Doctor of the Future

Recently in Bangalore, NASSCOM CoE – IoT & AI hosted a Roundtable which featured doctors as panellists who deliberated on the benefits of digitalization on the medical profession in general, not shying away from distilling the hype either.

Where are we in Digital Healthcare?

“We know where to go but not necessarily how to get there”, proffered Dr Arvind Kasargod, Group Medical Director, Cloudnine Group of Hospitals, also the moderator of the session.

Are doctors resistant to technology adoption? Dr Kasargod doesn’t think so and offered a simplistic explanation: “the stethoscope would never have seen the light of day if that had been the case”. He believes that technology adoption should create value for all participants, “We also need to ask the question to doctors and patients alike – what does digital healthcare mean to you and in what ways have you been impacted?”

Dr Anoop Amarnath, Chief of Clinical Services, Manipal Health opined, “90% of digital healthcare is hyped up.” He reflected further, “As a doctor, if digital will only validate what I already know then how will it help me and live up to its reputation as a game-changer?” Taking a cue from Dr Kasargod’s earlier remark, he suggested we look beyond and see from the patient’s standpoint as well: “Has digital healthcare improved outcomes? Has it made healthcare, in general, more affordable which lends greater accessibility?”

It may well be noted here that healthcare is an 8.2 trillion dollar industry but only 20% of the population have access to secondary & tertiary healthcare services. A great portion remains under-serviced. Just as this is true, the reality isn’t far when the “second opinion” sought may be from “Dr Software”.

The Human Angle 

At this point, Dr Aruna Ramesh, Professor, Ramaiah Medical College brought in the dimension of data, into the discussion. “A patient’s data helps in more accurate diagnosis, but, is there a likelihood of doctors getting too preoccupied with data to lose out on the human angle which is an integral part of the patient’s recovery?”  Inasmuch, she also emphasized that front-end workers be imparted adequate training on the interpretation of data. Also, the role of machines vis-à-vis humans needs greater clarity. The art of diagnosis has shifted to data-driven insights.

Dr Gunda Srinivas, Clinical Strategy Lead, M-Fine agreed that a system which is excessively reliant on a data-driven approach – removing the human element partially or altogether – may eventually expose itself to the patient’s dissatisfaction. He was quick to assert, “It’s important to have an open mind and be adaptable because the obvious gains of technology are formidable to be ignored”. He cited instances from his medical practice when he helped patients who were remotely located. “Technology connects people and that is why I was able to offer my professional services to save many lives”, he remarked.

Time Management & Increasing Doctors’ Productivity

Dr Sunita Maheshwari, Chief Dreamer Telrad Solution believes, her time can now be optimally utilized. “Digital healthcare has completely changed my life. I have been able to reinvent myself as a pediatric cardiologist, thanks to technology”, she averred, building a strong case in favour of tech propagation. “I use the services of Tele Echo which allows me to work online without having to visit the hospital daily”. An environmentalist at heart, she is pretty vocal about wanting to reduce paper usage. “A single tree on an average can provide 8k pages of paper. A doctor must be easily contributing to cutting down 2 trees which can be avoided if we use the digital medium instead.” She drove home the point with this illustration. Can we do away with pen and paper or at least minimize its usage in the medical profession?

Paving the Way – A Preventive Approach to Healthcare

Dr Kasargod relented that with EHR everywhere, it would be impossible to turn the clock back. This is not to suggest that he is opposed to technology but as the moderator, he was only playing the devil’s advocate to bring out the other side of the argument. He agreed that “losing the human touch” could be a fallout of tech propagation in healthcare. “I would love to wake up to a world where vital signs of patients can be decoded by AI well in advance to avert a major health hazard,” he added. “Right now, we do have the technology in place but we don’t have standardized templates to capture the data without which progress will be hampered”. On this aspect, Dr Kasargod didn’t hold back his genuine concerns either.

On average, a doctor may access her laptop 5 – 10 times a day, vis-à-vis her mobile phone which may be as high as 200 times. For EMR to be truly impactful, it must be made available in mobile format as well.

Need for Standardization in Data Capture

Data is critical to digital healthcare just as it is in other verticals. However, a lack of standardization is proving to be a hindrance. “Every death is a tragedy” reflected Dr Aruna Ramesh, “and we need to have standardized procedures especially in the cases of first responder treatment.” Technology plays a pivotal role when accidents occur and appropriate alerts need to be relayed effectively to the network participants – police station, hospital emergency unit, ambulances, etc.

Technology as an Augmenter

Dr Gunda Srinivas brought out the augmentation role of technology in healthcare. For instance, he suggested a structured approach to noting down the history of the patient, which would be a great time-saver. On similar lines, a doctor need not type out a full prescription and technology can come to the rescue instead, through AI-based prompts.  Diagnosing symptoms, follow-up with patients subsequently were some of the other areas where technology can add value and save the physician’s time. He offered a piece of advice for startups: “You cannot create a solution and then try to fit it into an existing problem. It has to be the other way around. First, identify a specific problem and carve out a solution accordingly. The ability to solve real-life problems will ultimately determine success.”

Dr Sunita Maheshwari, cited the radiologist to patient ratio for a few countries, stark as they are:

US – 1: 10K

India – 1: 1 lakh

Tanzania – 1: 10 lakhs

The acute shortage of radiologists is evident. In India on an average, a radiologist can tend to 8 – 10 cases per hour. But AI-based tools can perhaps bring up this number to 20 or more. Besides, priorities can be set on individual cases (depending on the severity) to adequately make use of time. AI can greatly enhance efficiency and it is critical when we have something like 20 million faulty diagnoses being made every year in radiology.

Are We Ready for Outcome-based Pricing?   

Finally, the roundtable ended on the possibility of having an outcome-based payment system or pay as per performance. We may be looking at this possibility in future and it may be a good thing as well. But at the same time, it should not be a punitive measure. They all seemed to agree on this.

A Final Word on Data Privacy

Patients are the owners of data and hospitals are custodians. We need to get the requisite clearance from relevant scientific boards so that data can be shared without which technology will not serve its real purpose. It isn’t as if patients’ data are not being shared – medical journals do it all the time. We need to have a more structured approach to ensure the ethical standards are met.

To sum up, someone said, “AI will not replace doctors. However, doctors who don’t use AI will be greatly outpaced by those who do.”

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