learn more
Not medical advice. Ask your clinician about your own results.
Reading an article is not recorded as care.
Across a population
Patterns across connected journeys can show where people need support and where care processes may need to change.
Tap any measure to update the chart.
Learning from follow-through
If scheduling is where journeys stall, a team can change its follow-up process and measure what happens next.
Use what happens to improve the next step—and evaluate whether the change helps.
Research & evidence
Published work identifies gaps in follow-up care and the infrastructure needed to connect care, action and continuous learning.
These sources explain the rationale for HWI. They do not evaluate HWI’s effectiveness.
Published finding: In 44 primary care practices (11,980 patients with overdue abnormal cancer screening results), EHR reminders, patient outreach and navigation raised adjusted completion of recommended follow-up within 120 days to 31.4%, versus 22.9% with usual care. An external study, not an HWI result.
Relevance to HWI (HWI’s interpretation): HWI’s intended role is to make unresolved steps visible and preserve responsibility and follow-up status, so participating teams can act and evaluate results.
Atlas SJ, Tosteson ANA, Wright A, et al. A multilevel primary care intervention to improve follow-up of overdue abnormal cancer screening test results: a cluster randomized clinical trial (opens in a new tab). JAMA. 2023;330(14):1348–1358. doi:10.1001/jama.2023.18755.
External cancer-screening study, not an HWI or Oral Genome result, forecast or target. The adjusted absolute difference was 8.5 percentage points (95% CI, 4.8–12.0). Reminders alone reached 22.7%; reminders plus outreach reached 31.0%. The trial supports the studied multicomponent interventions; it does not isolate the effect of tracking software or show that navigation added benefit beyond outreach.
Read publication (opens in a new tab) · Full text (PubMed Central) (opens in a new tab)
Published finding: Mapping cross-institutional specialty referrals, the study identifies work-system barriers that delay or prevent closing the referral loop.
Relevance to HWI (HWI’s interpretation): HWI is designed to preserve source, timing, status and responsibility as permitted updates move between participating organizations.
McCormack C, Savoy A, Mathew A, et al. Characterizing barriers to closing cross-institutional referral loops: workflow and information flow analysis (opens in a new tab). Appl Ergon. 2024;115:104177. doi:10.1016/j.apergo.2023.104177.
An empirical workflow analysis. It identifies problems and design requirements; it does not evaluate an HWI intervention or show that interoperability alone resolves them.
Authors’ argument: Interoperability is necessary but not sufficient; the authors call for a more intentional digital and data architecture, with changes in governance, incentives and implementation.
Relevance to HWI (HWI’s interpretation): HWI is designed to connect permitted information with identity, pathway status, timing, source and subsequent care across participating organizations.
Abernethy A, Afsar N, Anderson B, et al. Toward a National Health Digital and Data Architecture: Laying the Foundation for Digital Transformation (opens in a new tab). NAM Perspectives. Discussion Paper. National Academy of Medicine; 2026. doi:10.31478/202603b.
A discussion paper, not a clinical intervention trial or an assessment of HWI. The views are those of the authors and not necessarily of their organizations or the National Academy of Medicine; it is not an institutional endorsement.
Framework contribution: Learning health system infrastructure is described as interconnected services—people, technology, processes and policies—that support many improvement cycles at once.
Relevance to HWI (HWI’s interpretation): HWI’s intended contribution is reusable continuity and measurement infrastructure that can support multiple pathways, rather than a separate measurement system for every program.
Friedman CP, Lomotan EA, Richardson JE, Ridgeway JL. Socio-technical infrastructure for a learning health system (opens in a new tab). Learn Health Syst. 2024;8(1):e10405. doi:10.1002/lrh2.10405.
A conceptual account of learning health system infrastructure. HWI does not claim to supply every service or organizational capability the framework describes.
Read publication (opens in a new tab) · PubMed record (opens in a new tab)
Authors’ argument: The editorial proposes a “learning utility”: a data foundation, feedback and monitoring machinery, and an enabling environment of governance, trust and alignment.
Relevance to HWI (HWI’s interpretation): HWI is designed to connect recommendations, personal decisions, subsequent care and observations over time, so participating teams can evaluate process changes.
Bian J, Afshar M, Scifres CM, et al. The bottleneck was never data or algorithms: building a learning utility for AI-enabled learning health systems (opens in a new tab). npj Health Syst. 2026;3:43. doi:10.1038/s44401-026-00107-x.
An editorial proposing a broader institutional model. HWI aims to contribute to that model; it does not claim to constitute the entire learning utility. The DOI resolves to the publisher’s current version, which carries a modification notice.
Market assessment: The report identifies infrastructure for sharing information, tracking referrals and follow-up, accountability and measurement as an opportunity in medical–dental integration.
Relevance to HWI (HWI’s interpretation): This aligns with HWI’s initial focus on connecting oral-systemic pathways and measuring what happens after screening and recommendations.
CareQuest Innovation Partners. Beneath the Surface: 2026 Innovation in Oral Health. Oral Health Innovation Market Map Report (opens in a new tab). CareQuest Innovation Partners; 2026:6, 10–11.
Market analysis, not peer-reviewed clinical evidence or an endorsement of HWI. Its assessment of this area (printed pages 6 and 10–11) rates market need as Strong; clinical and economic value, infrastructure readiness, and capital and strategic activity as Emerging; and customer demand as Thin. Recognized need is not demonstrated purchasing demand—HWI must establish repeatable paid adoption and measurable value.
Takeaway: Connects learning health system cycles with an AI lifecycle and five continuous assurance dimensions—performance consistency, safety, fairness, transparency and security.
Relevance to HWI (HWI’s interpretation): Informs the requirements for any future HWI models and their oversight.
Limit: A conceptual model without empirical validation in a clinical setting. It does not establish that HWI has validated predictive models or implements the HALO framework.
Takeaway: The review included 49 studies; most reported results favoring the integration strategy, across a range of measures such as referral pathways and documentation.
Relevance to HWI (HWI’s interpretation): Supports evaluating oral-health integration and the processes needed to make it work.
Limit: Heterogeneity prevented meta-analysis. Many strategies involved training or policy change rather than software. It does not establish one best model or validate HWI. · PubMed record (opens in a new tab)
Takeaway: Among 15,076 trial participants, patient reports of cardiovascular events captured through an online portal showed low-to-moderate sensitivity and chance-corrected agreement with electronic health data.
Relevance to HWI (HWI’s interpretation): Supports keeping patient-reported progress distinct from events documented by another source.
Limit: Neither source is universally complete or correct. The findings concern cardiovascular events in one trial and should not be generalized to all patient reports or care events. · PubMed record (opens in a new tab)
Together, these sources describe why connected information alone is insufficient. Improvement also requires clear responsibilities, action on unresolved steps, and evaluation of what changes.
HWI is designed as continuity and measurement infrastructure around identity, pathway status, time and source. The intended role is to help participating care teams identify unresolved steps, evaluate process changes and measure what happens afterward.
HWI remains in active development. Its clinical and economic effects must be established through appropriately designed deployments and evaluation.
A person’s health journey continues—even when their care changes.
The whole-health vision · Illustrative · Additional connections proposed
Health signalCare response
See health information alongside decisions, care updates and what still needs attention.
Across many journeys, patterns can reveal where support or care processes need to improve.
Neutral analysis. Governed use of data.
One person’s journeyIllustrative group
Neutral analysis. Governed use of data.
Data gains meaning through context. Intelligence helps people act.
HWI is built to connect permitted health information and care events across participating organizations, preserving their source, time, and status.
The aim is a more complete view of the individual journey and a foundation for investigating patterns across populations. Population analysis depends on appropriate permissions, agreed data use and governance for each participating organization.
Over time, this evidence could support models that identify who may need additional follow-up. Predictive capabilities remain a development direction, not a validated capability.
Your organization
Choose your organization to explore where HWI could fit.
Dental groups & DSOs
Connect patient choices, scheduling and practice-documented care to identify unresolved next steps and evaluate follow-through across participating practices.
Where do patients need help moving forward?
Health systems & IDNs
Connect permitted updates across participating medical, dental and external care teams, preserving what was recommended, what happened and what remains unresolved.
Which transitions leave teams without an answer?
Clinics & FQHCs
Connect patient choices, requests for support and care updates so participating teams can identify pending steps and evaluate where access and follow-up processes need to improve.
Who needs support reaching the next step?
Payers
Connect permitted pathway information with patient choices and documented care to investigate gaps and evaluate program performance alongside other available evidence.
Where could a program change make a measurable difference?
Public & national health systems
Explore how governed information across participating services and regions could reveal gaps in access and follow-through, inform service improvement and support evaluation.
Where are people losing continuity between services?
Academic & research teams
Preserve the source, timing and status of longitudinal updates to support appropriately governed studies of feasibility, follow-through and process improvement.
What can these journeys help you investigate?
Biopharma
Explore appropriately governed longitudinal information about care progression and follow-through to inform research questions and evidence generation.
Which evidence gaps require a clearer view over time?
Technology & wellness partners
For diagnostics, wellness products, wearables and care software, explore how HWI could connect permitted signals with people’s choices, subsequent care and progress over time.
What happens after someone receives your result, insight or recommendation?
Potential applications. Scope, permissions, measures and responsibilities are agreed with each participating organization.
See how to get started ↓Start with one care pathway. Help people move forward, see what happens, and evaluate what improves.
Opens an email to Neil
Or meet us at HLTH 2026 · Booth 2860 · November 15–18. Preview the HLTH experience
The company
We’re building neutral infrastructure that connects people’s choices with care—and turns what happens next into intelligence for better health.
Diagnostic partner
Oral Genome supplies the screening signal. HWI’s role is to connect subsequent choices and care updates, measure follow-through, and support learning across the journey. The two companies signed a services and software licensing agreement in October 2026 for longitudinal program measurement and analytics.
Founder and CEO, Health & Wellness Intelligence, Inc.
Strategic Advisor, Oral Genome.
Neil brings a foundation in neuroscience and experience spanning digital platform engineering, diagnostic imaging, strategic advisory and healthcare partnerships. He connects clinical insight with technology and execution to make care journeys measurable and build a fuller picture of health over time.
“We cannot improve care if we cannot see what happened next.”Neil on LinkedIn