On today's podcast, we are featuring Doctor Anne
Meneghetti, the physician executive at Apocrates.
That's right, the app we've all loaded on our phones but have
let go dormant. Guilty.
But she's going to have you updating the app or re
downloading it on your phone after this episode.
Trust me. But before we get into this
episode for this month, I wanted to tell the NPS about signing up
for the TDC's group live webinar titled Risk Realities and
Insights into Medical Liability Exposure for Advanced Practice
Clinicians. It is on October the 23rd and
you earn one hour of CME credit while gaining valuable insights.
As advanced practice providers gain greater clinical autonomy,
their exposure to malpractice risk grows.
Register today. Link in the show notes Attention
all nurse practitioners and MP students.
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Hi Success NP, your host here, Sandra and I am joined today by
Doctor Anne Menegetti. She is an MD physician executive
who leads the medical information team at Upocrates.
Upocrates, as you may know is a widely used mobile medical
reference application that provides healthcare
professionals with access to clinical information, drug
information at points of care. So Anne has medical training in
internal medicine, pulmonary medicine, critical care
specialties, and she's also worked in healthcare policy
before joining the Hippocrates team in 2006.
Her team curates clinical decision support tools for
moments of care. Welcome to the podcast, Anne.
Thank you for having me, Sandra. Yeah.
Well, we're so excited to dive into what you do.
And again, she's Anne with an E, which all those people that like
Anne of Green Gables know that that's the best way to smell
Anne. Barring my daughter, that's the
only one that gets the pass. OK.
So tell us a little bit more about your clinical background
and your role at Epocrates. Sure.
I had those three board certifications really digging
into clinical practice at in internal medicine, pulmonary and
critical care. And then it was one day I was at
in a clinic and waiting for the next patient to arrive.
And I started thinking, how many patients am I going to see in a
day, in a week, in a year, in a, in a career?
And I thought it's a small number, even though I calculated
it out on the back of a prescription pad.
I thought this is just a small number and I wanted to make a
bigger difference in the world. And so I thought about three
ways I could do that. I thought about teaching and I
thought about medical research and healthcare policy, and I
thought those are ways I can really make a big difference.
And I tried all of those. And in the end it was really the
job at Hippocrates that I found out about where a million
clinicians could benefit from the information that is put
together for use at the point of care.
That really was my dream job. And when I read the job
description, I thought there's probably people who are Better
Business people than me, better at technical expertise than me,
people who are better clinicians than I am.
And yet when I saw that job description about gathering
information for clinicians to use at the point of care, I
thought there is nobody who is going to be more passionate
about this role than I am. And I was intent on getting that
role and I've been here ever since 2006 at Epocrates and now
I lead the team that I joined so many years ago.
It was my dream job. Wow, wow.
That moment of inflection, that moment in your career where you
decided how can I create the most impacts and then getting
that opportunity, you know, kind of presented to you call it
luck, call it divine next steps, but I love that it started with
a seed of how can I create maximum impact in my in my
career. That's so neat.
So for the listeners that might be new exactly is Epocrates if
they've been living under a rock and don't know, I mean, it's,
it's everywhere, right. So what are its main features?
Kind of walk us through with the with the Epocrates app does in
itself. Sure.
So it's a critical decision support app, which just simply
means when you have a decision to make at the point of care,
where do you go for support? So it's a an app on mobile and
web that's used by over a million healthcare
professionals. And for 10 years running, it's
been the number one mobile medical app by outside surveys
in terms of usage. And the, the main core thing
we're known for is drug information, drug prescribing
information, safety information, drug interactions.
And what clinicians tell us when we interview them by self report
is we ask them like how much time do you save by using
Epocrates? And we also ask them, how has it
improved the safety of the care that you give in terms of
avoiding medical errors or adverse events?
And we do this survey every few years.
And what nurse practitioners specifically tell us when we
asked them this question is that they self report that 30% of
them say they save an hour a day.
Wow. More administrative and practice
time by using Hippocrates, which is huge, which is more than is
reported from physicians using the app.
And then another quarter say that they save 30 minutes to an
hour a day by using the Pocrates and 50.
Percent, I mean. I mean, I don't need to tell you
how precious that time is, you know, to be able to see another
patient or two, to be able to finish your documentation on
time, to be able to get home to your life, that's precious time
in the life of a clinician. So that's pretty impressive.
The other value prop is about avoiding medical errors.
And in that same survey, when we asked nurse practitioners how
many errors do you think you avoid or adverse events, let's
say from prescribing the wrong drug or whatever, about 1/4 of
nurse practitioners reported that they save about 3 errors or
adverse events per week, and another third said they save
about one a week. So that idea that it's helping
you practice more safely and that it's saving you time are
those are the 2 value props I think that have made the app
most valuable to clinicians. And in terms of what they're
doing in the app, nurse practitioners are looking at a
lot of drugs, antibiotics, drugs for anxiety, pain management,
depression, allergy, asthma, heart failure, etcetera.
They're looking up a large number of drugs and drug
interactions. When you think about it, EHR can
help avoid like some of the most serious drug interactions if
something would be life threatening if you gave 2 drugs
together, for example. But what Hippocrates does is it
gives practical actionable information.
For example, it'll say if you give this drug with that drug,
you should half the dose of this drug and watch for the potassium
level. Monitor that.
So it's more specific and actionable than you would get
from San ER and well gives more actionable details.
In fact, nurse practitioners as well as other clinicians say
that of all the content and Hippocrates, what is most likely
to change their prescribing decision is those drug
interactions. So it's a real value.
Then in addition to the drugs, we also have other content.
We have disease information, diagnostic information, clinical
practice guidelines, we have laboratory interpretation and
other things. And yet our drug information is,
I think the best in the world. So it's what's most used about
our. Yeah, one of the value adds too
is the stress, because as you are in practice and you're like,
OK, I don't know what to give. I don't know how to give it, you
know, or even going home and ruminating that you didn't make
the right call, you didn't make the right decision.
I know that feeling. And so I was thinking as you
were talking like, and this would just alleviate stress too,
not the time. Not just, you know, being able
to do other things, see more patients, but also just the
stress of having a second opinion back behind you, kind of
helping you make decisions because it becomes again,
there's an art in medicine, right?
We're all making kind of specialized decisions.
Yes, they're clinical guidelines that you follow, but there's
some nuance all within those different things and decisions
that you make. And so I just felt like another
value add would just be it would kind of lower the stress.
I'm not as worried because I researched this and looked it up
before I made that decision. And it's anticipating things
that I may not have thought of, which is always is the fear,
right? It's such a confidence boost.
In fact, there's a story I wanted to tell you a few years
ago. I was speaking with a nurse
practitioner at a conference in Boston, and she uses Epocrates.
Epocrates Plus, the premium version of the app.
And she said to me something that has really stayed with me.
She said a physician might feel comfortable just acting on a
hunch or making a clinical decision, just going with their
gut or trying something unconventional.
But she said that she feels most confident when she is aligning
her clinical decisions with the highest standard of care.
And she would use Hippocrates Plus to research her decision
and get answers very quickly, within seconds.
And then she would she'd actually chart it.
She would put in her documentation.
I used Epocrates to make this decision about this path
forward. And it gave her this kind of
confidence that she was doing the best thing for her patients.
And so citing Epocrates in her notes and documentation was her
way of really reassuring herself and anyone else who might be
interested in looking at that record that she was doing the
best to align with, you know, a trusted source for her clinical
reference. And I was really impressed by
that, and it really resonated with me.
When you think about it, we all carry around a lot of knowledge
in our heads, things we've learned.
We've knowledge we've gained from our own experience.
We've learned from our problems. Yeah, we've learned from our
patients, you know, but sometimes the reason to consult
Hippocrates is simply to reassure ourselves that we're
doing the right thing. Yes, that's what I thought it
was. So it's not always a big
learning experience. It could be simply a
reassurance, yes, that is the dose of amoxicillin for this
aged child and that's that's a comfort.
So I think that's a really important value is just that
that reassuring ones. You know, this also brings up
the idea of sometimes we do need to understand what is the the
expert opinion or the best way forward when there when there is
uncertainty. Let's take something as simple
as cough. Very common reason for office
visit. You know, a cough could be an
infection, it could be asthma, could be allergies, it could be
post nasal drip, upper airway cough syndrome, neosilic
asthmatic eosinophilic bronchitis.
It could be cough from ACE inhibitors.
It could be so many things. And then for some of those cough
conditions, there are good treatments, but for a lot of
them, there's not really, you know, for a typical cough from
say a cold or something. And so it's good to know like
what have experts done to look at all the evidence, to look at
the what evidence is out there scientifically, but also bring
to bear their many years of clinical experience together and
form a consensus opinion and put it together in a clinical
practice guideline that is precious.
So nurse practitioners especially we've noticed really
value that medical society imprimatur of yes, this is the
guideline that we have concluded is the best standard of care
based on everything. So in a poverty is what we've
done is take like those clinical practice guidelines.
They might be 80 pages long in a PDF and we distilled them down
into if your patient has these features, this is what you
should do according to this guideline.
And sometimes the different societies have different
viewpoints, you know, like let's say on something like Pap smears
or mammograms. The American Cancer Society, the
American Society of Clinical Oncologist, ACOG, American
College of Physicians, They may differ in their opinions.
So you know, we present a synthesis of them and say like,
well, these two say this, these other societies say that and you
tailor it to whatever your patient needs.
But being able to take all of those really lengthy guideline
documents and distill them into something very quick is kind of
one of our specialties in Epocrates.
And I think that's one of the top secret features of Epocrates
that I think some people don't know about is the clinical
practice guidelines, synopsis and synthesis.
Epocrates in general, we aim to give answers in like 90 seconds
to questions that people have at the point of care.
So taking something like multiple society guidelines and
distilling the down into that 92nd experience that you can use
with a patient in front of you is really precious.
So we hear from nurse practitioners that they
especially value this kind of guidance.
It gives them a great reassurance.
Other MD's and other clinician types also really value those
society guidelines. Wow, I did not know that about
the Apocrates app. And that is a game changer
because in clinical practice, even now, I can tell you that
the NCCN guidelines for urology and the PA guidelines are very,
very different. And so sometimes certain
physicians will have these memorize and that's what they go
off of. And we'll go into the chart and
we're like, wait, why are we doing this this soon?
Shouldn't we? But they're following a
different set of guidelines. And so again, what you're saying
is so critical to practice as an MP because you kind of never
know, again, like that ardent medicine, they're all kind of
doing their own thing. And sometimes you need that
reassurance that what you're doing is the right thing.
What you're doing is, you know, referencing back to this point,
it's not my opinion. I'm not making this up.
This is coming from sources bigger and greater than me,
which again from a clinical guideline, from a legality
standpoint, all the things that we are worried about in
practice, they really bar to help support the nurse
practitioner as they're making decisions.
Especially in specialty clinics where you have an 80 page
document that you're reading in between patients.
It's not realistic. It's not a realistic expectation
that in between seeing patients you're going to be able to find
the thing that you need in that moment on the 80 page PDF.
So it is nice to know that Epocrates has that has bridged
that gap for us in practice. That's, that's excellent.
Can Appocrates be used to educate patients?
Because that's another big part of I think the nursing model.
Our nursing model is very heavily reliant on the patient
education standpoint. I mean, when you're a nurse,
you're really in the trenches. And then once you get into the
nurse practitioner role, yes, you're working on the medical
model in a way of diagnosing and treating, but you still have
that nurse heart of wanting to educate.
How does Appocrates help with that?
Yes. And 1st I want you know, my
mother was a nurse nurse, my sister is a nurse now with a
doctoral degree. And I have so much respect for
nurses and I know that when they become nurse practitioners, they
bring with them that patient centric approach which adds a
lot of value to the care that they deliver.
And you know one of the ways that we attune ourselves to
needs a nurse practitioners is by talking to them.
So even though we have physicians and pharmacist and
other clinicians on our team, there's no way that we will know
what nurse practitioners need unless we speak to them.
So we do countless interviews with nurse practitioners as well
as other clinicians to find out what is it they need.
Do they need checklist? Do they need Cheat Sheets?
Do they need algorithms? And we continually refine our
app in order to meet their needs.
I think one of the things that we've learned from nurse
practitioners is if they value medical news about updates that
are relevant to their practice because you're not going to look
up something if you think you already know it.
So let's say a guideline has changed or a new drug is out or
a new side effect of a drug or a new lab test is being
recommended. How will you know about that if
you never are, you know, looking up that topic?
So we have a medical news feed that nurse practitioners seem to
consume with greater interest than some of the other clinician
types. And we keep people updated on
practice changing news related to common clinical problems.
And I think that's one way that we have a model of sharing
information outward rather than just being a source where people
come to look for answers. Sometimes you don't even know
what's changed until you hear about it somewhere.
And so we filter out the news and bring together information
that helps support awareness of practice, changing news.
So that's, I think another element.
One of the other things we've learned about nurse
practitioners particularly is that nurse practitioner students
are very interested in alternative and healing
modalities, whether it's homeopathy or herbs and
supplements or acupuncture, Ayurveda from India or Chinese
medicine. There's a real interest there.
And I'm curious if you have any ideas about where that comes
from. But we've noticed that they have
an openness to it and they're wanting to incorporate it when
possible in their care. So I can only speak from my
personal perspective and I'm not speaking for all nurse
practitioners, but I do believe that there is a proportion of
nurses that are beginning to wonder if medicine and all
medical treatments, is there a way that we can do this for
cheaper, maybe have the same benefit and not have the patient
lifelong on medication. At least for my own personal
practice, I've been feeling that way more and more and I think
it's growing in the younger generation as well because I
think that we have been force fed and spoon fed a certain this
is the only way to get things done.
And I think that we're beginning to question that model in
general. Like is there another way that
you might be able to get similar benefits and maybe combining
therapies, maybe this for a short period of time where we
get you out of the psychiatric issue, but then we take you here
and we treat you with acupuncture so you can live a
life not on medication. I think that we're starting to
question if just the one-size-fits-all medicine
approach, it is as good as individualized care.
And I think that that's maybe what's starting to wake up.
At least it's starting to wake up in my own practice because I
think again, one-size-fits-all approach to everybody get in the
clinical guidelines only treat this way.
I believe, again, I think the majority of maybe that
generation, that new generation of NPS is just going, what if
we've got more options? What if we can do something
else? What if this is just as good and
half the price? I'm just wondering if that's
maybe what's starting to spring up and.
Newer providers. And that's so interesting that
you said that because I personally would love to take an
herbs class or recommend these things and be able to offer
patients another form of therapy that I'd have less side effects.
Maybe they can't tolerate that drug, but this works just as
well and doesn't come with this or that or maybe it doesn't work
as well, but if you had it with this, it could work.
It can synergistically improve the benefits.
I'm just thinking for myself that that could be something
that might be growing in the hearts of nurse practitioners
because again, we're at the bedside and I don't think we see
people getting necessarily better.
I just think we're learning to manage chronic issues.
We're learning to manage longer. And I'm wondering if we're kind
of wanting to push back on that. I mean, at least for me
personally in my own just I don't know what else do you
what, what are some theories you might have as healthcare
providers? Every single second counts,
especially when you're making critical decisions.
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Offer Code Success Apocrates is the clinical information you
need at your fingertips. I do think that because of the
pace patient centric approach, it's I guess not totally
surprising that the nurse practitioners of the future
might be more open to what their patients are interested in.
Because sometimes it's coming from the patient who's
interested in an, a way to not be on drugs.
And what, what we can do in Hippocrates is, for example, we
in our premium app, we have herbs and supplements that can,
can, for example, help understand if if this herb is
taken with this drug, what's going to happen and what side
effects might occur. Because I think clinicians when
faced with a patient who is saying, can I try something
natural instead of a drug or a surgery or other therapy, they
want to know, one, are there, are there going to be any, you
know, side effects or, or is it, is it safe?
Is it is it safe to give, but also is, is it effective?
Is it going to do anything for them?
And then three, will it interfere with other things that
are going on with that patient? So, and a lot of clinicians have
zero training in natural forms of healing and it's only through
maybe their own experience or learning from their patients
that they even know about some of these things.
When I was taking some herbs at one point, I felt nervous
telling my doctor that I was doing so I was a little shy
about explaining that I was taking some herbs because it
just seems, it seems so foreign to the, the medical model.
But I, I do think that consumers in general, patients are more
and more interested in natural forms of healing.
And that's going to come through think it's great when there is
evidence. Often times there isn't because
a lot of the natural healing that's done is very tailored
uniquely to a person. Like for example, in the
Ayurvedic medicine of India, they'll take, take your pulse,
check your features and tongue and so forth and come up with a
very tailored prescription, if you will for you.
But that might not be the same thing given to another patient
with that similar symptoms but who has a different constitution
or whatever. So it's hard to do clinical
trials on these, on these types of therapies and it's difficult
to gain that sort of placebo control randomized trial that we
tend to rely on when it's a drug, for example.
But it was just an interesting finding to see that interest
among nurse practitioner students.
When I read that the the drug aspirin is either formulated or
it's got a component of the Willow bark, you know, herb.
And so yeah, I found it very interesting as I was reading
about that and just thinking like, whoa, like what dropped us
from over here Willow bark to now aspirin?
Like what steps happened in between and were the effects of
those chemical changes from Willow bark to here.
And so I just I got a patient's ever come to me and been like,
Oh yeah, I have back pain and I'm taking Willow bark tea or
whatever. Like I would have been like,
wait, what? But then when I learned that
this is where they're basing this, how many other drugs are
based on a similar supplement over here, that they've changed
the name, marked up the price and created a bunch of side
effects and now they're calling it this name.
And now everyone, this is what everybody knows, but it's really
based on this. And so I find it just super
interesting. Just between you and me and just
the four walls, you're talking that it is, I think newer nurse
practitioners are are more interested in like what?
What are the other options? What if somebody can't tolerate
that and you can give this, is it safe?
What are the ramifications? What are the things we have to
be thinking about? I think it is so cool that your
app is starting to incorporate that into the knowledge that
it's giving its practitioners. I think that's incredible and
really, really valuable. What are some features that you
think that every NP should be using, but maybe overlook and
practice? So you kind of shared, hey,
listen, you guys don't know that there's clinical guidelines on
this app that helps you make decisions in practice that is
supported by the big governing bodies.
What is something else that you think I don't sleep on a
Pocrates? This is what's going on.
Yes, I think another under appreciated feature is pill ID,
the pill identifier. And a lot of times patients will
be saying I'm taking this, you know, pink pill or this green
pill with a line down the middle.
They don't know what it is. And one of the things that I
used to do in practice is I would have my patients brown bag
it once a year and literally put, put all the herbs,
supplements, everything they're taking in a brown bag and bring
it to me so that I could go through it and see what are they
really taking? Because the records that we have
have don't always reflect everything they're really on
over the counter, etcetera. And the pill identifier is a
great way to, if they have their pills in a case or whatever and
they don't have the bottle to sort of see, oh, there's this,
this is this symbol and this number on it and look it up and
find out what it is. We've had great stories from
EMTs who have found a patient with a fistful of pills in a in
a comatose situation and been able to use the pill identifier
to quickly identify what is it that they took and give remedial
treatment immediately in the field.
It's a great tool and it's fun to use and I think it's one that
people would really benefit from.
Yeah. So is it like a scanner where it
like you pull the pic I. Wish it were a scanner.
It's more that you, you open it up and then you'll say like a
lot of pills have a a. Letter or remember?
Yeah, yeah, yeah. Remember.
And then, you know, is it a capsule or a tablet?
Is it scoring? Is it not?
And you put in those features and then they'll say these are
the possibilities for that pill. I would like it to be a scanner,
yeah, but not at the moment. OK, at the moment.
All right, All right. We'll see if you guys build that
out. So for a nurse practitioner,
that's like, all right, I've got Apocryphes free version.
OK, you're trying to take my monies, my dollars to get the
Apocryphes plus sell me on it. Tell me, tell me what the
difference is and is it worth the upgrade?
Yeah. So I think if you if you do just
one thing all day long and you're seeing exactly the same
kind of patients and treating the same conditions, you become
expert in that and you don't need a lot of help.
Yeah, you might be curious about like some other clinician is
prescribing this or diagnosing that, you might want to learn
about it. But I don't think you need
Apocrates. Plus, if you are really doing
repetitive same kind of conditions, a lot of nurse
practitioners are seeing a wide variety of patients,
increasingly wide variety of conditions.
And so we noticed that for nurse practitioners, emergency
medicine or they're seeing a lot of patients, any kind of primary
care that it's very, very helpful if you want very quick
answers. So if you want to do deep
research and dig into all the clinical trials that have been
done, you know there are better references out there for
research. But if you just want an answer
in the moment, 90 seconds or less, then Epocrates is going to
be helpful to you. So the free app has drugs, drug
interactions, the pill identifier.
It has formularies that tell you what for a given health plan,
this is the coverage. Do you need to do step therapy
first, do you need to get prior authorization, et cetera.
It gives you all those details. It also has calculators and risk
scores. For example, if you're
prescribing A statin, you know, what is their 10 year heart
disease risk to know whether you want to go high or low or medium
for the statins. And that's all part of the free
app. The clinical practice guidelines
are part of the free app as well as the medical news feed.
So all those are part of free. And then if you go to the
premium level, then the disease reference comes into play.
And there's where you have, you know, over 1000 topics and we've
chosen topics that according to the Athena clinicals EHR are the
most common reasons for office visit.
So you're going to find things like, you know, cough and
various skin conditions and mental health conditions and a
lot of commonly seen things and it'll take you soup through nuts
through how do you diagnose? How do you treat?
How do you monitor and follow up and manage patients?
How do you prevent? So there's also a lot of topics
that are about like a, a sign or symptom like red eye, patient
has red eye. What could it be?
How do I proceed in diagnosing it?
Or abdominal pain, you know, how many patients come in with like
pain in their joints and like what is it?
So those kind of very helpful diagnostic and therapeutic
options, treatment options are there in the diseases reference
in our premium map. So the guidelines are part of
free, but the disease, the full disease reference is part of the
premium map. And we also have, do you guys
have? Adult and children?
Or is it just adult? Yes.
So some of the topics are are the same for both populations
and some are broken out As for adults and for children.
But yes, it's and, and older persons as well.
It also has an infectious disease treatment selector in
the premium map. So if you just want to quickly
know which antibiotic is good for which condition in which
population, it's a very another quick, concise way to get to an
answer for antibiotic treatments and antiviral treatments.
The herbs and supplements reference are part of the
premium app and a laboratory reference.
So somebody comes back with abnormal liver tests or thyroid
tests. How do you interpret that?
What are the next steps in terms of diagnosing and etcetera.
And also I CD10 codes, those are all part of the premium app and
it's really well suited to people in primary care who are
seeing a lot of different conditions.
Yeah, no, exactly. And that's where nurse
practitioners are really taking a stronghold, isn't that primary
care setting, Right. It's just not lucrative for
physicians to go into primary care.
And I think that based on the amount of time they're in
school, the amount of debt they're incruing to go to, you
know, it's just there's a huge primary care gap, especially as
the population of America is getting older and older and
we're seeing this baby booming generation moving into this
geriatric, you know, time in their lives where they need
primary care. A lot of them have been telling
me because I work in specialty care, I don't have a primary
care doctor. I can't find them.
There's nobody there. She was there, then she left
that she was complaining that she was overworked and she left.
Like this is what they're saying.
And so NPS are stepping in these gaps.
And so to have a resource to be able to get you an answer in 90
seconds that you're seeing a patient is, is huge.
So can you tell a story of how this is helping in, in the
clinical setting? Like, all right, so she comes
in, she sees a patient right then and there, she types it
into the app. Like how do you incorporate this
into your daily practice? You can tell a story of how a
nurse practitioner made a quick clinical decision using your
your app and practice. So I think that the most common
clinical decision that nurse practitioners make is which drug
to prescribe. So they might have a question of
me make sure, I think I know the dose of this.
Let me make sure are there any cautions, communications I need
to be worried about? Are there any side effects that
I need to consider and maybe inform the patient about?
Is there monitoring that I need to do?
Do I need to check the creatinine clearance, etcetera?
What do I need to do before prescribing that drug?
So I think that drug prescribing is probably the most common
reason. And even when people think they
know, it's that reassurance factor that we spoke about of
the confidence of knowing. Like, yes, I checked.
And we find that clinicians use the app in front of the patient.
Typically they're pulling it out of their pocket.
And you might wonder like, doesn't it make you look like
you're an idiot that you're having to look something up?
But we find exactly the opposite, that patients like
seeing their clinician using modern technology on their
behalf. So they welcome seeing
clinicians like I'm checking this.
And sometimes, you know, they'll show the patient what they're,
what they're looking at, if it's like an image or a diagnosis or
something like an image of a, of a certain condition.
But most of the time it's so cryptic to the patient that they
probably wouldn't be able to understand it if you turn it
around to show it to them. But like if or if patient
patient asks, like I have this side, I have this situation.
Is that a side effect of the drug I'm on that quick look up
is probably the most common way that nurse practitioners use.
And then as that, as that nurse practitioner in Boston told me
her story about how she uses it to document, I used Hippocrates
to make this decision when relying upon it as a clinical
reference. For example, people having
looked at a guideline or having looked at the diseases reference
to sort of confirm that the decision making is aligned with
with best practices. I do have a story of this was an
MD, not a nurse practitioner, but a physician who who I know
well who he was called in to see a patient who had severe
hyponatremia. His sodium levels were so low
that he was symptomatic and in he was put in the ICU for days
and they couldn't figure out why is his salt level so low.
And so my friend walked in and before he even saw the patient
he opened up a chart, took his list of drugs and runt ran it
through Hippocrates for drug interactions and found that a
drug he had just been put on a few days ago was causing a drug
interaction that led to a low sodium in his blood.
In under a couple of minutes he was able to say this is your
problem. They took the patient off the
drug and he went home. So, but there's just so much
power in having an app that has synthesized all that information
for you and can deliver it up in a few seconds to solve clinical
problems. What you're talking about, and
I've noticed this in practice too, is the fact that patients
are more open to the use of devices and artificial
intelligence and knowing that we don't know it all and we've got
resources to find the answer. And I feel like they are so open
to that and they're so thankful because ultimately what
Apocrates is helping all of us do, and I get kind of goosebumps
and emotional about it, is provide good patient care.
To provide care that at the end, what we signed up to go into
this field, which was to care for people, it allows us to do
that in the best possible way, in a way that is outside of
ourselves. It's acknowledging that I don't
know it all, I don't have infinite capacity, but that I
know my resources. And I think that that is
absolutely invaluable. And I think that patients are
beginning to realize and they appreciate a provider that goes,
I may not know this 100%, but I know where to go find the answer
and where to go get it. And that might actually help me
think about something that in my mind I didn't piece together or
I didn't know or I didn't recognize.
And this app is helping me help you.
And I think patients are so receptive to that.
And I agree with you what 100%? And I agree with you 100% with
what you just said. Everything you just said is so
aligned and it's what I have noticed.
I actually use a device to help me write my notes and it saves
me. The patients are fine with it.
They're like, Oh yeah, go ahead and use that.
Like they're totally fine because they know this helps me
save time. I'm going to make sure I'm
hearing everything that they're saying.
I can actually pay attention to them and not feel like I need to
be torn, that I can actually kind of TuneIn and make a
decision without having another thing going on in the
background. Cuz there's so much going on.
And it's nice to quiet the noise on a couple other things to stay
focused in on the mission, which is let me hear you.
Let me see if I can help you come to some of the answers so
we can get you the best care, so we can help you feel better, so
we can help solve this problem. And I think, yeah, Apocrates is
just another tool in the nurse practitioner tool belt to help
them do what it is we went into medicine to do.
Yeah, exactly. By the way, ambient listening,
everything. Ambient listening has just
changed everything. What a pleasure it is to
actually communicate and make eye contact with a clinician
rather than having them buried in their near EHR.
You know, a lot of clinicians call Epocrates their peripheral
brain because it's not just that you can't know everything, it's
that you make a conscious choice.
I'm not going to waste my brain power memorizing how, you know,
8000 drugs interact with 8000 other drugs.
It's there's no point. It doesn't serve me and my
patient. So it's a conscious decision to
use technology to support your decisions, give you confidence
and deliver better care. And I think patients are using
technology in their lives and it's not surprising that they
want to see it being used on their behalf in the in the
clinic, yeah. It's funny because it makes me
think of a pilot on a plane. Like I want a capable pilot, of
course. But at the same time, I like
that there's autopilot too. Like if a pilot needs, you know
what I'm saying? Like here's that, it's there.
It's just we want to land the plane.
You know, it's that's my name concepts in, in medicine and in,
you know, working as a nurse practitioner, we want to land
the plane and the plane is patient care, getting them the
results and you know, the things that we need.
So I think that's good that you are able to give an example of
how to use it every day in practice.
Don't be afraid to pull it out. Don't think like, oh, I got to
wait till the patient leaves, then go Google and then I have
1000 other questions that I didn't get to answer.
I think patients are really receptive to you just pulling
out of pocketies the app right then and there, talking to them
about it. So you can integrate it
seamlessly in your practice and make it easy and it's easy to
use. So I think that's great, right?
So for a new NP grad about who's going to be integrating, you
know, apocryphes in their practice, kind of where do you
see the best time to kind of start integrating the app into
your workflow? So is it at the beginning of
your, you know, appointment before you walk in the door?
Is it maybe what we talked about just in the middle, like, hey,
just whip it out in the middle of seeing a patient?
Or is it better to kind of integrate at the end of the
clinic visit? Where do you find?
Most people are integrating it into.
Their in our research with nurse practitioners, we've seen it
used before, during and after patient care.
So what we've heard is that a lot of them like to review.
They, they look at their patient list for the next day and
they're reviewing here's this weird diagnosis.
I, I'm not familiar with. Let me, let me see what that is.
Or this patient is coming back, you know, we're called to for an
urgent appointment because this isn't working, sort of looking
things up in advance related to diseases guidelines, etcetera.
And then during the visit, it's certainly very commonly used
when it's like someone says I have a side effect or a new drug
needs to be prescribed etcetera for all that prescribing
support. But then patients often as you
know, come up with things during the visit that we're not exactly
on their intake form. That's a one more thing I've
been having this. And so that's another time when
it's sort of pulled out something you didn't expect to
be dealing with during that visit arises.
And then afterwards there's information that during
documentation, if it's not done live, where clinicians look at
it again or just to validate. Yes, I think that that was
right. I made a good decision.
So we find it that nurse practitioners use a properties
in all three before, during and after a visit.
But I think where it shines most is during the visit because it's
rare to have a reference that you can get an answer in 90
seconds that doesn't disrupt your flow with the patient very
much. But we share it being used in
all three situations. Yeah, I was thinking too, when
you're in clinical practice, especially as a new NP, you've
got to go find someone to ask the question and that takes
longer than if you than 90 seconds, right?
Finding a provider fighting another MD and experienced MD or
another experienced NP to be like, hey, I'm seeing this, this
is new. I had a question like that
sometimes will take minutes and the patients in the room waiting
for you to go find someone to spitball or maybe sideline, hey,
what do you think about this? Which sometimes we have to do
Like that may not help with all of that, but it could take a
level of that off that you're like, as a new grad, I can just
reference this, get an answer and then maybe even verify like,
hey, I'm going to do this. I looked it up.
I think this is the best course of action.
Do you agree or disagree? That's a whole different story
than if you're presenting the case, asking for their opinion.
You have no thoughts of your own because you're new and you're
just figuring it out. But Apocrates can help have you
kind of come into the room with a plan and then get a
confirmation. That's a quicker conversation to
have with a provider that then gets the answer to the patient
with like, Yep, I was right. That's what we needed to do when
Apocrates helped me. But yeah, you get what I'm
saying. Like I can see that clipping,
that time issue as well as in UNP because that's what you end
up doing, right? Can you, can you tell me where
you see Apocrates in the next 5 to 10 years going?
I mean, look in your crystal, you know, and just tell me this
is where I hope to see our app, you know, do we have that
scanner that that pill scanner? What?
What else do you see maybe coming down the road?
Yeah, I would like to have that pill scanner.
So I think that one of the things that we can do for people
who rely on Epocrates is provide education credits just for using
the app because you are learning even when you're confirming.
So I think that education credits would be a wonderful
addition to Hippocrates. And I also think that we're
going to continue to do research on what are the needs and what
ways to serve up the information, for example, using
artificial intelligence to get to the right answer.
So I think there's still concerns that people have about
like if I get an answer from an AI bot, can I rely on that?
Do I have to go dig into each of the references and really verify
that this is true? But when it comes to using AI to
navigate and get to an answer quickly, if Pocrates already
does it very well. But we could do even better to 0
in, you know, more instantaneously on an answer
rather than having people click, click, click, click, click.
I think that's a really great addition and answers the next
question that I had about features that you can add in the
future. And I think that I'm really
inspired and excited to see what new things that Pocrates adds to
their app. And I will definitely be using
mine a lot more than I have been after this conversation.
I think you've definitely eliminated a lot of things that
I didn't even know Apocryphes was bringing to the table.
So this has been awesome. Thank you for your time and any
final tips, must know tips that you have for NPS and where they
can follow your work at Apocryphes.
So. Apocryphes.com has all the
information, including links to download for Android and iOS
devices, as well as our web product of course.
And consider signing up for the newsletters.
We have newsletters that go out called the Epocrates Scan that
really highlights some of the practice, changing news that is
most important and a guideline, updates and things like that,
that I think nurse practitioners will appreciate.
So those are the main ways. And then try out various
decisions, support references and see what saves you time,
what gives you confidence and what helps you practice more
safely. Try them out.
And I think that if you're really looking for something
that is very quick and very tailored to a wide variety of
situations that you have in primary care especially, that
you'll find that there's a lot of value in the Hippocrates
platform. Yeah, I agree IA 100% agree.
Well, we at the podcast, did you say, did you describe where
people can find you? Hippocrates.com.
Follow your work. I think you're think you're on
LinkedIn, right? Yes, I'm on LinkedIn.
Me personally. OK, yes, we'll put we'll link
your your profile on there in case somebody wants to reach
out. Apocrates has a social media
Instagram account. So hopefully we'll be when we
launch this episode, we'll be able to link them and all the
stuff and make people can click on their Instagram profile and
stuff like that and follow. Perfect.
All right, so at the podcast we do a rapid fire set of
questions. And Are you ready for rapid?
Fire I am ready for rapid fire all.
Right, let's do it. So if you had to pick a season
to live in, which season would you choose?
Out of the four, which one's your favorite?
It's your autumn, no question. Autumn is beautiful, it's
cooling and it's makes me reflect on life.
Such a reset. Well, nice.
And then if you had to pick your favorite color, color the whole
world in this color, what would it be?
Sky blue sky. Yeah, it's peaceful.
I like that color. Yeah, that's a, that's a good
pick. So for the last question, it's
not really a rapid fire. It's kind of a deep, it's a deep
dive, but it's one that I've been reflecting on a lot more
and more as I've gotten older and we at the Success NP
podcast. So we're focusing on what does
it look like for NPS to be successful?
But I wouldn't know what defines success for you in your life.
What does it look like? I define success as making a
difference in the world. Yeah, yeah.
That's good. No, It's one of those things
where kind of going back to the beginning of your story when you
were talking about making impact and how do you maximize impact.
And I think sometimes in healthcare, you think, and we
are making a difference in every single patient's life when we
interact with them and treat them and take care of them.
But I love that you have this global outlook of how do I make
and maximize my my impact for more people.
And you're doing that at pocketies.
And I think that the what you guys are putting together is a
top notch grade A product to help NPS in their practice.
And I'm so happy to have you on today.
I'm so glad you were able to share what it is that you're
spending your life creating to maximize your impact.
I think it's incredible. Thank you so much, Doctor Men
and Getty for coming on the podcast and sharing all of your
wisdom and what you're doing to maximize the impact of
Apocrates. And thank you for having me.
I wish your listeners every success in their profession.
Thanks for tuning into another episode of Success and P.
We hope today's discussion has shed some light on the diverse
career options or taught you how to improve your clinical
practice as a nurse practitioner.
Remember, whether you're considering a specialization,
pursuing advanced certifications, or exploring non
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Until next time, take care, stay curious, and keep advancing your
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Bye for now.