Dr. Norris is a practicing anesthesiologist who works to improve the business intelligence of all healthcare providers. When he’s non-clinical, he serves as a consultant and educator, helping physicians and practices survive and thrive by teaching the business knowledge they need to create their desired practice. He shares his expertise via his books, articles, teaching, speaking, and podcast.
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Erik Sunset: [00:00:00] Hello and welcome back. I’m Erik Sunset, your host of the DocBuddy Journal. Here at DocBuddy, of course, we deliver healthcare solutions that take the pain and cost out of broken workflows. we’re joined by Dr. David Norris. Dr. Norris is a practicing anesthesiologist who works to improve the business intelligence of all healthcare providers. When he’s non clinical, he serves as a consultant and educator, helping physicians and practices
Erik Sunset: survive and thrive by teaching the business knowledge they need to create their desired practice. Dr. Norris, thanks for joining us,
David Norris: Yeah, great. It’s a pleasure to be here. Thanks for having me.
Erik Sunset: but the pleasure is all ours. Thanks for carving out a little bit of your your calendar to spend at the DocBuddy journal. a pretty, it’s a pretty succinct intro on my parts. What else should our listeners know about you?
David Norris: Well, I mean, you know, I I started that journey,
David Norris: Oh, well over
David Norris: 14 years ago. Actually longer than that. It was when I got out of residency and fellowship and got elected positions of [00:01:00] leadership, I realized I was ill prepared to run a private practice. Right. And I didn’t know I was handed income statements and other financial reports and didn’t really fully understand what I was looking at.
David Norris: And, but yet I was expected to make business decisions. So in order to do my best by not only the partners and other physicians, but all the other employees that we have in the practice, I decided I’d go back and get an MBA. And as a result of that, I realized I wasn’t the only physician in this situation.
David Norris: I just happened to be one of the few who decided to go off and get a formal degree. I don’t necessarily believe you need a formal degree to get the information and the knowledge. But for me, it was the, fastest way and the most concise way to get that information. And then after that, I started writing and speaking and teaching about business to residents and other physicians and other [00:02:00] medical societies.
David Norris: And then wrote two books. The first one was Financially Intelligent Physician. That one, I, I walk you through financial decision making. How do you read income statements? How do you determine the financial health of a practice or business? The next one was about process improvement and really geared at patient satisfaction and trying to get the physician or the provider to think.
David Norris: Patient satisfaction goes far beyond what we do for them. It’s for goes far beyond the right diagnosis and the right treatment. It’s actually the entire encounter and how the patient feels at the end of that encounter, because patient satisfaction is really more about what they perceive. our patient care to be, not really what we perceive our patient care to be.
David Norris: And that really began to resonate with me as my parents became older and began to consume health care. I really began to realize that yes, you have great doctors, but you have [00:03:00] bad processes that necessarily they, they impact the patient’s perception of your care. For example, billing or revenue cycle management, not getting that EOB or not getting that bill submitted right.
David Norris: And then, You know, my dad would get the bill from the oncologist and it was always wrong. And he’s like, how can I trust him to be a good doctor if his office can’t get that right? And I was trying to say that those are, those are really two separate things as a physician or provider. We think of those two separate things, but really as a patient, that’s one continuum or one continuous experience of our practice.
David Norris: And, and that’s really what that book’s about is trying to get you to think about that differently. and how do you identify those bottlenecks? How do you identify those touch points and reinforce for the patient the emotions that you want that patient to feel as they go through your practice? And I think some things sometimes the tech helps and sometimes the tech [00:04:00] hurts, it just depends on how well you have that set up.
David Norris: And one thing I think it is, is if you buy tech or you get something like that and you. You put it on automatic it’s not always automated. And I think that some people turn a switch and they forget to go back and check, is it working the way we want? You know, how often do we need to audit and make certain that we’re getting the results that we want out of it?
David Norris: And I think some people forget to do that or it never occurs to them. They just flip a switch and, okay, it’s on, great. So and then I I have another series of four little books coming out here in a month or two. And I, they’re called my Grand Rounds for your practice, and they’re chopped up into topics.
David Norris: They’re quick little things you can read in a day with some things that we think, help you think or apply what we talked about in that lesson. And it’s lessons on leadership, negotiations. patient satisfaction and finance. So that’s what I’ve been doing. I’ve been trying to help physicians stay private or independent if they want, or [00:05:00] any provider really for that matter, stay independent and own their own business and operate that in the best way that they can.
David Norris: But I think a lot are afraid because they don’t have the knowledge. And so I’m trying to help them fill that gap.
Erik Sunset: You’re you’re so right. You’re obviously an expert in the space that you look at all of these factors that touch on. Clinical outcomes on a practice or a physician’s revenue cycle and their earnings. And then even going as deep into patient experience, patient accessibility, you know, over the last 15 or so years, you’ve seen technology really get its tentacles into all areas of, of a practice. There’s good technology out there. There’s some not so great technology out there. And when you look at some of the surveys from the reputable sources, Talking about what’s driving physicians to retire early, what’s the source of their frustration, what’s the source of their burnout, it really comes down to technology.
Erik Sunset: Number [00:06:00] one, and then you mentioned independent practice versus employed by a health system or a group. That lack of autonomy comes in as a number two factor for dissatisfaction with career. And it just doesn’t seem to have to be that way. So when, when you look at the role of technology and physician workflows
Erik Sunset: spanning that continuum, as you said, are some words to the wise?
Erik Sunset: What would you recommend?
David Norris: Keep it as simple as possible, particularly for the individual as they’re using the technology with with the patient, you know I think, I think for patients, they don’t really realize that, you know, the technology is necessarily helping the physician or the provider with the care.
David Norris: However. You know, depending on how it’s used in the exam room, it may appear that they’re being distracted by it and not really focusing on the patient. You know, I’ve been to physician’s [00:07:00] offices where, you know, they’re typing on the computer or a laptop, or maybe it’s a boom connected to the to a wall, right?
David Norris: And they’re not really looking at me as they’re doing the interview. I think it needs to be simpler with less clicks and something that’s a probably a little more mobile. You know, I, you know, hospitals, they have a lot of capital, so they, they don’t want things walking off. So they stick things to things that, you know, are immobile, but that also impedes, I think, more of a natural workflow.
David Norris: So for like, for me, what I do is I use an iPad. And I run we use Cerner, so I just run a Citrix emulator on my iPad. But, that allows me to go right next to the patient at bedside, and I can pull up all their information, which is very handy and very, very necessary. you know if they we, we can discuss their echo findings or their lab results.
David Norris: I can do that at bedside, but I can [00:08:00] be facing the patient and it’s no different than holding the patient’s paper chart like I used to, right? And flipping through it. It’s no different, but if I have to step three feet away and use the thing that’s attached to the wall, I think some of that, that, that interpersonal dialogue or interaction gets harmed because of that.
David Norris: So I think you really need to figure, think about when you’re looking at technology, how am I going to use this in the patient’s environment? How am I going to use this as I’m actually treating the patient? You know, some people I think depends on the workflow. You know, if you don’t have something, if you want to keep that patient interaction.
David Norris: personal and you use pen and paper and then you go back to the computer, you’ve duplicated your work. And I think some physicians do that, you know, they want to keep that more of a personal interaction and they don’t want to appear like I’m distracted typing on a keyboard while, while we’re, you know, in your [00:09:00] encounter.
David Norris: But at the same time, then they do duplicate the work. And I think that’s where the technology gets a bad rap. You know, it’s so painful. It could, you know, I add hours to my day. And I think that’s just because the technology or whatever vendor they’re using, hasn’t really considered or try to develop something to streamline the, that workflow for the patient or for the physician or the provider at bedside.
David Norris: So, and you know, when we went out, we, we actually back years ago when we actually got. Money for implementing an EMR we put in our own aims our own anesthesia Informatic system went out and sourced a bunch and and the one that everybody wanted was the one that was on an iPad that you Could carry on a mini or a regular iPad at bedside And it was use the stylus or your finger.
David Norris: And it was more of a tap click sort of thing with occasional text. And they all liked that because it didn’t [00:10:00] really slow down the workflow when we changed from paper to that. And then it was readily accessible. So, I mean, it was, people liked it and it was actually pretty easy to implement. But I guarantee if we had.
David Norris: moved it to where you had to go back to a terminal somewhere, they would have been complaining about it. So that was one thing we, I really considered when I went out and sourced is how little can I disrupt the current flow of that patient encounter yet still get the informatics that we need out of it.
David Norris: So,
Erik Sunset: To me, that’s an area where the industry at large and certainly won’t name and shame any vendors, but the lack of mobility and then not interoperability in the in the data sharing sense across, you know, general population to be able to take your documentation and workload schools with you and then have that data get back where it needs to go.
Erik Sunset: If it has to go anywhere, whether it’s your core EHR, you know, or to get it [00:11:00] back to your practice when you’re rounding at the hospital. That is a head scratcher to me. And listeners of the show will know I have a long
Erik Sunset: EHR background and you’re, you’re just not giving providers what they really want.
David Norris: Yeah,
David Norris: you’re right. And,
David Norris: you know, it,
David Norris: and anytime you switch a vendor or you change something, there’s always hiccups and that usually creates more problems than, than, than it solves, I think. So, for example, right now, I won’t name a facility, but they switched, where the, the fax server used to automatically scan and, Put the documents into the EMR, you know, it’d become in from outside So if say the physician wanted to fax over their HMP from their office because they don’t have the interoperability For whatever reason it used to get automatically put into the patient’s [00:12:00] chart now It goes to a fax server.
David Norris: Then someone has to print it out and scan it back
Erik Sunset: It’s
David Norris: And
David Norris: it’s like wait We’re going backwards in time. Why is this?
Erik Sunset: Electronic to paper and then back electronic.
David Norris: yeah. So things like that, I think are part of the reason for burnout or frustration on providers parts. They’re like, look, listen, we know what’s supposed to be happening. We know where you want to go, but when you make a decision and we’re not going in that direction, we begin to wonder If you know what you’re doing.
David Norris: I mean, it’s no different than, than like with the patient experience, right? My dad saying, can my, is my oncologist any good? Cause he can’t get the bill, right. You know, are our leaders any good if they don’t own up to the decisions they make in terms of tech and how it impacts us taking care of patients.
David Norris: So. I think that also causes employee satisfaction issues, if you will. [00:13:00] So,
Erik Sunset: Well, obviously we’re, we’re talking about workflows here and how some of them are markedly better than others. I’d love to get your, your perspective and your insight that as you know, you’re set up a hypothetical, you’re a practice, you’re shopping for a new, a new EHR, a new software. Obviously. Workflow from physician down to staff, down to billing, how it’s actually going to work is a really important factor and a big piece of the ROI. When you look at it, big picture, are you separating out workflow from the overall ROI of an investment? We’re talking about businesses here. They’re businesses that help people and treat patients, but a business nonetheless. So you have people ask, Hey, I’m, I’m shopping. This one costs. This one costs X, this one
Erik Sunset: costs Y, and this one costs Z. How do you walk folks through that process and sort of triage what makes the most sense?
David Norris: yeah, I think honestly,
David Norris: I think
David Norris: if you’re going to seriously go look at an EHR or any sort of [00:14:00] tech, you need to go beyond what a salesman tells you. You need to go physically look at that piece of technology in. In live wild function, right? If you will, you know, I don’t, I usually don’t buy car sight unseen.
David Norris: I want to touch him. I want to see him. I want to drive him. I think the same thing, you know, you need to do with an EHR. And you know, if you’re not the first client, then they have other clients. And then go spend, take the time and go look at that technology in, in place, working and functioning at another facility.
David Norris: You know, interview the people, ask the people as you are walking through it. How’s this tech working for you? Is it, is it delivering everything they promised? What sort of hiccups are you having and are those reasonable hiccups? You know, nothing’s perfect, 100 percent implementation, I get that. But on the whole, did it make it easier [00:15:00] for you?
David Norris: And I think you need to go, you need to go look at those and evaluate those and lay eyes on those and if not you, someone who actually Is going to be using the technology. If your business manager doesn’t use the technology in the patient room, I’m not certain they’re the best ones to go look at it.
David Norris: I really do think that it takes a clinical provider who’s going to be using that tech to actually go physically look at it. And in terms of ROI, I’ve always had a hard time putting a number on tech because I see it as a I see it as an expense, not necessarily as an asset that I’m investing in. Okay.
David Norris: You know, I, I know that’s how you want to sell it, but I don’t own it. It’s really no different than having a subscription to Microsoft word. You know I don’t see how I can get a return on the invest cause it’s not an investment. I don’t own it. It’s not an asset. It doesn’t sit on my balance sheet.
David Norris: It sits on my expense or my P and L. And so, [00:16:00] All I care about is how much value am I getting for that expense? How much headache is it solving for not only my, my providers and the people in my office, but more importantly, my patients, you know, and how does it impact? my patients. And you know, some patients they don’t like change.
David Norris: Some patients do. I’ll give you, as a personal consumer of it, you know, one of my physician’s offices frequent about a year and a half ago, they switched providers and EMR and everything’s online. I don’t have a problem with that, but you know, they want to text you this number on your phone and then they want you to sign these PDFs on a little phone.
David Norris: On an 8. 5×11 PDF, that can be kind of a pain in the butt to read through as you’re trying to figure out what am I signing. So some of those things, I understand why they did it, but at the same time it, [00:17:00] it, somebody didn’t really play the patient role and, and try and experience that. So I think as you try and figure out and source which is better, X, Y, or Z, I think you got to look at all of those and variables and say, how is it for the patient experience?
David Norris: Does it make it easier for them? Can anybody do it? Does everybody have to have technology in order to use it? I know everybody probably has phones these days, but not everybody. And then what’s, what’s that impact on my, on my staff? And then at the end of the day, how much headache do we really have?
David Norris: What were the reviews when I talked to the other clients of those companies? And then pick the one that has the most features at the best value for you. And and go from there. I think the other thing is some people, you know, they get, they get afraid of switching costs, right?
Erik Sunset: Rightfully so.
David Norris: and you know, that is a thing, but sometimes you just have to rip the Band Aid off [00:18:00] and move on, so
David Norris: it’s just, those are the, that’s how I would, how I counsel guys is just go and look at it, get your hands on it, look at it, which one do you like the best, you know, you know, call support, see what the support team’s like, that EMR, can you get through how quickly did they respond to you when you had an issue or someone else had an issue, those are all the variables I think you need to look at and like I said, I don’t buy the ROI, it’s an expense, what’s the real value on buying.
Erik Sunset: That’s a, that’s the first time I’ve heard that expressed from the, from the physician’s side, Dr. Norris. And you’re right, I mean, how much of investment is it really if Medicare will reimburse you less if you don’t buy it? Sort of a compelled expenditure in some ways.
Erik Sunset: So going a step beyond the, the selection process.
Erik Sunset: And again, I want to be totally clear. I am no longer in the EHR
Erik Sunset: world, but spent
David Norris: Mm hmm.
Erik Sunset: amount of my time in it. When you talk about implementation, it takes time to [00:19:00] learn something new, granted some of the, the funnier anecdotes and maybe only funny to those on the EHR side of the world is you earn a new client, win their business, physicians don’t want to learn it. Physicians don’t train on it, and they get frustrated, and they jam up your support, and they say, hey, this thing doesn’t work like my last one did. Yeah, you got something new now. So what are your words to the wise when you do switch technologies, whether it’s an
Erik Sunset: EHR, or if you’re adding a new
Erik Sunset: technology, how important is the physician role during implementation?
David Norris: Well, I mean, if you’re going to spend that kind of money, you definitely want all of your providers, all your physicians engaged and able to use the technology. I think some people they’ll use it as an excuse not to do something new. Right. And you know, a lot of us don’t like being told what to do.
David Norris: And I think particularly physicians you’re like, I don’t want to be told [00:20:00] what to do. So I I’m just not going to really try real hard at this. So. Depending on your situation, you might try and include some of those physicians, some leaders within the groups to participate and be involved in that decision making process in the selection and then help them.
David Norris: Train the other folks and teach the other folks how to use it. You know, everything’s a little different. Many of the items are different and the buttons you click for the information are different depending on the system you’re in, but it’s not something that’s undoable. You know I think it’s just a matter of some people just digging their feet in cause they don’t want to deal with change.
David Norris: So, you know, when we implemented it, I try to involve and show as many physicians the different options in our practice. I try to get everybody involved, you know, say, hey, which ones do you guys like? This is the one we’re leaning towards, and this is [00:21:00] why. Here are some benefits of the other ones.
David Norris: And then when we implemented it you know, we did it at one site. Got people trained up to use it. And then, and then when we went to the other sites, it was a lot easier. We started small with that change and moved on. So, you know, I. Ours has been, ours when we implement it was relatively easy. And I think probably primarily because it was good tech that had the, it was designed with the end user, the physician or the provider in mind.
David Norris: It wasn’t a big warehouse database or it wasn’t a revenue cycle management system that morphed into that tech an EMR. It was really designed to be a, you know, something. Specific for the anesthesiologist, it wasn’t an afterthought. So I think part of that might have been just we selected the right piece of tech.
Erik Sunset: It makes a big difference.
David Norris: It [00:22:00] does. So
Erik Sunset: So with the, with EHRs, the battle lines have kind of been drawn. You’re probably not buying your first one anymore. You might be buying your third or fourth, and you kind of know what you need it for, what you’re getting into, for the most part. Some of our more recent guests of the show, and you mentioned this actually yourself, around patient experience, patient accessibility is a part of that as well. are the smart practices doing with an eye towards either new technology or refining what they already have to provide a better experience? And this is a little bit of conjecture, as the younger generations start to be responsible for their own health care, you know, we’re looking at an instant gratification world. Amazon Prime, buy with one click. Uber, you get a ride without having to really do anything. There’s a thought, and I’m kind of in the middle on this, but there’s a thought that if I can’t get what I want on my phone without having
Erik Sunset: to call somebody, I’ll just find a practice that’ll give that to me. I’m not [00:23:00] going to work hard or dial a number to get an appointment.
David Norris: Yes, I think that’s true, but I think that’s more specialty dependent. And the reason why a patient needs to see or go to the health, go to the practice, right? You know, if I’m scheduling with my daughter’s dermatologist, I don’t care. I can do it on the phone because every six months we’re going to do a follow up.
David Norris: I can do that on the phone or we can, you know before we leave or after we leave if we need to change it. It’s something that I, you know, I could do online versus making a phone call. Yes, even I would prefer that. However you know, if it’s something that’s probably a little more urgent, I have a kid who’s got stuffy nose or running a fever.
David Norris: I want to get them in. You know, I might want to talk to somebody first to see if I do need to bring them in. Or is it something that I might be able to wait on? Do I really want to spend that money, depending on, you know, what my co pays are, if I have a [00:24:00] high deductible plan, you know, I’m eating all of that until we’re done.
David Norris: So I want to make certain that I really am going to be able to get the best value for my dollars. If I do take a half a day off of work or whatever to bring my kid in and it costs me 150, um, having a triage thing like that and somebody to talk to. I think is important. You know, these robo chats only go so far and I do think, you know, you need somebody on the other end to say, yeah, I do think, yeah, bring him in, you know, today we’ll get you in.
David Norris: You know and then, you know, some things are, you know, Depending on the specialist, you know, what’s the, what did the pathology show? You know, do you have that back? You know, you said you’re going to let us know, you know, in a week. It’s been a week and I haven’t heard anything. You might want to get in touch with a person rather than being accessed at.
David Norris: I have somebody explain that to you rather than just read it [00:25:00] online. Cause that’s what my mom would do is she would read all of her reports with her, her patient portal. And then she’s like, ah, that doesn’t mean what you think it means, mom. Did, did they explain it to you? She’s like, no, my appointments in two days, but I read it now.
David Norris: I’m like, okay, well, all right. You don’t have anything to worry about. It’s just a bunch of medical gobbledygook language. Translation, you’re going to be fine. You’re right. So I mean it cuts both ways, right? That instant gratification, instant access. So where do you, how you find that I think is really dependent upon.
David Norris: You know, the practice, who your patient population is, the type of patient you’re typically dealing with, and the type of information you need to share with the patient and get from the patient.
Erik Sunset: Sure. I mean, that’s, that’s a more reasonable response. And you know, you gotta be accessible 24 seven. You mentioned something that’s a little bit of a dog whistle to me, the RoboChat. More and more of these are being powered by LLMs, large [00:26:00] language models like chat GPT, a lot of talk about AI and in my view, so called AI.
Erik Sunset: Much of this is just machine learning and predictive analytics. At this point, we can get into that differentiation if, if you’d like, but where do you see AI
Erik Sunset: and so called AI leading healthcare or being embraced by healthcare either this year or further down the line?
David Norris: I see it as a, as a, it can be a
David Norris: helpful tool.
David Norris: You know particularly you know, when it comes to drug interactions you know, as patients begin to have more and more, you know, start taking more and more drugs, you know. Before I write a script and then hand it to the patient, if I have AI that, you know, can scan their lists and then say, Oh, you have potential interactions with this med or based on this laboratory value, we might want to adjust the dose so we don’t hit her kidneys or whatnot.
David Norris: I see it. I see that as being [00:27:00] very helpful and beneficial to the provider. In terms of actually trying to make a diagnosis, you know, reading CTs or x rays. I’m not entirely certain that that’s going to happen anytime soon. You know, having AI, you know, look at vital signs in the ICU and saying, Hey this particular parameters changing and when looking at the cohort of data, when we begin to see this trend, we know the endpoints down here.
David Norris: If we don’t intervene soon, right? Catching those things sooner rather than later. In terms of that analytics, I think would be very helpful and beneficial because if you have, you know. a unit full of patients and you’re relying on nurses who are capable, but they have two sick patients, you know some of those little trends can be overlooked or not even seen.
David Norris: Whereas if we can implement an AI or, or some sort of technology that can track and trend those and then flag an alert, by all means, I think, I think that’s what we’re going to do. I don’t [00:28:00] think it’s ever going to replace a physician, at least not in the immediate future.
Erik Sunset: No, I think you’d have really hard time doing that.
Erik Sunset: Just the patient acceptance of that as a reality.
Erik Sunset: And we’re not even talking about the lawyers and actuaries that will really
David Norris: Forgot about them. Don’t know why I forgot about the lawyers.
Erik Sunset: Yeah, right, right. Everybody’s favorite topic. And you’re I think you’re touching on where the reality of AI will be for health care. a lot of times it’s solution and search for problem, but you’re, you’re
Erik Sunset: referencing taking large data sets with known outcomes, feeding that into a model and then applying that to individual
Erik Sunset: circumstance like
David Norris: Mm hmm.
Erik Sunset: in ICU.
Erik Sunset: I think that is a very viable use for it. also kind of touching on another, another area that’s maybe a little forward looking, which is truly personalized medicine where you as a patient determine it’s right to sequence my genes and I will now [00:29:00] know which therapies are going to be most effective for me or which ones to stay away from. I certainly don’t want to pretend to be a physician. I only know enough to be dangerous. Some of the feedback that I hear on that is that in 10 years, we’re going to look back and say, how come, how come not everybody was doing this? It’ll be insane that not everybody’s genome was sequenced so that they know what’s coming down the
Erik Sunset: pike or what’s possible treatments that will be most effective in a given circumstance. Do you have any thoughts on that?
David Norris: I think there’s definite, there’s definite benefit for that. I mean, I know that as my dad was going through prostate cancer, that was definitely part of, part of it. You know, his therapy or an option for that you know, was to, you know, screen those and then determine which ones would be most effective and give him the longest life and the longest recovery.
David Norris: I do think that’s, that’s important. I do. I think, I think you’re going to have a lot of pushback on some of that just cause there’s just so many, I mean, some, you know the privacy issues. And then you know, what happens, you [00:30:00] know, if I have bad genes, you know, do I become uninsurable or do my rates get so high?
David Norris: And I think, I think, Having nationwide adoption on that would be very challenging on those regards. Although, I do think it would be beneficial and helpful. Now I don’t know enough about that right now to speak more than that. That’s kind of outside my wheelhouse of what I do.
Erik Sunset: That’s, that’s fair and I’m probably getting close to my boundary on it as well. That, the privacy aspect is a, is a major concern. What happens when somebody knows how my life might unfold or what the probabilities are for my life unfolding. Insurance to employment, whatever. Certainly wouldn’t want one of the
Erik Sunset: commercial providers for Ancestry to be. Responsible for that. I wouldn’t think.
David Norris: And I think that then goes to the root issue, you know.
David Norris: Are we, the philosophical, you know, thing. What our genes are. Can we be different? Right. Can we [00:31:00] beat it? Can we fight it? You know, and do I get to determine my own health or is it preordained? And I think a lot of people, not many people are going to accept it.
David Norris: It’s preordained. Well, well, well, right. I know I want. So. As someone who
Erik Sunset: maybe, a couple cold ones that would love go deeper with you on that. We can we can come back our core topic here. Technology in a health care setting. I said this before we started to record a doc by the are kind of analogy is that a lot of health care is still on paper film.
Erik Sunset: Yeah, yeah, yeah. So you take your roll of Kodak to the drugstore, you get it developed, and it’s kind of a clunky process. You didn’t know that at the time. You didn’t know there was something better coming. But we’re very much in an era of digital film in essentially all other areas of our life. So, in your view, if you, if you do feel it’s important, why is it
Erik Sunset: [00:32:00] important that healthcare needs to move to
Erik Sunset: digital film all phases, really?
David Norris: treats patients, um, You know, what I do is I put patients to sleep but, and I put all kinds of patients to sleep. Sometimes patients don’t know what’s wrong with them, or they don’t know exactly what a particular event, when it happened, what happened at that event. They don’t know, you know, exactly what’s wrong with their heart.
David Norris: They just know something’s wrong with their heart and they take medicine for it. And I think that if we had something that was far more transferable, like a JPEG, right? You know, you know, upload it to the cloud and then you could interface with it. That would make it a lot easier for providers like me.
David Norris: You know I can confirm what the patient says and dive deeper into that data. Right now what I have to do, [00:33:00] I have a patient that comes from four hours away. For their surgery. So it’s a four hour drive here. They probably spent the night here, came in today for their surgery. I don’t really want to cancel that patient.
David Norris: I want them to get their surgery because. People invested a lot of time and money to get here, yet at the same time, I want them to live. And so that winds up taking up some time and resources on the nursing staff, hunting down reports or hunting down data. If, and that’s the old, like you said, you know, hard copy film, you know, Polaroid, if you will.
David Norris: Whereas if it were more digital and we had better interface some way, somehow I could just automatically have that data. It would make. It would make that a lot easier. And it would be less stressful for me, you know so I, I think it needs to happen. You know, I don’t know what, you know, with all these, you know health exchanges, how far they’re really [00:34:00] going, I don’t feel that much progress has been made.
David Norris: But, you know, heck, even if patients, perhaps what needs to happen is a patient has their own EMR that they maintain that, you know, they keep in the cloud, you know, it’s no different than, you know you know, I’m having a drop box, but, you know, call it a health box or whatever, but they can put in all the forms, they could scan them in or, or email them in there.
David Norris: And then if the system doesn’t interface with the EHR that their physicians are using, they at least could say. Here it is. Here’s a link. Click it and you can download it all and look at it. I mean, things like that would be very helpful and very beneficial, particularly as you know, patients travel across the country.
David Norris: You have snowbirds that migrate, you know, things like that would be. Would be helpful rather than trying to recreate the wheel every time, you know, they go see a new physician or they have something new done wherever they’re at. So, um,
Erik Sunset: our application for
Erik Sunset: AI, too. [00:35:00]
David Norris: yeah,
Erik Sunset: the health box for me and tell me this patient’s history. What do I need to know? They’re going in for this procedure. Where, where’s the danger
David Norris: yeah, yeah, yeah. Find me the last, trend me the, you know, what their
David Norris: creatinine is, you know, and what the renal function is or, you know, read for me the last EKGs, three EKGs. Would they show? Have there been any real changes? Right? Things like that would be, would be helpful. And I think that, that’s where we could make good inroads into better health care for patients.
Erik Sunset: and better, better healthcare, obviously being great outcomes. costs is driven down as well.
Erik Sunset: What are you seeing on the the reimbursement side? What are you seeing on the cost to patient side? What are the hot trends there?
David Norris: Oh my rates are getting cut left and right. Everybody wants to pay me less. So I, for, I mean, for us, at least in anesthesia, it’s, the labor’s getting pretty [00:36:00] expensive. And they’re just sometimes just not the revenue by payers to support the cost of that. So, you wind up working your people longer, harder, and they, they eventually can make a mistake.
David Norris: You know, tired humans make mistakes. That’s just the way it works.
David Norris: You know, so for us, it’s our, the issues we’re facing is really a reimbursement. Everybody wants to cut us.
Erik Sunset: And it’s, it’s really hurting the profession. At least the data bears that out. There are physicians retiring well ahead of whatever that is ahead of the age at which they’re expected to retire, you’re not seeing the throughput through medical schools, at least this is what’s being reported.
Erik Sunset: I’m not feet on the ground to tell you this is absolute. but it appears that we’re, we’ve got an impending slow motion cataclysm for the availability of providers, be they anesthesiologists,
Erik Sunset: primary care, [00:37:00] everybody in
Erik Sunset: between. What do you do to fix it? What, how do you solve for that issue?
David Norris: Well, so, I mean, it’s very interesting because my daughter who is in college is waffling on going into medicine. She. She knows what she’s getting into having a father who’s a physician. She knows what it’s like to be on call and miss nights, holidays, weekends, events. But at the same time she looks out there and she sees the headaches and the hassles that physicians have to put up with.
David Norris: She’s also looking at the cost of just the cost to get the degree. When I went through to today, That cost has gone up probably 450 percent in 25 years. And so, when you roll out on the other [00:38:00] side, you already have a primary mortgage in student loan debt. Unless, you know, you can pay for it somehow.
David Norris: I think for her, she was like, I don’t know if I want to be saddled with that. I don’t know if I want to, you know deal with all these headaches. So she’s, she’s actually contemplating doing something else. I’m not encouraging her one way or the other. I just want her to pick something that she wants to do that she finds enjoyable.
David Norris: But I think the shortage of providers is, is gonna be a real problem. And I think what we need is consolidation. You know at least in the specialties I think you need more PCPs primary care physicians and whatnot out there. I didn’t think those need to increase but I do think we need some consolidation, some of those specialties.
Erik Sunset: Does
Erik Sunset: that mean Dr. Norris rolling something like an nephrologist into one categorization? I’m not sure I follow you on consolidation.
David Norris: I, I, I just, you know
David Norris: we don’t need. A gazillion, [00:39:00] you know, general surgeons, or we don’t need a gazillion, you know, gastroenterologists or orthopedic surgeons. I mean, perhaps we need a few, a, a fewer of those and we need more primary care, you know, and figure out a way to encourage. Those students to transition from the, uh, the higher paying specialists into perhaps the less stressful, not quite as high paying, but perhaps even more rewarding primary care of some form.
David Norris: And I think that the reason, and because physicians haven’t done that, that’s why we’re seeing a rise of of nurses, advanced practice nurses who are. You know, fighting and winning the battle to be practiced independently and, and without physician oversight and because we just don’t have enough of those individuals around.
David Norris: And that’s, that’s I think the crisis in terms of manpower that we’re going to see in healthcare in the next few years. 10 years, [00:40:00] 15 years.
Erik Sunset: Yeah, I’m glad to see that they’re, they’re, they’re winning those fights and the states are. I don’t want to say going along with it, but recognizing the real need that there is a significant shortage. I mean, I’m, I’m down here in Miami, just a short personal anecdote. I waited eight months for an annual physical.
David Norris: Wow.
Erik Sunset: really understand why, but that just seems extravagant to me.
David Norris: Well, you know, providers are selling time.
David Norris: This is what they’re selling,
David Norris: you know, your physician selling his time and he only has so many hours in a day to sell You know, and so and if you don’t have enough providers I Can’t sell more time than I have so you’re gonna have to wait unfortunately, so
Erik Sunset: fair. The supply and
Erik Sunset: demand is pretty basic equation on that one. What else what else is front of mind for you, Dr. Norris?
David Norris: Well, I mean, I, I think that
David Norris: what I’ve been thinking about,[00:41:00]
David Norris: you,
David Norris: know, I serve as a treasurer for the Association for Independent Medicine, and we’re really focused on trying to provide resources to physicians to stay independent. You know, we’re trying to help them build a database of good. Whether it EMR or RCM or whatever it is that they can then find these tools work together as a, as a, as a team.
David Norris: As a or association and really support each other and stay independent and work for themselves, set their own schedule, if you will, or build their own business. What I’ve found is, I don’t, I mean, I do meet physicians who feel burned out, who are in private practice, but they aren’t, they pale in the number of physicians that I meet who are burned out, who have been employed.
David Norris: As I go across the world country, you know, speaking at events and meeting physicians, it doesn’t matter the specialty. Far more of [00:42:00] the physicians that I meet who breast strong burnout or, or those who are employed. And I think it goes to the point you mentioned earlier, they feel a lack of autonomy.
David Norris: They feel a lack of self direction. And I, you know, we’re trained as physicians in med school, you make the decision, you know, you make the diagnosis, you make the treatment therapy, and you implement it, you, you, you, all the way through, until you become employed, then it’s, you know, somebody else kind of looking over your shoulder.
David Norris: Doing everything the way we want you to and I think that’s where that that conflict comes I do still think that there’s a place for private practice and I you know, I and I think like direct primary care Is really coming into? It’s place. I think it’s going to really grow over the next few years and it should I think it’s an interesting model and I know a lot of guys who are making it work.
David Norris: And they have good patient satisfaction. And I think, I think areas like direct [00:43:00] primary care where you’re going to see some cool innovations in technology because you have entrepreneurs who are like, how do I make my life easier? But, you know, provide great care to my patients and we take the headache out of everybody.
David Norris: I think you’re going to see some, some pretty cool advances. I come out of direct primary care in tech.
Erik Sunset: That, that brings to mind a an at least semi viral
Erik Sunset: tweet thread, or I guess now an ex thread. Are you familiar with healthcare’s top deck of the Titanic
Erik Sunset: moments? Does that
David Norris: No, no, I haven’t, I haven’t seen that, but it sounds good.
Erik Sunset: I’ll send you a link to it when we’re through recording. It’s a lot of it’s fairly far fetched and some of it touches on AI and how how something like chat GPT will allow independent medical practices to scale infinitely to those who are willing to separate themselves from the insurance that either their employer is paying for or that they pay for themselves. And, and create this parallel world where it’s all cash pay to call it concierge [00:44:00] medicine, but everything is just a straight up price fee for service is how much this costs. It’s how much that costs. And despite some of the very. Far fetched trains of thought this tweet thread had like decision making being taken from humans and given to software, which I don’t see
Erik Sunset: happening soon.
Erik Sunset: I think there’s
Erik Sunset: a few gems in there that’s actually fairly well thought out, so
Erik Sunset: I’ll get you a link. We’ll
David Norris: Yeah.
Erik Sunset: back and get your
Erik Sunset: thoughts on it.
David Norris: Yeah.
Erik Sunset: I have one more thought for you, Dr. Norris, you mentioned, and we’ve been talking about the, the pendulum swinging back and forth between independent practice and being an employed physician.
Erik Sunset: And this isn’t, this is kind of parallel to it, right? But all of the investments by private equity, all of the money flowing into healthcare, particularly like in the ASC space. That seems to have an actual ROI, like we talked about earlier, in a fee for service world. What happens to [00:45:00] the amount of
Erik Sunset: interest and investment in healthcare if
Erik Sunset: we end up in a value based world than we currently are?
David Norris: Well, so I always have a hard time with value based because I don’t know,
David Norris: I don’t know where you get, where they get their numbers, right? How do you determine what the true value is? You know how do you determine, um, which patients, Um, why certain physicians don’t do better than others and with certain patients don’t do better than others.
David Norris: And I think they’re trying to, you know, we’re spending all this money. We expect excellent diabetes control and excellent hypertension control from you, Mr. Physician. And or we expect no surgical site, you know, infections ever. And if you do, you’re a bad doctor or you’re a bad hospital or ASC.
David Norris: And I, you know, and I think that that’s great, and you know, if you prevent those things, you prevent the cost of the complications. [00:46:00] However, they, they, they leave out one important thing, and that’s the patient. And I, I don’t want to be cold, but When, well I wouldn’t, don’t use Boeing anymore, they’re having issues, but when Ford makes a car, they get to source everything that goes in that car.
David Norris: They source all the electronics, they source the tires, the brakes, the, you know, the steel. And when something comes off the line and it’s wrong, they know why. In healthcare, no patient’s the same. I don’t get to source my patients, or at least I don’t, I’m some sort of people do, you know you know, I’m only taking care of the beautiful, healthy people, but, you know, for me, I see a wide gamut of it and it becomes very challenging to ensure that the exact same outcome is going to happen every time.
David Norris: Particularly with those individuals who really. They don’t do the best in taking care of themselves, right? Everybody [00:47:00] knows you shouldn’t smoke. Patients every day tell me I smoke a pack a day. I’m like, okay, you obviously know that’s bad, but you don’t want to quit. Yet, you know if you have a complication, it makes me a bad doctor.
David Norris: You know, and there’s some, some things I can prevent. And then there are others where it’s just probability. and you’re rolling the dice, you know, and if you have enough of those comorbidities, you know, eventually you’re going to come up snake eyes and you’re going to have a complication. And, you know, I, I think fee for service is great.
David Norris: And trying to move to this value is, I think you need to really look at the patients and see, maybe I get a modifier for, you know, a patient who’s 500 pounds, because that is a very complicated patient. And I, you know, they just are. They’re hard to monitor, they’re hard to take care of, they’re hard to move throughout the system.
David Norris: And maybe I should get a modifier, or I [00:48:00] should get a little grace or something. But, uh, Yeah, I know private equity is moving to ASCs, they’re just, I think they’ll be in there for a while, and then they’ll realize this isn’t for us, and we’re gonna bug out. Because I’m already beginning to see them exit from physician practices.
David Norris: You know, I’ve, I’ve known some practices, some friends who got gobbled up and then like five years later, they’re like, yeah, this, this, we don’t want to be in this business anymore. We’re going to sell you or we’re going to get rid of you or do you want to buy yourself back? So I, I, I don’t, I, I think it’s going to, the pendulum is going to go the other way here.
David Norris: Yep. Yep. Yep. Yep.
Erik Sunset: to my knowledge, isn’t a line item management line of business. It just,
Erik Sunset: it isn’t. So we will see.
Erik Sunset: I was just going to say, if we, if there weren’t any other thoughts to share, which if you had one more, we’d love to get it.
David Norris: Oh, [00:49:00] I mean, no, it’s just I think
David Norris: healthcare is a great profession and we do good work. We just need tech to help us make that job better, easier and more beneficial for the patients. Cause that’s really why we’re in it. And you know, we adopt tech if it helps. And if it doesn’t, we push back.
David Norris: I mean For example, in anesthesia, end tidal capnography, you know, capnography, monitoring end tidal gases the pulse oximeter, huge step forward in safety and anesthesia tech readily adopted. You know, I think more and more after COVID, I started using video laryngoscopy all the time. I have a little camera at the end when I intubate patients.
David Norris: I use it all the time now because I think it’s safer and more definitive. It’s easier. That sort of tech, I think, you know, and if you can put that into the chart some way, somehow, or [00:50:00] the interface with the patients, it’ll be adopted all day long. You just got to figure out what that is. And that’s the, that’s the hard part.
David Norris: But, um, now I don’t, I don’t think physicians are anti tech. They’re just anti don’t make my life harder.
Erik Sunset: You’re so right. And all of the utilization data of the softwares that that I’ve been a part of over the years, it’s there’s an interesting split between smartphone use. It ends up being 96, 97 percent iPhone users for our physicians and then that 3 or 4 percent for Android. Virtually all of our clients have a Facebook profile.
Erik Sunset: They’re all virtually Amazon Prime
Erik Sunset: subscribers. So there’s certainly no aversion to technology. There’s
Erik Sunset: an aversion to bad technology, as you
David Norris: Yep. Yep. That’s exactly right.
David Norris: And I think if we could
David Norris: I was going to say, I think if we,
Erik Sunset: interrupting you, please.
David Norris: I think if we could encourage physicians to get more involved in that space and help design that tech,
David Norris: [00:51:00] particularly the user interface, you know, what feels good, what works well, you know rather than, you know, they just push it out without any real, well, what feels to be no real end user input, I think you could get a lot of physicians interested in that as well as make some nice advances.
David Norris: in the development.
Erik Sunset: on this, on this split that the, the legacy software vendor in the space, so think of your big EHRs. physicians, we’re doing everything that we can. But when Medicare says you have to capture all of these data points and we have to make them an inputable field in our software.
Erik Sunset: We’re doing the very best that we can for you. Is there a better way to capture that data, or do the requirements need to change, do you think?
David Norris: I think the requirements need to change.
David Norris: You know, some of these things you wonder why, why do you need to ask this question to every patient who’s coming into the surgery center for [00:52:00] you know, a hernia surgery. You know, that question bears no benefit to the providers or the patient. It’s just a box to be checked.
David Norris: And I think if, and I think if you, you look at the data points and say, what really needs to be asked in what situations, if you begin to, Rather than blanket, everybody has to ask these questions, or we have to check all these boxes no matter what. And you begin to really kind of say, well, it’s not really relevant in this situation, we won’t require it.
David Norris: You know, if they would have put thought into it, and have somebody there that actually knows, and put some thought into it, you probably pair that down quite a bit, and then it becomes an easier thing. And then I think the big guys might, um, be able to design or redo their software so that it’s not just clicking a box to meet a metric.
David Norris: And that’s frustrating. Nobody, everybody hates that. Nobody likes to check a box just because of a metric.
Erik Sunset: Well, and it’s not just check a box, but it’s check [00:53:00] a box on this tab, move to the next tab, find your dropdown, check this
Erik Sunset: box, go to the next tab, and all the way down the line until you’re at the end of the note. That’s,
David Norris: Yeah. And, you know, I’ve seen,
David Norris: I’ve seen some software where they push that to the patient on the front end, right.
David Norris: You know, and part of the patient intake questionnaire
David Norris: and, you know, sometimes patients like, I don’t even know what you’re talking about. So I ignored it. Right.
Erik Sunset: Yeah, right, right. But, it happens.
David Norris: yeah, big government gets in the way a lot.
Erik Sunset: Well, because you said it, I won’t be shy to say that you got to love the federal government getting so micro into a physician workflow for, for what benefit
Erik Sunset: exactly, what tangible
Erik Sunset: benefit does that bring the patient or the provider or the healthcare
Erik Sunset: facility?
David Norris: Yep. Yep. So,
Erik Sunset: Well, on that, on that rosy note would, would
Erik Sunset: love for you to share Dr. Norris, where can our listeners find more of you, social media, your website, where, where can folks link up with
David Norris: [00:54:00] Oh, yeah, sure. I’m on LinkedIn. David Norris, MD, MBA. Facebook, David J. Norris. And My website is DavidNorrisMDMBA. com. They can learn about me the consulting and speaking teaching that I do. They can learn about my books, and they can find my books on Amazon and Barnes Noble. If they’re interested, so, you know.
David Norris: And then if they want to shoot me an email, it’s pretty simple. Just David at DavidNorrisMDMBA. com.
Erik Sunset: Easy
Erik Sunset: as that. We’ll be sure we get all those links into the
Erik Sunset: show notes for our listeners. Any final parting thoughts before I read us out here? It’s an
David Norris: nah, I mean, just I’m glad to be a physician. I enjoy it and I just want to help other physicians
David Norris: regain the reason why they went to med school.
Erik Sunset: it’s an important message, especially in 2024. Well, Dr. Norris, I want to thank you for your time on behalf of the entire DocBuddy team. And thank you [00:55:00] to everyone out there in podcast land for listening. Be sure you’re subscribed on Apple Podcasts, Spotify, and YouTube. So you can always get the newest episodes of the DocBuddy Journal.
Erik Sunset: And until next time, I’m your host, Erik. Talk soon.