Elsevier helps ASL Bari boost clinician confidence in decisions to 84%
Executive summary
One of Italy's largest health authorities introduced ClinicalKey AI, and its clinicians report finding answers faster and feeling better able to care for their patients.
"A case that before could require a week of work, now could require three days, including writing our report." That is how one physician in the quality and safety department at ASL Bari describes the change since the health authority introduced ClinicalKey AI.
ASL Bari (Azienda Sanitaria Locale di Bari) is one of Italy's largest health authorities. It serves more than 1.2 million residents in the Province of Bari, in the southern region of Puglia, through a network of hospitals and community services, with around 5,000 clinicians, including doctors, nurses and pharmacists.
84%
of clinicians report medium to high confidence in their clinical decisions, a 25% increase on other solutions
86%
of clinicians could find diagnostic information within 10 minutes, a 16% improvement on other solutions
78%
of clinicians rated their ability to deliver patient care as medium high, a 35% increase on other solutions
The Challenge
ASL Bari faces the same pressures as health systems everywhere: more patients, more complex cases and not enough staff. On top of that, medical research moves quickly, and keeping up with it is hard when every hour is already spoken for.
Dr Vincenzo Defilippis, who was Head of the Safety and Quality Department at the time of the study and is now retired, describes what that meant day to day: "Managing the growing number of patients, many with complex cases, was becoming very difficult. With limited time and resources, finding reliable information often meant searching across multiple sources, which slowed down our work and added stress. This made it harder to maintain the quality of care we wanted to provide."
Some patients bring extra complexity, such as language barriers. Clinicians needed information that was accurate, up to date and quick to reach, in a tool that would fit into their working day rather than slow it down. They were also keen to use AI, as long as it was used responsibly.
The Solution
ASL Bari partnered with Elsevier to introduce ClinicalKey AI, a clinical decision support tool. Clinicians type a medical question in everyday language and get an answer drawn from trusted, evidence-based medical content.
The rollout began with a pilot, followed by onboarding campaigns and in-person training. Use was voluntary, so clinicians could adopt the tool at their own pace, and usage grew steadily over time. Senior leaders helped shape the policies that guided safe use, linking the tool to ASL Bari's existing quality and safety processes. During the evaluation period, more than 300 physicians used ClinicalKey AI, asking it more than 10,000 clinical questions across a range of specialties.
Clinicians describe it as support for their judgement, not a substitute for it. "Has my way of managing the patient changed? No, but it definitely makes me feel sure and more confident [...] because I have access to a source of education. It kind of supports me," says a neurologist.
The Impact
To measure the effect, ASL Bari and Elsevier interviewed 20 physicians and surveyed 51 clinicians, who rated their experience with the other tools they had used and then with ClinicalKey AI.
The biggest shift was in confidence. 84% of clinicians reported medium to high confidence in their clinical decisions with ClinicalKey AI, a 25% increase compared with other solutions. The share reporting low confidence fell from 41% to 16%.
An internal medicine physician explains why: "In some ways, it felt like having a guide. I could ask: 'I exclude this, I exclude that — what else should I consider?' It helped me reason through the case and feel more confident in my decisions."
Clinicians also felt better able to care for their patients. 78% rated their ability to deliver patient care as medium to high, a 35% increase compared with other solutions. The share rating themselves highly effective more than tripled, from 9% to 31%. Clinicians put these gains down to faster access to validated information and clearer guidance.
Time savings followed. 86% of clinicians could find diagnostic information within 10 minutes using ClinicalKey AI, a 16% improvement on other solutions, and nearly half (46%) got answers to their questions in under five minutes. In a health system where clinicians are seeing more patients than ever, that time can go back into patient care and planning.
Clinicians want to keep using it. 84% rated their likelihood of continuing as medium to high, and the share saying they were highly likely to continue rose from 34% to 56%. "Not a week goes by without me using it... and I think it will become increasingly necessary to work quickly," says ASL Bari's Director of Territorial Services.
What comes next
Dr Defilippis presented the findings at an international congress on AI and medicine in Rome in November 2025. ASL Bari's approach, built on voluntary use, in-person training, regular communication and senior leadership involvement in safe-use policies, offers a practical model for other health organisations introducing AI into clinical work.
For ASL Bari's clinicians, the priority remains the one Dr Defilippis described at the outset: maintaining the quality of care they want to provide, with reliable information close at hand.
A case that before could require a week of work, now could require three days, including writing our report