Melanie Cole, MS (Host): Welcome to the Healthcare Executive Podcast, providing you with insightful commentary and developments in the world of healthcare leadership as we feature discussion, insights, and perspectives from knowledgeable names in healthcare management.

Exact Sciences is now Abbott, is one of ACHE's premier corporate partners. Our premier corporate partners support ACHE's vision and mission to advance healthcare leadership excellence. For more information on Exact Sciences, please visit the corporate partners page at ache.org.

I'm your host today, Melanie Cole. And we're delving into the future cancer screening portfolio, health systems can prepare for an evolving cancer screening landscape by integrating established and emerging screening approaches with the data, digital engagement, and workflow infrastructure needed to expand access, close screening gaps, and support coordinated care.

In this podcast episode, we're joined by Dr. David Linz. He's the Chief Medical Informatics officer for Naples Comprehensive Health, NCH, and Lead Physician for Concierge Medicine at Moorings Park Center for Healthy Living.

Thank you so much for being here, Dr. Linz. Tell us a little bit about yourself and your background before we get into this topic today.

Dr. David Linz: Sure. Thanks for having me, Melanie. So, I practice outpatient primary care, general internal medicine. I have a geriatrics focus in my clinical care. But in my role as CMIO for the NCH Healthcare System, I work very closely with our system and our primary care and population health and try to integrate IT solutions and pathways into our cancer screening.

I'm also involved with our medical education. I'm involved with our internal medicine residency program affiliated with Northwestern Medicine, as well as our geriatrics fellowship at Moorings Park with Johns Hopkins University.

Melanie Cole, MS: Well, thank you for sharing that. So, let's talk about this topic. What does the future of cancer screening look like to you? Because this is really an exciting time.

Dr. David Linz: Yeah. So, I'm overall optimistic about the future of cancer screening. And i think the future is not necessarily one screening approach replacing another. I think it's more likely to be a portfolio of complementary approaches that are really patient-centered and involve the entire healthcare system to help solve this problem.

Screening programs may overlap operationally. But they're going to remain clinically distinct. We have cancer screening for different organ systems. We have breast, colorectal, cervical, lung cancer screening. And now, what's exciting is we have emerging multi-cancer approaches. And each of these have their own evidence, eligibility criteria, and pathways.

I do see primary care continuing to be the hub that helps patients navigate this increasingly complex portfolio with hopefully the goal to continue to support primary care rather than to continually add disconnected responsibilities to their growing list of tasks. And, you know, the introduction of MCED testing is an example of how new screening tools or modalities need to fit into and complement these existing screening programs. The Cancerguard test is an example of why systems need to think ahead. This test is really intended to complement, not replace any recommended cancer screening that currently exists.

Melanie Cole, MS: Wow. So, this is fascinating. What changes in screening technology, because I know we're moving so quickly in this area, or patient expectations do you feel are having the greatest influence on early detection?

Dr. David Linz: Well, technology is definitely changing both what can be detected, but it's also changing how information is captured and acted upon. And a lot of that is in the exam room, but some of it is outside the exam room, particularly at the population health level.

AI certainly has the potential role across the screening pathway and continuum. We're really trying to identify unmet needs in eligible patients. I think about this as identifying what patient gaps exist, so the patients that have not been screened, but also gaps in patients. What types of patients are we not screening, and how can we help at the individual level or at the population level?

I think about organizing relevant clinical information, supporting diagnostic processes, and helping teams prioritize where attention is needed. So, we need to involve diagnostic. So, I think about this is can we help teams when we're making referrals? Can we prioritize diagnostic colonoscopies versus screening colonoscopies when resources are limited? Can we recognize when a screening gap has actually been closed and avoid unnecessary outreach or unnecessary resources to people that have already completed that screening? Can we save it for the people that need it most? Physicians are going to remain central to the interpretation and the clinical decision-making, but can we work as a team?

Really at the same time, patient expectations are changing. Many patients, particularly in their midlife, are increasingly proactive about prevention, risk, longevity, and earlier detection. We're seeing certain cancers, particularly colorectal cancer, in younger patients. And so, that's bringing up a lot of discussions in the exam room.

But also, as patients age gracefully and are particularly in my population, they're healthy older adults, they may be aging out of cancer screening, and there's a lot of conversations about that. Should they continue screening, or when is it appropriate to stop screening? And that can be anxiety-provoking for patients and trying to deal with that.

Melanie Cole, MS: Wow, all of these questions are so interesting. And colorectal cancer in younger patients is certainly on the rise. And when you talk about patients aging out, these are great questions, Dr. Linz. And we know that people can get stuck in their ways. They're set in their ways. So, how can leaders introduce these new approaches to cancer screening without disrupting established programs that are working?

Dr. David Linz: Well, I think it's really important to recognize if something's working, we need to protect it. We should try to promote it. We should share it. We should enhance it. We should just do more of it.

Also just in general, healthcare systems vary significantly in their infrastructure and their resources. Some organizations have more than others. They may have centralized population health infrastructure. They may have sophisticated EHR tools that they can rely upon. They may have dedicated navigational resources and integration of imaging or multi-specialty care, which can make things easier.

On the other hand, other systems or independents may depend heavily on individual practices that may have more fragmentation or be self-reliant. So implementation therefore needs to reflect the resources and the maturity of the health system. You know, certain tests, again, like the MCED tests are additive to existed recommended screening. And leaders should continue to monitor whether innovation is intentionally or unintentionally creating duplicate work. Could it be confusing patients? Is it increasing downstream demand in good or bad ways? Is it pulling resources away from successful screening programs inadvertently?

Melanie Cole, MS: Well, that leads well into the next question because similarly we see, and you mentioned AI, but data, digital engagement, and we're learning more and more about televisits and how they're helping people in various areas get to see their doctor during their chronic conditions and whatever, and workflow technology.

So, what role are these things playing in health systems, and do you feel that they are adding, or as you say, adding a little bit of extra work, but yet on the end game, making it so it's so much more efficient?

Dr. David Linz: So, this is really the crux of what I try to work on. And technology should really make the care team more efficient, not simply generate more information. And I think about digital engagement having two primary audiences. Clearly, there's the audience of the clinicians and their support team.

We really want to provide clinicians with point-of-care information, and we want to help them with their decision support. So, I think a lot about the five rights of clinical decision support, that being the right information to the right person in the right format through the right channel at the right time. And when it comes to the screening, identifying those screening gaps in patients who could benefit when they're there in the room in a way that can be acted upon. And this workflow, it has to be actionable at that time. Then, there's also the role for the patients. And this is where patient portals can really help with patient outreach, education, reminders, completion support, and navigation. And there was even a study by Epic Research that showed patients who had these patient portals ages between 40 and 54 were more likely to receive breast cancer screening than those that were not using their patient portals.

So, I think that can be a really effective tool, not to mention social media and other advertising and outreach campaigns, bringing attention to the importance of screening. Not to mention dashboards can move screening from an individual provider activity to an enterprise management capacity and really involve an entire team.

We've used Cologuard-related dashboards at our system to help track our screening status. This has helped identify where patients were dropping out of the pathway. So for example, the test being ordered but not completed by the patient. And we could allocate additional resources to help get that care gap completed, have the patient complete that test, and then monitor our screening performance across a population. And so, this served as a tool to support multiple PDSA cycles in our quality improvement projects.

Melanie Cole, MS: There's so many avenues to streamline. And that's so interesting what you were just saying. So how can healthcare systems offer the right screening options for different patient populations while expanding that access and reaching patients who may not participate in traditional screening pathways?

Dr. David Linz: I think that's something that excites me, because we've never had as many options as we have now. And I think that more options can create more opportunities to engage patients, but also that the right option depends on that individual. So, screening decisions should consider first and foremost the clinical appropriateness, but also take into account patient preferences.

We also have to take into consideration community available resources, barriers, the availability for immediate referral or the burden of multiple visits that a patient may need to do to complete various screening. And also, just the overall likelihood that the patient can and will complete that screening pathway.

Various options are accessible, various options are non-invasive versus invasive. And trying to weigh those options can help reduce patients' barriers to the screening. Options that patients complete at home may be more convenient, but they may require a quicker follow-up or repeating on a yearly basis. So, the goal really should be incremental participation, not simply shifting already engaged patients from one screening method to another

Melanie Cole, MS: I feel those barriers could be a podcast in themselves, couldn't they? Because there's just so many. But what you're saying is fascinating. And how should leaders prepare for the potential integration of multi-cancer early detection approaches?

Dr. David Linz: Yeah. So, MCED testing may really shift or create a demand across service lines in ways healthcare systems and organizations need to anticipate. So for example, an evaluation initiative through a cancer screening pathway could uncover findings that require involvement not only from maybe hematology oncology that we may be expecting in cancer screening, but additional follow-up testing with radiographic testing may identify pulmonary nodules that may require follow-up with pulmonary medicine, or they may identify atherosclerosis or coronary calcifications that require cardiology follow-up.

This may also increase visits back to primary care to manage these conditions or they may uncover other organ systems that require referrals across your system. So, health systems should make patient identification, ordering, result review, and result management explicit parts of the workflow with established pathways and ownership now before that volume scales.

Primary care can continue to be that hub, but PCPs should not be expected to independently manage every single downstream diagnostic pathway. We got to continue to work at this as a team.

Melanie Cole, MS: Dr. Linz, this is such an interesting topic. Do you have any final thoughts on the future cancer screening portfolio?

Dr. David Linz: I'm still optimistic. And I truly believe that cancer screening can help save lives. Cancer screening, detection, and management are evolving, and we're seeing vast improvements. Unfortunately, screening rates are still low. Cancer-related deaths remain high. And we have active screening programs for only a limited number of cancers, but we're making improvements day by day.

Melanie Cole, MS: Thank you so much, Dr. Linz, for joining us today and sharing your incredible expertise. This was such an interesting discussion. Dr. David Linz is a paid speaker presenting on behalf of Exact Sciences. Views or opinions expressed during this podcast are based on Dr. Linz' own clinical practice and experience and do not necessarily reflect the views or opinions of Exact Sciences.

The content presented today focuses on the use of Cologuard and Cancerguard from Exact Sciences in accordance with the legitimate use of the project as defined by the company. Information presented today is not clinical, diagnostic, or treatment advice for any particular patient. Providers should use their clinical judgment and experience when deciding how to diagnose or treat patients.

Exact Sciences Corporation does not recommend or endorse any particular course of treatment or medical choice. Exact Sciences is now Abbott as one of ACHE's premier corporate partners. Our premier corporate partners support ACHE's vision and mission to advance healthcare leadership excellence. For more information on Exact Sciences, please visit the corporate partners page at ache.org.

For more information, you can also visit healthcareexecutive.org. If you enjoyed this podcast, please share it on your social channels and check out the entire Healthcare Executive Podcast library for topics of interest to you. I'm your host, Melanie Cole, and this is the Healthcare Executive Podcast. Thanks so much for joining us today.