Changing HCP Workflows: The Need for Real-World Support

Dr. John Whyte [00:00:10] Well welcome everyone. A lot of good conversation so far this morning. I’m John Whyte, I’m the chief medical officer at WebMD. I’ve been a physician for 25 years. When I say that out loud, it’s it seems a long time. I still see patients, and I point that out because over the past quarter of a century, I’ve seen a lot of technologies that help with clinical care, as well as some technologies that don’t help. And [00:00:43]we’re really at a time, and we’ve heard a little bit about it this morning, where physicians and health care practitioners really are mired in this administrative and bureaucratic burden, particularly of documentation. And at the same time, given the pandemic, we’re having patients come in now that previously weren’t seeing. So there is a higher acuity in terms of what we need to address. And then we have a higher patient load. And you combine that with the fact a recent survey showed that 41% of folks in that generation Z age range say they have some or a lot of trust in the health care system. And this is significantly down than where it was just a few years ago. So clearly, we need to reverse this trend and really talk about how do we empower health care practitioners to do their job, do provide quality care and get the information that they need in a timely manner? [69.9s] So it’s a tall order to do in 30 minutes, but I have the two experts that we need to guide this conversation. We’re going to start off with Doctor Tracy Norfleet, and each of them are going to introduce themselves rather than have me do it. So, Tracy.

Dr. Tracy Norfleet [00:02:13] Hello everyone. My name is Tracy Norfleet. I’m from Saint Louis. I’m an internal medicine physician. I’ve been practicing for over 20 years. I’m a certified obesity specialist as well, a health coach and speaker. I enjoy practicing medicine. I practice full time at this time. And I will turn to David.

Dr. John Whyte [00:02:37] And then we also have Doctor David Eagle.

Dr. David Eagle [00:02:40] Thank you. I’m David Eagle, I’m a medical oncologist. I practice with New York cancer and blood. We’re a group of of roughly 300 physicians throughout Long Island in New York City and starting to move up the Hudson Valley. I spent most of my career practicing in Charlotte, North Carolina. So, you know, I’ve seen how care can be very, very different between different locations in different communities. I see patients three days a week. I do legislative affairs and patient advocacy the other two days a week.

Dr. John Whyte [00:03:05] We were talking earlier before we came on about some of the presentations we’ve heard, and we’re particularly interested in hearing the conversations around stroke and patient’s interaction with the health care system and and hearing that perspective. But now I want to to to challenge my panelists to what are the two biggest challenges. And there’s a lot. But what are the two biggest ones, the two biggest obstacles to providing the quality care that you want to do during this patient journey? Tracy.

Dr. Tracy Norfleet [00:03:43] I would say the first biggest obstacle is time. [00:03:47]As a primary care physician, we do not have a lot of time to talk to our patients. Every appointment is 15 minutes, which gives me about seven minutes or less to have a discussion about every chronic condition and concern of the patient. So time is the hugest factor that most providers don’t have enough of. [20.3s] The second, I would say, would be just the opportunity to educate the patient, which goes back to time. [00:04:16]I don’t have enough time to talk about those side effects of medications are what what they should expect. I’m I find myself trying to, as they said earlier, check off the boxes. We practice value based care. There are a lot of metrics that have to be met according to the organization. They’re focusing on coding. So we we’re taking out the humanization of medicine. And we’re really just focusing on the computer. [29.4s] And so I would say time and just the, the difficulty of being a practitioner in general.

Dr. David Eagle [00:04:55] So I think for me, I think by far it’s it’s the fact that I think [00:04:59]doctors, nurses, health care providers and patients all live together in a broken health care system. And we’re on the front lines of that broken health care system. Most health care providers are kind of acclimated to those problems. And the patients may have no idea about these problems. If they’ve had prior exposure to the health care system, they kind of know what the problems can be. But for many of them, it’s just a complete shock. And, you know, this is the point of care conference. You know, so much of the authority for what happens to patients is now outside of my office. [29.9s] You know, it’s the insurance companies, it’s government regulations, it’s CMS rules. And, we’ve called this is the point of care conference. But those problems typically come up after the point of care. So a big part of what we do in our office is kind of chasing those those issues down after we’ve seen the patients. And days later when we find out that we can’t get that Pet scan done without getting on the phone with the insurance company physician, we can’t get that medicine because the pharmacy benefit manager tells us we need to get another medication. So chasing those problems down after the point of care is one of the most important things we try to do. A second challenge, and this is a good challenge, is just keeping up with all the information. In oncology, [00:06:09]40% of the new drugs, all the FDA approved new drugs, are in the oncology space. That’s wonderful. But that creates a problem. How do you keep up with that? How do you keep yourself educated to make sure when the patients come in that you really know which medications you’re going to use? What are the side effects? What are the potential drug interactions? How does it interact with their medical history and the solution to that? For me, most important thing is I’m always trying to chase down any piece of medical information that I can. [25.4s] But probably [00:06:35]the most important part of my clinic day starts the night before, where I spend an hour or two or more reviewing patients charts. Really kind of looking at the medical literature as it applies to them because really you can’t count on having that time during the day. It’s too fragmented, is too unpredictable. There’s too many things that come out of left field. So that’s before the point of care. [18.0s] So I think, you know, probably to highlight this is that, you know, the two biggest things is [00:06:58]you really have to take advantage of before the point of care to make sure you’re prepared. But a lot of the biggest problems come after the point of care. Because we don’t know sometimes when we’re talking to patients what the barriers and the problems are going to be. [11.7s] That’s typically brought to us later.

Dr. John Whyte [00:07:11] You know, the buzzword we’ve all heard over the past couple of years is patient-centricity. And what we loved about the title of this presentation is The Changing Patient Expectations. And the pandemic really has changed what we all think about in terms of what we need from that physician visit. So I’ll pose a question to all of you, a simple one. How many of you remember when you used to print everything up about a condition and then hand it to the doctor? Did anyone ever do that? Print everything up. You know, we talked about the fax machine. We still have the printer. And what would the doctor do? He or she would take it, put it to the side, and then kind of do whatever he or she was going to do to begin with. That’s not how it is today. Patients come much more informed, much more engaged, and it really changes that relationship. It’s really this idea that they search content. But then you want to connect that to care and you want to do that right away, whether it’s a virtual visit or an in-person visit. So I want to ask, Tracy and David, what do they need from the attendees here, those folks that are involved in point of care marketing, point of care development tools, pharma. What do you need from these folks that are going to help you meet changing patient expectations?

Dr. Tracy Norfleet [00:08:46] I would say [00:08:46]one of the first things that I would ask for is providing me with materials to be able to explain things to patients. Patients are very visual. [9.8s] So having information where if I’m talking about the heart, I can show them what that looks like.

Dr. John Whyte [00:09:03] How do you want these materials? Do you want them as print? Do you want them digital? Do you want them as a QR code? I thought QR codes died before the pandemic, but I feel like the the pandemic resurrected QR codes. So. So what do you think that people need? So how do you want it?

Dr. Tracy Norfleet [00:09:20] I want it in like a laptop, like a little iPad. That way I have the ability to manually change it the way that I like to because every patient does not want the same information. So [00:09:34]being able to tailor that to the patient would be very helpful. As I was sitting at the table, I think it would be very awesome if after I talk about that information, I could maybe put their email in and then shoot it off to them so that after I’m done, I know that they have the information there. [17.4s] But when we have that information, if I could have perhaps like checkboxes to be able to tailor it. I think the biggest thing is [00:10:00]different patients have different expectations and different questions. And they want to feel like they information is personalized. So the more that I can make that experience feel that way, the more my patient feels heard and the more they are satisfied with the visit. [15.2s]

Dr. John Whyte [00:10:17] In the field of oncology, cancer care is a different type of information that you need. What what what do you need in your practice David to help you meet the patient expectations?

Dr. David Eagle [00:10:28] It varies because the problems are so varied and people come at things from such different places in terms of what they want to hear, what they need. But I think [00:10:35]anatomic information can be very helpful because if you’re talking about lung cancer patients, you know it took us a while to learn anatomy in medical school, and you just wouldn’t expect people to know the anatomy of the lungs, or the pancreas if they have pancreatic cancer. [10.3s] So sometimes being able to just show simple anatomic information on a screen to a patient can kind of help orient them. That can help. [00:10:54]Drug information that’s usable can be very helpful. But a battle that we that is very frequent is you’ll talk to a patient about a drug. They’ll go home and they’ll read about the drug, meaning they’ll get this massive list of side effects. And they will never want to ever take this drug. And they’ll often quote a side effect that I’ve given the drug dozens of times for. I’ve never seen a patient with that side effects. So these  lists of side effects just often don’t come in a context of how common these side effects are. And and that can be a real, very big battle with psychology patients. [32.0s] You know, just the misunderstanding that that can come from because from these self-driven educational searches, which for some patients can be extremely helpful, but for others it can create barriers to care that we have to work through during the visits. So [00:11:40]I think printed materials on drugs can be helpful, but only if that truly explains, you know, side effects in a way that has some sort of context about how severe and likely they are. [9.6s]

Dr. John Whyte [00:11:50] And we talked beforehand about really [00:11:53]this renewed idea of the patient journey and point of care. It’s not just when the patient comes in to the health care providers office. It’s also kind of that previsit when they’re looking up information to come in. And then it’s also that post visit that they didn’t remember. [18.9s] As is often the case because our meetings are brief. We use a lot of words that they may not know or parlance that they’re not familiar with. What’s that post physician visit that they need? Is it greater collaboration, as we talked about earlier with pharmacists and other providers? Is it something that you need from marketers that a patient can take home to refer to later? Tracy, what are some of those things that you think about in terms of what you need from folks here as we revisit what that patient journey means, where it’s not just when they come into the office.

Dr. Tracy Norfleet [00:12:53] I think collaboration is essential. Because, again, we don’t have a lot of time. So being I think the important thing is that [00:13:02]after a patient is seen, they’re going to have questions. And how do we get those questions answered so that they can follow the treatment plan that we are giving them? [9.7s] I feel that one opportunity would be, patients want to feel like they’re being seen. They’re being heard. I think is great to communicate via computer, but people are human and they want to feel like they’re humanized. If you could provide something to my patient, [00:13:36]I would love for you to provide resources where they can call and ask a question, and someone to just answer the simple questions that they have. They’re not complex, but it’s usually based on something that Google said are something that they heard. And if they can get that question answered, then it’s more likely that that patient will be compliant with the the plan. [22.1s]

Dr. John Whyte [00:14:00] Does it have to be a real person answering. Can it be AI. Can it be other technologies?

Dr. Tracy Norfleet [00:14:06] It could possibly be AI, but I think the option should always be if they’re not completely understood, to be able to connect with the person. So in my office we have a pilot with AI, which allows us to respond to patients via the inbox and it’s great, I love it, but there are some areas where a robot can’t do what a human can do. And so I think we can start off that way, but then have the option to connect if that connection is needed.

Dr. John Whyte [00:14:38] David, what about for you? How in terms of when you look to folks in this room, what you need to address that whole patient journey?

Dr. David Eagle [00:14:48] You know, with psychology it’s just it’s so difficult. You know, one visit is just not enough. You know, for a patient that’s going to be starting on a treatment plan there’s just, you know, we it’s not our expectation that patients can just digest  all that that amount of information and come to terms of that with one visit and just kind of retain that information here. So we always plan more than that. And they’re also going to call home and talk to the families about it and then come back to the office. Some more questions. You know there will probably be a family member present for the second visit that wasn’t there for the first visit. You know, we try to do a lot of reinforcing. So, you know, we’ll have a nurse education session where before a patient starts chemotherapy, they’re going to come meet with me, but they’re also going to meet with our nurse education team. So it could be the nutritionist, the social worker, the nurse education person who’s going to sit down with them. So materials for that visit can really help. [00:15:34]Patient assistance is huge because again, I mentioned all the problems that come up can come up after the visit. So patients, you know, being able to fill those gaps with patient assistance is just absolutely fundamental because there’s just too many ways that that breaks down. And any education materials that you can give to our office staff and billing personnel about that would be incredibly helpful [19.5s] because every company has its own, has its own kind of programs embedded. And then other things we try to do and we’d be looking for help, too, is, in New York Cancer Blood, we, we take all insurance plans. We have a lot of clinics in underserved communities. So we’re trying to do more with structured health related social needs intake forms. Trying to find out proactively who has transportation issues, who has utility issues, who have food issues, connect them with our social work team better and then connect them with resources, either community resources or practice foundation resources, so we can get a better meet those patients. So any way people can kind of help us with those efforts. That would be very, very helpful.

Dr. John Whyte [00:16:32] Must resources be in multiple languages? Is Spanish enough? What? And then how do you provide the resources to folks?

Dr. Tracy Norfleet [00:16:42] Yes. So yes, the the answer to that is yes.

Dr. John Whyte [00:16:47] Which part?

Dr. Tracy Norfleet [00:16:49] The part about it being in different languages. So I do find that, being a difficulty for me, I like to make sure that my patients have education. I like to provide them with those materials. But I do find in the search in our electronic health record, it may offer some options in different languages, but the majority of the information is not. So when I have a patient who comes in with a translator, I’m always concerned about what information they’re going to get after the visit as far as the results of their labs or questions that they have. So that would be very helpful to have information in different languages but also printed in different languages. That’s the barrier that I see there.

Dr. John Whyte [00:17:36] So we’re talking about patient education. How do we better educate patients, family members. But [00:17:43]we also have to acknowledge our own education and, a startling statistic in a way, is that every 73 days there’s a doubling of medical information. And that’s been changing exponentially over the past ten years. So when it comes to our education about new technology, new drugs, new interventions, new preventive scoring challenges, how do you want to be informed for that? [28.4s] So folks here might, you know, have a new intervention they want to talk about. How do you want to find out about it. Do you want to find out about it as in a webinar. Do you want to have it as an email? Do you want them to come by and talk to you? What’s the most effective strategy in your practices?

Dr. Tracy Norfleet [00:18:31] I would say neither of those. No. No webinar. No email.

Dr. John Whyte [00:18:39] Yeah, I and why not? Why not?

Dr. Tracy Norfleet [00:18:42] Because the webinar can’t ask questions. I want to be able to have that back and forth conversation. Email. We’re bombarded with email. The inbox is full. We just don’t have time. And then in the office, no, because I don’t have time. So I do want to have time, though, to listen to you and be able to ask you the questions and get the answers that I need. So what would be best for me would be a schedule time, whether that’s a zoom meeting, something personal where we can have a conversation. But you don’t necessarily need to come into the office. What you could do is send me materials before the visit. Right? We can prepare for it. But then I’m in a mind space where I can actually listen and hear you, and then you can hear what my needs are so that we can better serve the patient.

Dr. John Whyte [00:19:30] Does that occur during the clinic day or outside the clinic day, either early in the morning or perhaps, you know, after the clinic is closed? What what’s your preference and what do you find your colleagues like?

Dr. Tracy Norfleet [00:19:42] I think I would prefer to either at the beginning of the day or at the end of the day. The the day in itself is never going to be predictable for a provider. Nothing ever goes completely right.

Dr. John Whyte [00:19:54] And then the beginning of the day is better.

Dr. Tracy Norfleet [00:19:56] Beginning. Beginning is better. But then at the same time, you have the pre-chart, right? So we have to prepare for the patient. So there’s not a great time at any time, but I just need enough time to be able to listen to, you know.

Dr. John Whyte [00:20:11] And specialty care is always changing in terms of new drugs. They’re primarily relating, you know, to specialty. How do you want to get new information about new treatments, new options? What format works best for you, David.

Dr. David Eagle [00:20:28] [00:20:28]I like getting information in multiple different formats. I find that complementary. [2.9s] So I have an iPad full of all my [00:20:34]journals [0.0s] that I download that I read when I travel or other times that that’s an important issue. I like I like [00:20:40]podcasts. [0.0s] I like educational oncology podcasts. I think that can be I like to sometimes use that format if hearing it is good. I like those [00:20:48]daily news feeds, you know, Asco post, you know, Asco Daily News. I think finding that information would be very helpful too. [6.5s]

Dr. John Whyte [00:20:55] Does it matter where it’s from like you mentioned. Yes it is. Is it does it have to be a specialty society.

Dr. David Eagle [00:21:03] No it doesn’t. A lot of ,I have to keep up with a fair amount of general medicine as well also, so it can come from it can really come from anywhere [00:21:09]as long as the material is digestible and reputable I think that’s fine. [3.6s] And I like to get it in different formats. But time is always the issue. But we have reps come by the office. Lunch is always good. You just have to understand that time can be limited. You know, we’re in the middle of the busy day in those days are unpredictable. And I like the primary reference material. You know, if there’s a study from the England Journal that highlights something, I think having that preprinted material from the New England Journal can can be a helpful way to share that information with doctors.

Dr. John Whyte [00:21:37] You know, everybody here. Wants to learn from each other and to network. And much of it is about hearing from you too, as experts. What’s kind of a best practice that you can share, whether it’s in terms of a tool or a technology or a product that has improved efficiency in terms of workflow during the day, or is a good way in terms of a best practice of how you’re getting information, either for yourself or for a patient. Can you share a best practice for folks?

Dr. Tracy Norfleet [00:22:18] [00:22:18]A best practice for me, I would say prior to the appointment was is knowing what the patient needs from me. The reason for the visit is not usually the reason why the patient is there. [10.0s] So that would be helpful for me. After would be just getting the information that my patient needs to understand their disease, why they’re being treated and what the medication is for and the side effects to look out for. Because I don’t have time to give them that information. What I do is I keep the door open for my patients. So I tell them to email me, let me know if they have a concern. If they feel something, let me know. Because as you said, it is hard to go through all the side effects. So from you, [00:23:02]if you can give me simplified information on the anatomy, the disease process, the medication and how it works, very simple. And then maybe the potential top side effects. Don’t list the whole the the entire list because you’re going to scare the patient away. But the ones that we usually see. So it’s all about communication and trust with the patient. And if I can give them the information where they know they can get back to me, if there is a complication or concern, that would be very helpful. [34.0s]

Dr. John Whyte [00:23:37] What about in terms of when we’ve, chatted about how point of care has changed in terms of expectations? We were chatting beforehand about when patients come in, they often want something, want something done. They want to leave with something, whether it’s a prescription or an imaging order or a piece of information. So how is that changed? When you think about the point of care products that you need? The expectations of patients. They don’t want to just come and talk all the time. Sometimes they they really want something done and feel that they’re leaving with something.

Dr. Tracy Norfleet [00:24:15] Yes. I think the first thing that a patient wants is to be heard. Once I can hear them and understand what their needs are, then I’m able to address them. I think it’s important, again, to have trust with your primary care physician because you can order every test under the world. But I like to know what’s on the mind of my patients so that I can reassure them that if they’re thinking way outside of the ballpark, that that’s probably not going to happen, and then discuss with them and and explain to them why it is more likely something else. [00:24:49]When a patient comes in, they already have something on their mind. And if you don’t understand what their concern is or what they’re scared of, then regardless if you’re giving them the right information, it doesn’t matter at that time because you haven’t addressed their concerns. [14.8s] Sure.

Dr. John Whyte [00:25:06] And David, you’re in charge of patient advocacy. So what do you find in terms of a best practice that’s going to help you provide better quality care? That’s either going to improve workflow or help you become better educated about your clinical area of expertise.

Dr. David Eagle [00:25:25] I think for this audience, [00:25:26]one of the critical things that can be done is, help us with educating our nurse practitioners. You know, there’s a massive workforce shortage, and we’re always trying to kind of find more ways to spend time with patients. [10.4s] At New York cancer blood we have 120 nurse practitioners, and PAs is just in the oncology division. And, you know, they don’t have specialty training always in oncology. So part of our onboarding process is to give them education about cancer medicine. But, you know, if you can embed, Pas and nurse practitioners, you know, into the medical team really working side by side with the oncologist, that really is a huge efficiency leap forward and being able to spend more time with patients and particularly if they’re good. So I think in terms of, you know, but that’s one of the first things we have to do. We have to educate them. You know, they haven’t been trained, spent years in oncology and hematology specifically. So, you know, simple things like educating them on intravenous iron products would be would be extremely important because they’re going to spend a lot of time with iron deficiency patients setting up intravenous iron, talking about intravenous iron. [00:26:25]I think that’s a huge opportunity probably for this audience is how do you educate the the extended workforce that don’t come into specialty areas with the same level of previous training but yet are just going to be so vital to the fabric of our care [15.1s] because we have all these other things that we have to take care of. But we have all these other things. It’s really the one of the few ways that we can really extend time for patients. Either my PA has got a great relationship with a certain patient, this happens, and that patient comes in every Monday and we assign them to them. I come in part of the part of the visit because she just has such a close relationship with this patient and the wife,  but she’s in charge of all of our onboarding and education for all of our nurse practitioners. I think if there’s an opportunity for this audience, that’s one of the ones I’ve put near the top is, you know, how to how do we kind of [00:27:15]better train the extended workforce in terms of the physician workforce is going to be stretched so thin. [3.8s]

Dr. John Whyte [00:27:19] And and oncology care is somewhat different in specialty care than in primary care. And and let’s be honest, physicians are not always the best collaborators with other HCPs. But let’s think about even the earlier conversations we talked about point of care testing in terms of point of care marketing, should we be working more, and how do we work more with pharmacies,and pharmacists, in terms of maybe there’s testing prior to coming to the doctor’s office to have more information? Have you have you thought about that approach in your practice or your colleagues thinking about that approach? Because we’ve heard for the last, you know, 20, 28 minutes time is is an issue for all of us. So how do people here help us think through more point of care marketing, point of care testing, point of care interventions?

Dr. Tracy Norfleet [00:28:09] [00:28:09]I think it’s great to have any point of care testing that is reliable, sensitive and specific that can be used outside of the office would be great. Where a patient can provide me with information so that I can further have a discussion with them. I love virtual medicine. [16.3s] That’s the best thing I would say that Covid brought was because it opened up virtual medicine for the medical field. [00:28:33]If I could have a patient be able to test themself at home, and then we follow up with a virtual visit to discuss the results, that would be amazing for me. [10.4s] Many times a patient doesn’t have to be touched all the time. A lot of time, it’s about the education of the patient and making sure they have the information that they need. So anything that you can provide in which a patient can test themselves or get the information that I need as a provider to further care from them, that would be very valuable.

Dr. John Whyte [00:29:06] David, on your end.

Dr. David Eagle [00:29:07]  I think there’s [00:29:08]opportunities for remote patient monitoring [1.5s] as well too. You know, the point of care can extend to all points of care. So, you know, temperature monitoring, things like that. I think there’s opportunities in oncology to expand in that direction as well. Also.

Dr. John Whyte [00:29:20] Well, clearly there’s lots of opportunities to do more. We’re all going to be here throughout the conference. So please feel free to come up to us, during the breaks and we can continue the discussion then. And with that, I’ll give everyone back 30s of time.