<p spaceabove="5" spacebelow="5"><u><font face="Arial" size="12">Interviewee: 530 PCP, Nurse Practitioner</font></u></p>
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<p spaceabove="5" spacebelow="5"><u><font face="Arial" size="12">PowerPoint Comments</font></u></p>
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<li value="1"><p leftindent="27"><font face="Arial" size="12" color="#1F3864">Does not remember going through any kind of training for the CV Wizard</font></p>
</li>
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<p spaceabove="5" spacebelow="5"><u><font face="Arial" size="12">Transcription results:</font></u></p>
<p></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Melissa (M) 00:01</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay, so you mentioned you don't remember the-- or you don't know of the training for the CV Wizard?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Interviewee (I) 00:06</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I don't recall getting anything specifically, no.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 00:09</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. So how did you start using it? What did you think when you first saw it?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 00:14</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">There was some discussion from the nurses down the hallway who had-- I think they had received some training in terms of they were going to be the ones who were going to see the notification and then as they were rooming the patient, print off the information. And then from there, I took a look at a couple of the samples and then just incorporated the information into patient education during the visit from there.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 00:36</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. That's good.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 00:39</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Would you have liked to have received some sort of formal training or I guess been notified more so of a formal training for the Wizard?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 00:51</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I guess that would depend on what the goals of the Wizard were. I mean, my understanding of it is it's a way to consolidate those cardiovascular risk factors in one kind of condensed piece of information, so that it's both to my-- brings it to my attention as well as then I can discuss it with the patient at the time. So I mean, if that was the ultimate end, then I would say it's been accomplished [laughter].</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 01:18</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Good to know.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 01:19</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">So I don't know what other information there was or could have been that I would have received through the course of instruction.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 01:26</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">That's good to know.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 01:27</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">So had you heard which populations it was targeting or--? [interviewee shakes head no] Okay. So that's interesting. So--</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 01:32</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">No [laughter].</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 01:34</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah, so did you--?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 01:34</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I suppose you can't see my head shaking on the--</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 01:36</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">No. Yeah [laughter].</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 01:37</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I mean, I presumed it was peripheral vascular&nbsp;disease, cardiovascular disease, hypertension, dyslipidemia, I mean, prediabetes, those kinds of--</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 01:44</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Right. Yeah. So what this does is it fires for patients who are prediabetic, diabetic, or have serious mental illness. So other patients who don't have those three&mdash;or don't fall into those categories, it doesn't fire for them. So that's--</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 01:55</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Gotcha.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 01:56</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah. So it's--</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 01:58</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Does it fire for prediabetes based only on laboratory values or based on the ICD-10 code in the problem list?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 02:05</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I think it might-- it would probably-- it would go on both, I believe, because it's--</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 02:09</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I believe it's both, as well.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 02:11</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah. If someone's already been diagnosed with prediabetes, but it also can flag people who are potentially prediabetic--</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 02:18</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">If they've had an A1C checked.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 02:20</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">If they've had an A1C. Exactly. Right. Yeah.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 02:22</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah. Because it doesn't go off of glucose readings, I'm sure.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 02:24</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">No. Yeah. We have the fasting glucose and then the non-fasting and I don't think the EMR differentiates.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 02:33</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Not at all.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 02:33</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 02:33</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 02:34</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay, so if you had training, what would you think would be the best way for it to be conducted?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 02:45</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">[laughter] For the CV Wizard or for the--?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 02:48</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yes. And the cancer integration into the CV Wizard. What kind of training would you like to see if you had a choice?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 03:04</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">[pause] I guess I'm finding myself somewhat agnostic on the question. I mean, whether it was face-to-face, I mean, that would be time out of the day. I mean, the SABA training seemed very effective in terms of utilization of this type of a piece. I mean, it depends on, I guess, how broad you would want your intervention to be. If it was just a matter of recognizing the BPA, acknowledging it, and getting the document printed off, it sounds like the LPNs and nurses or medical assistants are going to be utilizing that piece. But if the intervention is primarily focused on utilization of the decision aids, then I would say they probably need some face-to-face support. And how to make that a practical implementation and change into a clinic visit.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 03:51</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 03:51</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Definitely.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 03:52</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">That's a great answer. So then, prior to our presentation, where have you heard about the cardiovascular Wizard? You mentioned you use it, right?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 04:02</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Right.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 04:03</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. Have you heard any other talk about it from other physicians at other clinics or other providers, nurse practitioners, and physician assistants?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 04:11</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Not that it's been-- no, I haven't&nbsp;had conversation with anybody else about it.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 04:14</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. So how do you like it?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 04:18</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I think it's a helpful tool in terms of-- I mean, there are&nbsp;clinical components and with respect to cardiovascular risk that I feel like I'm discussing with the patients that I'm seeing already, anyway. But to have something tangible and visual that summarizes, I think, the information in a very helpful way provides a tool for pulling that information together, even prioritizing which cardiovascular risk factors to focus on.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 04:49</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. So do you have any concerns about it?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 04:56</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Not especially. No.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 04:59</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. That's good. Can you think of anything that could make it better?</font></p>
<p leftindent="26" rightindent="4"></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">[silence]</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 05:15</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Not at this time. No.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 05:16</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. Yeah, that's good feedback. So what are your initial thoughts on a single Wizard that assesses both patients' cardiovascular risk and their cancer prevention screening needs?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 05:27</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I think as long as the design and utilization is efficient and helpful, I think the aspiration is laudable&nbsp;in terms-- because you're pulling a lot of different pieces that, in the course of a busy day, could easily be overlooked. So if there is that type of a kind of a quick way that pulls all those disparate&nbsp;elements together and summarizes them and says, "We need to address this, this, and this," then I think that's helpful.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 06:02</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Great. And how about integrating it into the clinic work flow?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 06:08</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">The notification process I would see as being much easier to implement into the clinic work flow because then, I mean, that's flagging, as we discussed before, cervical cancer screening, HPV, all of those different elements. Decision tools, I think, are more labor intensive and demand more time, not just because of the specific components in terms of risks and benefits, but because they have kind of such a separate-- they demand a separate level of focus that rather than having a conversation about it, you really have to kind of carve out a specific amount of time to navigate in and through those. And if you don't utilize them on a regular basis, it becomes even more time intensive. And so I would see that would be the larger barrier of the intervention, would be utilizing those decision aids.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 07:08</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. So it sounds like there's some time considerations that [crosstalk] have time.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 07:11</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Absolutely.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 07:12</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. So how would you prioritize cardiovascular risk and cancer screening with your patients?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 07:22</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I'm afraid I don't understand the question.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 07:24</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">So say you have a patient that comes in and has cardiovascular risk that's high and they also are due for a cancer prevention screening. How would you prioritize those two needs for that patient?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 07:37</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I would make the time to address all of them.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 07:40</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. That's great. So in terms of cancer prevention, how does the Wizard compare to other EPIC tools that Essentia Health uses in primary care?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 07:51</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">From the presentation that I've seen, and not having actually manipulated it in the practice setting, it looks like it functions in much the same way as other tools that we already have in terms of BPAs, specifically.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 08:06</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. And one thing I didn't mention in the presentation is that the Wizard is going to be available both as print copies and then also through EPIC, so you can-- there's a way to fire it currently now, the CV wizard in EPIC. But when it's on the computer, it's in EPIC, there's going to be hyperlinks called active guidelines that will link out to orders. It'll be specific to your clinic.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 08:31</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Order sets or--? Because right now the HPV BPA fires to, I mean, to a reference material that describes kind of the two different, two dose or three dose, but doesn't have an order set in it. In a separate area, it pulls in the smart set under adult immunizations.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 08:49</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. So what this will do, it'll populate orders. So the current BPAs don't do that?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 08:55</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">They do.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 08:55</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Oh, they do that, too? Okay. So this will put it all on one page, I guess, so online if you want to use it. Otherwise, you can order them the way you're used to ordering stuff, too.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 09:06</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Sure. Yeah.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 09:07</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">So do you see any advantages&nbsp;to this Wizard versus the current EPIC tools?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 09:17</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I think in terms of consolidating those disparate pieces, the variety of recommended health screenings, rather than having multiple different BPAs and notifications, if it pulls them all into one area. I guess the analogy that I'm thinking of is Medicare Wellness Visits is another notification or BPA that comes up. And that includes a number of different elements in terms of recommended screening, immunizations, and testing. And so, rather than pulling all of those different pieces on multiple different screens, having all those different pieces under one kind of smart set, so to speak, I find is user-friendly and helpful.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 09:58</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah, that's great. And this actually does fire for RNs who do&nbsp;annual wellness visits, as well as&nbsp;other providers, which is pretty-- that sounds like it can take the place of some of those BPAs that they receive with the provider.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 10:13</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 10:14</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">As a--</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 10:14</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Or if they're appropriately kind of identified in that annual wellness visit, I would think that that would satisfy some of the criteria, so as this Wizard is doing its kind of review and scrubbing, so to speak, then hopefully they wouldn't both need to be firing for the same information.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 10:33</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Right. That's a good point.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 10:36</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah. As a nurse practitioner, about how long are your visits typically? Are they 20-minute visits? Or do you have more 40-minute visits?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 10:43</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Actually, I have 30-minute visits all day.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 10:45</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">You have 30-minute visits all day?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 10:46</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Nice. That's really great.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 10:49</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Time with these, during those visits. Someone comes in. How would you, or would you, incorporate these shared decision-making tools?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 10:59</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">That's very patient-specific, I think. I can't imagine anybody's going to come in to walk through a decision aid to talk about HPV screen, immunization, or lung cancer screening, just that. So I mean, the standard approach or kind of experience that I have on a daily basis is regardless&nbsp;of why they're here, I try to address whatever&nbsp;those screening recommendations are. So if they're here for a blood pressure recheck or a diabetes issue, follow-up, or something like that, "Oh, I notice you're not up-to-date on your mammogram," or whatever the case may be, and then having that conversation in the context of everything else. So I mean, if it's someone who has multiple health issues from cardiovascular, renal, endocrine, thyroid, whatever the case may be, where just getting through the problem list is [laughter] enough of a challenge even in 30 minutes, and then trying to incorporate those health screenings, it is, I guess, more condensed. But I'm still trying to be comprehensive. Again, I can't imagine trying to pluck out one element of lung cancer screening, for example, and saying, "Come back in a week and we'll talk about this entirely separate." I've got them there for that amount of time, so I'm trying to address as much of it as I can. So trying to take another five minutes or more to walk through a decision aid, apart from the counseling and shared decision-making conversation that I'm already having, which, to this point, has felt effective, I can't imagine having a strong motivation to wanting to incorporate another decision aid tool, beyond the shared decision-making conversations I'm already having.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 12:56</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Sitting in the patient position as a patient, would you rather have something like this? Or would you rather your provider chat with you about your risk?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 13:15</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah. I guess I'm having a difficult time putting myself in their shoes. I mean, from the type of-- I guess, having the tool available-- and this is just my own learning preferences and style. Having the tool available to review on my own, I think, would be helpful. If an individual patient wanted to have a separate conversation utilizing a decision aid, I would not throw up a barrier to that in any way.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 13:51</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">So the shared decision-making tools are basically for the providers to use at their discretion. The only one that has any requirement would be the CDC AHRQ. And this is for patients who are on Medicare. The only way Medicare will pay for the low-dose CT scan is if they actually come back and have a separate shared decision-making visit about this. But that's the only time that it would be something to use, so.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 14:18</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Which is different information&nbsp;than what I guess I'd received in the past.&nbsp;I mean, my understanding is that the LDCT had to be ordered initially in the context of an annual wellness visit when a shared decision-making conversation has been had, not as an entirely separate visit.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 14:33</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. Well, that's really good. Okay, then maybe we have the incorrect information, then. So that's good to know.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 14:40</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">So, I mean, that was my understanding of the LDCT for Medicare patients. Now, I mean, the screening, as you know, starts at age 55 before Medicare applies--</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 14:50</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">It does. So, right. For those patients, yeah.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 14:52</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">So then, there's-- I mean, I'm still having that shared decision-making conversation, providing patient information. Anecdotally, I mean, I see my pulmonary colleagues ordering LDCTs for lung cancer screening for people who meet those criteria, regardless of what the visit type is.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 15:10</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Well, that's good. No, that's really good to know. Yeah, because we heard one thing so it's good to find out that that may not be what's happening and practiced because-- yeah.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 15:17</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 15:17</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">So do you think that the shared decision-making tools would help you make a shared decision with your patients?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 15:27</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I feel like I'd be speaking out of order. I mean, I haven't utilized them formally, over and above-- I mean, I've used the Mayo statin tool with patients, I mean, to give them kind of that visual, kind of population-based atherosclerotic cardiovascular disease ten-year risk kind of image, to pair both the conversation with the visual.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 15:51</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. So let's see. What do you think of the tools, actually? I mean, what are your impressions of them? I know you've talked about using them, but what do you think of them?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 16:05</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I think they're great. I think they're very helpful in an idealized situation, I mean, for a motivated, activated patient who's interested in kind of receiving that information. And so I can and do make the information available. The extent to which it impacts their decision or our decision together, I mean, varies a great deal. So some people are very hungry for that information and in that situation, I'd be happy to partner with them in that, in providing it and having a conversation. And other folks really aren't at a place where they can comprehend or understand or kind of manipulate that information, or they just aren't interested.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 16:55</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Right. Okay. Yeah, that's true. So right now, the plan is that for half intervention clinics that would get these shared decision-making tools, that they would fire with the BPA for the Wizard. And so they would be handed to the patient-- or the provider, actually. Do you think that's the best way for the patients to receive these, or the best time? Because I guess there's a concern about integrating it into work flow. That's something that other people have brought up. When is the best time for the patients to receive this to have time to review? Do you have any thoughts about that?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 17:30</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">When is the best time [laughter]?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 17:32</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Right. Yeah.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 17:33</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">In an ideal world.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 17:33</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">An ideal world. Yeah, ideal time.</font></p>
<p leftindent="26" rightindent="4"></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">[silence]</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 17:45</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Like we've had suggestions of in the beginning during the rooming phase, the patients get those so they can look them over. Or they have them prior to the visit through MyHealth. Or they go home and look at them and digest them themselves and then make another appointment.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 18:03</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Afterwards, yeah.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 18:05</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">And the next time they come in--</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 18:09</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">And I see pros and cons in all of those circumstances. I mean, getting the information ahead of time is very out of context and may not be familiar and could even be scary, I mean, if there isn't an opportunity to supplement that with a conversation.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 18:24</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">That's a good point.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 18:25</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Getting that during the rooming process, when they've got other immediate, practical and tangible&nbsp;concerns apart from this information, I think could introduce some cognitive dissonance in terms of distraction, more difficult to address what their priorities are that they're bringing that day. Adding another layer of complexity&nbsp;and consideration when maybe we're adjusting their diabetes&nbsp;or hypertension management. And adherence is such a challenge when, I mean, with the more details and changes that we're already implementing. Taking it home [laughter] afterwards, after trying to process and digest, it may just end up in the waste basket or recycling bin and be barriers to follow-up. So--</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 19:17</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">That's good feedback.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 19:18</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">--I don't think there is one right answer. I mean, we've talked a little bit about the annual wellness visit to this point. And I think a lot of those questions are very practical, day-to-day. So when we send that questionnaire out ahead of time - how many fruits and vegetables, are you physically active, home safety questions, and things like that - that, at this moment, makes sense to me that they would receive that information ahead of time and could kind of walk and process this. Personally, I guess I would be inclined, I suspect, of, if these materials print out because a patient or someone I'm seeing is due for any or all of these, having that material, going through the other&nbsp;stuff, information, and then having that shared decision-making conversation&nbsp;to supplement the decision aids. And then giving them the option to take it home and review it, and then circle back, I guess would probably be the most kind of comfortable&nbsp;and effective approach that I would imagine at this point.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 20:32</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah, that is the one plan for the study. But it could be a possibility later on after, if the intervention is maintained&nbsp;at a center, to do something like send it out, like with the annual wellness visit material. Now, do they email that out to the annual wellness visit patients? Or do they mail it, hand deliver or hand mail that--?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 20:52</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I'm not familiar with that part of the process.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 20:53</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">No. That's interesting. Yeah, I don't think we've heard about that, that they get anything before having hand, so that's interesting.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 20:59</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I hear about it happening sometimes but not all the time.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 21:02</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">It may not be, okay, consistent. Okay. So how do you currently utilize the CV Wizard print-outs during an office visit?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 21:11</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">The majority of the time-- well, depending on the chief issue of the visit, I either do or do not use the print-outs. I mean if they're here for a sinus infection, fill in the blank, then I probably will just disregard. If it's for follow up of chronic disease management or annual wellness or something like that, then the majority of the time, we'll go through everything and then use it as a summary tool at the very end. And say, "This is just a way to consolidate information." And then, I mean, I'll provide both sheets to them, explain what the six cardiovascular disease risk factor components are, where they're at in each of those components, trying to prioritize those different elements, trying to make sense out of them. And because we've discussed them earlier in the visit, it's a lot-- it's just kind of reiterating and summarizing. And then gives them something tangible to look at to take with them.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 22:20</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah, that's great. So how do you physically get the handout?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 22:26</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">During the rooming process, the nurse will fire it and print it off and then in with the rooming form; it's just clipped on the outside of the room.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 22:38</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">So do you ever have a chance to review it before you go in to see your patient? Or do you review it once you're in the room?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 22:43</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I review it on the fly.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 22:45</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. So how do you document the use of the tool in EPIC, if at all?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 22:54</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">The print-out, specifically, I don't. I mean, so assuming somebody has impaired fasting glucose prediabetes, dyslipidemia, and hypertension, and they smoke, I mean, my standard documentation is very problem-oriented. So assessment and plan will just incorporate those elements of each of those problems and what we've talked about and any particular treatment or therapy that they're on. But I don't specifically name-- discuss the CV Wizard tool.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 23:30</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Right. Okay. Yeah. And I think that's pretty common not to document it's use. So that wasn't, I don't think, part of the training.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 23:40</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">[laughter] Which I didn't get, anyway.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 23:42</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Which you didn't take, anyways [laughter]. Yeah. So how do you think the integrated Wizard with cancer prevention will affect Essentia&rsquo;s primary care providers and staff in practice?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 23:59</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I think the intent, and I guess I hope what the outcome would be, is that it will be more overt in terms of bringing forward those kind of regular screening recommendations&nbsp;so that the implementation of those screening recommendations would be more effective, more regular--</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 24:23</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. Yeah.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 24:25</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">--or at least addressed. I mean, I've got a number of patients that, for whatever personal reasons, they do not want to do colorectal cancer screening or mammography. But we've had the conversation and that's been documented. And I mean, a Wizard like this would bring those issues to the fore to at least make sure that they're being addressed and discussed.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 24:45</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">So it sounds like helping to engage the patient?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 24:47</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Mm-hmm.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 24:49</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah. So do you see any potential disadvantages for providers and staff?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 24:56</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah. As smart as we make BPAs, they're still dumb. So there are those, I would say, just the frustrating realities of them that a lot of paper, materials, or extra-- where, if in the kind of global health status of that particular patient or again, the reason that they're there for that particular visit, it's just automatically spitting out data and information that may have absolutely no relevance&nbsp;to that particular visit at that particular time. And so I mean, between that and the clicks and how well it's integrated with other BPAs creates the potential for complexity and frustration and ultimately weakening the effectiveness.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 25:46</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. That's a good response. So how do you think it&nbsp;will affect Essentia patients in primary care?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 25:55</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I&nbsp;think the&nbsp;notifications&nbsp;will help to promote patients receiving information that I think they are eligible for or that we owe to them, as, I mean, evidence-based best practices for clinical decision-making, screening health and wellness. So I think patients would benefit from having consistent notification and awareness&nbsp;of what's available and why.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 26:32</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">So can you see any disadvantages to patients of the tool?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 26:38</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Just in terms of the--?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 26:40</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">The Wizard, of the shared decision-making tool. You've talked a bit about this but-- the Wizard, do you see any disadvantages?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 26:52</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I think in the same way that, I mean, the CV Wizard functions now, coming back visit after visit and getting the print-off, that there's a certain amount of, maybe, psychological burden associated, you know? If you continue&nbsp;to see obesity, obesity, obesity, or, "My cardiovascular risk is whatever because of my tobacco addiction." Where its repeated messaging, true though it may be, is pretty black and white on a Wizard. So I mean, coupling that with hopefully a therapeutic relationship. Not to undermine that but maybe at least mitigate it through a supportive engagement.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 27:38</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">So, kind of one of the principles behind the repeated exposure is to hopefully help change behavior.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 27:45</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Mm-hmm.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 27:45</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Do you think repeated exposure to this for patients may help them increase their likelihood of reducing smoking or addressing--?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 27:52</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">From a population standpoint? I think in that regard, yeah. I think that would have a statistically significant impact.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 28:00</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 28:01</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">But on a--</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 28:01</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">We can hope [laughter].</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 28:02</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Right [laughter]. But on an individual basis, I mean, stress can either mobilize or immobilize.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 28:10</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">That's a very good point. Yeah, that's true. So what triggers you to discuss cancer screening and prevention with your eligible&nbsp;patients?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 28:19</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">[laughter] My neurotic&nbsp;personality.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 28:21</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay [laughter]. Not the BPAs or--?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 28:25</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">For cancer screening?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 28:27</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 28:27</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I think the BPAs are helpful. But I mean, in the almost three years of practice to this point, I mean, I've just developed a way to constantly remind myself to circle back and focus on this every visit.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 28:42</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. So you do try to address cancer prevention screening every visit that you have?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 28:47</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Absolutely, yeah.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 28:47</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. That's great. That's fantastic. So given your understanding and experience at Essentia, what do you feel are major or minor concerns that our research team will need to address to ensure a successful implementation and high utilization of the Wizard?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 29:06</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I think I mentioned before, just in terms of the design elements and the coordination or flow with other parts of the EMR.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 29:18</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 29:19</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Because if it's pulling inaccurate information or there's three BPAs that are firing about the same thing and there's so much overlap, that's going to be a point of frustration and ultimately, people will just wash their hands of it.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 29:34</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. So can you think of any organizational barriers we may face, in addition to alert fatigue?</font></p>
<p leftindent="26" rightindent="4"></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">[silence]</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 30:01</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Not just organizationally, but in terms of just a-- you had mentioned before some of the discrepancy in kind of recommendations.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 30:16</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Right. Yeah, like for the breast cancer screening--</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 30:18</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Right. I think that's&nbsp;a&nbsp;practical reality that's faced even now with, I mean, recommendations that fire for diabetes and some of those recommendations that-- I mean, cervical cancer screening has changed over the last half a dozen years. Recommendations, breast cancer screenings-- people are still very contentious about LDCT screening and managing incidentalomas and appropriate&nbsp;follow-up.&nbsp;So I mean, I presume and hope that individual providers are finding ways to kind of navigate that in a way that's comfortable and effective for them and their patients. I mean, you've got to draw the line in the sand somewhere, I mean, whether it's in terms of hypertension management or which guidelines, ACOG or USPSTF, or noticing that there's no prostate cancer screening on this tool anywhere.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 31:26</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah, there was some discussion about that.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 31:28</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I would imagine-- yeah, as is appropriate to have the conversation. So I think there's lots of fertile ground for discontent from that perspective, in that there is no unanimous consent&nbsp;or decision.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 31:48</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Right. Yeah, we have gotten some feedback that if a provider doesn't necessarily agree with one of the recommendations, they may just not want to use the entire Wizard. So that is a concern. We do want to make sure that providers know-- I mean, it is, again, up to your discretion to use, too, so.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 32:06</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">And we had talked a little bit before, as well, about some of the criteria that are involved in some of those cancer screening recommendations, I mean, namely the LDCT and frequency in terms of Pap smears. I mean, is the Wizard able to make a distinction between family history or previous abnormal Pap smears? I mean, there's a level of kind of clinical specificity there that demands more-- as I said, as smart as we make a BPA, it can only be so smart.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 32:39</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">So that's a good point. Yeah. So hopefully the cervical cancer BPA-- or the algorithm in the Wizard, I should say, will go and look at the family health history and document-- or previous history to see if there had been atypical cells&nbsp;or something, so. Yeah, so--</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 32:54</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Right. Which I'd be surprised at. I mean, the way that the pathology reports are implemented and utilized, you don't necessarily always see a health history or problem list that's updated to reflect that effectively.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 33:06</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">That's good feedback. Right. Okay. So there may be some, I would say inaccuracy. But the EMR may be kind of hard to scrub for some of those things?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 33:19</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Absolutely.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 33:21</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. So what do you think about ensuring a seamless implementation and high utilization? What could we do to increase the likelihood of both of those things with Essentia&nbsp;patients?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 33:36</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">[inaudible].</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 33:36</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Do you want me to rephrase it?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 33:37</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah, please.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 33:38</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">So what do you think we could do to encourage use of the Wizard with patients at Essentia?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 33:44</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">[laughter] The cynic&nbsp;in me would-- pay for performance.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 33:55</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 33:56</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Garnishing wages for people who don't utilize it [laughter], but that probably would not go over so well.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 34:01</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">No.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 34:08</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Is there kind of a conceptual framework, I would assume, underlying kind of implementation to this point? I mean, I guess I would presume I'm part of it in terms of, I mean, just getting information--</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 34:22</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yes. Yeah.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 34:23</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">--to this point in developing, trying to identify, I mean, well, stakeholders, I mean, barriers, and opportunities for progression, so.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 34:32</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Right. Yep. Barriers and facilitators. Exactly. Yeah.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 34:34</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 34:35</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 34:37</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">And so I would feel a little presumptuous [laughter] trying to offer a clear vision of how to implement something that you're implementing.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 34:48</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Okay. That's okay. So is there any questions that I didn't ask today, comments that you have or concerns, maybe, that you'd like to talk about?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 35:02</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">No. I think we've addressed-- I think I've had an opportunity to kind of give voice to some of the potential gaps and barriers--</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 35:13</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Which is great.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 35:14</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">--and pros and cons, so.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 35:15</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah. We really appreciate it.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 35:17</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah. We really do. Yeah. We need those things. We need to know what's going on on the ground and how the CV Wizard is currently being used and--</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 35:24</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Or not being used.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 35:24</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Or not being used [laughter]. Yeah. Because this will add extra layers to it. So we want to make it a tool that providers want to use, as opposed to never use.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 35:35</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Burden.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 35:35</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Right, or a burden. Same with patients, too.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 35:37</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yep. And realistic aspirations. I mean, from a design team, I mean it&rsquo;s --, and even from a research study, it's your-- I mean, you've got a personal stake, invested interest in the success of this, I presume. I apologize if I'm projecting&nbsp;inappropriately, but I think you'd want it to be successful.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 35:58</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">We'd hope, right.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 35:58</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">But I think managing realistic expectations in terms of-- I wouldn't anticipate that there's going to be a universal panacea that's going to address all of these things for every patient. So--</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 36:08</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Exactly.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 36:09</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">--approaching it from a population perspective where we're moving the bar a little bit, I mean, it does seem to be an appropriate aspiration.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 36:17</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Right.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 36:18</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Great.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 36:19</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Thank you.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 36:20</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Thank you so much.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 36:21</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah. This was an excellent interview. Would you like to continue being updated on the project as it goes forward and--?</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 36:28</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">It sounds like I'll be hearing about it coming up in January.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 36:31</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">In January.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 36:32</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yeah.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 36:33</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Probably before then.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 36:33</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Before then we'll do--</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 36:34</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Hopefully you'll get training this time [laughter].</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 36:35</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yes.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">I 36:37</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Hopefully I haven't suffered too much as a result of not getting training on the CV Wizard.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 36:41</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">No.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 36:42</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Right.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">H 36:42</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">No. You seem to know what's going on pretty well.</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">M 36:44</font></p>
<p leftindent="26" rightindent="4" spaceabove="4" spacebelow="4"><font face="Arial" size="12">Yes. Definitely. Yeah.</font></p>
<p></p>
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