From Bedside to Data & Beyond: Navigating Health Tech, Genes, and Career Changes

Welcome to the latest episode of The Pivotal Podcast, where we explore the uncharted territories of healthcare transitions and technological advancements with our incredible returning guest, Peggy Jenny.

In this enlightening conversation, Peggy, who is the Director of Value Intelligence at MUSC Health, shares her first-hand experience and insights on topics that are crucial for healthcare professionals considering a shift into healthcare technology roles.

🔍 In This Episode, We Discuss:

✔️ Expert advice for professionals eyeing a shift from patient care to health tech.

✔️ The time commitment required to attain the informatics nursing certification from the American Nurses Credentialing Center.

✔️ Key skills, knowledge, and aptitudes valuable for a successful transition.

✔️ Peggy's personal journey from nursing to tech – the challenges, the lessons, and the silver linings.

✔️ Delve into the role of a Director of Value Intelligence at MUSC Health.

✔️ Building vital tools to screen for social determinants and the importance of identifying patients for care coordination.

✔️ Insights on the vast data entered in health tech and the evolving landscape of Telehealth.

✔️ A deeper look into the world of genetics and genomics – demystifying the intricacies.

And much more, including personal passions and indispensable advice for those pondering a career change in healthcare.

Peggy Jenny, with her rich experience and unique perspective, unravels the maze of healthcare technology. Whether you're a healthcare professional considering a shift or someone curious about the blend of tech and health, this episode is a treasure trove of insights! 🌐

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Thank you for your continued support, and we look forward to bringing you more exciting episodes in the future.

Chapters

• 0:00 Introduction
• 1:00 Expert advice for professionals eyeing a shift from patient care to health tech
• 4:50 Exploring Informatics Nursing Certification: Benefits, Commitments, & Essential Skillsets
• 8:54 Making the Transition: Challenges, Surprises, and the Passion for Population Health
• 13:13 Leveraging Data to Optimize Patient Outcomes and Address Social Determinants of Health
• 24:06 Navigating Healthcare: Barriers, Technology, and the Role of Care Coordinators
• 32:53 Exploring the Future of Genetics and Genomics in Healthcare
• 41:09 Career Change into Healthcare IT: Passion, Opportunities, and Finding Your Fit
• 44:10 Conclusion

Transcript

 Welcome to the pivotal podcast where we unlock the future of healthcare technology and explore the journeys of those making waves in the industry. Join us as we explore the innovative minds, game changing companies, and inspiring journeys that are shaping the future of healthcare. Whether you're a tech enthusiast, a healthcare professional, or someone looking to make a career pivot, this is the podcast for you.

I'm your host, Ben Marley, and I'm thrilled to have you join us on this exciting episode of the pivotal podcast. And And today I'm super, super excited to welcome back Peggy Jenny. Peggy, thank you so much for joining me again. 

I'm so happy to be here. I'm, I'm glad that we can continue the conversation.

Yeah, absolutely. And so I know this might feel like for anybody who was listening before that we're bouncing around a little bit because we kind of progressed on past this, but we didn't get an opportunity to really dig as deeply into some of the things we were talking about as maybe we would've liked.

Right. So let's start off by going back to a question that's on a lot of people's minds right now. Just thinking about those people that might be interested in transitioning from direct patient care to healthcare technology roles what advice would you give for a professional that finds themselves in that situation?

Fantastic question, and I think the, the first thing to do is reach out to people that do that kind of work. You know, if you're working at a hospital or if you know of someone if you don't know of someone connect via LinkedIn, do, do a search for Ben and connect to some of his for, to, to him and some of the folks that, that he might recommend.

And when you connect to them, I think it's important to. Understand the day in the life of so potentially shadowing would be a good way to understand their daily tasks. You know, ask them what kinds of challenges they have, ask what they like about their job, ask what they don't like so much, and see if that would match with your with your values and skill set.

I love that advice so much because both in my work with high school students who are trying to figure out their target future career and then base their college selection on that. And in the career consulting work, I've done, I've had that exact advice, right? Like, how do you know what it's really like to be in one of these roles?

I mean, you can only really. Understand so much on Google, right? Like there's like all of the, and, and it's going to vary too, from company to company and from role to role, but to really get an understanding of what it's like to have a day in the life, you need to talk to somebody who's doing it. That totally makes sense.

Okay. So look on LinkedIn, find these people. Do you have a. A specific like recommendation for how to reach out. I mean, literally find them and try to see if you can message them on LinkedIn, or maybe see if you can find their email address or something. 

Absolutely, you can so there are positions within hospitals especially for transitioning from nursing.

Chief, chief nursing information or informatics officers are, are essentially leaders at hospitals that, that. Are most likely have made that transition from from nursing to from bedside nursing to technology and. That role is is centered around trying to trying to maximize the use of technology and and the interface between technology and nursing.

So those are great people to, to reach out to and recommend, depending on what your interest might be, they can, might be able to put you in contact with with someone that's in a similar or has been in a similar situation. 

Hmm. Interesting. And so you're recommending people potentially at the same, in the same healthcare environment that someone's currently in.

So depending on, depending on your relationship, you can reach out to to all sorts of people. There are, there are podcasts like this one for, for folks to come and. You know, I'm, I'm available. I obviously love helping people make this transition, which is why I wanted to come back and speak today.

So reach out to me via LinkedIn. My email address is published, but you can also search for hospital systems that are near you. You can search for you can search for Folks close by that might have a nursing informatics certification. So one thing I wanted to mention, if you are interested, if after you've talked to folks the American Nurses Credentialing Center has an informatics nursing certification.

So if you did want to go in, in, into a nursing informatics role, you can go ahead and take that curriculum and take that test. And that, that would probably set you aside, apart from a candidate that doesn't have that particular certification. 

Yeah, that's amazing. Do you have any idea what kind of time commitment might be required to attain a certification like that?

So I think it depends on where you're, where you're coming from. So if you search Google, of course for for the American Nurses Credentialing Center. They have an outline of the certification exam and it goes from found. It's just 125 questions, and it goes from foundations of practice, system design and lifecycle, and then data management and healthcare technology.

So it's a good foundation to understand how data is captured, how it's stored and so depending on where your current knowledge is in each of these areas. That would probably influence how much time it would take to get up to be able to pass the exam. 

Sure. Totally makes sense. Yeah, that's huge. I love the idea of doing something to practically set yourself apart from other applicants, right?

And probably just like having conversations with people going through the material. Is another good way to gauge your own interest in the field, right? Like as you're studying it, if you, if it's, I mean, if it's really challenging to make yourself digest the information, maybe it's a good indicator, Hey, this might not be a great field for me.

Right. Absolutely. Other opportunities around interning there, you know, there, there are a lot of hospitals have interning opportunities. Typically, they're unpaid, but but it's a nice way to get a sense of what the, what the different teams do and how they interface and. And some of the different roles, you would get a lot of exposure to different roles.

That, and then that might help guide your decision as to what direction you'd like to go from there. 

Yeah, absolutely. That makes a lot of sense. I can't remember how much we dove into this before, but so that credential is helpful. Are there other specific skills or knowledge or other just like inherent?

Inherent, like, aptitudes that you, you think that would be really, really valuable to somebody who is looking at something like this. 

What's what's really awesome about technology is that it actually mimics the nursing the nursing process pretty closely because in nursing, you gather information, you assess, you make recommendations, same thing with technology.

So so I think basic logic and you know, understanding programming, and I'm just talking even even the basics of programming and and how a programming language works. Database concepts is another thing that is helpful because all if you want to be able to take take the data that is entered into an EHR and and use it.

You need to you need to be able to pull it pull it out. And in order to do that and be more. Efficient in doing that, it helps to understand how data is stored, potentially using sequel, which is a programming language to to query databases. Even even more basic is just getting really familiar with office Microsoft office.

As, as, as maybe silly as that sounds you know, all of the work that you do typically one needs to be presented somehow. So the more comfortable you are with Microsoft PowerPoint and pulling that together the, the, the easier it will be for you to combine all of your thoughts and present that to whoever you might need to present information to.

Working in Excel, I do a lot more in Excel than I ever thought I would. So being able to manipulate data and being able to summarize and and graph data is is, are, are valuable skills to have. So again, I think on the last podcast, we talked a little bit about Oh gosh linkedinlearning.

com now? 

Oh yeah, yeah, yeah, that's what it is now. 

Right, and so so that's a great place to get a lot of those skills, and if you don't have them. So you can get your library library membership, and then you should be able to access all of those training materials through your library account for free.

Yeah, that's amazing. So a nice way to, to to build skillsets. 

Absolutely. Do you remember any specific challenges or lessons learned from when you made your own transition and out of nursing and back into the technology side of things? Was there anything that, because again, like you came from the, like the it background a bit before that, right?

And then you also had the clinical side and then you were also doing the work when the EHR person was out, right? So you. You, you, you probably had a lot of insight into what you were stepping into, but was there anything that still really, like, took you by surprise or you realized like, wow, I have more to learn here, to feel proficient than I thought I was going to?

Well so when I first started in the IT side of the house, I was, I was surprised by the. Depth and breadth of health care and so so I had had a limited exposure. I had been a labor and delivery nurse and I was a bedside nurse and I had done that for 3 years. And then the, my only other exposure to health care was.

As a patient, and so going to the doctor's office and checking in and having my blood for sure, take it and and. And all of that. And so I didn't understand a lot of the, the additional work that it takes to to keep hospital or clinic doors open. So, understanding understanding the billing aspects of health care, understanding compliance and the rules around.

Around what must be documented when by whom. In order to bill bill, appropriate codes to to payers. Understanding the relationship between between healthcare payers and, and hospitals and how billing works. I mentioned compliance billing you know, scope of practice for each different type of role within the healthcare system is something that I've had to learn.

So what can a certified medical assistant do that a medical assistant cannot do? And. What can a licensed practical nurse do versus an RN versus an advanced practice RN and all the way through what can a surgical tech do? So, and there are so many different roles within healthcare. And then, on top of that, understanding that every clinic functions a little bit differently.

Every every unit functions a little bit differently. Every specialty within healthcare has a little bit of a different nuance. So you know, if you're working with with a, a patient that is being seen in oncology, that's going to be a whole different set of protocols and concerns and, and considerations for that patient.

And. For documentation. Now, flipping that over and looking at OB, which is, you know, where I'm comfortable and knowing what needs to be documented about that pregnancy and the mom's health and then what happens with the baby. So so there, there is just so much to healthcare that I think that that was my biggest challenge when I transitioned into it was.

There's a lot to learn. And it's also the exciting thing though, because you're learning new every day. 

Yeah. Yeah. I was going to ask him like on the flip side of that, what was the most positive surprise? The thing that you were most excited to say, okay, well, I didn't know this was going to be like this, but I'm really glad that it is.

You know, I think the most passionate about is population health. So all of the information that gets entered into the not all of it. We try to use all the information that gets entered into the EHR into the electronic health record to improve the quality and efficiency of care. And so I, I love that aspect of it.

I love being able to improve outcomes, you know, if we can prevent somebody, if, if we can put together some clinical decision support that. Delay someone going from C. K. D. Stage four to end stage renal disease and needing dialysis. That's a huge impact for those patients. And so, you know, so that's that's where that's that's where I get really excited is being able to use all that data that we've collected to improve.

The quality and efficiency of care. Yeah. 

Wow. And so in your role, are you able to see those kinds of outcomes? 

Oh my gosh, that is my role to identify those kinds of outcomes. And so, so to identify the opportunities. where we have the biggest opportunity to to improve by putting evidence based practice in place.

And then also tracking that tracking the adoption and seeing whether or not people are using it and then tracking the impact. So you know, we, We've been able to reduce a on average for our heart failure admissions, we've been able to reduce the length of stay for our help for heart failure admissions by one full day.

Wow. And that is a huge impact to the patients because they can be home and instead of in a hospital and I don't know if you've ever been admitted to a hospital that is not a restful place. So they can be home, but that also frees up a bed for someone else. So from a hospital revenue generation perspective and from a patient care perspective, it, it helps move the needle for all the good reasons.

So so that's, I, I absolutely love doing that part of my job. 

Yeah, that's amazing. And so just to make sure I understand when you guys identify one of these opportunities, what happens 

next? Oh, goodness. Well, so in this, in that particular example that I was giving around heart failure so heart failure had been identified as a, a, an opportunity around clinical variation.

So and I'll explain that one a little bit. So medicine is a practice and it's, it's an art. It is not, it's not a pure science. It's not. A plus B equals C because every patient is different. Every physician is different. And so and then not everyone has consensus on what the evidence says is the best way to approach a particular problem.

So so for heart failure, we have a team of folks that reviewed that reviewed all of the evidence around heart failure and how to best treat heart failure. When a patient is admitted, and they worked with clinicians to identify a an ideal care plan. So and just to give a little bit more of a concrete example.

If if a patient with heart failure is having an exacerbation and they go to the ED and they say, you know, I'm having shortness of breath, I'm I'm starting to get it. I'm, I'm feeling the need to get into a little bit of the pathophysiology, but I'll try to keep it, keep it brief. So, you know, if they're having a heart failure exacerbation and they're having shortness of breath, they might, their heart isn't working as efficiently as we would like.

And so they might have extra. Fluid on board. And so how much how much of a diuretic should we be giving to that patient to get the fluid off to make it easier for your heart to pump? And so depending on how much diuretic you have on at home, there is a evidence based recommendation about how much we should prescribe when they get to the ED.

Your average E. D. provider probably isn't up to date on, you know, all of, I mean, how could you possibly as an E. D. provider stay up to date with all of the most recent evidence. You know, coming out of out of research. So so what what this group did was they reviewed all of the evidence and graded it, worked with the clinicians and came up with a recommendation.

And then we put clinical decision support in place to to say, Hey, clinician, guess what? This is, you know, this patient showed up with heart failure exacerbation. And so here is the calculation you need to do to figure out how much diuretic to order when they show up. And then that progresses through the entire through the entire stay.

So hopefully that wasn't too technical. 

No, no, that's great. No, that's great. So, okay. So when they get this, is this, are these best practices recommended through like the EHR itself or through like a system they're already interacting with? So like, okay, what are the symptoms? A and B. Okay. And now here's the decision tree.

So I need to go do C. 

Yeah, it's awesome. So, and, and that's the whole thing is, is, you know, in informatics, you want to make it easy to do the evidence based you know, the evidence based, make the evidence based decision. And we want to make it easy to place the orders that need to be placed. And so, yes, we have an alert that pops up that says, Hey, this patient has heart failure and is here for an exacerbation.

Click me so that you can figure out how much to order. And and so, you know, the, the clinicians don't have to keep all of that in their head and they can just click, click and boom. The, the most, the evidence based recommendation can be ordered. 

Gotcha. That's amazing. No, that makes a lot of sense.

And yeah, it's really cool to have a very practical way to make an impact like that. So I know in talking previously about the types of projects or data analysis that you typically work on to drive these improvements. Okay. So we just talked about clinical variation, but before I think you also wanted to talk a little bit more about building tools to screen for social determinants.

Can you elaborate on that a little bit? 

I would love to. So, the evidence the most recent evidence is is actually stating what I think most people know most people, most people know in their hearts, but might not have been explicitly said is folks I think it's 80% of people's health care outcomes are actually defined by their social, social situations.

And outside of the clinic and outside of the hospital, because where do we spend most of our time? Not in the hospital and not in the clinic. So so for example, for my heart failure patient you know, if we prescribe a, a, a new diuretic or new medic medicine for them, if they're worried about how they're going to feed their family that night, They're not going to fill that medication.

So screening for social determinants of health. So the, the, some of examples of those are food insecurity that I mentioned, transportation transportation challenges, housing challenges financial financial challenges. And so if, if, if there are barriers there to executing on a plan of care, the patient's not going to be able to execute the plan of care.

And when, you know, clinicians are going to wonder, you know, how, how come my patient hasn't, you know, gone to PT? Well, if they don't have a way to get to PT. Physical therapy. Sorry. I'm trying not to use acronyms. Then they you know, then they're, they're not going to be able to do it no matter what they, what they want to.

So so screening for social determinants of health, and then trying to close gaps and connect patients that have gaps in their social determinants with community based organizations that can help with those kinds of things is, is. Is an up and coming responsibility that that hospital systems are starting to take on because they are starting to see the connection between addressing social determinants and healthier outcomes for their patients.

Yeah, that's super logical, but I don't think it ever occurred to me before that hospital systems were working with community based organizations to make sure all of the dominoes were lined up so that the person could carry out on this recommendation that was given to them, right, to maintain their health or improve their health.

Absolutely. That's awesome. You mentioned also about identifying patients that would benefit the most from care coordination. What does that look like? Oh, gosh. 

So. In that same vein around addressing barriers to care. So, care coordination is is around. After a patient leaves clinic in order to prevent them from coming to the, or in order to prevent them from an admission that might not be necessary.

Care coordination is reaching out to those patients between those visits. And trying to address any barriers. I, I, I am pleased to say that I have worked with care coordinators that have actually physically gone to patients houses. to move furniture so that they could have to help move furniture because this patient didn't wasn't able to physically move furniture around so they could have a hospital bed moved in.

Wow. And so there are incredibly dedicated people that that work in the health care system that that are, that are willing to help. resolve any, if not any issue, but lots of issues that might prevent someone from getting the care that they need. 

Yeah. Yeah. And that's amazing. 

Well, and so you know, I think more in that vein how do we know who could benefit from care coordination?

And and because, you know, Hospital systems have limited resources. So we want to you know, we, we want to use those resources as efficiently and effectively as possible. So and, you know, care coordinators, care coordinators might be able to take on a panel of 300 patients. So, which patients do they, should we prioritize for those care coordinators?

To do outreach to and so there's there's algorithms that can be used to to assess risk and assess and to take all that information that we gather in the electronic health record and compute the patients that would benefit most from all that, the care coordination activity. 

Yeah, so what I think is like the big takeaway that I'm hearing here is all that data that gets entered, not all of it necessarily, there's, there's a purpose for that, right?

And it literally helps you make decisions and affect different outcomes because you have the data. 

Absolutely. Absolutely. And I think that's, you know, so all of this the transition to using electronic health records starting started with what was called meaningful use about 10 years ago. And it was incentivizing hospitals and and clinics to transition to electronic health records so we could collect this data.

And so we could exchange data. And so that everyone had was working from the same from the same information for each patient. And and then also to set us up to be able to use that data to identify patients for care coordination and identify patients that have a rising risk of developing a particular disease so that we can get ahead of it, because what's clear in in all of the evidence is that the longer patients wait to to have a discovery.

A health concern address the more expensive and the harder it is to address that. So if we can get ahead of it. We can, we can have a healthier United 

States. Yeah. Wow. That's, that's a little scary for me right now because I'm sitting here and my hand has been hurting. I've had this weird pain in my thumb and I realized like, oh man, it's been like two and a half months now.

I keep telling myself, I'm going to set aside some time to talk to someone about this. I'm like, Oh, I, I'm waiting. I hope that's not, not a problem because it's been going on too long now. So 

I'll put on my care for nation hat and ask you what's keeping you from going to the doctor. 

Yeah. It's literally just like the busyness of life and the pain's not that bad, you know, like, and it, it's kind of intermittent, right?

Like it comes and goes. Right. So if it hurt, like if it was maximum pain all the time, I'd probably have, you know, already handled it. But the other thing was I went on my health insurance website. And tried to find a provider and I found one that said it was in network in my area and called that provider.

And I was like, that was, that's interesting. Cause that's not normally the hospital system that this thing refers me to. So I called them and they were like, Oh yeah, no, we don't take that health insurance. So after that happened, I kind of Googled it or not Googled I searched on their website once more.

And it's like, and granted I was, I don't know if I was looking too specifically, I was looking for Oh goodness. What is it? What's the bone doctor? Yeah, I was looking for orthopedic specialists or even like hand orthopedic specialist. And so the hand one was maybe too specific adverse. So then I just looked for like orthopedic surgeons even, and it was like cities that were hours away from here and I was kind of shocked.

So I was like, well, I don't know, I'll come dig into this again later. So like I tried a couple of times and then didn't find a provider that was in network. So that's kind of what's prevented me. Right. 

Right. Well, and interesting because. Another task or another another great thing that care coordinators do is they can help address that barrier finding providers that are in your network.

And and. And then also, I mean, if you had a little bird on your shoulder saying, hey, what's keeping you from going to the doctor. Isn't that a little bit more of a, you know, someone that's. willing to help you make that happen. So, sorry, just a little personal explanation of, of how care coordination can help.

Yeah, absolutely. That would 

be amazing. If you can imagine folks that are not not as health, health literate, trying to navigate through that system and trying to navigate it. There's, there's so much to health care and knowing who to call and knowing where to go. And so, you know, it's, it's, you know what's interesting is most folks don't realize that primary care is supposed to be your health care quarterback.

And so you could just go to your primary care physician. And they can refer you wherever you need to go. They might say, Oh, well, I think it's X, Y, and Z and you just need PT. School therapy. Sorry. 

Yeah. You're like, he didn't know bone doctor. I can't use any more acronyms.

Good luck. Right. So anyhow again, you know, so these are all the things that come up in healthcare that everyone is up against. That from a population health perspective, trying to put education about out about, you know, what is primary care and where do you go for care? And when do you go to urgent care?

And when do you go to the E. D. and all of these things. So that the general public has a, you know, has a better understanding of how the healthcare system works and how it's designed. Cause that's a huge barrier to care 

right there. Yeah. Yeah. I mean, I've had, yeah, well, I've had, I've had kind of terrible, terrible experiences calling my health insurance company before.

And I feel like the response I often get is like, well, you can look at this online. Why didn't you look on the website? And it's like, well, the website wasn't that helpful or whatever. So I've thought about calling them. But I didn't want to wait on, I'm like, okay, when's a good time where I've got just like 30 minutes to kill on hold.

Nah, nothing comes to mind. Right. Right. And that maybe lunch. And that's a great way to spend lunch. And then, you know, thinking like, okay, I probably could go to my primary care, but then I've got like two visits when maybe, maybe a 30 minute hole would have been better than having to go to places. I don't know.

Maybe the problem was I should have an option.

Telehealth. Yeah, I've done that before but it was more like during the height of COVID, probably I've done telehealth. But yeah, yeah, that's true because that's really convenient because if it's like, oh, well, if, if I don't really expect my primary care physician to like fix me, but they can just talk to me and give me some insight into, you know, a referral that I'm going to need, then that's pretty convenient actually.

So that's a good, I feel like tomorrow I've got some phone calls to make. What's 

that? No, I just, who knew that we would be talking about, about all these fun things, but yeah. Yeah, I know. So, ebook is a great option. E visits are a great option. You know, hospitals offer asynchronous visit types. So so a good example, you know, if you have a sinus infection something that's a little bit more straightforward to treat, to treat.

So our patient portal is called MyChart, which is an epic patient portal. You can log in to MyChart, fill out some question, a questionnaire, and a clinician will review your answers. And then, you know, if you do happen to have a sinus infection, they can, they can prescribe you antibiotics to your pharmacy of, of, of of choice.

So so that's, that's another fun barrier, you know, barrier to care, you know, understanding that you can do these asynchronous things that only take 10 minutes and you don't have to go to the physician. 

Yeah. It makes a lot of sense for some reason. And I, I feel like I'm fairly technologically savvy.

Right. But I've had trouble for some reason, setting up Like the app or the portal for my grocery stores, pharmacy, or for my portal for the, like the primary care physician. And it's like, I understand that if I got this thing up and running theoretically, it would be easier, but getting it set up is.

Enough of a challenge that I just go ahead and call the person anyway. Right. And like, and I'm good with technology. Like, I mean, I've, I've run things and I've run scripts in Python before. Right. So like, I'm decent enough in technology that I go beyond like Googling bone doctor sometimes. Right. So, right.

So if it's a challenge for me, imagine the people that don't have the daily experience of using technology or maybe an older population that didn't grow up with it. Yeah, I can't imagine how overwhelming it would be to them. So is that something that maybe a care coordinator helps with even saying, like, here, let me help implement these sorts of things.



So depending on the care coordinator, absolutely. And. It's, it's interesting because, you know, I think about I have, I have someone in my mind and I'm not going to name them, but I have someone in my mind that is I think probably around 70, not technologically savvy at all, has never you know, has never had to work on a computer and does have a smartphone, but struggles with the smartphone.

So, you know, So that's the person that I keep in mind when when trying to, you know, we have all of this great technology, but getting it to those folks that might need it the most is, is definitely a barrier. So, you know, just even that, just that computer literacy is, is a, is a challenge, but. And I do think that, that there are care coordinators that do work on that, you know, from that level in order to to help with communication and and help improve.

I mean, the whole point of the care coordinator is to help improve the quality and efficiency of care. So. So it's a really interesting area. 

So wait, how does somebody know if they have access to a care coordinator? 

Well, so typically, oh my goodness. So this is where we get into that that risk of care coordination or risk of you know, that risk assessment and who could benefit from one.

And so that really depends on... Your providers and how they're signing. Some providers some hospital systems do have a referral process. If if if a clinician thinks that their patient could benefit from a care coordinator some insurance providers offer care coordination for particular things.

So for pregnancy episodes or for chronic kidney disease. So so yes, there are, there are resources and again, it gets back to knowing the resources that are there and in order to take advantage. But again, every patient is a unique situation because. Each insurance policy is a little bit different.

You know, the, the, so it's, it, it varies. 

Right. Of course. Yeah. So, and okay. And we're talking about that from like the challenge perspective, right? Like healthcare is changing. Technology's changing. But for maybe the more positive side, I know we talked a little bit before. About the landscape of healthcare technology evolving with like the advent of chat GPT, right?

But I don't feel like we got to talk at all about genetics and genomics. Is that? Oh yeah, absolutely. Yeah. So what were you thinking there? 

Taking the data that we have and being able to apply it to to healthcare situations. So. So we know your DNA and we know how, if we know the best chemotherapy to that your body is going to process the best way prior to trying something, because my impression, I've not worked in in oncology, but my impression is that there seems to be a lot of trial and error you know, you try something and if it doesn't work, then you try something else.

And and that's a lot of medicine actually. But and so if you you know, but if you know what your body or what a patient's body is going to metabolize the best way, and you can skip all the guesswork you can save a lot of time and, and and angst, I suppose and that's not just, you know, for cancer.

That's for a lot of different conditions as science evolves. And so that's something to keep an eye on. And You know, the challenge from the informatics perspective is, is how do you take that information and present it to the clinician? In the best way possible, because clinicians might not be.

Up to date with the most recent evidence. And they might not be paying attention to how genetics and genomics are influencing, influencing prescribing. Have it. But but knowing that that is coming is really exciting from a medical perspective. 

Yeah. And the other example that you would list in your notes here was about knowing what like antidepressants would work most effectively based on someone's genes.

Right. And I actually had another guest on just recently. I think the episode is not live yet, but he mentioned the same kind of thing because he was coming from a mental health practice background and was talking about how knowing your genome you can really map things that are going to be a lot more effective.

But that leads me to this question. And maybe, you know, I don't know, but yeah. Is my genome mapped and it's like in my EHR somewhere, like we've done this, we know we've got my code written out somewhere. 

So so you would have had to have had a test done in order to do that. And and so so in South Carolina, if you happen to be in South Carolina, all you podcast listeners.

There is actually a there's actually a program for you to get your DNA sequenced for free. And so all that's involved is, it's actually a really, really interesting test. You actually spit in a tube. 

You spit in a tube. You spit in a tube. I did this test. Oh, you did? I did Yes.

And so and so you know, and you get results. Based on, you know, what, what you're predisposed to, what, what, what some conditions you might be predisposed to, but as they, you know, so that's filed away and you can marry that data up either retrospectively or prospectively. So you can after the fact say, oh, okay, well, this patient had, you know, for going back to heart failure.

You know, if we're treating this patient with this medication and they have this DNA sequence and they responded this way, is there, you know, is there, and we have that for 100, 000 patients, can we you know, can we make any recommendations out of that? So so, yeah, it depends on if you've had the test done and where that data lives and who's using it for what.

Yeah. So with that specific test, since I participated in that, does that mean that my DNA sequence is now mapped to my like health record 

somewhere? I, you know what? I don't know the answer to that. I do know that we have all of that information. I'm not on the research side of things. So I don't know if the NRDNA.

Group has connected that to all of my like, because I didn't do it because I wanted to know what it right, but I don't that record has been connected to this is Peggy Jenny in epic at M. U. S. C. And so I imagine that they might do that. From a. What's the word de identified perspective, but I don't know for sure.

I would love to be able to do that. 

Sure. Of course. And I was thinking that I was going to get something very different in terms of results than what I got. I think when I saw that the results and not like, I mean. It showed that I didn't have really any risks for like anything they were testing for. But what surprised me was the things they were, and I can't remember now, but the things that they were testing for were like, so oddly specific.

There are things I hadn't even heard of. And I was like, I didn't even know to worry that I might have a genetic like proclivity to, you know, to have that. Like it was some kind of condition that like I never even heard of. So I don't know that.  

But we're also in the infancy of genetics and genomics, and so they're doing the easy stuff.

And so that was probably the easy stuff to identify. But as we get further into having more and more people with their DNA mapped and being able to marry that data together, to say, to do research, to understand what the best, you know, to be able to identify what the most effective. Treatment for depression or bipolar or you know, breast cancer might be based on your genetics and genomics.

That's, that is a super cool future state of healthcare. 

Yeah, yeah, no, that's, that's awesome. And I guess I'm, I'm glad that hopefully my information will contribute positively to, to medicine in some way. The other thing that, that was being screened was our ancestral ancestral background. Right. That's different.

Anyway What's odd about that to me? Not odd. Like I thought, Oh, I'm going to get something really specific about this. And it was the opposite, right? It wasn't oddly specific. It was like, Oh, you're probably from somewhere in Europe. And I was like, I'm pretty white. So that would have been my guess. Like, all right, thanks test.

I'm glad I spit in that tube for this one. It wasn't like ancestry. com where it was like, you're 83% Portuguese and 12% Irish and whatever, you know, not that that's not my background. 

Well, and I would imagine that they have more information, but they're also trying to present it in a way that is easily digested.

So they probably have more 

sure. I, I can't even remember to, like, I think they tested for, like, I can't remember if it was caffeine sensitivity or lactose sensitivity, or maybe it was a beef allergy. There was something in there. I don't remember. And I, I don't think I had it, but clearly like, I don't remember.

So I'm like, can I drink milk? Can I not drink milk? I need to look back at the results, but I have the results. That's the, 

well, and the interesting thing is as they learn more because they have your results. They'll be able to, like, if they identify that you're at risk for something, they'll be able to, to share that with you because they know, 

yeah, yeah.

As long as it hasn't been like randomized or de identified or whatever, as long as they've got it mapped to me somewhere, they're like, Oh, that was you. Yeah. Here, look out for that. Yeah. So I'm later. 

Now that I think about it, my, in your DNA results were, were. Resulted to me through my chart. So they are connected.

Oh, 

yeah, I know. That's true. Okay. Yeah, no, that makes sense. Well, that saves me later from having to Google bone doctor and can I drink milk? I'm going to go look in my chart and see good. Well, this is if, if for no one else, this has been a productive conversation for me today. Yeah, right. And that's really why I'm here.

I mean, it's a pretty selfish endeavor. It's fine. So let me see trying to, okay, good. I'm scrolling down through the notes that you made from our last conversation. And can you think of anything that's, that you really had hoped we would have talked about that we haven't spoken about yet? Anything that's either personally like a, like a passion of yours or that you think would be really critical again for somebody who's considering making a career change.

So for those, you know, I think I'll just reiterate my first point. And for those that are interested in making a career change shadow watch the day in a life, attend, attend meetings see, you know, see what challenges people run into. You know, As I, as we've already talked about, healthcare is incredibly diverse.

It's you know, it's very complex. And so, you know, there, there is a spot where, you know, if you sit down and think about what you're passionate about and the impact that you want to make, I'm sure that there is a place that you can do that from an IT perspective, because every clinical component has an IT perspective.

And, and so, you know, imaging lab radiology, I already said imaging, radiology you know, if you're interested in helping people have babies, fertility, you know, there's EHRs around, around helping people have babies and being able to attract them. The intersection between technology and healthcare is as diverse as healthcare is.

And it's only going to grow. I mean, it's not like health care is going away. It's not like technology is slowing down. Right. 

And, and, you know, and then, you know, I think during our last, our last session, we talked about. you know, teachers that might want to be getting into to health care. And so, you know, that's another angle that you can hit that you can, you can work, you can help people understand how to use the EHR better and how to interact with it and how to take good, you know, how to use it to take better care of your patients.

So there's, there's lots of different ways that you can get involved. And I think the best way to figure out where you might want to fit is just talk to as many people as 

you can. Yep, absolutely. I definitely second that having those conversations because you'll, you'll hear things that you wouldn't have imagined or wouldn't have read online.

And then shadow. Yeah, right. Of course. And then shadowing though. That's super important. I had an opportunity to shadow doctors for a couple of weeks in our local hospital when I was in high school and I thought that I wanted to be a physician and then I went and watched two surgeries and Turned white as a sheet and got super sick.

And I was like, Oh, maybe this is not for me. Maybe I'm not supposed to be doing this. So, but I'm super glad that I found that out in a free program in high school and not like when I'd already committed to med school, you know? 

Right. Absolutely. Well, and the other thing to keep in mind is it's never too late to make a change.

I've changed as we discussed last time, I've changed my career pretty much three times now. And and so follow your heart. And follow your passion. Yeah, 

that's awesome. Those are wise words. Well, Peggy, thank you so, so much for coming on a 2nd time to continue this conversation. I really enjoyed it 

me too.

Thank you. No. And hopefully, hopefully you'll be able to contact your PCP and how more people will use their PCP quarterback to care and understand. Care coordination and all the, the things that it can be can offer and 

hopefully it and it really does make me think like, okay, I need to put this on my calendar tomorrow.

I need to stop messing around, making excuses, just get it done. Because what if it did turn into something that was serious and preventable had I just gotten after it and been proactive a little sooner? Yeah, that's great. So to all our listeners, thank you so much for joining us on this episode of the pivotal podcast.

We hope Peggy's story and expertise provided you with a deeper understanding of the opportunities that await in the healthcare technology field. And as we continue this exciting journey, we've got a lineup of thought provoking conversations. Innovative minds and game changing companies that will shape the future of healthcare.

So whether you're a tech enthusiast, a healthcare professional, or someone looking to make a career pivot, stay tuned for more episodes packed with inspiration, knowledge, and powerful insights. Remember to subscribe to the Pivotal Podcast so you never miss an episode and together let's unlock the future of healthcare technology and embark on a transformative journey.

Until next time.