Identify
Patient Risk Identified
+4.2 lbs over 3 days. Prioritized for review.
High Priority
Cardiac Care Between Visits
Specialty Care Doesn’t Stop Between Visits
ISHI’s AI-powered specialty care platform enables multidisciplinary clinical teams to deliver continuous, personalized, guideline-directed care for heart failure and cardiometabolic patients between visits.
The ISHI Care Model
Continuous Cardiac Care Between Visits
Clinical expertise, structured pathways, and AI-enabled workflows keep care moving while the primary clinician remains informed.
Identify
Engage
Act
Coordinate
Align
Engage
Outreach Completed
Symptoms reviewed and follow-up initiated.
Completed
Act
Clinical Review
Medication and care-plan needs assessed.
In Review
Coordinate
Care Plan Moving
Monitoring and follow-up continue between visits.
Active
Align
Clinician Informed
The practice maintains visibility and control.
Visible
Cardiac Multidisciplinary TeamNurse navigators, pharmacists, and nurse practitioners support proactive patient management, symptom assessment, education, medication support, and care coordination.
Structured Care PathwaysEvidence-based workflows support consistent follow-up, timely intervention, medication optimization, and clinically appropriate escalation.
AI-Powered Care PlatformProprietary machine-learning models support heart failure population screening, while AI agents automate patient outreach, education, clinical summarization, and care-team workflows, and support clinical prioritization and triage with human oversight.
The Challenge
Cardiac Care Breaks Down Between Visits
The challenge is no longer simply knowing what care patients need. It is consistently executing that care between visits as populations grow, conditions become more complex, and clinical teams operate at capacity.
Access
46.3%of U.S. counties do not have a practicing cardiologistNeed
1 in 4people will develop heart failure during their lifetimeScale
133M+At least one cardiometabolic condition including Heart FailureThe Current Care Journey
Care Is Fragmented. Gaps Between Visits Create Risk.
Traditional cardiac care is organized around episodic visits, leaving limited visibility and capacity to identify and address patient needs between encounters.
Most solutions make care visible. Few ensure that care is delivered.
The ISHI Difference
How ISHI Delivers Care Between Visits
ISHI extends specialty care beyond the clinic through multidisciplinary clinicians, structured care pathways, and AI-enabled workflows that support proactive patient management between visits.
- 01Patient Enrolled in the virtual specialty care program
- 02Personalized Care Pathway
- 03Continuous Monitoring & Engagement
- 04Risk Identified & Care Escalated
- 05Care Optimized
- 06Fewer avoidable ED/Hospital visits
Why Clinical Partners Choose ISHI
Built for Clinical Impact, Scale, and Enterprise Confidence
ISHI combines measurable clinical outcomes, purpose-built AI, clinical infrastructure, and enterprise-ready operations to help clinicians deliver high-quality specialty care beyond the clinic.
Clinical Evidence
Published Clinical Outcomes
15.5%Improvement in beta-blocker utilization
14.9%28.4%SGLT2 inhibitor utilization
33.9%46.5%ARNI/ACEI/ARB utilization
99%Clinical alerts addressed within 48 hours
81%Alerts managed by the multidisciplinary team
Care Delivery
Clinical Care Infrastructure
- CardioCommand care delivery platform
- Multidisciplinary clinical care team
- Structured care pathways
- Implanted and external cardiac device integration
AI-Enabled Workflows
Purpose-Built AI Agents for Cardiac Care
- Clinical prioritization support
- Clinical summarization
- Care-team workflow automation
- AI voice agents for patient outreach, education, structured information collection, and care-team follow-up
Enterprise Trust
Enterprise-Ready Operations
SOC 2 Security ProgramIndependently audited security and operational controls built for health-system and enterprise partners.
HIPAA-Aligned Care DeliveryClinical workflows and patient support designed around healthcare privacy requirements.
EHR-Integrated WorkflowsVendor-agnostic integration with major EHR systems for seamless clinical data exchange and reporting.
Mayo Clinic Platform CollaborationML models developed for HF screening and risk prediction.
Technology-Enabled Care
The Technology Behind Continuous Cardiac Care
ISHI combines clinical expertise, structured pathways, and Clinical AI to help care teams manage larger populations, prioritize and automate work, coordinate interventions, and maintain visibility between visits.
Post-Discharge Heart Failure Care
Extend Heart Failure Care Beyond Discharge
Structured post-discharge care helps patients transition home with proactive follow-up, symptom and physiologic monitoring, medication support, education, and timely escalation to the clinical team.
Program capabilities
- Early post-discharge outreach and follow-up
- Symptom, weight, blood pressure, and physiologic monitoring
- Medication reconciliation and guideline-directed medication optimization
- Care coordination and clinically appropriate escalation
Patient AHeart failure
Care team- Check-in call completedNurse navigator
- Symptom review loggedNo escalation
- Education sent to patientDelivered
Virtual Heart Failure & Cardiometabolic Care
Expand Access to Specialty Care
Virtual specialty care programs extend heart failure and cardiometabolic expertise to patients who may have limited access to specialty services, including rural and underserved communities.
Program capabilities
- Virtual multidisciplinary specialty care
- Heart failure and cardiometabolic care pathways
- Initiate and optimize guideline-directed medical therapies
- Patient education
- Longitudinal monitoring and care coordination
Population viewHeart failure and cardiometabolic
Screening- Higher-risk cohort surfacedPrioritized
- Care gaps grouped by pathwayQueued
- Panel ordered for outreachAssigned
Cardiac Device Monitoring
Turn Device Data Into Continuous Heart Failure Care
Powered by CardioCommand, ISHI’s AI-enabled care platform integrates cardiac and connected-device data into structured clinical workflows, helping care teams maintain visibility between visits, prioritize patients for review, and coordinate timely follow-up.
Program capabilities
- Connected weight and blood pressure monitoring
- Pulmonary artery pressure sensor monitoring
- Heart failure monitoring using data from implantable cardiac devices
- AI-enabled longitudinal trend analysis and patient prioritization
- AI agents supporting patient outreach, data collection, and care-team workflows
- Structured clinical review, escalation, and follow-up
Patient DImplanted and external devices
Monitoring- Daily reading receivedRecorded
- Weight trend outside rangeAlert raised
- Care team notifiedActioned
Testimonials
What People Are Saying About ISHI
Resource Center
Evidence, Education, and Insights
Explore the published outcomes, practical guidance, and perspectives shaping the future of cardiac care between visits.
Featured Case Study
Executing Heart Failure Care Between Visits
ISHI demonstrated that structured, multidisciplinary care can improve guideline-directed medical therapy, manage high volumes of clinical alerts, and extend care without adding workload to community cardiologists.
15.5%Improvement in beta-blocker utilization
99%Clinical alerts addressed within 48 hours
81%Alerts managed by the multidisciplinary team
747Heart failure patients supported
2,013Clinical alerts managed
0Escalations to cardiologists after protocol application
ASM Resource Center
Prepare for the CMS Ambulatory Specialty Model
Foundational education, FAQs, and practical guidance for cardiology practices preparing for ASM.
Explore ASM Resources →Insights
Perspectives on Specialty Care
Clinical execution, care delivery, capacity, and the future of cardiovascular care.
Explore Insights →Extend Cardiac Care Beyond the Visit
Learn how ISHI helps cardiology practices execute care more consistently, expand clinical capacity, and improve patient outcomes between visits.
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