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Join Joshua Reischer, a physician executive, as we delve into the complexities of modern health care delivery. Explore the challenges physicians face in obtaining essential patient information, the frustrations experienced by both patients and providers due to outdated processes, and the potential role of technology in improving patient care. From discussing the impact of time constraints and administrative burdens on the quality of care to envisioning a future where digital health tools proactively anticipate the needs of both patients and physicians, this episode promises insightful insights and engaging discussions on the evolving landscape of health care.

Joshua Reischer is a physician executive.

He discusses the KevinMD article, “Time wasted, care hampered: How antiquated tech hurts patient engagement.”

Our presenting sponsor is Nuance, a Microsoft company.

Together, Microsoft and Nuance are leveraging their rich digital technology and advanced AI capabilities to tackle some of health care’s biggest challenges. AI-driven technology promises to revolutionize patient and provider experiences with clinical documentation that writes itself.

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Physicians who use DAX have reported a 50 percent decrease in documentation time and a 70 percent reduction in feelings of burnout, and 85 percent of patients say their physician is more personable and conversational.

Discover AI-powered clinical documentation that writes itself. Visit https://nuance.com/daxinaction to see a 12-minute DAX Copilot demo.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Joshua Reischer. He’s a physician executive. Today’s KevinMD article is “Time wasted, care hampered: How antiquated tech hurts patient engagement.” Josh, welcome to the show.

Joshua Reischer: Thanks so much for having me, Kevin.

Kevin Pho: So we’ll talk about your article in a little bit, but let’s start by just briefly sharing your story and journey.

Joshua Reischer: Sure. So my background’s in internal medicine. I was a practicing physician up until about five years ago. Loved seeing patients, didn’t love collecting, organizing, and documenting data, which is what I spent most of my time doing.

Before medicine I focused on political science and business, so I didn’t go straight into med school, didn’t have the traditional path that many others might have. I worked at a startup, did some clinical research, did a fellowship in something that many folks have not heard of called biodesign and innovation. And so I had a little bit of a circuitous journey, and loved seeing patients but just saw so many opportunities to make things a lot better. And really that’s why I do what I do today.

Kevin Pho: All right. So for those physicians who may be interested in maybe branching off into that startup world, you have your foot in both worlds. What kind of advice do you have for practicing physicians who do want to feed that entrepreneurial spirit?

Joshua Reischer: I think there’s multiple ways to be part of it. A physician can dip their toes into the world by doing something as simple as advising startups, starting your own company, doing it full-time, depending on whether you want to have a side job. A side job could be something like you’re starting a new clinic, or joining with other physicians. Starting a software company is very different, often very capital intensive, and a long and arduous process to raise money, to build a team. And so you can do that part-time for the first year, but it’s really hard to do that part-time forever.

I know lots of folks that we’ve spoken to and have worked with have said, oh, I want to do the same thing. But the question is, do they really want to? Do they really want to give up their reasonably well-paying positions to have nothing for a while, to jump in?

So I think if the problem that you want to solve is burning, you have to really want to do it. Just like I think most physicians I know and most physicians I’ve ever met don’t go into medicine for money, you have to not go into entrepreneurship only for money either. You have to really be passionate about what that thing is, because it is not easy and it’s a long journey. So I’d say that it’s worthwhile if you care about it, just like in medicine. Really the same.

Kevin Pho: All right, let’s talk about your KevinMD article. It’s titled “Time wasted, care hampered: How antiquated tech hurts patient engagement.” Now, for those who didn’t get a chance to read your article, tell us what it’s about.

Joshua Reischer: Sure. Essentially the premise of why I started the company was, I realized when I was seeing patients, I focused mostly on geriatric care. I’m not a geriatrician, but most of my patient population in the clinics that I worked in in southern Arizona were above 65, and I had the luxury of having a fair bit of time with each of those patients. But I really realized how much time I was spending gathering information, when they could have been better prepared for the visit and I could have spent better quality time with those patients.

So for example, and this is in the article, and I think most of your listeners will be very well aware of this: patients come in, sometimes they’re not sure why they’re coming in, sometimes they’re not sure what medications they’re on, they’re not sure about their medical history. And sometimes even during the visit, if they’re not there with someone, or with someone who’s not familiar with their history, they’re calling a family member, they’re calling a friend to figure out, wait, what medications am I on, when’s the last time I saw a cardiologist, et cetera.

And so the premise here was, why can’t we do a lot of that previsit preparation really previsit, and have that automated as much as possible? So for us, from a technology standpoint, we’re constantly thinking about how do we make technology easier for older folks.

Kevin Pho: Just give us a sense of some of the administrative tasks that primary care physicians who deal with that geriatric population, what do they typically need to do, or what do these patients need to bring in, in terms of the forms they need to fill out and that bureaucratic burden that they have to come to for a primary care visit?

Joshua Reischer: Yeah, I mean, if it’s a new patient visit, sometimes they’re filling out seven or eight pages of information. And if they didn’t bring their medications or any other records, they don’t know what they need to bring in. Even if it’s a follow-up visit, very often they don’t remember a number of things, where it just takes a long time for them to think about it. So enabling patients to have an easy way to think about something before they show up is really incredibly helpful for them.

My patients often would bring in either a bag of medication or a shoe box of medication. Half of them are expired, they’re not taking it anymore, they’re duplicates, and you can spend easily 15 minutes just going through those medications, figuring out what are you actually taking, what are you not taking, who prescribed what and why. When a lot of that, not all of it, but a lot of it can be figured out before that visit. And any parts that can’t, you can figure that out together in the visit. But if you can jump start and save 10 minutes before that visit starts, you can really just spend quality time and have a more confirmatory visit and explore the pieces that you need, as opposed to spending a lot of time just asking questions.

Kevin Pho: And now we have the Medicare annual wellness visit exam. Now, for those who aren’t familiar with that particular exam, just tell us about some of the documentation and bureaucratic burden that that entails.

Joshua Reischer: Yeah, there’s a lot of basic questions. Well, I’ll start with, very often patients don’t know what that even means. They’re scheduled for an annual visit. An annual visit to most patients is like, oh, it’s my once a year. But from a Medicare standpoint, it entails specific questions and questionnaires that are asked, like for example a fall risk screening. So we’re asking specific questions to the patient trying to assess what is their risk of falling while at home, and that helps categorize other items.

And right now either nurses, medical assistants, or sometimes even physicians themselves are having to ask all these questions and manually type this into the EHR, when really all of that can and should be done before the visit even starts. And with our software, that’s what we help enable folks to do.

Kevin Pho: All right, so tell us about the technological solutions. You obviously have a product, but in general, what are the options that are available out there that can help streamline this process and help patients?

Joshua Reischer: Yeah, so there’s a number of options out there, starting with paper. Sometimes clinics are still sending pieces of paper to patients before a visit. Sometimes they’re sending PDFs, sometimes they’re sending a link via email, which typically you get a very low rate of patients answering.

There’s a number of intake platforms out there that have been around for 10 plus years at this point, and a lot of them do a pretty good job of gathering some basic information: demographics, medications, allergies, medical history, surgical history, things like that. And many of them have gotten a lot better and easier at becoming more accessible through text. You click on a link, you open it up, it’s really easy. Of course, there’s often the patient portals, which adoption rates vary a lot based on the patient age, ability, et cetera.

But generally what we’ve seen is that many technologies don’t have any intelligence behind that, meaning that it’s a static form. It doesn’t matter what the patient has, the reason for their visit, what has changed from the last visit. And that’s where technologies like ours take into account, why are you, the patient, actually coming in today? What can we do for you today? And if they’re saying there’s a new reason for a visit, or a follow-up for an existing condition, we can take them down just a slightly more intelligent algorithm or sets of decision trees, just like a physician would, to gather information.

The way we think about it is, how do you get a medical student type person to talk to a patient before the doctor did? So sort of a handoff, just like in medical school or residency would happen. It’s really a common workflow that physicians are already used to. But now, when you don’t have that extra person, when we’re strapped for time, when there aren’t enough physicians in the country to do this, how do we enable our providers to do the same amount of work with less resources? And I think everyone’s aware that to compete you really need something like that, and the groups that we work with, that’s what we hear all the time.

Kevin Pho: So in terms of that technology, are we talking about things like AI and large language models and some of those techniques to summarize that patient information?

Joshua Reischer: It can employ a number of different things. So we focus on what happens before a visit. So for us, we’re not just asking the questions that would be asked at the front desk or by that medical assistant or nurse, we’re asking the questions that a physician would ask.

Now, in terms of asking those specific questions, those are pre-programmed beforehand, and you don’t necessarily need AI for that. Where AI becomes interesting and more helpful is, how do you summarize this in a way that’s actually useful for different providers and can be configured in different ways faster? And that’s where AI comes in.

For us, one of the ways that we employ large language models is looking at the notes that we write, looking afterwards at what a provider writes, comparing those two using natural language processing and large language models to see, what are the differentiators, what are we missing, how do we improve the product using the technologies that are being launched today?

In the future, I think there’s going to be even better ways to leverage things like ChatGPT to make this more configurable, customizable, and usable for more providers and more patients, whether they speak different languages or not. I think there’s a huge amount of opportunities that are coming in the pipeline really soon.

Kevin Pho: So regarding these technological solutions, as you’re aware, there is going to be various technological literacy, especially among the elderly population. So how do you address sometimes that disparity between patients who of course are online all the time versus patients who may not have access or don’t have the tech literacy to use these tools properly?

Joshua Reischer: For sure. So there’s always going to be some subset of patients who have a difficult time communicating what’s going on to their providers, or have a difficult time using any sort of technology. That’s really hard to solve right now. But what we attempt to solve is, if they have a mobile phone at all, which a vast majority of folks do, how do you make that simple for them? Where if a patient has to download an app, if the patient has to remember names and passwords, or anything that I’ll just call a barrier to the technology, that’s where things break down.

I remember when we first started, we were working in a clinic in Arkansas, rural Arkansas, and I went to the clinic, I was sitting down in the waiting room, and I was sitting between a 77 year old and a 79 year old, former farmers who didn’t finish high school. And so those are the types of folks that I thought about as we were designing our software, where it’s like, if you can click a button and there’s literally arrows pointing to what to do and it’s just really, really simple for the patients, they’ll actually use it. And the data shows that they do. For us, patients who click on a link, more than 97 percent of them complete every single question that we ask, no matter how long that questionnaire is, and we only ask one question at a time. We make it really, really simple.

So I think just in general in health care and in medicine, designing software that’s simple for patients to use is really huge. Sometimes people ask us, oh, do you employ voice? And the truth is, I’ve watched patients use that and it’s often confusing. They don’t really know what to do or how to use it. So you really have to sit with patients and various different populations to see what works for them. It’s hard to get 100 percent for everyone, but how do we get more patients involved? And I think we’ve actually done a pretty good job of that.

Kevin Pho: So let’s put some of this in a scenario so people can visualize it. Give us a success story where a technological solution is working optimally, both for the patient and for the physician.

Joshua Reischer: Yeah, sleep medicine is an interesting example. There’s a lot of standard questions that a provider would ask beforehand to measure what a patient’s risk is and what type of exams would be done. Now, if you just use static questionnaires, you lose context, and physicians often have to ask lots of questions. But I know there’s sleep medicine physicians we work with where we really automate the entire note for them, and then you get to have a contextual conversation with the patient during the time that they have, not asking question by question. They’re really just clarifying and understanding, hey, I understand that you’re coming in for this, and this is what I understood. And the patient feels like they’re heard and understood, and that really makes the difference.

So when we hear feedback from patients, we’re hearing that it almost felt like the doctor knew me before I even walked through the door. And that’s a really interesting paradigm shift, especially when we’re in the age and days where not everyone, especially in primary care, has the same doctor for many, many years. They’re going in and they’re seeing someone different all the time. So anything that can bridge some of those gaps of, OK, I know you a little bit before you come in.

And I think that’s a huge part of medicine, is rapport. If you don’t trust the person you’re talking to, how are you going to take their advice? And anything that you can do to help build trust before a visit I think is really invaluable for that patient physician relationship. Because you can recommend all the medications or treatments that you want, if the patient doesn’t trust you it’s really hard to have a success story there.

Kevin Pho: We’re talking to Joshua Reischer. He’s a physician executive. Today’s KevinMD article is “Time wasted, care hampered: How antiquated tech hurts patient engagement.” Josh, we’ll end with some of your take-home messages to the KevinMD audience.

Joshua Reischer: From a physician standpoint, I’d say it’s worth trying technology. I think a lot of physicians, there’s a few different camps. Some can’t wait to try the latest and greatest, and I think that’s awesome. I think in the past people have been burned by technology that didn’t really work great, so they’re a little bit hesitant to try things. And then there are those who think it just takes too much time and effort. But what we’ve seen is, when you put a little bit of time and effort in up front to work with those technology vendors, you get a huge return afterwards. Really, really huge, from both patient satisfaction and job satisfaction, just day-to-day work satisfaction.

So I really implore folks to get involved. Sometimes physicians say, oh, we’re going to have other people make these decisions for us. But I think physicians should really be involved in technology choices, or at least partner with people at their organization, so it’s not just siloed and they don’t say at the end of the day, oh, they’re trying something new but it’s not going to work for us. Well, get involved in the process earlier and then you’d help guide what an organization might need or want. So I guess the take-home message is really, get involved.

Kevin Pho: Josh, thank you so much for sharing your story, journey, and insight, and thanks again for coming on the show.

Joshua Reischer: Thank you so much.