Dear Doctor: Angela Lamb

The Mount Sinai Doctors Faculty Practice Access Center Medical Director and CTO of Mount Sinai’s Dermatology Department discusses her transition to virtual care and how she ensures that her patients have access to the medication and care that they need.

Dr. Angela Lamb believes that medicine is an art that should be practiced with integrity. The recent transition to synchronous virtual care has presented new challenges, but as a physician who’s passionate about integrating technology into her practice, she’s excited about the opportunities virtual care presents for improving patient access to medication and quality care. Read on to learn how she’s adapting to the new normal and which changes she believes will remain constant in the post COVID-19 world.

How did you get started in medicine?

Research shows that about one-third of physicians come from a family lineage of doctors. I fall into that statistic, given that my father is a vascular surgeon and has long been passionate about medicine. Though my parents never pressured me into the profession, my early exposure to the field helped inspire me along my medical track.

What I love about medicine, and particularly my specialty of dermatology, is how it has allowed me to manage complex medical cases in a wide variety of patients. In my practice, I see patients from two days old to one hundred and two years old. I’m also able to treat both men and women, and I really love the diversity. I also love the ability to manage cosmetic work, as well as more severe medical conditions. Finding medicine, and specifically, dermatology, has aligned perfectly with the type of career I always wanted to have.

Can you tell us about the Mount Sinai Doctors Faculty Practice Access Center and your work as the Medical Director?

Before joining Mount Sinai, I had the fortune of training on a very popular electronic medical record platform called Epic. So I already had a strong grasp of how to program an EMR’s user interface so that it would work well for dermatologists. Many physicians struggle with electronic health records, and while they can be frustrating and cumbersome to use, my experience taught me that it’s all about getting the electronic medical record to work well for you.

Thankfully, I was able to customize Mount Sinai’s dermatology interface in a way that worked very well for our department, and through that experience gained exposure to hospital administrators outside of my clinical practice. I soon became involved in a variety of different leadership roles within my department that eventually led to my position as Medical Director of the Faculty Practice Access Center.

As Medical Director, I facilitate relationships between our practices and our patient access center — which manages roughly four million patient calls per year (including our nurse triage and refill medication lines). I also co-created our clinical decision trees, which determine when and how patients are scheduled. These are crucial in any hospital system.

Access is a very popular term in healthcare right now, but for us, it’s all about ensuring that patients are seen effectively and without waiting, and that they can connect to the right doctors at the right time. Unfortunately, many patients in this country run into obstacles when looking for referrals to certain subspecialties. In some cases, they can end up waiting three-to-four months for an appointment, which is unacceptable — both from a clinical and a public health perspective. By working to improve patient access, we’re ensuring that our patients can receive exceptional care exactly when they need it most.

How do you see technology playing a role in ensuring patients can access their medication?

This is definitely a pain point within our current health paradigm. Right now, if you are part of a larger medical institution or doctor’s office that has some kind of online portal, ideally you would submit the request via the portal. Portals like these tend to be pretty efficient because they are paperless and the requests get submitted immediately.

While a lot of clinics do have online portals, we need to be mindful of patients who may not have access to a smartphone or the internet — or who just don’t feel as tech-savvy or comfortable submitting a medication request online. For those patients, we have to offer better care and services. Within the Mount Sinai Health System, our patients have the option to submit their request over the phone, but there is still an education gap where many people don’t even don’t know that the online portal option exists. Educating our patients about the technology available is the first step in offering better services. The second step is helping them use it efficiently.

How has COVID-19 affected medication access?

Unfortunately, COVID-19 has created a real burden for some patients in this regard — while also uncovering exactly how necessary technological solutions are for the future of healthcare.

Stay-at-home orders have presented new challenges for patients without existing relationships with mail-order pharmacies. This is particularly true in circumstances where a patient may need to see their doctor before refilling or beginning a new prescription. How do you meet these requirements when you can’t even go outside?

That’s where integration between telemedicine and getting your prescription delivered, through hospital mail-order pharmacies or pharmacies with same-day delivery like Capsule, is really critical for patients to be able to have the access that they need.

Can you tell us about your experience in moving your medical practices to virtual care? What are some things that have appealed to or surprised you about virtual care?

Before COVID-19, I was doing very little virtual care in my practice. Specifically, I was only practicing what we call asynchronous virtual care. A common example would be when a patient would send me a photo of a lesion or rash through a secure email server or through the MyChart portal and I would reply back with advice.

But since COVID-19, I have fully integrated synchronous virtual care into my practice. Now, my patients and I use the MyChart Epic telemedicine platform to have a visit similar to what we would have had in my office. The system has proved essential, and I think it will continue to be an integral part of my practice even after COVID-19 subsides. Be it making things easier for patients who commute from Connecticut or Brooklyn or simply expediting follow-up visits, it’s pretty clear that this technology is mutually convenient for both patients and providers. I’ve also noticed a decreased no-show rate since implementing synchronous virtual care, which makes sense since there are far fewer barriers to keeping virtual appointments.

The challenges, however, are still plenty. The first is personal: I’m pretty accustomed to spending the day on my feet walking to-and-from appointments and standing with patients. Now, I’m spending a larger portion of my day sitting, which presents new health challenges.

The other challenge is that it can be difficult to see certain things through an online connection. I cannot feel a lesion with a touch screen or use my dermatoscope tool to evaluate the lesion and its morphology, for example. And there are also general technical challenges like poor resolutions, unstable connections, speech delays, and cut-offs that don’t arise during in-person visits.

Is there any advice you’d give other doctors about the transition to virtual care?

Make sure you have a good interface and platform to work with. One of the reasons why the platform we use works is that the patient can use it easily and efficiently. They log-in, check-in to their appointment, and immediately we get a push notification that the patient has arrived, which really cuts down on waiting time. Also, in some cases, patients can pay their copay through this platform, too. Everything is integrated with our records and prescriptions so that we don’t have to bounce back between systems. It makes a huge difference and works 98% of the time, though there are always minor glitches, but we are working those out.

I’m also a firm believer in integrity, kindness, and humility in the workplace and life. Thriving in our modern world can be difficult — especially now — but I try to live by principles above and treat everyone I work with, regardless of their job function, with them in mind. The difference between my life and the life of someone that may report to me often has to do with a myriad factors that neither of us has control of (family upbringing, privilege, race, luck, etc). So it humbles me to remember that I am no better than they are and that I don’t know everything. Some of my professional stumbles have come from permitting short-term emotions to drive my reactions as opposed to having a more calculated response. I have learned from those mistakes and am better for it. A dear friend of mine was murdered, at the age of 22. She had a bright future and was a wonderful person. There are days when I am overwhelmed and feel down, but then I quickly pivot and remember that I am fortunate to be alive.

Given your passion for technology and medicine, what excites you most about the post-COVID world of medicine? What do you believe will change going forward?

I think that all of the players — including patients, physicians, pharmacies, and insurance companies — are going to be forced to re-evaluate how we do things, especially since a lot of what we did in the past was predicated on patient volume and physically seeing patients.

Many have likened this transition to 9/11 in that we are entering a new normal. There are definitely permanent changes in the works, but I’m excited by the possibilities, since healthcare often gets a bad reputation for being very inefficient.

Now, there’s a lot of momentum behind making these new changes work for everyone. COVID-19 has forced us to really look at the gaps in the industry and public health — many of which have existed for some time — to find feasible, effective, and long-term solutions.

As someone who is interested in the intersection of technology and healthcare, it’s incredibly exciting. We know that bacteria and viruses are not going away, but hopefully, we can use our experience with COVID-19 to be better prepared in the future. We just have to remember that we all have short attention spans. As long as we don’t forget these lessons and as long as we keep our foot on the pedal, there will be plenty of opportunities to improve patient care, decrease physician burden and burnout, and help keep people healthier.

Vital Signs

What are you watching? I’m from Jacksonville, Florida, so I had a great time watching the HBO documentary, McMillions, which tells the gripping story of the Monopoly game scam that took place between 1989–2001.

New favorite at-home activity? I have two school-aged children, so a lot of my spare time has been dedicated to helping them transition to virtual learning — they have both done a fantastic job at adapting to the new medium.

One of the best meals you’ve made recently? Even though we stayed home, we threw an Easter feast complete with short ribs, glazed carrots, and roasted garlic mashed potatoes.

What’s one healthful habit you’d love to see patients adopt? Sunscreen, sunscreen, sunscreen! As a dermatologist, I just can’t help myself — sunscreen will do wonders in preventing damage and keeping your skin healthy and looking great. Also, embrace the principles of healthy living, even if only in moderation. Eat foods that are whole and unprocessed when you can, spend time with friends and family (virtually counts!), and exercise every now and then. Every little thing amounts to a collective difference.

Know a great female doctor in NYC? We’d love to meet her, introduce us here!

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