Insights from Imran Qureshi, Chief AI and Technology Officer
Health AI has hit a critical wall.
While large language models (LLMs) can answer simple health questions, they struggle with the complexity that defines real-world healthcare. Health Skills are the solution.
The Problem: When Generic AI Becomes Dangerous
Consider a patient with rheumatoid arthritis, taking Humira (an immunosuppressive biologic), with a documented egg allergy who asks: “Do I need a flu vaccine?”
A typical AI might respond: “It’s been over a year since your last flu vaccine, so yes, you need one. Schedule an appointment at your local pharmacy.”
Technically correct for a healthy person—but potentially dangerous for this patient.
What this patient actually needs:
“I’ve reviewed your medical records and identified several critical safety considerations:
✓ Allergies reviewed: Egg allergy documented
✓ Medications reviewed: Humira (adalimumab) – immunosuppressive biologic
✓ Conditions reviewed: Rheumatoid arthritis on immunosuppressive therapy
You need a flu vaccine—it’s especially important given your increased infection risk while on Humira. However:
- You CANNOT receive the nasal spray vaccine (live vaccine contraindicated with Humira)
- You SHOULD receive an egg-free flu vaccine (Flublok or Flucelvax)
- Timing matters: ideally mid-cycle between Humira injections
I strongly recommend discussing with your rheumatologist:
- Optimal timing relative to your next Humira dose
- Which egg-free vaccine formulation is best
- Whether you should temporarily hold Humira around vaccination
Would you like me to schedule a consultation and provide talking points?”
This is the difference between dangerous AI and trustworthy AI.
Academic Knowledge vs. Practical & Organizational Knowledge
Learning the driver’s education handbook doesn’t make you a driver. Healthcare works the same way. Medical textbooks help you ace exams, but they don’t fully prepare you to manage health in the real world.
Today’s LLMs excel at academic knowledge—they’ve been trained on vast medical libraries. But they falter where it matters most: in the practical realities of healthcare and the organizational nuances of healthcare delivery.
Real-world healthcare requires three types of knowledge working together:
1. Academic Knowledge
The foundational medical science: pharmacology, pathophysiology, clinical guidelines. This is what LLMs do well—knowing that immunocompromised patients shouldn’t receive live vaccines, understanding drug interactions, citing CDC guidelines.
Academic knowledge tells you what’s true for a hypothetical patient.
2. Practical Knowledge
Clinicians develop this through years of hands-on experience. In our example, practical knowledge means knowing that:
- TNF inhibitors like Humira cause enough immunosuppression to contraindicate live vaccines—not just theoretically, but enough to make them potentially dangerous
- Egg allergies matter for flu vaccines because most formulations are egg-based, but egg-free alternatives (Flublok, Flucelvax) exist
- Timing vaccination between biologic doses can optimize immune response—giving the vaccine mid-cycle when drug levels are lower
- Patients on immunosuppressive therapy have increased infection risk, making vaccines even more critical despite the complexity
This practical knowledge isn’t always explicit in textbooks—it’s learned through clinical experience and years of patient care.
Practical knowledge tells you what’s true for this particular patient.
3. Organizational Knowledge
Understanding how medicine is practiced within a specific health system transforms clinical recommendations into actual patient care:
- Referral protocols: Should this patient see their PCP, an infectious disease specialist, or both?
- Resource allocation: Which pharmacies carry latex-free vaccine formulations?
- Insurance and authorization: Which vaccines require prior authorization?
- Formulary preferences: Does your health system prefer certain vaccine brands?
- Care team structure: Who coordinates between primary care and specialists?
These protocols vary dramatically across organizations, yet this organizational knowledge is essential to delivering coordinated, efficient care.
Organizational knowledge tells you how to get things done in this particular health system.
The Three-Dimensional View of Patient Care
Academic knowledge alone: “Patients need a flu vaccine once a year.”
+ Practical knowledge: “This patient with rheumatoid arthritis on Humira has immunosuppression. They need an egg-free, inactivated vaccine (not live), and timing should be optimized mid-cycle between Humira doses for best immune response.”
+ Organizational knowledge: “In our health system, this patient should see Dr. Martinez in Rheumatology (available Tuesdays/Thursdays). Egg-free Flublok is available at our Main Street and Riverside pharmacies. Our protocol recommends coordinating with the rheumatologist before vaccination to discuss whether to temporarily hold Humira.”
This is the complete picture—and this is what Health Skills deliver.
What Are Health Skills?
Health Skills aren’t just prompts. They are specialized health knowledge combined with structured workflows, written in plain English, that teach our AI assistant bailey how to navigate specific health needs with the precision of a clinician and the safety of evidence-based protocols.
The Anatomy of a Health Skill
Every skill is built on four foundational pillars:
1. Deep, Specialized Knowledge
CDC schedules, clinical guidelines, drug interaction databases, contraindication rules, and your organization’s unique protocols—all integrated into a single knowledge base.
2. Structured Workflows
The exact steps to follow, the specific questions to ask, and the mandatory order of operations that ensure consistency and safety. For vaccines, this means:
- Retrieve patient’s complete allergy list
- Review all active medications for immunosuppressive effects
- Check problem list for immunocompromising conditions
- Review immunization history and CDC schedules
- Cross-reference all contraindications
- Determine appropriate vaccine type and formulation
- Identify which specialist should be consulted
3. Safety Guardrails
Mandatory checkpoints that bailey cannot skip. The AI cannot recommend a vaccine without first reviewing allergies. It cannot suggest a live vaccine without checking for immunosuppression. These guardrails ensure patient safety is never compromised.
4. Living Intelligence
Skills aren’t static—they’re adaptive systems that:
- Automatically update when the CDC updates vaccine schedules or the FDA approves new contraindications
- Access real-time patient data from your medical record (current medications, allergies, immunization history, lab values)
- Deliver recommendations that are always current, always personalized, and always based on your complete health picture
Why Plain Language Is a Breakthrough
The most transformative aspect of Health Skills is that they require no coding.
Historically, translating clinical guidelines into digital tools required a frustrating “game of telephone” between medical directors and software engineers. By the time code was deployed, guidelines might have already changed.
With bailey, clinical experts write skills directly in plain language. If the CDC updates vaccine schedules or your organization changes protocols, a clinical lead can update the logic themselves—no developer required.
This creates a system that is:
- Transparent and Auditable: You can see exactly what logic bailey follows—no black box
- Fast to Deploy: Updates happen in hours, not months
- Clinically Owned: The teams responsible for care quality finally own the technology
Built on Open Standards: Agent Skills
Health Skills are built on Agent Skills (https://agentskills.io/), an open standard for defining AI agent capabilities.
Why this matters:
- Transparency: You can see exactly how Skills are structured
- Portability: Your Skills aren’t locked into our platform
- Clinical Control: Clinicians can read, write, and audit Skills without technical expertise
- Industry Alignment: Contributing to an ecosystem where healthcare AI is transparent and clinician-controlled—not vendor-controlled
This is the difference between owning your clinical intelligence and renting it from a vendor.
Building the Library of the Future
Our vision includes an expansive Skill Library with two categories:
b.well Core Skills
Universal, evidence-based skills maintained by our experts covering needs common across all healthcare settings:
- Medication interactions and contraindications
- Preventive care gaps and screening recommendations
- Vaccine eligibility and safety protocols
- Chronic disease management guidelines
- Emergency symptom triage
These automatically update when authoritative sources like the CDC or FDA publish new guidelines.
Customer Custom Skills
Your organizational intelligence—both clinical and operational:
Clinical Customization:
- Your formulary and preferred medication protocols
- Your organization’s clinical pathways for specific conditions
- Your specialist preferences and consultation criteria
Operational Customization:
- Your referral networks and specialist protocols
- Your insurance authorization requirements
- Your scheduling workflows and access protocols
Example: While Core Skills know immunocompromised patients need special vaccine considerations, your Custom Skills know that in your health system, these patients see Dr. Johnson in Infectious Disease on Tuesdays/Thursdays, your formulary prefers Flublok for latex-allergic patients, and your protocol requires a CD4 count within 30 days.
Health Skills in Action
Patient Profile: Rheumatoid arthritis, taking Humira, egg allergy
Question: “Do I need a flu vaccine?”
| With Health Skills | Without Health Skills |
| Reviews complete medical history including allergies, medications, and diagnoses | Provides generic guidance based on time since last vaccine |
| Identifies critical safety issues: Humira contraindicate live vaccines; egg allergy requires egg-free formulation | Suggests standard flu shot at any pharmacy |
| Provides specific vaccine type: inactivated vaccine only; recommends egg-free options (Flublok or Flucelvax) | Generic recommendation without distinguishing types or addressing egg allergy |
| Flags egg allergy to ensure egg-free vaccine formulation | Misses allergy consideration that could cause severe allergic reaction |
| Recommends rheumatologist consultation for optimal timing with Humira dosing schedule | Suggests any provider or pharmacy without considering complexity |
| Generates talking points about timing relative to Humira dose, egg-free vaccine options, whether to hold medication | Ends conversation after basic recommendation |
| Offers care coordination: schedule rheumatologist appointment, send talking points, identify pharmacies with egg-free vaccines | No follow-up or coordination support |
| Shows transparent safety review of what was checked and why | Black box response with no visibility |
The Bottom Line
We don’t need AI that just knows textbooks—we need AI that knows each patient and each healthcare setting.
By moving clinical logic out of code and into plain English “Skills,” we’re creating health AI that:
- Clinicians can trust because they can see, audit, and control the logic
- Health systems can control because your clinical leaders write and own the Skills
- Patients can rely on because safety protocols are mandatory and defined by your clinicians
- Organizations can customize because updates don’t require developers
- Healthcare can scale because expert knowledge becomes accessible 24/7
The power isn’t in the AI—it’s in who controls it.
Health Skills for bailey represent a fundamental shift: from AI that mimics conversation to AI that embodies your clinical expertise. From black-box responses to transparent, auditable decision-making that you define. From one-size-fits-all answers to personalized, safety-vetted guidance based on your protocols.
This is how we build AI that healthcare deserves—AI that clinicians control, patients trust, and organizations own.
