Leveraging natural language processing software to implement and execute abdominal aortic aneurysm surveillance

Long-term follow-up is essential for patients with abdominal aortic aneurysms (AAAs). Our health system implemented an AAA surveillance program in 2021. We sought to evaluate the program's nearly 5-year outcomes and identify the benefits and challenges in maintaining a large-scale AAA surveillance program.

A commercially available AAA-specific natural language processing algorithm (Illuminate) was applied to all electronic medical record imaging reports at a large, academic, tertiary hospital (January 1, 2010 to June 2, 2021) to identify AAAs. Beginning on June 3, 2021, imaging reports were reviewed prospectively. A nurse-navigator team utilized Society for Vascular Surgery surveillance guidelines to then interface with patient/providers to establish/re-establish care with the goal of increasing guideline adherence. The outcomes evaluated included yield of surveillance as measured by imaging, new clinic visits, AAA repairs, and the direct contribution margin among new or re-established patients.

During the study period (January 2021-November 2025), 7,516,363 imaging reports were processed. Optimization of workflows and efficiency resulted in a reorganization from a single nurse-navigator (1.0 full-time equivalent) to a nurse-navigator team (total 0.7 full-time equivalent). After filtering for studies that included the abdominal aorta, 16,923 patients were identified. Of these, 12,952 cases (76.5%) were closed; the most common reasons for closing a case were surveillance not indicated (n = 1211), no AAA (n = 4423), or patient deceased (n = 2587), In our population of patients evaluated, 2856 patients (16.9%) with AAAs were being appropriately followed. An additional 492 patients (2.9%) were newly identified; 333 (67.6%) were never followed, and 155 (32.3%) were lost to follow-up. The program yielded 1008 new imaging studies (438 computed tomography, 43.5%; 519 ultrasound, 51.5%; 51 other, 5.1%), 1080 new clinic visits, and 47 AAA repairs, resulting in a direct contribution margin of $3,330,928. In August 2024, this program was expanded to imaging performed at a newly acquired hospital; the first 15 months yielded 22 patients, 51 clinic visits, 45 imaging studies, and 5 AAA repairs, resulting in a direct contribution margin of $321,397.

The AAA surveillance program established aneurysm care for over 500 patients, improved system-wide monitoring for AAAs, and generated significant clinical activity and financial contribution margins, highlighting the program's value to patients and the health system. This demonstrates the potential to leverage technology to improve long-term patient care. Adjustments to the team structure ensured the program's sustainability and scalability, as evidenced by successful expansion to a newly acquired hospital.