- Before
- Searches the library, the label and the literature, pastes paragraphs into the template and checks every claim by hand. “I don't need a faster writer. I need to see where every sentence came from.”
- Now
- Opens a composed letter with a source on every paragraph and the passage one click away, decides the checker's findings and signs.
One question, from the inbox to a signed letter
Martin Kessler, PharmD, a clinical pharmacist in nephrology at Harbor Point Regional Hospital in Baltimore, emails Northwind Bio Medical Information about a heart-failure patient on Corventa who starts haemodialysis on Monday. Here is what happens next, screen by screen, in the working solution.
- 01Oct 7 · 09:52
Two questions in one email — one on the label, one off it
Inquiry readerThe patient is 68, on Corventa 10 mg once daily, with an eGFR of 22. The inquiry reader splits his email into two parts: severe renal impairment and dialysis, which the label speaks to, and a 5 mg dose given after dialysis, which it does not. No single standard response covers both, so it routes a custom letter. The request check verifies Dr. Kessler in the HCP directory and records that the question came from him directly — unsolicited, so an off-label section may be written.
Route: “Custom letter — no standard response covers every part.”
- 02One click
“Replay the agents” — the letter assembles in view
The agentsPriya Raman watches each agent light up in turn. The evidence finder draws four sources: the Corventa Prescribing Information, standard response SRD-COR-011 v3 Use in Renal Impairment, Varga 2024, a single-dose pharmacokinetic study, and Okonkwo 2025, a case series in patients on maintenance haemodialysis. The letter writer composes in the US custom letter v7 template, one section per part of the question.
“Every paragraph carries its source · click one to read the passage.”
- 03Paragraph by paragraph
Every paragraph tagged; one click shows the passage
Priya Raman · Medical information specialistSection 1 is tagged PI §8.6 and §12.3 and SRD-COR-011 v3: no dose adjustment down to eGFR 30, not studied below 30 or on dialysis, and Northwind Bio has no clinical trial data in dialysis. Priya clicks paragraph 4 and the Varga 2024 results open beside it, highlighted: exposure 1.3 times higher with eGFR below 30, and less than 5% of the dose removed by a 4-hour session.
- 04Section 2 · off-label
Evidence only — and one sentence struck
Off-label guardSection 2 opens with the approved dose — 10 mg once daily, or 2.5 mg with a strong CYP3A4 inhibitor — and says plainly that a 5 mg dose and timing around dialysis are not in the approved labeling. Then the evidence, its limits and the hypotension warning. The writer had carried over a sentence from a draft of letter MI-23977: “Clinicians may consider reducing the dose to 5 mg once daily, given after the dialysis session.” The guard struck it.
“Advises an unapproved dose and has no published source. An off-label section may state the evidence; it may not recommend.”
- 05Route to sign
She signs with the meaning of her signature
Priya Raman · Medical information specialistThe checks are on one line: 8 of 8 sentences cited, the off-label section built from scientific evidence, 1 sentence removed by the guard, 3 references attached. The signing route shows Priya first, then Omar Haddad, MD for the off-label section, then secure email to Dr. Kessler with the case closed and archived. She signs with her password.
Meaning: “I reviewed this response and approve it as accurate, balanced and specific to the question asked.”
- 06Second signature
The medical reviewer checks the off-label section
Omar Haddad, MD · Medical reviewerBecause the letter contains off-label information, it waits for Omar's second signature. His screen lists what he is attesting to: specific to the question asked, the disclosure, the balance, 3 references with the label enclosed, and kept apart from promotion — sent privately to the requester only. Priya's first signature, Oct 7 at 10:24, is shown beside it.
- 07Sent · 10:47
Sent the same morning, with the label enclosed
Send and fileThe letter goes to Dr. Kessler by secure email with its 3 references and the Prescribing Information. The case closes and the letter, its sources, the decisions and both signatures are archived. The library keeper counts 4 dialysis dosing questions this quarter and suggests an off-label standard response to Dr. Omar Haddad.
“Sent Oct 7 10:47 by secure email with 3 references and the Prescribing Information.”
- 08Another letter
A sentence from a retired standard response, caught
Citation checkerDr. Helena Marsh, a dermatologist in Portland, asked about Veltrimab in pregnancy planning, breastfeeding and dosing every 2 weeks. Her letter has 11 sentences and 1 to decide: “Northwind Bio suggests considering stopping Veltrimab 15 weeks before a planned conception.” It came from a letter that followed SRD-VLT-014 v4, retired on Jun 12, 2026; v5 removed it because the Prescribing Information sets no period for stopping before conception. The checker offers the current wording; Priya decides.
The citation checker never accepts its own finding — a person accepts or rejects each one.
- 09This quarter
The questions that keep coming back
Library keeperThree questions have had 4 or more custom letters in 90 days and no standard response: giving Corventa through a feeding tube (6), a washout when switching from another biologic (5) and Talmirex with untreated brain metastases (4). One click drafts a standard response from the signed letters and their sources, for its owner to approve.
Drafts only — owners approve.
- 10Last 30 days
The desk at a glance
Dana Okafor · MI managerDana sees 1,184 questions answered in 30 days and 236 custom letters, 20% of questions. Every one of the 2,124 sentences checked carries a source, and all 41 questions submitted by field teams were confirmed with the requester before drafting. A flow shows today's 48 questions from how they arrived — phone, web portal, email, field medical, chat — to how they were answered and where they are now.