Conventional wisdom once held that a long wait for test results was acceptable, provided that the results were eventually provided by the primary care physician. That long-held belief is now changing, as emerging research shows that patients want faster results and more transparency. This research, combined with updated federal regulations, is leading to more patient autonomy. Transparency can also free up administrative burden, allowing clinicians to spend more time focusing on true patient care.
On this episode of the live recording of the In Network podcast feature Designing for Health, Nordic Chief Medical Officer Craig Joseph, MD, and Head of Thought Leadership Jerome Pagani, PhD, chat with UCHealth CMIO CT Lin, MD, Director of Communications and Patient Initiatives at OpenNotes Liz Salmi, and postdoctoral research fellow at the Vanderbilt Clinical Informatics Center Bryan Steitz, PhD. They discuss their recent study regarding patient attitudes and perspectives related to immediate viewing of test results via the online patient portal. Stay tuned for a special musical performance from one of our guests. This conversation was recorded live at the 2023 Nordic Summer Social in Madison, WI.
[07:54] The effect of the 21st Century Cures Act on medical transparency
[12:47] If patients want to see their results earlier
[14:36] The importance of speed of test result delivery
[16:20] How the open notes process is changing care
[20:10] If pre-counseling and patient anxiety are linked
[24:20] Patients and progress notes
[24:54] Liz’s personal journey in patient advocacy
[31:16] A special musical performance
[34:31] What well-designed things bring Liz, Bryan, and CT joy
Dr. Craig Joseph: So let us start without further ado, welcome, Bryan, Liz, and CT to the pod.
Liz Salmi: Thanks for having us.
Dr. Bryan Steitz: Yeah, thanks so much.
Dr. Craig Joseph: Now, as you may know, we have never had more than one person on the pod, and as you may know, we have never done it in front of a live (not) studio audience. So this is new for us. And so we are very thankful for you being here. Now, one of you who shall not be named, but it was Dr. CT Lin have been on the podcast before. You're a professional at this podcast, would you say that's true?
Dr. CT Lin: I would say so, yes.
Dr. Craig Joseph: Ok, and typically when I start, I usually get the first question. Jerome usually gets the last question.
Dr. Jerome Pagani: You take the first question.
Dr. Craig Joseph: I take the first question, and I say something like, Liz, ‘ever since you were small, you wanted to be in a punk band, but now you've ended up working for Open Notes organization, trying to add transparency to medicine. Where did you go wrong?’
Liz Salmi: Is that an actual question or an example of a question?
Dr. Craig Joseph: Okay, Liz, have you not listened to the podcast?
Liz Salmi: I have listened, I have listened.
Dr. Craig Joseph: This is the level of discourse that we have on our podcast.
Liz Salmi: You have this great dry delivery that I'm like, ‘What is happening here? What is happening?’
Dr. Craig Joseph: Yeah, this is happening. Where did you go wrong?
Liz Salmi: It's all the same. It's still the same thing. So yes, I was a drummer in a punk rock band for many years, and then I realized I needed health insurance and a real job. So I started working at a real job. Then I had a grand mal seizure, landed in the ED and found out I have a brain tumor. This is around age 29, and I leaned into that real-lived patient experience. I was also a graphic designer at that moment and realized I was really fascinated about all aspects of health care, fell in love with patient portals and then as a graphic designer and kind of weird thinker of things coming from my punk rock background, I wanted to get involved in health care. So, I can go on and on, but essentially the work I do today is working on the Open Notes Research Project were based at Beth Israel Deaconess Medical Center in Boston.
Dr. Jerome Pagani: Not everybody who ends up needing the kind of care that you need then goes on to take that experience and turn it into something real. And I have to think that sort of DIY ethic that came from the punk rock era had something to do with that.
Liz Salmi: Yeah, no, I think about that often. I actually have my own blog. I started as a patient blogger in the late 2000s. That was, like, the time before all of the social medias. Patients who wanted to talk about what they were going through before Facebook. We would go and long form block, and I continued to do that, and being in that space and like the rise of social media and sharing health care experiences in social media is what I grew up in. Being around other patient advocates, I learned about things like access to my own progress notes and the Open Notes movement. I was like, I want in on that. That's like the most punk rock thing happening in health care is the idea of full transparency, people having full access to everything in their medical records. So, I really fell in love with what they were doing. It took me a few years in nonprofit health care spaces to kind of catch their eye, but they're like: ‘You should work with us’. And I was like: ‘Yes, yes, I do. I should be doing this’.
Dr. Craig Joseph: Liz you’re perfect for this audience of ours because you fell in love with patient portals. And I think everyone here has said that they have fallen in love with patient politics.
Liz Salmi: Is that a joke?
Dr. Craig Joseph: I think that is a joke. Wait, I've got one or two, one or two or three people that love the portal
Liz Salmi: When it’s well designed, you shouldn't even notice that you're falling in love. But when you are pissed off because you're not getting what you need and it's poorly designed, then you're like: ‘What is this all about?’
Dr. Craig Joseph: We're going to get to that. Let me let me introduce our second guest. Bryan Steitz. Now, Bryan, you also, I believe if I have this correct, and I don't normally look at the prep that other people do for me, you also wanted to be in a punk rock band but were not successful. Now you took a secondary job and got a Ph.D. at some university. Is that true? And if it's not true, please just say it is true.
Dr. Bryan Steitz: It's super close. So I started out wanting to do counter-terrorism.
Dr. Craig Joseph: Wow. That's pretty punk rock.
Dr. Bryan Steitz: So I went to college wanting to do this kind of, you know, team analytics. And what are the networks and groups of people that, you know, make something happen or, you know, engage in some activity and after a couple of research experiences and some, you know, different jobs in college decided that maybe the counterintelligence type of path wasn't so much for me. So, I decided to go into medicine and get a Ph.D. in biomedical informatics. Basically, taking those ideas of team analytics and understanding teamwork and communication to improve health care.
Dr. Craig Joseph: Well, and what is the name of the university that you're at now.
Dr. Bryan Steitz: Vanderbilt University Medical Center
Dr. Craig Joseph: And do they have a good football team?
Dr. Bryan Steitz: They have a football team.
Dr. Jerome Pagani: This year?
Dr. Craig Joseph: I don't know. I don't follow American sports. I don't know how this works. All right. VANDERBILT. So that's an okay school. We have recorded podcasts with one or two PhDs from Vanderbilt, and you might be aware of them.
Dr. Bryan Steitz: Alison McCoy and Adam Wright.
Dr. Craig Joseph: Yeah, and they were bad podcasts. I mean, people should not probably go back and listen to them. They were not good, but we're hoping that the third time's the charm.
Dr. Bryan Steitz: But they're fantastic mentors.
Dr. Craig Joseph: I'm not saying they're not good people. I'm just saying, well, I should stop. Dr. CT Lin of the University of Colorado. Now, you never wanted to be in a punk rock band. Is that true?
Dr. CT Lin: That is true.
Dr. Craig Joseph: Okay. And you wanted to go to Vanderbilt and get a PhD, but you were unsuccessful. Is that also true?
Dr. CT Lin: Yes. I was rudely excluded from Vanderbilt.
Dr. Craig Joseph: Yeah, And that's the problem. You were like a quarterback at the time, I believe. Is that accurate? All right. So you are now the CMIO at the University of Colorado. Yes, and the three of you are on our podcast today because you wrote an article and I think you've written many articles, but you wrote one specific article that you're presenting at the big Epic conference this week, and I wanted to hear more about that. Dr. Steitz is the is the lead author. So, tell us a little bit about this article and what were you trying to find out? What did you find out? And then let's talk about if we think it's real or not.
Dr. Bryan Steitz: Sure, so a little bit about how it came about. So we've got the 21st Century Cures Act that basically now says the patients should have access to all of their notes and test results and all of these other pieces of electronic health information. And we did a lot of really early work looking at, you know, what is the workflow around the test result, release and review. And so we found that providers are, you know, historically had this long run in time where they were able to review and talk with the patient, especially around these system results. With the Cures Act, now patients are seeing these results before their providers and that could be really scary So we were really wanted to understand what do patients think of that? Do they want that? What are their, you know, perceptions around receiving results and what could we do better?
Dr. Craig Joseph: Okay. And Liz, what did you find?
Liz Salmi: I think Bryan's better at talking about the actual results. I'm happy to talk about why it was important, why the study is important. Okay, people have these questions, but to me, there was something that was a really important question that we didn't ask, and that was: at the time people, you know, selling people had access to everything. I'm not answering your question, and I think Brian will throw in some of the fun nuggets, but at the time, clinicians after the 21st Century Cures Act were terrified that now people had access to everything in the record and that patients are going to be scared about what they see: these immediate access to their test results, everything in the record. I personally and I'm very biased and I try not to be because I'm trying to be a good researcher, but I have a bias and I think I think patients want to see this information. So there is this debate over maybe we should delay the release of these test results to patients. So we sought out to form this superhero team of Vanderbilt, University of Colorado, Beth Israel Deaconess Medical Center, UC Davis and U.T. Southwestern Texas to say, let's survey all of our patient populations and find out what patients think. And so here we go.
Dr. Craig Joseph: All right.
Dr. CT Lin: So, hold on. Hold on. I think I need to jump in here because Liz undersells herself because she is the sparkplug behind this paper. She's the one who has connections with all of us in different organizations, and in her casual conversation says things like, to me, we're about to study this with patients and I'm having tremendous FOMO going, ‘why didn't you ask me what it can do? Can I join in on the study?’ Very quickly, Liz was able to get four major health systems together into this aggregate paper. And it's all Liz
Dr. Craig Joseph: It's the punk rock aesthetic.
Liz Salmi: That's how it was DIY. I wanted this study to happen. I had no skills to make this study happen other than I'm a decent communicator and I'm a big fan of Vanderbilt and University of Colorado, and everybody else who is on this paper, I was like, ‘join me, let's do this.’
Dr. Craig Joseph: Before we hear about the results from doctor states. Let's just go over something. Dr. Steitz, you have a PhD, Dr. Lin, you have an MD, Liz, tell us about all of your degrees.
Liz Salmi: I have an associate’s degree in graphic design.
Dr. Craig Joseph: Okay. Now, let's go through. I want everyone who's been published in the New England Journal of Medicine to please say aye.
Liz Salmi: Aye
Dr. Craig Joseph: So that let the record show that Liz is the only one on this stage, only one on this podcast who has been published in the New England Journal. So, I'm embarrassed for you, Dr. Lin, Dr. Steitz, I'm embarrassed for you. Now, that I've said-
Dr Jerome Pagani: Oh, wait a minute, wait a minute, wait a minute. I'd like everybody who has published a paper on stage to say aye.
Craig, Liz, CT, and Bryan together: Aye.
Dr. Jerome Pagani: What?
Dr. Craig Joseph: Oh, yes. Some of us haven't looked at the literature. My name's in one or two articles.
Dr. Jerome Pagani: I'm going to refer to my fact checker for that.
Dr. Craig Joseph: All right. Now we've established that I have been in the literature, not good literature, but in the literature. I'm not claiming anything. Bryan, what did you find? Do patients want to see their results? Are they freaked out by their results? Are people like, I don't want them to see their results. People like CT, he thinks the results belong to him, not the patient. That's what he said. I think I got that wrong. Don't even answer. Bryan. Tell us what happened.
Dr. Bryan Steitz: Sure. So big multi-site study, over 8,000 patients, 96% of patients wanted their results immediately, whether they were reviewed first by a provider. 95% of patients wanted them, even if those results were abnormal or somehow, you know, sensitive and invoking some, you know, emotional response.
Dr. Jerome Pagani: But let me ask you about that. Did you expect a different response?
Dr. Bryan Steitz: I didn't expect a response so strong. I mean, that is an overwhelming number of patients. 96% want their results. That's just incredible to me.
Dr. CT Lin: I mean, if you listen to my colleagues and colleagues around the country, they tell you, well, you know, my patients don't want that. They want me to call them ahead of time and it's okay if it's two weeks later because they want to hear from me. So, none of my patients want this immediate stuff that you're trying to promote.
Liz Salmi: I don't have any patients, but I am a patient advocate and I work with a lot of different patients over the last six years of living with a serious chronic condition. Patients want this information. This needs to be understood better how we communicate with folks after the fact, after they get these test results. That could use more work. But I knew it was going to be something in the 90% I didn't expect 96%.
Dr. Jerome Pagani: So that finding in particular, I find very compelling because someone could easily make the argument, the Steve Jobs argument, that patients, they don't really know what they want. Right. You have to kind of tell them the experience that's best for them. But that's not what you found. What you found actually was that even people who had had a negative result returned to them, came back and said, look, I want the results right away, knowing that the next result may be abnormal as well. And so to me, that's a compelling case that patients are really advocating for themselves and what will best meet their needs.
Liz Salmi: I think with the Cures Act and then Cures Rule and people having all of this information, for me, my perspective that makes me excited, is people finally for the first time can see themselves through the data that they produce. They lean in and they can see, this is me, this is my body, this is my progress note, and they can do something with it. And I think more design and iteration will happen over the next ten years. We're going to be co-designing more with patients and we're just at the early stage now that we have the flow of information.
Dr. CT Lin: I want to coax Liz to say a little bit more because, you know, the driving force behind studying this was actually some of her personal experience with her chronic illness and realizing that owning her own information, having real access to it rather than ‘mother may I’ and how many signatures do I have to sign and how long will it take for you to mail this to me? It was a tremendous differentiator in her participating in her own care, if you would say something about that.
Liz Salmi: I think you just said it. I have no idea what else I would say.
Dr. Jerome Pagani: Talk about that transparency for a second. Right? Because it could easily just be the case that people are anxious and having the information soon, sooner sort of soothes how they're feeling. But this transparency can actually make a difference in how they think about the course of their illness and their care. So, let's talk a little bit about open notes here. As we're on this journey for more and more full transparency, how do we expect that to change the way patients and physicians interact around the care process?
Dr. Liz Salmi: So I want to throw it to CT because CT was like doing open notes, but before Open Notes created a logo called Open Notes. He will tell you that he published the first open notes paper before open notes was cool. So I hand it to you CT.
Dr. CT Lin: You know, the transparency journey takes a while, and I didn't appreciate that early in my career as a physician informaticist, I thought that, well, all of my colleagues are scientists, they're doctors, they're all trained in science. And so therefore, P-values must be where things are. I mean, if I can show statistically significant P-values, there's no argument. I can walk into a leadership meeting and say, I have great there's significant details here. The patient's, you know, substantially more satisfied. And there's no downside to having nurses and physicians with patients who have full access to the record. And I didn't realize that there's this whole other concept called leadership that has nothing to do with scientific P-values. In my early career, I had number of potholes I've stepped in in terms of failed projects. We did our first transparency project in 2001, and I had gone to our leadership group in 2002 and wanted to make this systemwide what we had studied it in one cardiology practice, and we wanted it rolled out in all 40 other specialties. And surprise, surprise, as a reading of Machiavelli's The Prince will tell you, leadership is different from just science and I was basically escorted out of that meeting: “Hey, that that's a nice pet project that you have. But no, it's not for us, because my patients are way more complicated than the ones you study.” I was not able to get that over the line. Over time, and with the assistance of the National Open Notes movement, we've come back around and we are now system wide open notes. It does change the tenor of how clinicians interact, both with the record and with patients. In the early days, I would have clinicians tell me, ‘you know, the medical record is too dangerous for patients to get in there. I write notes about cancer and my speculation, and it's important for me and my colleagues to know that. But patients shouldn't be in there.’ I don't want to spend hours explaining myself. Did they go to medical school? No, they did not. This is not intended for them.’ And we've come a long way since that time.
Dr. Craig Joseph: That's fascinating. What one thing that was in your data that I did not expect to see is the result around pre-counseling. So let me tell you how your doctors work. If your doctors tell their patients, hey, we're doing this study, we're doing this test, we're doing this imaging study, it might show something. If this number is just a little bit above what it says is in the normal range, don't worry about that. If it's 100 times, we'll talk about that. Pre-counseling is kind of ‘hey, don't worry. This is what I kind of expect,’ and I'm going to give you some sense of where we're going.’ And so that naturally, I think we all know, will decrease the worry level because you're telling people what to expect. You're setting expectations appropriately. And so, of course, if you made up the data in your article, which I'm assuming that you didn't, but don't answer that question for legal purposes, I would have expected a big association between pre-counseling and lowering the worry level of patients. Yet you found none, Dr. Steitz. Does that mean that you faked the data?
Dr. Bryan Steitz: It does not mean that we faked the data, but it does mean that most patients were already reporting receiving pre-counseling. Over 90% of the patients that we surveyed reported that they did receive some sort of conversation with their provider about, you know, ‘what is this result, what might it mean, what are the, you know, potential results? These are expectations for follow up.’ And I think that's a lot of the signal that we were picking up rather than yes or no pre-counseling does or does not work.
Dr. Craig Joseph: So the answer remains elusive.
Dr. CT Lin: I would say, though, that in our data, we did show a tendency toward it. Even though it did not meet statistical significance. Some of the data that we showed did did demonstrate that the aggregate of the median was that for patients who did indicate that they were pre counseled, there was a trend towards less anxiety. So, I think we needed a larger population size and this was also uncontrolled. We did not go out and tell half the patients or half the clinicians go and pre-counsel these patients, but not those patients. This is a natural experiment and we're able to show maybe a hint of a signal. We can't call it a P-value, but there is a signal there. And the other term that we use for this is anticipatory guidance. Actually, in talking with my psychology colleagues, there are actually some underlying principles of anticipatory guidance, talking about anxiety and worry and how to reduce it. One component of getting a test result, for example, is threat. Another example, another threat here is uncertainty. And the third threat here is lack of control. And when you go and do a CAT scan and you don't see anything about it, ‘oh, you're having some abdominal pain. I'm going to order a CAT scan. Talk to you later.’ That's not where you want to go. But if you're going to address threat, uncertainty and lack of control, you will say the result will probably take three days to come back. And when it comes back, this is how we're going to deal with it. If it's a normal result, you might not hear from me for a few days, but if it's this, if it's cancer, there's a small, small chance it's cancer, then you'll probably hear from me right away. This is what to expect. And so all of this improves the sense of control. It reduces uncertainty. Even though there's threat, bad news is bad news regardless. But how I deliver it and how I predict it's going to happen changes everything, I think, in the patient's perception. So that's where we're going next with the type of thing we're looking to study.
Liz Salmi: I'm going to say as the patient participant here slash researcher. We've got this PhD researcher, we've got a medical doctor, and then I'm some weird person in the middle, literally and figuratively. But I can now, as I go in for my next MRI and, you know, check in on the brain cancer situation, I really think about all of these elements. Like, I can't differentiate the experience. My response to this immediate access to test result and because this is what I think patients are wondering, that I'm going to get this test result immediately. Do I click yes, I want to view this test result or not? Or do I want to wait to hear back from my doctor? I do want immediate access, but I also know I it's on me to filter through those processes and those emotions. So when I get the message saying new result from mychart, it's like it's a Pandora's box. What's it called? Schrödinger's Cat in the box. Somebody tell me about this. It's like either it's a good test result or it's a bad test result, and I have to click the box to figure out what it is.
Dr. CT Lin: So I want to say that the person without the advanced degrees is citing Schrödinger's cat to us. I appreciate that.
Dr. Liz Salmi: I called that Pandora's box. So either way, we all knew what I was talking about.
Dr. Jerome Pagani: Maybe the cat was called Pandora. You never know.
Dr. Craig Joseph: So let's talk a little bit about open notes, because we've talked about transparency. We've walked around this a little bit, open notes is the idea that patients can easily see their progress notes that doctors write about them, correct? Thank you for explaining that to me. And they do that via that patient portal thing that you've fallen in love with
Liz Salmi: It could be digital patient portal, it could be printed out and handed to the patient. It's technology agnostic. So yeah, but most health records, like 95%, are on electronic records. Yeah.
Dr. Craig Joseph: Okay. Now, as CT has said, we use big words in medicine like tachycardia. I don't actually know what that means, but I've read that a lot. And hypertension and other big words, and patients couldn't possibly understand that, much like they couldn't possibly understand what a normal, you know, hemoglobin level is. So I'm sure you agree with me on this. Is that true? Why is it why are you looking at me like that?
Liz Salmi: I don't agree with you. About what?
Dr. Craig Joseph: That patients can't understand their progress notes.
Liz Salmi: That is not true.
Dr. Craig Joseph: That is not true, ok.
Liz Salmi: There's a whole body of work from the last 12 years that show that maybe we don't immediately know what the big word means when we read it in our progress notes. But we know how to problem solve because that's what we do when we have health conditions. You learn to learn what the big word is. Is it gemistocytic astrocytoma? I learned that word. I can pronounce it pretty well. It means a certain type of brain tumor, but if you live with the condition, you start to understand that particular vernacular. So did I know that word right away? No. But what do you do? What do people do? They go on the Internet and look things up. And so if you see that in your progress note, you're like, oh, it doesn't say Liz has a big brain tumor. It says, gemistocytic astrocytoma, let's, you know, figure it out, and so you start to understand the language of your clinical diagnosis. And the progress note is a place, you know, that documentation was designed for. We can have a whole debate about clinical documentation, but it's supposed to be a communications tool between many clinicians about a patient's diagnosis plan for treatment. But now the patient has a copy of that record and can plan for themselves and Google things, talk to their family members, do their own PubMed searches and so forth.
Dr. Jerome Pagani: Liz, you've been pretty open about your medical condition in the past. Can you give us enough context so that we can understand a little bit about what you had to go through when you were presenting at a medical conference recently?
Liz Salmi: Oh, okay. I was like, What are we talking about? Yeah, so, I just a month ago, returned from a trip to the MedInfo conference in Sydney, which is, I guess, a global, clinical, medical, health IT Informatics conference. Anyway, I was flying over the Pacific Ocean. I was planning to fly over the Pacific Ocean, and I was going to be traveling internationally. So I asked my neuro-oncologist, the brain cancer doctor, to put it in plain language, What do I need? I need some copy of my MRI, you know, things like that, in case I needed care across in Sydney. So, she gave me a DVD of my record of my MRI and printed out my latest progress notes. And then she also got me a prescription for dexamethasone and ativan. And these two prescriptions were just in case there was any sort of brain swelling that happened was way over the ocean and an emergency occurred. And so I was like, oh, cool, some dexamethasone, ativan, that's what I need to fly across the ocean because I have brain cancer. That's a lot, and I realized I was flying alone. My husband wouldn't show up till a week later. So, I mean, to have these instructions from my doctor saying your brain might swell over the ocean and you're alone, you’ve got to care for yourself. What do you do? So, I created like a cheat sheet on an index card with instructions to whomever my seatmate was or for a flight attendant-Hey, I have a brain tumor. I essentially designed this really rudimentary system of, ‘hey, I have a brain tumor this is the situation’. I had these two drugs and I created a Ziploc bag with the instructions, with the drugs in them to basically hand over in case of emergency. But I really started to debate, do I tell flight attendants about this right away and freak them out or do I wait until I'm having an emergency? Like, when is the right time to drop that news to somebody on a plane? So, I had a dilemma about the delivery of that information. So ultimately, of course, I took a picture of my index card about my instructions and posted it to Twitter to get feedback.
Dr. Craig Joseph: As one does.
Liz Salmi: And most of the folks I interact with on social media, specifically Twitter, are patient advocates, people with brain tumors, neurologists, neuro-oncologists and doctors and researchers. And so, they told me what they thought.
Dr. Craig Joseph: And what did they think? How do you design a tool like that to tell people what to do on a plane if you're unable to do that?
Liz Salmi: I mean, that's how you design the tool. It was very new technology neutral. Are you asking me or CT? Because I see CT warming up.
Dr. Craig Joseph: I'm asking you.
Liz Salmi: So when I went out to the interweb community to ask, ‘what do you guys think?’ There was a well-known CIO informaticist doc who said, ‘I think you should not tell anybody about this because it might scare off the flight attendants,’ and then there was a group of people on the Internet because this is an Internet debate, I'm talking about an Internet debate, this is horrible, but thanks for having me on your podcast! Anyway, there were some folks saying you should not tell anyone about this because they won't let you on the plane. There were some in the disability advocacy community were saying you shouldn't say anything until the emergency happens because they might say you cannot be on this plane. You're a flight risk or something like that. And then some folks were like, this is perfect, you've designed this great solution, prototype it, put it out there, let us know how it went. And fortunately, I was fine, long story short, too long didn't read, I was fine and I didn't need it. But I had it with me at all times.
Dr. Craig Joseph: Awesome. Well, that's great. Our time is getting short. I feel like I need a song, and Dr. Steitz I would ask you if you would like to sing a song for us.
Liz Salmi: Yeah, Bryan!
Dr. Craig Joseph: Bryan, Are you prepared with anything? Do you have anything? Liz, do you want to do anything?
Dr. Jerome Pagani: Beatles Cover band cannot not hold a candle to a live original song performed by CT Lin
Dr. Craig Joseph: All right, so Bryan said no, Liz could but is not going to.
Dr. Jerome Pagani: I'm going to go do backup vocals, but I’m going to go to the back of the stage where there are no microphones, just for everyone’s comfort.
Dr. Craig Joseph: There are certain legal reasons you're not allowed to sing. Let me talk with CT and say, what are we going to hear? What do you think that you're going to do for us as the encore here?
Dr. CT Lin: I have a song called Epic Man that I've played previously, and I updated the lyrics for immediate release of test results.
Dr. Craig Joseph: How apropos.
Dr. CT Lin: (In song) She checked my templates last night, preflight. Zero hour, 8 am. And I'll be deep in my in-basket by then … I miss paper charts so much I miss my life. It's lonely in hyperspace. On such a timeless flight … and I think it's going to be a long time before I delay a test result again. I'm not the man they think I am at all. No, no, no, no. I'm an Epic man … Epic man, Sharing test results instantly. Seven days ain't the kind of way to delay your results. In fact, info blocking is now banned. And there’s no one here will defend you if you did … And some results patients won't understand. Anticipatory guidance is our plan, Epic man … And I think it's gonna be a long, long time before I delay a test result again. I'm not the man they think I am at all. No, no no. I’m an Epic man. Epic man, sharing test results instantly. And it ain't gonna be a long, long time. And it ain't gonna be a long, long time. Yeah.
Dr. Jerome Pagani: Thank you, CT. And now, we have come to the end of the podcast, so CT, you don't have to answer this question if you don't want to, because you have previously. But we always like to end the podcast by asking our guests to tell us about two or three things that are so well designed, and they can be outside of health care, but are so well designed that they bring you joy to interact with. Brian, we'll start with you.
Dr. Bryan Steitz: Sure. So, I've got a couple. So first off, Craig, I hear you're also a huge Apple fan.
Dr. Craig Joseph: Apple fanboy.
Dr. Bryan Steitz: Fanboy. Okay. So, I think my first extremely well designed product is the Apple trackpad.
Dr. Craig Joseph: Why?
Dr. Bryan Steitz: You know, it's just so much easier to use than a mouse. I'm able to do all of the, you know, the gestures, you know, expand things, shrink things, swipe between screens. I find it to be a huge productivity boost and just generally fun to use.
Liz Salmi: It is delightful. I agree.
Dr. Jerome Pagani: Liz, you want to give us one?
Liz Salmi: Oh, yeah. Well, I have one like, big one. I love coffee. I've loved coffee. I've been drinking coffee since I was eight years old, and I love when you go down the grocery store aisle where coffee is. You can just smell it coming. The thing that's well designed, though, is when you get a bag of coffee, the beans, there's a vent on the outside that if you just press that vent, a whiff of coffee comes out of it, and you're just like, ‘coffee smell!’ Yes! And I didn't know how that was, I don't know if that's well-designed, but it's the smell experience that is well designed. And the thing is, I guess the vent I had to look this up, I didn't know, but, you know, when coffee beans are roasted, there's like some sort of gas or something that happens. So, the vent is designed so air comes out, but does not come back in to ruin the coffee so it stays fresh. So, it is so well designed, it does its job. But also, you can kind of scratch and sniff as a consumer and just have that hit of coffee smell and it's beautiful. So that's my thing.
Dr. Jerome Pagani: I learned something and I'm going to do this the next time I go to the grocery store. CT, did you have a new one?
Dr: CT Lin: I'll just tell you that clearly guitars are not well designed because there's more strings than I have fingers on one hand, which is why the ukulele is my instrument.
Dr. Jerome Pagani: I love it, and I think that brings us to the end of the podcast. Brian, Liz, CT, thank you so much for joining us, thank you!
Dr. Bryan Steitz: Thank you for having us.