The Honest Conversation Your Practice Needs to Have About AI

Doug Flora: Let's kick it off. We're gonna do a series for you guys over the course of the next year or so, talking about the realities of practicing community oncology, which is getting hard, where the majority of patients are treated, and what's happening with digital health, AI, technologies, the pressures that we're all under from burnout, from being overwhelmed by patients, by trying to reduce the distance between what we know is possible and what's actually delivered in the community where the hard work happens. Hi, everybody. We're glad to have you today. This is gonna be a fun hour.

Hopefully educational, but certainly entertaining. And I'm Doug Flora. I'll be our moderator and emcee of choice for the hour. On my left is my good friend and compadre Sanjay Juneja. You know him as the Onk Doc.

He is ubiquitous in oncology as a master of education, and is really leading the charge for driving smarter cancer care. To his left is Clint Taylor, who's our industry executive. We need your input too, because I think what we're gonna be talking about are how do we find the partnerships instead of a vendor, vendee relationship, and so we really wanted to have Clint involved. And then my dear friend, Emily Touloukian is our first guest, and I probably don't need to introduce her, she's sort of oncology's Katie Couric. Everyone loves Emily, so we had to have her here for our first thing, but Emily is a practicing oncologist.

She's president of Coastal Cancer Center, she's a COA board member, former, I guess, past president of South Carolina Oncology Society, and the founder of No One Left Alone, and we'll get into some of that. So, let's talk real stuff. So, we are seeing the doubling of cancer patients by 2030. We are 2,200 medical oncologists down in The United States alone, and we're a very well developed country with great access to cancer care. I won't even get into what happens in other countries.

We're gonna have a million nurse shortage, and about 23,000,000 survivors that will need continued care, so the math doesn't math there. So for me, there is a compelling burning platform right now. Maybe that's why I'm the pied piper, I'm out there banging the drum more than anybody ever wants to see Doug, because I'm the patient, and I'm the doctor, and I'm desperate for these changes to happen. I do not see these solutions coming out of academic medical centers, and I have many, many friends that work there and do amazing work, but I also have worked inside those walls, and it's not fast. I'm at a hospital practice, and we're darn nimble for a hospital practice, but it's still committees and committees and committees, and sometimes it's not the clinicians that are limiting factor, it's well intentioned people who are protecting the hospital, protecting HIPAA, those sorts of things.

This is where we get excited about community oncology in this series. I want your take on this because if it doesn't happen in your office, it doesn't happen anywhere because I think your practice is an exemplary place for care delivered close to home, in people's bedroom communities, by people who know their families and care about them. Maybe talk about how you process this because you are the person who has to mind the store, has to be sustainable, your nurses and your MAs have to feel the love, your doctors have to not know they're being changed, but you keep your eye on the bigger prize. So tell me how you're doing this and still likable and kind and trust because I'm not pulling it off like you are.

Emily Touloukian: I mean, it's incredibly challenging, right? This is not a, you know, the math does the math as you said. This is a very challenging problem to solve. What a great problem that we have so many more survivors, right? That we're doing so much better in cancer care, that we have all these survivors.

But at the same time that we have all these survivors and all these patients that we need to take care of, the workforce shortage is very real, and I think everybody in medicine feels that. I think a lot of other industries feel that as well. And for me, putting the patient at the center and always making that the focus of everything we do is how you get it done. And you talk to your patients and you talk about the patient experience. And I genuinely care for every single one of my patients.

I feel them right here. And I think if you keep the patient at the center of what you're doing and think about what they're experiencing and what they're going through with every decision that you make and every initiative that you implement, you can't go wrong. But you have to maintain that focus and with the stalwart effort, you cannot stray from that. And if you do that and you're making decisions because of the patient, you can't go

Sanjay Juneja: wrong. And for adopting this technology, do you believe that AI, which is just talked about so much and I love it and almost hate it, you know, just for how much it's been done.

Doug Flora: We all do.

Sanjay Juneja: Do you believe it has the potential to be as catalytic, not as, more catalytic and transformational than any other piece of technology that's entered our world? Does it have the potential that actually justifies the hype?

Emily Touloukian: I really think it does. AI can mean so many things, right? But I think that where it has the real advantage for practices is time saving the busy work. You know, the scut work that we all did in residency and internship to really give us hours back to be able to be physicians and to spend time with our patients and do the things that we were trained to do. I really think that does exist.

Sanjay Juneja: And there was no hope for that before. Like everything was more and more and more work, less, less, less patient time. So you're saying, you know, this is the one opportunity to actually reverse that and bring back, and that seemed pretty hopeless a few years ago.

Emily Touloukian: Yeah, and I think that we just need to make sure that we're focusing on the right things and the right solutions and the right problems so that we are improving efficiencies, we are giving doctors time back, not just creating I more

Doug Flora: want to just sit with that for one second because Sanjay, you nailed, for me, the trust part. I'm there. I'm in. I'm all in. I've been reading about this stuff for eight years.

I wrote a book about it. I run a journal that does nothing but vets these tools, and I'm a couple years ahead and I'm telling you guys that this isn't passing. I mean, the AI hype is under hyped, as ridiculous as that sounds, and the pace of change, we're now cramming ten years of drug discovery into one year. We're now able to do these gigantic corpus of knowledge assessments in seconds to identify drugs that used to take $1,400,000,000 in ten years and a thousand PhDs. So, cheer for this because this is bringing solutions.

Every problem I feel as a community oncologist, you and I talk about, I wake up two hours behind every day. It doesn't matter what I do because I'm drowning in data. 144,000 articles were indexed last year to PubMed for oncology. Now I read it online, and it's analyzed for me. The statistical analysis, every journal article I read goes into my Claude co work and I have a project built to help me analyze this as if it's a journal club.

Saves me hours a day. Emails. We hate emails. You don't have to do emails anymore. Building an AI agent is a minute.

I'll send you the prompt. So, I think when they get in the sandbox, they'll see that and the trust nurtures and develops a little bit more. And to Emily's point, the stakes have never been higher. We are drowning and we say we need help and it's here, you have to recognize it. You have to embrace it, just like we did when we learned immunology again, or just like we did when we learned genetics again.

That was a heavy lift too. I wasn't a strong immunology med too at Ohio State in 1998. I'm an immunologist now, right? Oh, yeah. Yeah, so I think that's great.

Well said. I'll tell our audience, we're recording this backstage at COA, where you've had an incredibly busy week. You put together an amazing meeting centered around innovation. Can you talk to us at the national level? What is happening around community oncology that you're excited about?

We saw some cool stuff the last couple days. I've been blown away by some of the presentations.

Emily Touloukian: Yeah, this has been an incredibly fantastic meeting. Our theme is innovation in practice, and we thought it was incredibly because community oncology practices are set up for innovation. We are set up to make changes quickly, to be nimble, to implement new technologies. And I think the really wonderful thing about innovation in community oncology is that we can actually do it. I can go back to my practice on Monday with an idea of something new that I want to do, and we can do it, right?

And if I look at one of these things in the showcase and I go, You know what? That's it for us. Let me sit down with that person. Let me talk to where are you already working, what practices you're working with. Let me talk with those folks.

And I think that that's where community oncology is really great. There's no gatekeeping in community oncology. Know, if my practice needs something and I can call Deborah Pat and I can say, How are you guys doing this? And she'll share the information with me about that without holding anything back. I can call several people around the country and get different opinions about different tools.

And that's where I think immuno oncology really excels because we all are working together towards the same goal and we want to prevent practices from the missteps that we've taken, and we want them to have the same success that we've had. And in this era of innovation that is just moving so quickly, right, just turning over rapidly every three weeks, I think I heard a statistic that the volume of medical knowledge doubles, what, every three months?

Doug Flora: Yeah, it's 73.

Emily Touloukian: I mean, it's incredible.

Doug Flora: Just read that.

Emily Touloukian: So it's trying to do that part of being a physician and running a practice and taking care of patients while the technology innovation is happening at nearly the same rate, maybe even faster. And marrying those two things is really hard to do in isolation. So, I think relying on our community of community oncologists and my other team members and colleagues, you can't beat that value. It can't be replaced.

Doug Flora: You're innovating at the speed of practice because you have to, and I can't do that in a hospital center. I've got so many committees, and my place is so much more nimble than an academic medical center that has eight chieftains, you know, where you've got a physician group and a hospital group, and so it's gotta happen in the community. That's why we're focused on community oncology for this. I guess from a clinical standpoint, this is something maybe for Clint too to hear as a guy who spent his life around the software. The other difference now is that AI is not just a general purpose technology like electricity or the steam engine or the internet, where it can be applied in any vertical.

It is an inventor of inventions. It's getting better in nine days, not getting better in nine months. And so that's really, really hard for clinicians because we have a trust issue too. We don't love black boxes. We don't love the possibility of a hallucination, which are getting smaller and smaller every month, but for you guys, it's really, really important to us, I guess maybe I'll ask Sanjay and Emily on this, that term black box gets thrown around and you're making treatment decisions that are life and death, and probably we haven't gotten to the point that clinical decision support is fully formed.

It's better now than it was six months ago, for sure. But talk a little bit about what that means in your practice because I think we need a little bit more explainability, right?

Sanjay Juneja: Yeah, that, and I would argue, I worry with nomenclature because clinical decision support. Now what does that mean? I think all of us have a different definition even of it. But to your point, there are some low hanging fruit, so to speak, indications where, you know, even clinical decisions in the sense of of working up, for example, is is potentially in agreement. So you need certain stains, h and e stains, and pathologists that are general pathologists have, you know, a lot of difficulty knowing what to stain it for, and, oh, now I need, you know, HER3 is a stain that's gonna be, you know, coming out in the future, as well as the molecular thing.

So there's that level where you can use natural language processing and a rag system to go up with the guidelines. But then there's this whole other layer that I worry personally people are jumping to too fast, is this is how you should manage the patient. But if we thwart everything that has to do with just surfacing an IHC stain that's missing or a molecular pattern because we use the term clinical decision support in that circumstance as well as the one that's telling you what to do and being wrong, then I worry we have this major delay because that burn is very echoing. So that's a lot, you know, in about a two minute explanation, but I think it's important to think about.

Doug Flora: That was entirely too long. It's cool. You know, talked to your friend of mine, Deborah Pat, we mentioned her earlier, and and we've had these conversations ad nauseam about that specific thing. And the nomenclature is clumsy right now because we really don't know. It's the first inning.

We don't have any idea what to do, but Deborah loves to mention Nudge Theory. Right? And you've heard her talk about this, this Richard Thaler book, if you haven't read it, it's fantastic. But talking about choice architecture, I think that's where digital health can really help. This patient hasn't had a restaging CT scan in five cycles.

Would you like to order one? This patient hasn't had next generation sequencing since her original diagnosis four years ago. And those aren't necessarily easy to characterize as standards of care for everybody because they're always nuanced. She might live two hours and forty minutes away, again, right? But I look at it as a copilot, and don't make my decisions for me.

I still wanna be the chef that tastes the food and seasons it, but help me get to that point. Be my copilot just like you have with AI on an airplane, watching all of those different devices and telling me what's happening and telling me, here 's noise, here's signal, and I think some of the best products that are out there are calling that out, and it's not really necessarily helping me make decisions, it's reminding me of something that might be buried in the chart, that I don't know about, hey, this patient has a DPD deficiency detected four years ago, before she transferred her care to you, do you want to think about your Capcitabine dose? Hell yes, I do, right? Yeah, and so maybe for you guys, it's

Sanjay Juneja: For germline testing that hasn't been done in a Yes, might. Mean, little things, you know?

Emily Touloukian: I think that's incredibly important. And I like the nudge theory. I like the co pilot. I like that sort of analogy because I really think that's what we need, Because that decision support tool isn't gonna know they live on a boat three hours away or whatever it is, and they're not gonna know that, hey, no, this patient adamantly won't take anything that'll make them lose their hair, you know, or they've got this life event that they wanna be at how we construct patient treatments around that all the time, right? And so, you often hear, know, are you worried doctors are gonna be replaced by AI agents?

I really don't think so. I think that AI agents and clinical support tools will help us to have these nudges, these co pilots to help us be more efficient. But I think in the end, medicine's a very human profession. It's very relational. It's very much, What are your goals?

What do you want out of your life? I tell my patients all the time that it's my job to make sure that they understand what's going on and what the options are, and then we decide together what's best for them. It may not be the textbook. It may be an every four week treatment instead of every weekly treatment. It may be that they choose this path because it's oral and they want to travel and go on some trip that has been their lifetime goal and their life expectancy isn't gonna be as long as we would like it to be.

And so, I really don't think that that human part of it will ever really be overtaken. But I think that it can be augmented and that we can make not better decisions, but maybe more well rounded decisions and be reminded about things that we may not have in the forefront of our mind at every given moment.

Doug Flora: We see radiology's a couple years ahead, probably 70% of FDA devices using AI are in radiology or pathology right now, and there was a little pushback initially, in my center, and we instituted a tool, an AI tool, and we got our first year data, and it's crazy. The number of potential cancers and cancers we detected with that, helping them over read. So, still radiologists are reading, but it puts a red bar around this box. Pay attention to this area. If it's green, it's good, you know, like a negative D dimer, no PE, right?

But the yellow box, you spend some time on, and I think they love it, and we now had a significant, I wanna say twenty seven percent uptick in our detection rate, and our callback rate didn't go up at all. So that's an example of leveraging the technologies to assist in very nuanced, very difficult things, and most of the reds are not cancer, and say that's a vascular malformation that looks suspicious to a computer based algorithm, but that's not cancer. And that's the mix, right? That's the magic for us as we do this. I'm gonna ask one of every guest, and for us, if you had sixty seconds to address to every community oncologist leader in the country, what's the one thing you would tell them about navigating this moment from your experience as a senior leader?

Emily Touloukian: I really think that the best thing any community oncologist can do in this environment is make sure you have a strong network. I think that's where I benefit a lot. It's from other practices' experiences. It's from asking advice about something that I'm investigating. And it's easy to do.

If you don't have a strong network, it's easy to build. It's easy to build at meetings like the COA meeting where we are right now. Community oncologists, as I alluded to earlier, we very much want to help other community oncologists. So, building that network is not as challenging as one would think it would be. So, I would say make sure your network is strong and use your network.

I think that's where a lot of people sometimes fall short is, oh yeah, I know that person. Ask them. Know? There are so many of us that have niches that we are interested in and an expert in that not utilizing that network is everybody's to detriment.

Sanjay Juneja: Yeah, that's beautifully said. I think maybe an extension of that is there is so much to be done in oncology that's really concerning when it comes to staffing. You talk about this all the time when it comes to the needs and everything that's happening everywhere. I think it is so important that, you know, if there was a culture of like physicians do physician things and, you know, tech partners do this and pharma does this, and administrators do this, that we have got to dissolve those barriers in the biggest way possible because there is plenty of challenge to go around. Like, there are so many things that we have to tackle that's going to take working with one another, figuring out and workshopping and building these tools as they should be done.

You know, in my opinion, sharing data so we just get more intelligent about, you know, the things that are coming out and the drug design and how we can better serve our underrepresented populations. I think we need to lose, we just need to dissolve the silos. And in a world that's very accessible and very, you know, communicative now in so many different ways, like, you know, that's key to having a brighter future.

Doug Flora: I love it. Clint, same question to you that we ask Emily. Speaking to your industry colleagues, right? You've been out there, we've established, you and I are the old guys. A lot of younger guys out there that don't have our scars yet.

Maybe if you could speak to people who are developing the tools, are desperate to meet the Emily Touloukian's or the Deborah Pat's of the world. What advice can you share with them that you've learned when you earned those scars? Can I

Clynt Taylor: answer that second? Can I answer the first question first?

Doug Flora: No. I think it's great.

Clynt Taylor: I can do it in less than sixty seconds.

Doug Flora: Oh, we got time today.

Clynt Taylor: On the first one, I think that that I would be encouraging people to use And I know it might sound like you guys are like, well, of course everybody's using it. But I run across people all the time that really haven't ventured into it. Something happens when you start to use it. You have these moments. Your mind broadens.

You start to imagine what it can do. You start to experience some of the limitations. And I think often we're having conversations with people and and I'll say, which LLM do you use? What what tool do you use? And they're like, I haven't really gotten into it yet.

And I think my first thing would be to do that because it's gonna be difficult to even imagine how that get in the sandbox, that's But we really have to know our customers and we really have to study that, and we really have to be able to listen and and imagine what does our solution look like sitting alongside all of the other constraints within a practice, whether those are people constraints, whether they're organizational constraints, the way the organization is set up, the way that the the payer mix, all the things that have to factor into a solution of any kind, gotta you think about all of that no matter what you're bringing in. So I think that's probably the biggest thing. We will we'll feel not only will we be much more valuable to a practice when we walk in, we understand the context, our solutions will be much more relevant. So, that's what I would say.

Doug Flora: So, you know, I talk about this inventor of inventions, and maybe the thing for me that's most interesting is the the pace, right? You know, and we're we're leaning heavily into this stuff, maybe faster than all of us are ready for, but you see the necessity. And for us, maybe the bigger picture is how do we embrace the pace, but still be responsible, and I think you and I both know our jobs as executive leaders is, you know, we're stuck where we have one foot on the dock and one foot in the canoe, and maybe talk about how you've adapted that. You certainly did it well during COVID, right? You had to adapt, and clinical trials got opened in two weeks.

Now it's four months, six months. How do we bring back the urgency that exists after the emergency left us?

Emily Touloukian: I don't think we have a choice but to adapt at that rate. When we talk about the things that we do at COA with legislative changes and physician reimbursement and some of the things that are threatening the existence of community oncology, I think we have no choice but to continue to expand at the rate that technology is expanding and to adopt those things to help us be able to stay relevant and to have community oncology in the future. We've been good at that. As you mentioned, with the COVID-nineteen pandemic, we were very nimble. We were able to institute new solutions and new ways of getting patients in the clinic.

We didn't close a single day during COVID. Our clinic was open consistently. Our patients got care every day, and we figured out how to make it work. For a while, we actually drew labs in a tent in the parking lot. There was so much uncertainty in those early days, but we decided we were going to do that.

And I ordered a tent on Amazon, and it was delivered the next day. We started drawing labs in the parking lot and having people drive through, and we did telemedicine adoption very quickly. But you're absolutely right. That was because there was this sense of urgency. There was this thing that was unknown, that was threatening to us, threatening to our patients, and we made it work.

And now, as we see, really the threat is to community oncology practices and our patients if we don't stay in existence. So, adopting these technologies is really essential, I think, for our survival in the long run.

Sanjay Juneja: But it's not like the days of having, you know, a piece of software you're purchasing or, you know, a scanner. I mean, there's a lot of things involved when you make a choice when it comes to these AI tools and data. Clint, if you will, like, walk us through really some of the considerations that maybe early on, physicians and leaders weren't necessarily, appreciating in terms of complexity of really what a commitment it is when you're doing something that relates to sharing your data and how AI is gonna be integrated into a practice.

Clynt Taylor: You know, I think one of the biggest paradigm shifts for us today is that for someone like me who has my whole career been in software development, you you think you have a problem figured out, you create a product for it, and then you go find someone who needs that product. It's super product centric. But all of that's changed. If we don't take the time upfront to really understand what are the challenges, we're gonna miss it because we're gonna be back to product selling. And I think that we have passed beyond that because my my colleague and partner often says software is dead.

He's not the only one saying that. But that's because that concept is is passed. So I think the real adjustment we have to make as companies is to approach it really from understanding the business. With that, you have to have a partnership to do that because you have to trust us enough to say, let me tell you what my real challenges are, or I don't even know them. You're gonna have to help me uncover those.

Sanjay Juneja: We're gonna

Doug Flora: have to do it together.

Clynt Taylor: Yeah, we'll have to do it together.

Emily Touloukian: I think one the interesting things about the community oncology space is that your decision maker is often a user. True. Right, almost exclusively. And that can be of a tremendous benefit to the company if you're talking to the person who's gonna decide whether or not you're gonna operationalize a platform in the clinic, it's actually the person who uses it. And I use this in my clinic all the time.

If I have a new technology that I want to pilot, I pilot it, And so, that I can kind of start working out the kinks before I present it to my entire group of physicians to say, I think this is something that's valuable. And sometimes I palate and I go, You know, that's not going to work for us. You know, thank you for your time, we're going to go a different route. Sometimes it's a great product and I say, Hey, you know, this is going to work really well. To make it scalable, to make it integrate, these are the things we need to modify.

And that, I think, is really where the vendors have an advantage in talking to community oncology practices because we are the end users and the decision makers.

Doug Flora: Yeah. Emily, the reason I really wanted to start this series with you specifically, I mean the Katie Courth thing in the highest praise because I feel like she's authentic and trusted, and I think the decision for us, we have three community oncologists here. 've all seen 28 patients a day, we're all completely overwhelmed and doing our best, and very empathetic people. I know how Emily leads. I think the first decision about AI is trust, and part of that is relationships, part of it is getting a general understanding of the tools so that you can make, you can vet better.

But tell me, in your office, because you and I had similar practice, I have five cancer centers, I think you guys have about the same. How do you communicate this amount of change doctors? You have legacy doctors there like I do. They've been there twenty years, and they are deeply in the weeds, and they can't come up for error at all. How are you doing the trust part?

How do you do the change management to say, help me help you?

Emily Touloukian: Right, I think a great question because even if you have what you think is a great solution, if you can't implement it across your practice, you're not gonna get buy in from your doctors, it's not gonna be successful, right? Even if you think it's the best thing that you've ever had. And I think that that's very individualized, and I think it's very relationship based. You know, I have a really wide range of doctors. I have some that are more seasoned and some that are new to practice fellowship.

And some of the more seasoned physicians are a little more skeptical to adopt new technologies. They've been doing something a certain way for thirty or forty years, and that's the way that they do it. And I think that taking ownership of the initiatives myself, really piloting them first, and sitting down with people and saying, This is what I would like to bring to the practice. What do you see as pain points? How can I help you implement this and implement it well?

That's not always easy and that takes time and it takes some creativity sometimes.

Doug Flora: But you're great at that. For the audience that's just listening while you're working in the kitchen or typing things, Emily said seasoned and then she looked directly at me not Sanjay, which I'm not very happy with because I know what seasoned means. We're gonna say mature. Wise. Maybe not.

All right. Well, maybe a question to follow-up on that. How are they receiving that message? Because I think I have the same thing. I have some doctors who are very efficient with their notes and they are not interested in Ambien, and Ambien is the talk of the day, right?

I have physicians who think that their current methods are doing awesome, but you know as a practice administrator that they might be under or over billing accidentally without tools that might help. And so, some of these are things that are being pitched to us three to five times a day. How do you moderate the voice? Because you're the voice of reason, but you also have to bring them along at the pace that's comfortable for them.

Emily Touloukian: Right. And we've had a couple hurdles with that. We've had hurdles with our pagers. We finally were able to phase those out when the phone company that we used stopped supporting pager services, and that was how we got rid of pagers. We got rid of transcription services because one morning we came in and our transcription service said, We are no longer providing transcription services.

So, I said, Here's your dragon, and here we go. Here, we're going to do this. We'll get some training. But again, I think it's continuing that conversation, making sure that people are comfortable and providing the support they need to make those transitions, I think, is really critical.

Doug Flora: We're going to have to participate. I can't get out there, and you and I talk on the road probably every couple weeks about this, begging the companies like involve clinicians in your build. Don't solve the wrong problem because I feel so badly for these companies to put millions of dollars into product, and it is like the ninth or tenth thing on my list, and I can't even get to number three. And they've got a decent idea, but maybe I'll talk to you about it in 2028 because I've gotta solve patient experience first, or you know, some other major glaring problem that their tool doesn't do. But I can't have it both ways.

I say, put clinicians on board when you're building the product, get them on your scientific advisory board, and make sure that they're doing user interface, and that you're understanding how important it is to work in the background seamlessly and not interrupt our flow because it's destructive to do so, and we can't convince our doctors if it makes their day worse, it has to make their day better. So I would say one of that. The other one that's really hard for you guys, and I know you came from the IBM days and product is product. Everything we do doesn't make sense, and in a good way, in a most human being way. You do this really, really well, because Sanjay and I talk about patients all the time, but I may have a patient who the algorithm would say, this is weekly Taxol.

It's the therapy of choice, but the algorithm doesn't know that she lives on a houseboat two hours and forty minutes away. And she insists that it's me because we're sort of band of brothers, we've been in it together, she's not gonna change doctors. They love their oncologist. Even my pharmacist will come up like, why are you giving this patient Doxil? She hasn't even had a taxane yet.

Well, she's incurable. She loves her life on the boat and she's unhappy when she's not on the lake. And so, we pick a twenty eight day regimen because it's the human thing to do, bioequivalent, you know, for for this lady's survival. She's gonna get taxol next. How do you teach the engineers that?

Right? Because that's what they need to know and that's not what they're wired for. So maybe that's your question for you guys on the builder side, how do you get the oncologist to help you make

Clynt Taylor: sure that you're solving the correct problems? Yeah. We've talked about this because I've had the privilege of being in this field in oncology for long enough to know that and I've had family members who've gone through this. And many times I've said, hey, how do you feel your wishes on how you want these last years to look? Do you feel your oncologist knows this?

Sometimes it's yes, sometimes it's no. But I've always wondered how do you build this into technology? And I go back to what I said before, it's harder when it's like, well, we got we'll code it and put it on a product road map and we'll do something like this. And it's like, well then what more questions does the doctor now have to ask? How do you get that feedback in?

How could it be consistent? A lot of these things, like I said, are starting to really change because we have a powerful technology that's gonna allow us to bring some of that in. If ambient's taking care of grabbing some conversations that you're having with a woman who lives on the houseboat, and now suddenly, you're like, this looks like a good therapy, but then the system says, however, she lives on a houseboat. She can't get in here that often. Then that's gonna prompt you in a way that we never had that ability to do that kind of stuff before.

So that's why I'm super excited about the new technology and the kinds of things that I think it can do to really to support what I think you're saying, which is the relationship between the doctor and the patient. We've often thought, Alright, how do I automate this for the practice or make it easier for the doctor? But what can we do that really says, I can actually enhance the relationship between the doctor and the patient? That starts to be really attractive. And I think for the first time, we really are starting to see some technology that can do that.

Emily Touloukian: Yeah, and it's quality of life. Quality of And that's what you all are talking about, right? That's what you're talking about with your patient, and that's what we're talking about with the physicians. If technology doesn't improve my quality of life, doesn't make my workflow easier, doesn't let me see more patients, I'm not going to utilize that technology. And so, that's where, to Doug's point, it's so important to have physicians involved early on because if a technology is not going to improve my quality of life, it's not going to make my work life easier, it's not going to make my patient's life easier, it's not going be utilized.

Physicians only have so much time and bandwidth to contribute to these things. So, getting those ideas out there before you've spent thousands of hours working on it to say, Hey, is this something that you would actually need, actually use? Would this make your quality of life better, your work life better, your patient's life better, is incredibly important.

Sanjay Juneja: Yeah. I think you really bring up a good point that isn't talked about enough when it comes to just, okay, they don't support a pager system. Because with AI, you have a lot of different places depending on if it's somewhat of a point solution versus an actual platform that something could fail you.

Clynt Taylor: We all we go through this evolution where the market's flooded with lots of great ideas, and then it settles out. And the things that are hard to do, people start to realize you have to do. And it goes to what you were just saying. You have to build the security. You have to build it in such a way that you can scale it.

It really can support various levels of organizations whether it's, you know, we have multiple locations, multiple doctors, maybe we're part of a big network. All of that has to be considered and that's where a lot of the hard work comes in. But then you have to really stop to think, okay, wait a minute. If we're really gonna do this and everybody's gonna adopt it, how do we do it the right way? Takes Right.

A

Emily Touloukian: It has to be scalable and it has to be nimble too. Think that's sort of what you were saying because, you know, different things change all the time, right, in medicine, right? Whether it's coding and billing, whether it's new legislation, whether it's the quality metrics that we have to collect, those things change, I feel like, almost daily sometimes.

Clynt Taylor: They do.

Emily Touloukian: And, if your platforms and your products aren't able to be nimble and to pivot with those changes, that creates a big problem because you don't want to have a platform that you've implemented that you're now sharing data with that you trust that you then have to start over completely with somebody else if that platform can't shift with the speed of practice. And in community oncology, we're very nimble. We're very early adopters of things. We are very innovative, and it's easy for us to adopt new platforms, new technologies when it's appropriate. But I think that's one of things we all think about is will this be able shift and change as our practice shifts and changes?

Doug Flora: But Sanjanae, really, we spend a lot of time on this. We work with a lot of companies. We know all of the EMILYs of the world, and are cheering for your success because that means everybody's lives are better. I am a cancer patient. I'm good.

I'm cured. But it means a lot that there are people out there in the trenches fighting for better tools, better solutions, better outcomes. So, for those of you that are out there, this is what Sanjay put together, listener call to action, right? Gather your clinical leadership team for thirty minutes. A huddle.

Thirty minutes is all. No vendors in the room. No slides. Ask one question of your team. What's the single biggest friction point in our patient care workflow right now?

And let's think, can technology help us with that single biggest friction point? Tackle one problem at a time, write it on a whiteboard, that's your starting point. You don't have to think any bigger than that. Everything else follows from a real problem owned by the people who live it every day, and then you get in the sandbox. And I think maybe what happens then is you develop a deeper trust in the technologies because you're actually using it for good, instead of having it done to you.

And I will tell you, physicians, oncologists in particular, we want the best things for our patient. I don't know if there's another specialty that bleeds as hard as we do when we go into the depths of the caves with them. Nobody else is willing to do that, and I'm so proud to be part of community oncology and do that. Maybe that's why we're out here doing this, is we're so desperate to give them the tools that they don't know yet exist, help to them accomplish everything they're trying to do and replace the humane, or the mundane with the humane. Yeah.

Right. Well, thank you all for joining us, episode one. Thank you Katie Couric slash Emily. Amazing. Everyone trusts you and we appreciate your time.

This is probably the busiest week of her year and she took time out here. She's just, you're a light. So thank you so much and you guys?

Emily Touloukian: Thank you, guys.

Doug Flora: We'll be back for Issue Episode Two and it's gonna get even cooler.

Sanjay Juneja: Just getting started.

Doug Flora: Let's go.

‍