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What kinds of software are missing in reproductive health
Under the microscope

What kinds of software are missing in reproductive medicine? Insights from Dr. Esther Chung

What kinds of software are missing in reproductive medicine, and in which areas should software not interfere with the physician-patient relationship? We asked LEVY Health’s Chief Medical Advisor, Esther Chung, MD, about her pain points and how she would like to see them addressed.

The interview was led by Silvia Hecher, MSc, Co-Founder & Chief Product Officer at LEVY Health.
Dr. Esther Chung is an REI fellow at Stanford Medicine and Chief Medical Advisor to LEVY Health.

Silvia Hecher

Esther, you are both a representative of Generation Y, which means you have been working with software throughout your college education and career, and you represent the medical field of reproductive endocrinology, one of the youngest and fastest-developing fields in medicine. I would say that makes you both experienced and critical when it comes to medical software. Which new software functionalities would you like to see in your daily practice treating fertility patients, and why?

Esther Chung, MD

I would like to see repetitive and educational tasks integrated into the software I use with patients. Fertility treatment requires a lot of patient education and expectation management upfront. However, even in a one-hour consultation, it is hard to ensure that patients truly understand what I’m doing for them and what their options are. So much information is conveyed during that hour that there’s no way they can absorb everything I’m telling them. If there were a way to prepare patients in advance and explain what I’m ordering for them, it would alleviate some of the burden and help patients feel more comfortable with the workup they’re going to receive.

Another example is ordering all required tests after the first consultation. I spend an additional 15 minutes clicking through all the labs patients need, assigning diagnosis codes, and then informing my team so they can assist with scheduling. These tasks can easily be automated. I think there are many low-hanging fruits, a lot of inefficiencies that current tools are not addressing.

Silvia Hecher

Speaking of the first patient consultation, how can software contribute to making it a better experience and more efficient?

Esther Chung, MD

By making better use of both the patients’ and the reproductive endocrinologist’s time. Imagine being a fertility patient who has been trying to become pregnant for a long time. Ideally, you’d like to be pregnant within two weeks. You wait for your first consultation, only to be told that, due to the clinic’s operational processes, you won’t actually be starting treatment for several months. Understandably, this is frustrating. For women over 35, time is crucial, and an additional three months may be half the time they’ve already spent trying.

If you engage patients immediately after they reach out to schedule their first appointment, you not only bring them onboard right away, but you also save them time and show that you understand the urgency of their situation. 

Without a proper fertility workup, I end up providing very general information during the first consultation, when I could have offered personalized guidance on what the patient should expect and what treatment recommendations we would have. If patients have more understanding of their lab results and what they mean, about how fertility treatment procedures work, they are less afraid to go ahead and, you know, commit to treatment.

I find it frustrating that in reproductive medicine we’re so open to changing how we treat patients based on good data and good reasoning. And we’re so slow to try to make the experience better for patients.

Silvia Hecher

Onboarding patients immediately could be done by an advanced practice provider or a nurse practitioner as well. What’s the benefit of having it done by software?

Esther Chung, MD

The benefit is that it can be done in a standardized yet personalized way, ultimately allowing clinics to scale. We not only have a shortage of reproductive endocrinologists, but experienced staff for proper patient onboarding is also hard to find and expensive. Clinical guidelines change, lab parameters and assays change, and having software that accounts for all of this would be a relief for the entire clinic staff.

Silvia Hecher

Why are many clinics, and specifically some reproductive endocrinologists, hesitant to do fertility workup before the first consultation?

Esther Chung, MD

I think there are two main reasons. Firstly, it can be logistically challenging for clinics without the proper software or trained staff to handle it. There’s also the insurance aspect to consider, as patients might only have coverage at specific labs. Secondly, some tests, like preconception genetic carrier screening, have many nuances that require counseling. For example, I want patients to understand the pros and cons and the possible outcomes of carrier screening. Some providers feel they can’t order specific tests without first explaining them in detail to the patient.

However, within the 40 to 60 minutes we have for the first consultation with fertility patients, we simply do not have enough time to cover every test and its pros and cons in depth. Even if we did, it would be an information overload for patients. Software that prepares patients for treatments, explains why tests are needed, discusses the pros and cons of certain diagnostic procedures like carrier screening, and allows for personalized diagnostics is a huge time saver. It enables me to have a more personalized, meaningful first consultation with patients.

At the end of the day, it’s a trade-off. By allowing software to manage certain diagnostic tasks, I might lose a bit of control in the onboarding process. However, I will have my first consultation with educated patients asking more meaningful questions. Patients will receive more relevant information from me, making it easier for them to make informed decisions. The entire process becomes more efficient, ultimately leading to a much better use of my time and reduced time to treatment.

Silvia Hecher

Where do you think the line should be drawn between the capabilities of software explaining things to patients and the role of a reproductive endocrinologist in providing explanations?

Esther Chung, MD

If you want to grow and ensure care is provided in a standardized way, everything that can be automated from a checklist perspective should be optimized using technology. The key word here is synergy – I want my patients to be informed as they come through the door so that any further counseling I do with them, they can actually absorb. Software that is elegant and not overwhelming can help educate a patient as they embark on a complex treatment process. It sets patients up well for conversations with their providers. As an REI physician, I want to focus on personalized guidance regarding treatment recommendations, patients’ personal risks due to comorbidities, and what patients should expect in terms of outcomes in their specific situations.

Silvia Hecher

How can we ensure technology does not get between the patient and the physician?

Esther Chung, MD

To ensure technology is helpful, it’s crucial to include those who will be using it in the development process. One reason I was drawn to LEVY Health was that I could tell it was co-developed by reproductive endocrinologists. While physicians have differing opinions, many of us can agree on what a fertility workup should entail and what patients should be counseled on. Without that kind of input, software preparing patients for treatment won’t be as effective as it could be.

Another important aspect is that software should be adaptable to a clinic’s workflows, with feedback constantly incorporated. Requirements and workflows change, and providers who see their feedback implemented will use the software more effectively. For us, as physicians, getting involved in the development of the tools we use daily may seem like extra work upfront, but it will pay off in many ways in the future, in terms of clinic efficiency, scale, as well as patient understanding and satisfaction.

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