Educational Webinar: Integrating PCR solutions into everyday practice

Good afternoon everyone and thank you for joining us today. My name is Brandon Martin, customer engagement manager with McKesson Medical surgical. I'm pleased to welcome you to today's webinar integrating PcR solutions into everyday practice brought to you by our speaker. Today is dr Dov Shapiro. Dr Shapiro is a managing physician at Associated Pediatric Partners. He attended Medical school at the Pritzker School of Medicine at the University of Chicago and did his pediatrics residency at Lutheran General Hospital in Park Ridge Illinois. He prides himself on providing top notch care in a warm, friendly and compassionate manner. His areas of interest are preventative health care, allergies and asthma a D h D, behavioral in school issues and child development. He sees Children from newborn through college age and is equally comfortable in caring for newborns, adolescents and young adults. Dr Shapiro is married and lives in West Rogers Park with his wife and five Children. Before we get started, I just want to direct your attention to the lower left hand screen. If you have a question for Dr Shapiro feel free to post throughout the presentation as there will be a brief Q and a following, simply locate the Q and a panel as I mentioned in the lower left corner of your console, type your question in the text box and click send. We will do our best to answer questions as time allows at the end of the webinar, A recording of today's presentation and a copy of the slides will be sent to you within 48 hours via email. Once again. Thank you so much for joining us today and please join me in welcoming Dr. Dove Shapiro. Hi everyone as you mentioned, I'm dr Shapiro, I'm here to talk to you today about how my practice integrated PCR into our everyday practice and how that actually helped to transform the way my practice provides care to our patients. This is the title slide. My journey in using Gene Expert, express how it transformed my practice. I've already you already had a wonderful bio. Me, thank you. That was actually very generous. Um One of the interesting things about my practices, we are the oldest practice in the entire state of Illinois. This is our 67th year in practice. I have not been there all 67 of those years. I'm in there 22 years. Um But as a result we actually now have first generation patients. We actually have 2nd and 3rd generation practice patients in our practice. We see grandparents bringing in their grandkids and the grandparents themselves were Children in our practice Once upon a time, what we discovered in adopting um PcR in our office was not only did it achieve higher patient satisfaction, better clinical care, but it actually improved my practices efficiency and profitability and I wanted to share a little bit with all of you about the journey we undertook and how it affected my practice and how it could potentially affect all of your practices moving forward. Quick disclosure, support and honorary fees for development and delivery of this presentation have been provided by the soviet speakers bureau. Alright, so for all of those in healthcare, which I assume is everybody on this, on this presentation today, there has been no event in my career and I doubt in anyone else's career that has been as transformative And as disruptive as the COVID-19 pandemic. It's changed the way we interact with our patients. It's changed the way we interact with our friends and family. It's changed how we go to school. It's changed how we shop in many cases to change how people celebrate family occasions, people that pray, it's changed how they pray in synagogues and churches. It's really changed almost every facet of our lives and like I said in no area has it affected us more than in the medical care area where we have to be very careful about not exposing our patients to a disease which can make them quite sick. One of the things we noticed early on is our patient's expectations and our patient's behavior changed early on in the pandemic. Many practices saw a downturn in volume in the beginning of pandemic. People were afraid to leave home. They didn't want to come to a doctor's office, they didn't want to get sick if they were going to come out to see a doctor. Um They only wanted to be seeing the facility that could rule out or confirm covid otherwise they were going to go to a state lab or they want to go to a local local acute care clinic to find out because they couldn't rule out covid. There was no point in coming to see the doctor. They also wanted to make sure that whatever results they got, it was accepted by the workplace in school. That way they could get back to work and their Children can go back to school. The quicker the result would come back would of course be the better you may recall in the beginning, sometimes it took a week or longer to get back to pcR results. People were out of work and out of school that entire time. So the quicker one could get back to the patient with an accurate result. Um, the better for that patient, a better patient satisfaction. Now from the standpoint of our office, we also had to adapt. Number one, we have to be able to see patients without exposing ourselves and our other patients to covid 19 and we have immune suppressed patients. In our practice, we have newborns. I don't want to expose them to some with Covid at the same time, we had to see a lot more Children for illnesses in the past, when a child had a mild cold or mild cough, they stayed at home for a little while only if it went on for more than four or five days or they developed a fever, difficulty breathing when they come to the doctor. now because of Covid, these Children couldn't go to school with any of those symptoms. They're coming in on the first day of symptoms because they want to know if their child has Covid and whether or not they have to be out of work and they promised to be out of school. So we had to find a way to accommodate all those extra sick visits while still seeing all of our regular health checkups and regular chronic care for our patients and we still have to maintain an efficient workflow in doing that. Another very important point is something I'm going to discuss several times during this presentation is that Covid has changed the way viruses present. For almost all my career viruses had a seasonality flu and RsV were always wintertime viruses. Uh the enteroviruses like hand, foot mouth or summer viruses strapped while you can see it all year round was most predominant in the fall when school would begin. And many other bacteria viruses had a very strong seasonality to them because of Covid. And because of the different types of measures we've taken to keep ourselves safe, like masking and social distancing and schools being closed, we've completely upended that pattern. I don't know about all the rest of you, but we were seeing lots of little hops until just last month, even though it's only august we're already seeing tons of RsV. So much so that in many states we started to give infants of premature birth. RSP. McGlaughlin already early um, to protect them from RSP. So once again, all these diseases are changing. We're seeing diseases and completely wrong seasons. And as a result, um we have to keep our eye open, not just for covid but for other illnesses that normally wouldn't appear in the current season. They're still on our list and very often do a car. So that's changed how we view patients, illnesses. We no longer can rely on seasonality to inform us what our patient may or may not have. We realized early on that in order to be able to continue to see our patients and provide the care which we were used to. We had to be able to offer covid testing in our office and there was all types of technologies even back in the beginning and to this day of all the rapid antigen tests which can be done at the doctors office or at home. But as everyone on the slide knows PCR is still by far the gold standard when it comes to testing for a moment. So much. So the term PcR is one of those terms that everybody in the country knows now. Whereas prior to covid 19 only doctors and medical professionals knew that term PcR but we realized early on that all Covid tests are not created equal. And as a result, we had to make a decision in my office. And what type of test we were going to offer this next slide actually comes from the beginning of the pandemic. Although the reality is the numbers haven't changed dramatically. The bottom line is the most popular most well used test. The ones that people now do at home you can order for free through the government a rapid antigen test. Rapid energy tests have the benefit of being very quick, very easy to use. One of their big advantages. They're very specific. So what does that mean? When I say a test is very specific specificity refers to how likely is a positive test to really be indicative of the disease. So if a rapid engine test says you have covid Depending on the test, the numbers are close to 100% accurate. It is very rare to get a false positive on any test including a rapid aging test. Unfortunately when it comes to sensitivity that's where they lack sensitivity refers to how sensitive is a negative test. If I think I may have covid an eye test and eye test negative, how likely is that test to be accurate? Maybe I still have Covid the testis is incensed enough to pick it up. And unfortunately most rapid engine tests in the beginning were in around the 50% mark the best ones in the market are best 60 to 62% and that's only for people that are very symptomatic for people that have mild cases are asymptomatic. The numbers are even lower. And all of us have seen those cases of people that have done 234 rapid engine test at home. All the negative, they do pcr and they're positive. So once again, we realized early on that if we wanted to be able to tell our patients with confidence whether or not they had Covid, the rapid engine tests were not going to do the trick. We did a lot of research and we came across um, Cynthia's expert express system, the gene, the gene express system and that's the copy a picture of a machine on the right. That's a picture of a cartridge on the left. What's beautiful about this particular system? It is by far the most sensitive one in the market. Just like the rapid aging test, it doesn't have any false positive. You look at the right side negative percent agreement. That's another similar term to specificity. A positive test on this test means you have covid, no question. They detected covid in your area in your nostrils. But if you look on the positive percent agreement, which is another word for sensitivity, how likely is it to be accurate? How likely is it not to miss a positive for flu a flu B and RsV? It is actually nearly 100%. Even for Covid, it's actually 99.2 to 100% sensitive. Which means in this is less than 1% of Covid test. This makes it actually the most sensitive PCR test in, in, in uh, that's currently available for office use, it's extremely accurate. As you also notice the beauty of this test is it doesn't while you can test for covid alone, you can also test for common other viruses all with the same swab and all in the same amount of time. So we adopted this system early on in the pandemic. In fact, we were the first practice in the entire state of Illinois to begin in office pcR testing and using this machine and our patients were thrilled and our volume went up tremendously as a result. And we were able to give our patients same day very, very quick results with, with a greater deal of accuracy. So a question people ask me is okay, great. Why are you testing for four things? Why not just test for covid? Well, the answer is early on. We did just test for covid. But once we realized how much the seasonal viral patterns had changed, we realized that testing for covid alone was not sufficient because many of our Children had other conditions which could be treated. For example, flu. As many of you know, if you catch flu early enough, especially a child that has some risk factors, you can initiate treatment whether it's Tamiflu for younger Children or for older Children. You can make a real difference if you catch flu early enough with RSV, which is very, very dangerous for little babies. Um knowing that a family member has RsV is really important because if they have a young child or a baby in the house you have to be very cautious that that baby doesn't catch R. C. And if a baby is diagnosed RsV we gotta watch them really carefully to make sure they don't end up needing hospitalization. So knowing early on what your patient has not just that they don't have covid but actually what virus they do have can very much inform the treatment they get and resulting in better outcomes for the patient. It's interesting before covid most of my patients, you know the virus it's not it's not covid not flu. Um The virus people accepted that nowadays because people are used to viral testing. Now a lot of my patients I would say the majority find it find it unsatisfying to something you tell they have a virus. They often want to know what it is and whether or not there's a medical justification for this and I would argue that there are there is in most of these cases it definitely improves patient satisfaction. You can give them a definitive answer what they have not just because you can initiate treatment because you can tell them what to expect. You have the flu, it's already been two days. So it's too late to treat you. You can expect that fever for another four or 56 days. Watch for shortness of breath so on and so forth. Being able to tell a patient early on what they have, increases their satisfaction and also lets them know when their symptoms veer from what's expected. So in my office we've actually used the forks flex testing for actually almost dollar patients and we're still getting positive RSVPs every single day right now. Um and last month we're getting positive fluids multiple times today I found it to be a very effective test and it's actually changed quite a bit how I practice medicine. One of the beautiful things about this machine, If you look at the picture in the upper right hand corner is depending on the size machine, you get whether you get a two slot machine or a four module machine or eight module machine. Each one of these little modules, each one of those little doors you see on the bottom um can run a test independently and they can also run independent of one another. So for example in slot one you can be running a strap test slot to be running a Covid test and slot three. You could be running a four plex test testing for Covid flu and RsV. Then slot Glory can be running flew alone and each one runs on its own timeframe independently of the rest. It's almost like having four machines or two machines or eight machines in one. So that works really well with the workflow in the office because the staff doesn't have to line up the test and put them in simultaneously. They put them in as they obtained them. It really is an incredibly easy system to use. Training for my staff took less than an hour. You scan the barcodes in for the test, you scan in the patient's name and number and information is literally almost impossible to make an error. If you do anything wrong machine doesn't let you proceed to the next step. It's also really a walk away system. Once you obtain the specimen you added to the medium, shake it up, put a few drops in the cartridge, put it in push the button and leave and you go on to your next patient and it results um depending on the test anywhere from 20 minutes to 35 minutes. Um So as a result it's really worked very well from my office. And once again one swab contest for one virus to viruses. Three or all four viruses including covid flu A flu B and RsV. So how do we adopt this in our office? And this is something I've seen different offices manage different ways. This machine has gotten very popular in my area. Um All the local hospitals, the local care clinics, the emergency rooms and doctors offices have become to adopt this system over the past six months to a year we were first but it's become probably the most popular system in my area in acute care clinics. I've seen the first model used where patients are triaged right when they arrive the nurse or P. A. Or wherever is putting the patient in. Um If they meet certain criteria already starts the swab and by the time you see the provider we already have results and those are given to the patient. Second model also works in acute care clinics and also works in private physician offices. Whereas you don't actually do the test until you see the patient because you're not sure if they need it or not. And then you get the results in an hour or less and you call the patient back or you email them with the results within the hour. The last model is one of my office is done and while it does take a little more time up front it's allowed my office to see a large number of patients in a shorter period of time. So why have we done that to this day? My office still does not allow sick patients and well patients in together at the same time we started that with the with the beginning of covid. So during the morning for an hour and a half and during the evening for an hour and a half we have sick hours. That's when all of our people with six symptoms whether it's cold cough fever, shortness of breath, that's when they come in and during the middle of the day we see all our healthy patients are newborns are healthy Children. That way we never expose healthy and sick Children 2 to 1 another. And that has removed our patients concerned about coming to the doctor's office. It's also prevented us from sharing covid among our patients. Which is something we obviously don't want our patients to leave with. Anything that didn't come in with. So in our case after lunch, the doctor's given a certain period of time where they call back all the patients that have called that morning asking to be seen. The doctor gets to history the answer in the system including some orders. Then when the patient arrives later that afternoon, The tests are already ordered. The nurse goes ahead and obtained the tests. The doctor. The patient gets seen by the doctor and then they're discharged depending on when they came in and we have a result by the time the doctor sees them or in many cases the result comes in 30 minutes later they then called and the results are put in our portal. This allowed us to see a large number of patients in a shorter period of time. I can often see 1516 patients in an hour and six hours now. So I've already gotten the entire history. I already know the plan. So it's really just a question of examining them and talking to the patients and their parents about the next steps. And this is a lot of once again to keep our healthy and sick kids separate. So any of these models work for any practice. It's really a question of the size of your facility where you have space to keep sick and well separate and and also where you schedule your sex. But once again these have worked real well and made my practice able to see many, many more patients in an hour and a comedy. As many sick patients as we need to. Now that's all for viral testing for respiratory illness. But that's not all of the expert express system does even before covid they were very popular in the use of their strap a testing. Now this we adopted actually at the beginning of Covid epidemic as well and has really changed how my office treat strap. Like many like many people on this call up until Covid the way we did strap testing was we did a rapid strep test result in about five minutes. It's not terribly perfect. It does have some false pauses. It does have some false negatives. Um, probably as much as 5 to 10% of strep cases are missed, which is why all of us know that if you have a negative strap rapid strep test, you still gotta send out our overnight culture. The beauty of the strap Pcr is it's so sensitive. In fact in this case 99.4% sensitive. It actually does not require overnight culture. A negative strep test on the expert express strep a PcR test. It means they don't have strapped no overnight culture is necessary. You can give the patient a definitive answer within 18 minutes whether they have strap or not. Not only does that give the patient satisfaction of knowing they do or don't have strapped enough to wait two days to find out. It also avoids needless use of antibiotics prematurely. It also says my staff and myself a lot of time having to track down this culture and then track down the patient when they're positive. This has changed how we treat strap. No longer. Rewriting antibiotics, which we always try to avoid because we're suspicious. They have strapped despite a negative rapid strep test and no longer are we having to track down patients two days later to tell them they had stopped the past two days, they have infected all their friends and family. Now we find out that same day definitively whether they have strapped or not. So how has using the system transformed my practice as I mentioned the beginning, while other practices were suffering from reduced visits were busier than ever and we're able to comment all our patients, both healthy and sick. I also mentioned this is really true. The opportunity to see many, many, many more sick visits um has has only increased due to Covid. Now the patients need to come in at the onset of symptoms to prove they don't have covid state can return to school and their parents can return to work. Being able to accommodate our patients and prove they do or don't have covid and then get the parents back to work and the kids back to school the next day has resulted in a very high patient satisfaction among my, among our patient population. My office is always tracked our satisfaction satisfaction scores really, really carefully. We've always wanted done really well in the mid eighties, which have been very proud of. But since the beginning of the pandemic and I would attribute a lot of this based on the comments to our ability to test kids in the offices even same day, give them the same day. Results has increased in the upper nineties. As of last quarter, it was 97% satisfaction, which is fantastic. And our patients can't stop singing our praises to all their friends saying that, oh, I'm sorry you had to wait a few days and we saw a doctor the same day and got an answer much. I was back in school today, As I mentioned, this is a very key point for me, the ability to quickly and accurately diagnose what our patient has not just they don't have COVID, but what they actually do have, whether it be flu RSV has resulted in better earlier and more efficient care for our patients. And while this was not the reason we set out to do this. I was surprised and pleased to find out that in the 20 years that I've been a managing position of my practice, um we've actually had the most profitable couple of years in all the years I've been running the practice. And the main reason for that is more sick visits and better reimbursement for PcR testing compared to other tests. And this has really changed how my practice has practiced medicine and made a huge difference to our practice, not only during the pandemic, but I'm hoping moving forward current climate, you know, Covid changing, it's becoming more of a chronic illness now. It's still serious and people that are high risk still can get sick. But we've come to learn to live with Covid now, but here in Illinois during times of high covid transmission, many cities and counties are only accepting PcR tests, return to school or work. They don't mind testing at home. But if you have really classic symptoms in many schools and many workplaces still want a PcR test to allow someone to come back to work. It's been interesting to watch it over the last two years. Almost all large hospitals and all of the local Children's hospitals in my area have all started using the same soviet system for their own inpatient and outpatient clinics because it's the best on the market, it's become the standard of care. It's become the gold standard. Um and like I mentioned, almost all the practice and pediatricians I know in the area have also now switched or are switching to separate from the other systems. And that's because it actually is the most sensitive tests. They've added more sequences, genetic sequencing tests for than any other test results. They picked up not only traditional covid but all the new strains as well. Um And this has made it a very popular machine and one that seems to become have taken over the market as the gold standard as the most popular and best and easy to use um system on the market. Um A couple of resources here um The gamma team um can help you to get a machine and to work with any questions you have. There's also website that talks about a political codes and reimbursements which all I'll say are very very generous and um definitely definitely help practices um financially and they can help you with that information as well. And then of course the most impatient, it helps our patients helps our patients because we're able to provide them better care and give them real meaningful results in a very very rapid amount of time. Um So once again delivering a better way to improve patient outcomes by enabling access to pcr testing everywhere in this case by offering it in my office we've been able to improve patient satisfaction and patient outcomes. I'm not open for any questions anyone might have. Excellent. Thank you so much dr Shapiro uh the first question that's come to us, could you speak a little bit about um adopting this technology in your practice? Um as far as like the ease of uh bringing this in and uh any sort of anecdotes about training around using, I was pleasantly surprised. I always assumed that a pcr system would take a lot Training to be hard to put together. It was really simple to put together. I think that took us about 20 minutes and we downloaded some of the software updates online. But the part that really really impressed me was how quickly been teaching people to use the system. We in fact hired at the outset, it never took anyone more than an hour and most people less than 30 minutes to learn how to use. We just hired two new nurses in the past month. They both trained on the new system within within less than a day. So I mean they practiced with us for half an hour by the next day. They're already doing it themselves. It is really, really easy to use. It's all scanned and go um it really walks you through the steps. It it is an incredibly user friendly system and requires almost no training to run. And it won't let you make a mistake if you don't do it right. It won't let you go to the next step. So training has been has been as simple as I can imagine if any other system literally you don't need a medical degree to run the system, you could have a high school student if you want to run the system, it doesn't require any advanced training and it's been very easy to adopt in my office. Excellent. Thank you so much. We'll leave a couple uh a couple of minutes here in case any other questions come through while we're doing that. If I could just direct everyone's attention to our product information Disclaimer and I would also like for you to review our McKesson webinar Disclaimer. Excellent. Well, thank you so much. Dr Shapiro, I really appreciate your time uh today, I appreciate you joining us and uh walking through this system as we come to a close. I do wanna take this opportunity to thank all of our attendees for joining us today. As a reminder, you can find a list of our upcoming webinars on our website at M M S dot McKesson dot com slash educational dash webinars. Well, thank you all very much. If there are no more questions, I want to give them another minute to see if anyone has any questions, you know, over the years, my office is always like adopting new technology, something we're known for. I really enjoy technology and seeing how it can improve the care I provide and I've made some bad moves and some good moves over the years. Some systems I thought were to be incredible into being expensive and really did not work out well, this particular system is by far the best decision I've ever made. It's made me look brilliant in my partner's eyes because it's worked so well for our office, not just from a patient care but financial perspective. And it's nice to pick a piece of technology that's so so necessary, you know, as a result of this pandemic, we've come to realize how important the the flexibility and efficiencies and of pcR testing in office. And that has become our standard of care, which is going to continue long after this pandemic and into the future. You know, stuff is working on many new kinds of tests that can be run In the office. Um I really think it's changed how we think about testing, being able to get the same result, many in most cases less than 45 minutes, in many cases less than a half an hour really changes how you treat your patients. And it's been a huge huge success for my office, which is why I'm so passionate about it and why I like giving these talks well. That is excellent and I certainly do appreciate your time and insight today. Um and we have gotten a few messages of thanks uh come into our Q. Q. And A. As well. Uh so dr Shapiro, I really appreciate it. Um just to remind our audience, we will send a copy of the presentation and recording of uh today's event. So watch your inbox for that. If you do have any questions that come up later for uh Dr Shapiro, uh please feel free to reach out to uh to us, and we will be sure to relay that message. Dr Shapiro, once again, just thank you so much for your time today. You're welcome, everybody. Have a wonderful afternoon.