FROM THE Operating Room TO THE Board Room

If you have ever used the virtual assistant to reschedule an appointment in Duke Health’s electronic MyChart System, you can thank the handiwork of Neil Ray, MD, MBA, MMCi, assistant professor of anesthesiology. The feature is just one example of Ray’s work to streamline health care operations to save providers and patients time and money, and offer patients seamless, high-quality care.

As an emerging leader at Duke, Ray has led the development of numerous AI-driven technology initiatives. Most recently, he has been the architect behind the FAST (Finance, Analytics, Strategy Tool) platform that helps health care providers visualize and apply financial and operational analytics to strategy, expansion, and hiring practices.

Ray’s business development work began with the first technology project that he led for Duke Anesthesiology - development of the electronic chatbot, “Blue,” which enhances website navigation for users by providing quick access to commonly sought-after information.

Developed a year before the COVID-19 pandemic but enhanced during the recruitment freeze the following year, the “Blue” AI chatbot addressed a critical need: maintaining engagement with residency candidates when in-person interviews were no longer possible. The bot provided 24/7 access to program details, faculty profiles, and interview logistics, replicating the depth of on-site visits. Prospective students were also able to use the “Blue” bot to register for virtual open houses.

In turn, faculty could be matched with internal and external trainees interested in mentorship, and for various other housekeeping activities such as submitting receipts, accessing the continuing medical education (CME) portal, and renewing medical licenses.

“The ‘Blue’ chatbot was born out of necessity during the pandemic, when traditional recruitment pipelines froze overnight. We needed a way to differentiate ourselves and maintain meaningful connections with residency candidates—without in-person interviews,” says Ray.

The success of the “Blue” bot ultimately helped Ray introduce conversational AI into the Duke University Health System for the first time, and it is now being used in multiple patient-facing modalities including patient call centers, the chatbot in MyChart, and the chatbot on Duke Health web pages.

In 2021, Ray was named chief innovation and technology officer for Duke Health Integrated Practice (DHIP) and associate vice chair for business development for the Department of Anesthesiology.

“Neil has been an incredible leader for us as a busy practicing physician who has developed an extraordinary sense of technology, automation, and user experience,” says Simon Curtis, chief operating officer of DHIP. “He has used those two things to uniquely define key complex problems in the health system and then to develop really useful practical solutions through a combination of build, buy, and partner with IT teams. He can communicate with ease with both groups and help translate in a way that benefits our physicians and patients through better care.”

Moving the needle on efficiency

Growing up in Missouri, Ray always had an ‘engineer brain,’ with a passion for making everyday operations run more smoothly and successfully. One of his favorite outings in elementary school was a trip to Radio Shack to get equipment to tinker with at home, where he would make solar-powered toy cars or fans.

Ray went on to major in biomedical engineering at the University of Michigan, and from there, attended the University of Chicago Pritzker School of Medicine, where he gravitated to anesthesiology. A summer research project in medical school opened his eyes to the business side of health care and the importance of efficiency in a medical setting.

Working with mentor David Glick, MD, MBA, Ray analyzed surgery cancellation trends and found that patients were about five-and-a-half times more likely to have a day-of surgery cancellation if they cancelled an outpatient appointment the year leading up to surgery. Furthermore, patients were also almost one-and-a-half times more likely to have a day-of surgery cancellation if they visited the emergency room. “I dove into the economics and business side of health care through that project,” says Ray.

After completing residency training in anesthesiology at the University of California San Francisco, Ray began a fellowship at Stanford University where he became involved with an informatics platform called Collaborative Health Outcomes Information Registry, or CHOIR. The platform helps clinicians assess and group patients into subsets based on clinical data.

Ray says the platform gave him an understanding of how health care providers can use clinical informatics to identify and monitor trends so they can target interventions and optimize outcomes. For example, finding a link between high-pain catastrophizing patients and increased emergency room visits could help clinicians identify specific patients for targeted interventions and prevent unnecessary visits.

In 2015, Ray joined Duke Anesthesiology, where he cares for patients who are undergoing surgeries such as knee or hip replacements or who need help managing acute and chronic pain. His experiences in the clinic, along with his earlier taste of business and informatics during his medical training, convinced him to pursue additional educational training.

In 2017, Ray received a Master of Management in Clinical Informatics from Duke. In 2020, he completed the Massachusetts Institute of Technology’s Executive Program in Machine Learning: Implementation in Business program, and in 2022, he received a Master of Business Administration (MBA) from North Carolina State University.

“I realized I wanted to learn more about the business side of health care so that I could stitch the whole picture together,” says Ray. “Working directly with patients shows you where the real gaps are — in access, communication, efficiency, reimbursement, etc. Technology isn’t the goal; it’s a tool. My focus is on identifying real problems and building solutions that actually make the system work better for everyone.”

Looking at the whole picture

Finding ways to streamline the “business” side of health care is no small task. Duke University’s Health System, for example, facilitated more than 71,000 inpatient stays and close to 5 million outpatient visits in fiscal year 2024. Ray’s unique background in medicine, business, and informatics has positioned him well to understand gaps in health system operations and pose solutions.

His first largescale project for the health system was partnering with Duke’s Digital Strategy Office to incorporate conversational AI into the patient call center, resulting in approximately 250,000 calls per year becoming automated. This significantly brought down the cost per call and saved $1.5 million over the course of 2024.

Next, Ray led the introduction of an AI platform that allows nearly 100 percent of patient calls that come in through Duke’s call center to be monitored and analyzed. Previously, only about three percent of recorded calls were monitored manually by members of the Human Quality Improvement Team.

“The platform measures how our call center agents are interacting with our patients,” he explains. “This helps us identify agents that could use some coaching but also celebrate agents that are doing a fantastic job and can be shown as lead examples to peers.”

For another project, Ray led the development of a live chat feature on Duke Health’s website, making Duke one of the first health systems in the nation to offer such a feature. The technology was piloted in 2023 and is in the process of being implemented throughout the Duke University Health System. Another system wide technology adoption Ray helped introduce and lead was the transition from a legacy patient feedback vendor to a more real-time feedback system. After a patient leaves a clinic, a patient feedback survey is immediately distributed, says Ray, as opposed to the antiquated process of distributing paper surveys weeks after the fact.

“Technology should solve real problems — not create new ones.”

Dr. Neil Ray integrates artificial intelligence into frontline operations.

“We wanted to meet patients where they are,” adds Ray. “This new approach helps us gain more insights from our patients about the quality of their experience in a real-time manner, helping us to address any gaps or challenges more quickly.”

Ray’s most recent project, a visualization tool known as FAST (Finance, Analytics, Strategy Tool), integrates financial, billing, operational, and quality data to optimize strategic planning. Health system leaders can analyze challenges and opportunities and develop data-driven strategies.

“Putting all of these different data sets together helps us answer questions like ‘What types of surgeons do I need to hire?’” says Ray.

Analytics that pay off

Since its inception, FAST has already helped Duke identify and address critical issues across the health system. For example, when analyzing anesthesia revenue integrity, FAST helped identify missing CRNA billing from Medicare and Medicaid, saving a total of $280,000 per year for anesthesia services.

When planning for a hospital expansion in Cary, North Carolina, Duke leaders used FAST to model case volumes, staffing needs, and revenue projects to ensure alignment with service-line growth. FAST also improved perioperative efficiency when it was used to unify hospital and professional billing data, identifying around $400,000 per year in missing gastrointestinal charge capture and $200,000 per year in urology device coding gaps.

“I’ve enjoyed working with Neil and have appreciated his ability to blend together operational, financial, and market data to better inform leaders and help them to make the right decisions for the organization,” says Gregory Pauly, MHA, group president for the Duke University Health System.

On top of that, a component of FAST focusing on inpatient documentation and coding identified approximately $30 million per year in opportunity, helping lead to the creation of a Duke Clinical Documentation Integrity Committee to assist with retrieving the large opportunity. FAST’s linkage with ICU learning health systems better revealed the exact cost implications of central line-associated bloodstream infection incidents, bridging clinical and financial accountability.

This widely applicable tool is used by a range of health system staff, including Wendy Webster, MA, MBA, FACHE, system vice president for perioperative services, who says she has used FAST on multiple occasions for many critical use cases.

“Dr. Ray has created a platform that has been integral to our strategic development and streamlining operations as Duke grows its surgical footprint,” says Webster.

In June 2025, Dr. Ray helped Duke and the technology company LeanTaas agree on commercialization terms for three licenses created as part of the FAST platform. The collaboration will create a revenue stream for both Duke and the Department of Anesthesiology.

Commercialization

“We didn’t set out to build a commercial product. We set out to solve real problems — and did it so well the market came to us.”

“These tools were built for Duke, but their impact shouldn’t stop here. Commercialization ensures broader reach—and reinvestment into our next wave of innovation,” says Ray.

Outside of work, Ray’s efficiency skills have also proven useful in his personal life. He and his wife have four children and enjoy traveling. He also enjoys the hobby of home automation.

His vision for the future entails Duke evolving into a “more nimble, data-driven organization, capable of efficiently dismantling silos as necessary for both large and small scale decisions.” BP