AI, Digital Health and the Future of Patient Care

AI, Digital Health and the Future of Patient Care

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As the most influential tech event in the world. I've always wanted to see what this place was like. I'm a tinkerer.

Carlos and I were talking about that a little bit before. Whether that was the misguided experiment that I did in the kitchen with my son when they were in grade school. I have twin boys that are 22 years old now, but in grade school I read something on the internet about how you could extract bismuth from pepto-bismol. And so we were trying to do that. And it sort of exploded in my face.

And I've got a few Black dots here to remind me, too, about the safety of this sort of tinkering. But, yes, kindred spirits in here as well. And more recently, even printing N95 masks from 3D printers when we couldn't find them in our hospitals. And so my son and I had 20 3D printers at home churning out N95 equivalent masks during the COVID response. And so, yes, the creation of technology to solve problems is something that's near and dear to my heart.

But, you know, getting to the point, as the last two years have shown us, taking care of ourselves and our families is not without challenges. And and we've seen over the last two years, many industries have risen to that challenge and organized medicine has risen to that challenge as well. And so is technology. And I'm proud of the American Medical Association's role to identify and expand digital health as an important care option for our patients.

I'm keenly aware of the critical role that technology has in delivering health care and that digital monitoring and other digital tools. And so I'm looking forward to this conversation and the comments today. So who is the ama? So we are a Chicago based institution, so 175 years old, the largest and most influential physicians organization in the United States. And so our policy is made by our House of Delegates.

And so this is a group that represents about 190 state and medical specialty organizations that convene twice a year. And this includes medical students, residents and Fellows. So physicians in training and that entity, the House of delegates, establishes policies to guide the practice of Medicine. So anything that the AM takes a position on, that's a policy that's been created by this House of Delegates through this process, and it influences policy decisions at State and federal levels.

So when state capitals are dealing with issues, when we're dealing with those issues in Washington, d.c., our advocacy on those issues is driven by the policy that's created by this House of Delegates. And so this is something that you can imagine. It's sort of it's like when the House of Delegates convenes, the ideas that get exchanged, you know, when these 1,000 people in this room sort of create that the AM is going to do x What that looks like. But then when it does come out, that's exactly when we activate the machine to go into these state capitals and in the nation's capital to advocate for what this group has decided to do. And so because of this output, we've led major initiatives around smoking, around vaccinations, around opioids or on automobile, automobile safety, COVID 19, you name it.

This is the work that the 3M has done to advance the health of our country. And our mission calls on us to promote the art and science of Medicine and the betterment of public health. So, so very straightforward art and science and medicine, acknowledging that it's both an art and science. And right there in our mission statement is the betterment of public health.

And so we are what we consider the physicians powerful ally in patient care. And so we do this by removing obstacles that interfere with patient care, improving the health of the nation, by trying to prevent chronic disease. And so our main focus there is around pre diabetes and hypertension and then driving the future of medicine, reimagining medical education. I graduated from the University of Michigan in 1995. It it was a couple of months in gross anatomy, a couple of months in histology, two years total in the classroom.

And then off you go to the hospital and spend two years there. That method of training is something that needs constant sort of reinvention and to make it more applicable to what it's like to practice medicine nowadays. And so reinventing medical education is something that's one of our core purposes as well. So the present and future of Medicine have considerable challenges for physicians in our health care system and among them, increasing digitization, something that I don't need to tell any of you about of health care across every aspect of the delivery of that care. Continued rise in chronic diseases.

So despite our investment in health care, the fact that there's more people with prediabetes that don't even know it, more people with hypertension that don't even know. We were just talking, Carlos and I, more people with sleep apnea that don't even realize it till they come to my office. And I look and I see that there's barely an airway there. And they had no idea that they had a condition that rises there, raises their mortality rate by 30% in this coming year.

So this lack of awareness in the rise of chronic disease, major public health events, you know, the next COVID. God forbid it's any time soon. The aging population, diverse patient communities, the fact that in four eight, 503, which is the zip code that I live in, in flint, Michigan, the lifetime, the estimate on life is about 10 years shorter than 48439. The longevity, which is just one zip code South of us where my parents live. And so this diverse patient community and the effect, the impact on their health just from a change in zip code is something that we're focused on growth in remote patient care.

Right? something that we're seeing in every hallway of this building and in these buildings at this meeting about the role of remote patient care in improving the health of our country and then augmented intelligence integration of that AI into applications in health care, something that I'll talk about more here shortly. So as we know, digital technologies from wearables to AI allow almost limitless, limitless potential to transform health care, not only in how physicians practice it, but how patients experience it. So better connectivity, seamless data exchange, real time information at that point of care.

Patient centered designs. Leveraging the physician expertise and experience in implementing and improving that health care. But the AM believes, as do I, that without direct input from physicians at those early stages in the conception and the design, that far too many of these technologies will fail to deliver on that promise.

Or worse, they'll complicate health care for patients and physicians. And and I'll use this metaphor a lot. It's just it becomes one more icon on the desktop of my computer.

And my office staff and my wife who shares an office with me. One more icon that just creates data that isn't useful to improving the health care of the patient. That leaves that exam room that day. So we should be working towards this quadruple aim of improved patient care, lower health care costs, better outcomes for patients, and then finally, clinician well-being. This is clinician well-being is something that's on our radar very much at the AMA in the wake of COVID.

The fact that so many people are leaving practice early for various reasons, not just the public health challenge, but dealing with technology that isn't useful. The fact that I see a patient, I take care of them, and then the office chart may produce a 10 page. Note that I sent to their primary care physician. Three lines of which are critical to that patient's care. And the rest is all stuff that we're required to do or that our electronic product churns out.

And so if new health care technology isn't designed to accomplish at least one of these goals, then the question is what is it there for? And that's what we hope to add our voice to the conversation to make sure that it does accomplish those goals. So as far as digital health trends, the AM released in September of last year, our digital health care 2022 study with findings on how physicians are using these digital health tools and how they're working for them. I know it's a busy slide, but I'm just going to highlight a few of these things that there's been an increase in physicians that are taking advantage of these digital tools. So it's a trend that's improving. It's going in the right direction.

The adoption of these digital tools has grown among physicians regardless of their gender, their specialty or their age. So it's across the entire physician community. It's not just a particular specialty. It's not just the young folks that are just fresh out of residency that are embracing it in every specialty, every gender, every age group of practicing physicians.

There's been an uptake of these digital tools, adoption of remote care tools. This is huge in the wake of COVID. So television televisits have nearly tripled since 2019, and remote monitoring has nearly doubled.

So providing remote care to patients has increased significantly and has been a major motivator of the adoption of these digital tools. And then growth in enthusiasm, again, largely driven by televisits. The fact that now my wife, who has a lot of well-women exams, she's an OB gyn, the fact that she didn't have to bring these women into her office masked and worried about catching something in the waiting room or catching something in the office that she could do all this via telemedicine is something that has taken that has changed her practice. And so even post-covid, this is something that's going to stay. So making sure that the technology supports that.

And then plans for adoption. If you look and see what physicians are saying about this. One in 5 are currently using augmented intelligence for improving their practice.

Efficiencies in nearly three in 5 believe that that's something that's going to be useful and something that they're going to do in the near future. So the ground is fertile for this sort of activity. So in 2017, the AM founded health 2047. So 2047 is a 200 year anniversary of the founding of the AMA.

So health 2047 is a Silicon Valley based for profit enterprise and it was created to bring together innovators, corporate partners, am members to identify critical health issues, things that we identified in our practices that the products weren't serving as well as we would like. And so there's four key areas that we're focusing our work output on. And one of them is data liquidity, making sure that data is easily portable from one office to the next. I'm realigning systems to better manage chronic care, right? So we as physicians have known for decades that we spend so much resources with the consequences of things like pre-diabetes when it becomes diabetes, the consequences of things like hypertension, when it becomes a stroke or a heart attack, that sort of managing that chronic disease better way upstream of that downstream consequence is going to be critical if we want to improve health care in this country, radically enhancing productivity at all levels. Right so make us more useful to our patients in a way that's not frustrating to us. And facilitating value based payments.

So not just the traditional sort of fee for service, but when our output is better, when we are tackling things like chronic disease and doing a better job, that the payment system should recognize that and pay for that. So health 2047 spin out so far, the health 2047 executives and advisors have decades of experience in medicine and Public Health. And I and so to date we've launched a half a dozen spin off companies. So one of them is first mile care, which is building a platform to improve the care of those with prediabetes, right? So we've identified prediabetes as something that we would like to impact.

So there's fewer people that become diabetic. And this is an output of this for profit entity health 2047 to deal with trying to manage prediabetes so it doesn't turn into diabetes and so that it does that by peer to peer connections, sort of virtual platforms in collaboration with the National Diabetes Prevention program that was developed by the CDC. So a lot of the right people at the table to figure out how to prevent that diabetic pre-diabetic from turning into a diabetic patient. Another startup is genomic science, which is an AI derived test that analyzes the causes of obesity. Right we now know that not every obese patient is obese for the same reason. Right? so looking at their phenotypes, trying to figure out what it is that's making this person have this BMI, this type of obesity, what is it that needs to change? Because it's not going to be the same change in every obese patient.

So that's what genomic science is doing. Zinc health is another physician led plan to help the underserved, and it's sort of connecting services for that underserved population, improving that patient physician relationship and improving the outputs of the health care of that underserved population through that sort of community care model. Emergence health care is a group of physician practices. When my wife and I run our practice, we decided early on I will take care of everything and you take care of HR is what I said to Nita. And so but the fact that we have to take care of any of that, right.

The fact that I do payroll and she does HR and I do supplies ordering this is something that not everybody is prepared to do coming out of medical school. And so emergence, health care is that practice solution that sort of helps people that want to maintain their independence but don't want to deal with something like, OK, we ran out of paper towels and toilet paper, let me run to the store and grab some. The emergence health care exists to manage that aspect of the practice. So there's more info on this at health 2040 The am physicians Innovation Network is something that we're very proud of.

It's a platform that connects the worlds of Medicine and innovation, much like this conversation is doing today and we launched it in 2017. It's an Innovation Network that now has more than 18,000 users and 30 organizational collaborators from across the industry. And so we're encouraging that collaboration, making sure that the physicians input is available at the early phases of that technology creation to make sure that when it comes to market, it's something that we are excited about using and something that's relevant to us. And we're doing this with physicians and practice with residents, with medical students engaging with one another and learning about how to make the output of these product efforts more useful. And then I. So, of course, the AMA, the AMA, as I mentioned,

is focused on helping physicians harness the power of this augmented intelligence by providing physicians with a voice in designing and developing this AI, by providing training in this AI and resources and support, by producing AI trends and analysis and looking at it from the point of conception to the point of delivery. And making sure that we're creating policies that will guide the creation of AI in its application in health care in a way that is useful to us in our patients. So as far as physicians perspective on I mean, this is something that when we ask, it wasn't clear how willing the physician community was going to be to adopt AI. And so we convened experts from the Federation of medicine, which is basically everybody and their brother across the country that is involved in health care. And and it was pretty loud and clear that there was a lot of hope that AI, if done correctly, has enormous potential to improve health outcomes.

And so there is enthusiasm about the disruptive nature, the constructive sort of disruption of clinically validated AI. And that's sort of a key phrase, right? So not just AI for the sake of AI, but something that's sort of pass the pass the test and pass muster to actually improve the care of our patients. There was some concern about the lack of transparency of that. So so in reference to that trust, where were these tools designed? How were they validated? Making sure that that's available in the same way that scientific literature is available? Let us see the science that basically says that this tool is actually going to be helping us. And so where the rubber meets the road with AI that the evolution of health care relates to being able to relay what it's being used for? Right? so tell us, OK, this is the tool.

This is how it was created, this is the impact it's going to have. And then show us the science behind that. And the AM is working in this realm as well. Just because CPT is how we relay how it is that we're using this, the work that we're doing right.

And so AI is going to rely on CPT to basically translate to people that are interested in the work that we're doing that are paying for that work, how it is that we're doing it. And to lump AI into one code is just impossible, right? The applications of AI, I'm not telling you anything that you don't know. You know this better than everybody out there. Is that not? Not all AI is the same. And so we can look and see, OK, this application of AI for the management of prediabetes versus this application of AI for the management of the intraocular pressure in a glaucoma patient. Right two very different things that the codes need to capture the nature of that work and not just be something that we're using some old code and saying, well, that's close enough, let's use that.

This is what CPT does. And so this is our output to make sure that we capture the efforts that are being put in when we're using AI for our patients. So this slide shows the results of a survey, findings of physicians and as far as their adoption of digital tools, specifically AI.

And so right now we're at about one out of 5. Using it to some extent. But you see that there's a lot of hope for that, right? So three out of five people, even though they're not using it right now, are very hopeful that it's going to add something to their practice. So it is definitely something that physicians, based on these surveys, are excited about with these stipulations and with these sort of pauses that I mentioned earlier. So in summary, physicians are excited about the new digital technologies and their potential to improve patient care.

But we look at it with some question. So first of all, does it work just as we do for drugs or biologics? We need to see the clinical evidence, the efficacy, the safety of it. So does it work? Second, is it going to be paid for? Right is insurance going to pay for this? Because that's the world we live in, right? Doing something and not having it compensated is a recipe for failure in that regard. And so if indeed it is useful to our patients, then we need the insurance company to say, yep, this is going to improve the care of our policyholders and improve their overall health outcomes, we will pay for it. So so does it work? Is it going to be paid for? Thirdly, who's accountable for it? So if it isn't what it's promised, then who is accountable for that failure? Right and that's not something that physicians want to have on their shoulders. If we're adopting something, if we're going to be early on in that world of saying, OK, we're going to use this technology to improve the care of our patients, and it doesn't pan out, we don't necessarily want to be on the hook on that, both financially and liability wise.

And fourth and most importantly, is it going to work in my practice? What value is it going to add to my unique practice in flint, michigan? Is it going to improve health outcomes? Is it going to improve health equity? And so the output of it is important as well. And so, you know, we've talked about the importance for our patients and the value of technology. I think it's a good place to transition into this conversation and very much looking forward to your thoughts on my thoughts and the questions that come from that. So thank you.

Thank you. That was excellent. I'm just looking at the time because I want to make sure we have plenty of time for some questions, so I'll make some initial observations about your presentation and then we'll just go right into the questions and the discussion. So you touched on certain topics that I find are really key to this conversation about digital health data, first and foremost, trust, which goes along with that. But you also mentioned, you know, dealing with multiple chronic diseases, which is a big deal and a big drag on the health care system. In terms of resources, especially money.

So all of these things play into the conversation. I'm sorry, inequity. You talked about equity.

I love the example of two zip codes that literally abut each other can have a 10 year difference in life expectancy. And it goes to a lot of what we've heard about the American Medical system. You know, we have the best medical system in the world. If you've got the right amount of access or the right insurance plan or how to navigate the system, but there are still too many people who fall through the cracks. And it's really encouraging to see 175-year-old organization looking forward to their 200 year anniversary by becoming more digital, by becoming more modern.

So that's really, really encouraging. So let's jump in and ask I'm going to ask the question you very specifically use the term augmented intelligence instead of artificial intelligence. And I'd love to understand the Genesis of that. I think I, I think I know, but I'd love to hear it from you.

Yeah Yeah. I mean, it's obviously a very deliberate choice of words. And I think of it like this.

So when I'm in my office and I'm and I'm seeing somebody who has a bad external ear infection and they've got pus coming out their ear, and I look at them and I and I'm treating them, they may not mention to me and I may not remember that three, four years ago they were in my office. And they live on a lake. Right and that's why they're sort of prone to this issue. If it doesn't come up in that isolated conversation, it's something that may get lost that would change my treatment plan. Right by the way, we're an ear plug, by the way. That lake has this sort of bacteria.

Use this medicine instead of that medicine. This is where I would love for the technology in that room. Right my ehr, my laptop that I'm using to say, by the way, their address puts them on this lake.

This is something that you should. I noticed you put in otitis externa, right? This is the voice of the computer that I'm imagining in my head. I notice you put in otitis externa as your diagnosis.

The zip code says they live on a lake. We look through. Five years ago, they mentioned that they were swimming and then this happened. You should consider this.

How awesome would that be? It's not replacing my role in that room, right? It's not. It's not artificial. It's augmenting my intelligence. Right it's. It's augmenting what the patient neglected to mention in their history or forgot to mention something that I didn't recall or something else, for example.

So somebody comes in and their hemoglobin A1C is a little higher. Right this visit than last visit for a primary care physician interacting with them. You know, this AI, the augmented sort of nature of this is something that could tell me that they've changed their employment.

Right their employment status went from employed where they maybe had access to their prescription plan, access to their insulin and now their employment status has changed, something that they may not tell me about, either out of shame or out of forgetfulness. Maybe thinking it wasn't relevant, I may not say. OK, well, I may assume that they're taking their medicine, but the reality is they can no longer afford their medicine. Right this is something that augments my ability to take care of this patient, not replacing me in that exam room, but reminding me of factors that I may not consider in that 15 minute interaction. And so this is why we refer to it as augmented intelligence. Help me to help them.

That makes a lot of sense. Now And you can see in a field like medicine, people love the relationship with their physician and other clinicians and they wouldn't want that to be completely replaced by a computer. But there are ways to augment that.

So that makes a lot of sense. But you did mention that you were hearing that computers voice in your head. Does it just out of curiosity, does it sound more like Siri or how I just want to know if I need to be afraid when I go to your office for me it sounds like hell, but that's a generational thing, I think. All right. Just checking and talking about the data and trust and also your notes about the willingness of physicians to use digital technology in terms of data. We've got a lot of data in health care.

We talked about this yesterday on the KEYNOTE. I was quoting some statistics from Intel. About a third of the world's data is generated by the health care systems around the globe. But we only use about 5% of that data in health care to generate insights.

What are the barriers to adoption? What is it making it so difficult for physicians to say, hey, we've got all this data, we've got all this information, let's create this augmented, intelligent future that will make us, you know, better caregivers for our patients. Yeah, I think it's I mean, really, what it comes down to is volume, right? So how do we find in that data. So much of which unfortunately still comes over our fax machine, right? So, so in our office, Kanita and I, you know, it's a story that is it's not a stretch.

All this is literally what happens in our office. So Kanita is an OB GYN. She does robotic hysterectomy, so she'll go to the hospital, do state of the art surgery, doing a hysterectomy, using a robot. And then we'll come to the office and then fax the operative report from that robotic hysterectomy to their primary care physician. So that they know that their patient had this operation.

I mean, it's just the fact that we're doing both of those things within the hour just feels like we're. Fred, Fred Flintstone and George Jetson at the same time. This is a generational sort of joke again. And some folks here might not know who those people are. But but the fact that she's doing robotic surgery and then faxing, that is a problem.

And so this is exactly what we need to change. And so when we have all of this data, let's make it useful data, let's make it easy to find. So we're not generating, again, I don't know what's bigger than a terabyte, but but I heard there's a bronto bite, which is like the biggest one. So, so just enormous amount of data within which there's 1 or two lines that are of critical importance.

And that's what we're afraid of, right? Don't bombard us with data. Have me add more and more external drives to the computer, to House it, and then within it I could fit all of the important data on a flash drive because that's what's important out of this bronto bytes of data. Right? and this is what we want to avoid, is just bombarding us with data and then having to find and distill so much of it to get to something that's clinically relevant. So it reminds me of an old adage that I heard 20 years ago health care is data rich, but information poor.

And really what you need is to weed out the signal from the noise. You don't. We talked about this earlier. You don't need yet another icon on your desktop. You need the data to integrate into the workflow. You need the promise of digital health, the promise of augmented intelligence.

To another phrase I heard that, I said I would shamelessly steal. We need the best thing to do for the patient to be the easiest thing for the physician to do. Yeah, I mean, how awesome would it be if using ai? I could be the thing that then sort of goes to all of these sites to get this data right, to get the data that your sleep study produces, right? That otherwise I would have to click on an icon. But how awesome to have that be in the background. That then populates a line within the note that I'm creating for that patient that basically says they've had this study, this is their RTI that I've written in their sleep apnea.

So immediately the computer knows that, OK, this is where my mind is. It pulls that data saying this patient had a sleep study and this is all done while I'm sitting there talking to the patient, not my office staff going and clicking on it, not me having to sort click on it after hours at midnight while we're finishing our charts at home. As you well know, this is what our life is like, but this is the promise of technology. This is what I'm hoping comes out of meetings like this. So do you think we're on the right path? Do you think that there is in the next few years, the folks that are here displaying all this amazing technology and I don't think I mentioned this to you, the area set aside for health technology at this CTA is larger than the area set aside for AI and robotics. This is a big deal.

You heard Renee said, you know, we're kicking off days of a program here. The health division is also the fastest growing division. So how do we corral all this energy and all of this innovation and creativity into something that we can put into practice today, tomorrow or over the next couple of years? Yeah, I think that to answer that last question first, the way to make it implementable quickly in a way that we embrace we as physicians, is to involve us early in its creation. The fact that when I went to a HIMSS conference and I was just sort of shocked at the paucity of physicians at this conference related to health information and the fact that here were two EHR vendors, Epic and Cerner are huge producers of EHR that's out there in the country that we're just the width of one little narrow carpet area apart.

But yet I'm still using a fax machine to send a note that was created in this system over to this system, right? And so involve us in those conversations so we don't end up in that situation right where things aren't connected. And so we can share with you what life is like in our offices, in our departments, in our universities as far as, OK, this is what we need to this is what we need this data for and this is what's going to make it most usable for us. Involve us in those conversations. I think it's fantastic that we have all this product that's being created, but it's that cross talk to help this product inform this decision that's being made that needs to happen more. And I think physicians are that conduit for that cross talk. So another maybe conduit to help get these things into the market is this concept of trust that you mentioned.

And I think trust comes in two big forms here, trust in the data and how the data is being used, but also trust in the algorithms and the software and the things that are taking that data and creating the insights or the augmented intelligence that you'll be relying on in the future. What can we do to help ensure that trust? So that patients feel comfortable giving up their data or doctors feel like the data is accurate and that the insights make sense. Yeah just so we are trained in this just as well.

We look at studies, right? So we look at studies, whether it's whether it's covid, whether it's the management of diabetes, whether it's the prevention of cancer. We look at the scientific bodies of evidence to show that this works. Right and so the more transparent those studies are, the more we will embrace the results of that.

And that's what really needs to happen, is that when this AI is created, when this technology is created to have it be validated scientifically and then put that validation out there for our consumption, for our embracing is what's going to make it more likely for us to use it. Right and so I think back to when I first heard about AI. This was about a decade ago. And it was a story about how an algorithm decided which patients were able to be discharged earlier from the hospital based on their status of their diabetes. And what the AI basically said is that this population can go home first and it was the most brittle diabetic. So brittle diabetes are the ones that are the ones that are most likely to have complications.

The brittle diabetics were what this computer was saying could go home first. Well, the reason is that when they were in the hospital, those are the ones that got the most attention. Right so their numbers were fantastic because their vitals were being checked every 15 minutes instead of every hour. They got the most attention. So on the tail end of it, they look great. Like, of course, these are the people that go home first.

Look at how great their numbers are. But the missing link was the amount of attention it took to get them to those numbers. And so that's what I would say is a mistake as it relates to the application of AI.

So let us be in participation. Look at those studies, see these protocols, see these algorithms so that we can believe in the output and not have that sort of mistake be something that we are asked to incorporate. Now, that makes a lot of sense. And you know, there is even outside of health care, there is a push for some technology companies to make their algorithms public or, you know, some more transparency so people can understand exactly what the software is doing to manipulate the data and then produce results. So it makes a lot of sense in terms of trust and talking about that as well.

There is a lot of scrutiny in the use of data by technology, by apps, by software based ecosystems and the like outside of health care. But there is maybe a potential risk that, let's say there's a pretty strict government regulation on the sharing of personal data. Does the AM feel like they maybe you can't speak well, you can speak for the AMA or speak for yourself. Do you feel like in health care we need to make sure that. Private secure data is immune from some of those sorts of regulations as long as it's being used for good, for research, for patient outcomes.

We don't need technology companies in health care to be selling banner ads or anything. That's a different business model. The business model is really taking care of patients. How do you feel about that? Yeah, no, I think it's I mean, I think there's a balance there and it's something that the patient should be involved in that conversation also. Right? I mean, so after all, it's their data. But I do think there is a role to improving our trajectory as it relates to the care of these patients.

And data is going to be important to improve that trajectory, that there is a way to get there to be able to use that data, but to do it in a way that doesn't violate anything on the patient side of things, that doesn't create discomfort because it's for the greater good, but it requires that conversation, right? And so that's a conversation that happens in our exam rooms when I say that. OK, well, you know, your sleep data, right, is something that we would love to use for a research paper. Disclose that that's happening, not send it and then find out after the fact that my data was part of this and I gave no permission for that.

This is a conversation that needs to happen in those exam rooms so that we can add and I can confidently say that majority of patients, the vast majority, would be happy to do that as long as they are involved with that decision. Right and aware of that decision. And that's what I think needs to happen to in order to advance health care, advance the technology, but do it in a way that doesn't violate any rights of patients.

So thank you. So so sitting where you sit and knowing after we chatted earlier that you're like me, a tinkerer, kind of nerdy, what have you seen in the last few years from a technology standpoint that excites you the most? You know, I really I think it's I, I mean, I think that is something that is fantastic. I mean, when I think about if I my standard schedule is Monday, Wednesday, Friday. I'm in the office Tuesday, Thursday, I'm in surgery. Sometimes surgery is stressful. And I come to my office, and I'm still thinking about the extra 100 cc's of blood loss that I had and what was supposed to be a minor procedure.

And is that patient going to be doing OK in the recovery room while I'm already in the exam room seeing this next patient? That's that's the human side of medicine, right? The human side of being a surgeon. This is where I would love I who isn't stressed, right? I'm giving it a personality who isn't. So the I doesn't feel the stress of my morning and makes sure that I don't miss anything in that conversation. Right so it it basically takes the failure of humanness in that patient physician interaction and banks it up with technology.

Right that's what I'm most excited about. Right? so make me less fallible because of the technology. Now that makes a lot of sense. And I'm looking at the time. I know we've got a few minutes. I don't know if we wanted to let some questions come from the audience.

I can't see because the lights are so bright. But is anybody. I see a hand there. If you want to stand up and maybe say it loud. Yeah one of your slides was just sort of about observation.

Said that. Telehealth remote patient monitoring. Kind of stagnated and. Wondering why. Line of is it good? Is it.

What are the reasons for that? Yeah so I think about it as it relates to my own practice. It's the volume of data and the questionable nature of the acquisition of that data and its ability to be implemented in a decision to actually change the care of that patient. So, for example, the American Medical Association is doing a lot of work, as I mentioned, on pre diabetes and hypertension.

There's a proper way to take blood pressure. There's a proper instrument to do that. There's clinically validated instruments to do that. So how do I know that the kilobytes of data that are coming in with blood pressures are taken the right way, the right time of day, the right position with the right equipment when that's coming to my office. And so that's where that hesitancy comes from, is just making sure that when we're getting all of this data, that's actually going to be usable because, you know, the patient's going to come into that exam room expecting all of this. These are the numbers that I got right.

And so then it takes time to say, OK, well, what machine did you use? How did you use it? What position were you seated in? And it's that gray area. Is that data something that's useful or is it just is it going to be something that I need to walk the patient back from? It's something that they already had in their mind after exploring how they acquired that data. And that's why I think you see hesitancy there. There's one there, right? Such an interesting topic in combination with. Talk and I'll just say I'm not from the health care side. I'm more in the design and innovation realm.

What's been so interesting about the things that you have all been pointing? So much of the patient information you want to obtain is actually in the home in the environment. So I'm wondering and then with like, you know, the trends of at home testing and things that people are wanting, telehealth things that are happening in the home. Do you feel like the new hospital is actually your home? And then is there a way that patients. And and we talk a lot about data and trust.

Is there a way that a patient. Contain or hold that data, whether that be on a watch or your driver's license, and then you give it to the, you know, your whomever to. Provide that information. So I'm wondering if we flip. There is there an opportunity to flip some things around and think really strategically about data shareholding and then actually thinking about the space in the rooms where the appropriate data is. It's more of a thought.

But yeah, no, I think it's an important thought and it sort of reminds me of sleep studies, right? Something that a lot about. So it used to be that patients used to have to come to a facility and get their sleep study in a bed that wasn't theirs and a room that kind of looked like a bedroom, but it's not really a bedroom. And now we have in-home data that's collected to tell us what it's like in that room, right.

With your pillow, with your mattress, with your temperature, with your humidity. How many times do you obstruct your breathing? And so as far as the site of acquisition of data being less in my office or in the hospital and more in the home, absolutely. I think that's happening.

I think that's a good thing. I think that's a good evolution. Even blood pressure. Right taking blood pressures in my exam room, that white coat, hypertension that we talk about in medical school. Right I don't wear a white coat in my office. But the point is that when they're in the office, their blood pressure is likely to be something different than what it is at home.

It usually higher, but it may be lower. And so having the point of acquisition of the data be where 99% of the patient's life is occurring, whether that's work or at home is important. And I think that's I think that's a trend that I would like to see continue. And if I can indulge myself to answer as well, I think it's a really important observation and it's nice to see that it came from someone who's not specifically in health care sitting and listening, because you're right, we are dealing with a situation where patients want to do more and more away from the hospital or the doctor's office. And even before we started talking about digital health, you only went to the doctor's office a few times a year. Hopefully, you never go to the hospital or very rarely most of what you do that keeps you healthy and well is what you do at home or what wherever you call home.

And so, yes, we are seeing that proliferation of the data that's important for the provisioning of care being collected in other locations in terms of flipping the paradigm where the patient owns all the data and then it shows up with their watch or their thumb drive with their bronto. By the way, bronto bites. I can't get the Fred Flintstone out of my head because bronto bites sounds like an appetizer that he would have ordered at that drive in theater. For those of you who remember when they put in the car, flipped over. Anyway, sorry.

We're dating ourselves here. You know, there are some countries, for example, that where they've passed laws, that health care data belongs to the patient. And they the data is more portable and the patient has more access to it. But there's still a lot of infrastructure is not quite there. Even if we passed a law tomorrow that said patient data, you own it, you collect it, you do it what you need to do with it. Most patients would not know what to do.

They wouldn't know how to show up at their doctor's office with the right data that the physician would need, then there'd be no augmented intelligence. So I think we still have to figure out how that works. I think there is absolutely a discussion to be had about who owns the data, who has the rights to use it and how. And I think patients need to be at the center of that discussion. Absolutely and then again, last thing, just yes, more and more and more of what we do in health care will happen outside of the traditional health care facilities or at least will be augmented by the data and the technology that is applied outside of traditional health care venues. Great question.

Yes we're good. Oh, yes, we are done. Look at that.

All right. One more quick one. So it's twofold, but you can answer quickly. I'm Jim Colson, VP of digital health of Texas E&M University. I'm interested in this entire conversation.

Augmented intelligence doesn't address the learning topic. So one of the issues generally is that systems learn. And so they don't give the same outcome later.

So in your example, when you said, chronic patients are. We handle them. Therefore, when they go off, when they're sent out, if you follow those directions. They would crash, right? So that system would have to learn and say, well, I'm not going to do that in the next outcome would be improved. But then you can't repeat that stuff five years down the road.

You want to say. How did you make that decision? When you find out five years from now that so how do you how is the AM handling that topic? And the second facet of this? Infusion conversation is about putting things together. What are you doing to fuse together? Things like dental together with. Yeah so as far as the evolution, you know what? You're absolutely right. The product that I buy that has version 1.0 of this AI

that's going to help me with this patient care this year, in 2023 is something that I hope will evolve. So that 2024 version is learn from 2023 version. And so there's an added value to the age of that product. What what we're advocating for is that it does evolve, that it's not a static thing that the sale happens. I walk away with it and the expense associated with getting version that

has gotten better over time is not something that's born. I mean, this is a very practical aspect of what things the decisions that my wife and I have to make in our office with it. And so absolutely, it's something that I think should evolve, but it's something that the physicians should have access to the evolved nature of that product going forward. All right. Well, Thank you all.

This was a great conversation. Thanks for the great questions. Thank you.

It was awesome. Thank you. Yeah so good to meet you. Join Us At 10:00.

We're going to have a panel on big tech and health care. Thank you. Thank you.

2023-08-08 06:03

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