AI’s role in health care: Supporting, not replacing, physicians

March 6, 2024
Chats

In this video, Margaret Lozovatsky, MD, FAMI, VP of Digital Health Innovations at the American Medical Association, explores the partnership between physicians and artificial intelligence in healthcare, focusing on AI’s role in clinical decision support. Watch now to learn about current AI trends and why physicians should be involved in shaping AI policies where they practice. Don’t miss out on this insightful discussion on AI and healthcare!

Guest

Margaret Lozovatsky, MD, FAMIA, pediatrician and vice president of Digital Health Innovation at the AMA

Podcast transcript

Transcript is autogenerated. Although edited for clarity, it should not be considered an exact replication of the podcast and may also be updated as needed.

Alex McDonald, MD: Good morning or afternoon, wherever you may be watching this from. I’m Alex McDonald and welcome to PermanenteDocs Chat. Today is going to be another great chat. We are talking about AI today. Just a small topic, nothing too exciting! We are joined by Dr. Margaret Lozovatsky, who is the VP of Digital Health Innovations at the American Medical Association. Dr. Lozovatsky, thank you so much for joining us.

Margaret Lozovatsky, MD, FAMIA: Thank you for having me. I’m thrilled to be here.

AM: If you’re watching live and if you have questions, please drop them in the Q&A box. This is going to be short and high yield, so make sure you get those questions in early and we’ll try to address as many of them as we can. We’re going to just jump right in here; tell us who you are and what you do.

ML: Absolutely. My name is Margaret Zolovatsky. I am a general pediatrician. I practice as a pediatric hospitalist, and I am currently the vice president for Digital Health Innovation for the American Medical Association. I am double boarded in pediatrics and clinical informatics and have served in multiple CMIO and CHIO roles across various health care organizations.

Augmented intelligence vs. artificial intelligence

AM: So, lots of hats and lots of aspects. I’m excited for this conversation. As I alluded to already, AI, augmented intelligence, artificial intelligence, whatever term you like using, is all over the news these days and not just in health care. It’s poised to be a disruptor in many different industries. So how much of this is real? How much of this is hype? How fast is AI being deployed in health care and the health care setting? Are we talking about months? Are we talking about years?

ML: Wonderful question and of course top of mind for all of us in clinical medicine. We here at the AMA really think about AI as augmented intelligence, and we use that term very intentionally because there’s a lot of technology that’s out there in the clinical spaces. We’re all aware of it and we recognize that it’s there to augment the physician and the physician’s role. We think of it as technology that’s going to be helping our physicians with their day-to-day work to be able to care for patients. In terms of timeline, in the last, say year or so, AI has become very top of mind for everyone largely because of generative AI that has come out. But when I really think about clinical technology, I think of AI as having been in the clinical spaces for many years from clinical decision support to natural language processing to a lot of the predictive analytics that is live and being used in the clinical spaces today. So is it moving fast and will it move faster? I think so, and I think it’s already integrated into our clinical environments.

AM: Interesting. And I just want to reinforce the concept of augmented intelligence, which is designed to help make our jobs as physicians easier and better and improve patient care. I know lots of electronic health systems have reminders that pop up, “Your patient is due for their tetanus. Your patient is due for their flu vaccine.” And I guess even those are augmented intelligence that’s already being deployed, which we’re all very comfortable with, I think. Is that accurate or not, I don’t want to put words in your mouth or reframe the issue. You’re the expert here, so you tell me.

ML: Well, that is a really great example of what we call decision support that’s already out there and often on the back end of that decision support. The reminders that you mentioned, maybe some augmented intelligence is helping to generate those reminders. We also are all very used to predictive models. You sometimes see a score that says your patient has this percentage chance of becoming septic or whatever the clinical scenario may be, and those also have some of the AI models running in the background to help give you additional information. It’s gathering that data in the back and it’s showing it to you at the time that you’re providing care to help you make decisions based on some of that augmented intelligence that’s doing the calculations.

How quickly is AI developing in health care?

AM: That’s really helpful to know. How do you think the next generation of generative AI is going to change medicine in the next five to 10 years? I know it’s a bit like reading the tea leaves, but from your perspective, do you think that it’s going to be major changes or this going to be a slow, iterative process?

ML: I think that there’s going to be major changes at the end of this in terms of how we’re able to utilize our technology to be an enabler. So I think of all the years that I’ve been in medicine and I like to talk about how I started with a clipboard and now the residents and the medical students can’t even imagine a world where we don’t have technology in every aspect of care. And so I do think that those changes are iterative day to day, but at the end of the day, when I look at the power of augmented intelligence, I really see it as a tool that can help gather information and feed it to the clinicians.

We think about this cognitive burden that we experience on a daily basis. I’m a pediatric hospitalist and so when I come into the hospital, there’s all of these pieces of information that are being thrown at me and you’re trying to manage so many different patients at the same time. Wouldn’t it be great if the system could provide the information that you need for the particular clinical scenario of that patient at the right time and the right place? That’s where I think the power of AI is and where I hope to see it moving to.

Concerns about AI in health care

AM: Yeah, that is certainly helpful. And the vast knowledge base in medicine is continuing to expand and continuing to grow, and there’s no way that any physician can know everything all at once. So, just for my own clinical practice, I really appreciate some of those reminders and some of those pieces of information being like, Hey, did you look at this? Or, Hey, think about this over here. That’s very, very helpful for me personally as a physician.

Now, there are some doctors out there who are hesitant about AI technology, particularly some of this new ambient listening technology for charting and they’re worried about privacy concerns and work automation. How would you address these concerns? How can we help clinicians feel safe in exploring AI in their clinical context?

ML: It’s interesting, the AMA did a survey of physicians and what they found is that a large majority of physicians said that they are excited about this technology, and the things that they brought up are similar to what you had said, which are the fears with the technology entering the clinical spaces. The biggest concern was actually the patient-physician relationship; data privacy was the second biggest, which I think are really important.

I would say that with any new technology, we have to be very thoughtful as to how we implement it in the clinical spaces. The key to this is number one, making sure that physicians are engaged in these implementations and are thoughtfully helping the technology teams analyze the new technology, the workflow, how it’s going to be used. The second piece that is really critical is it is there as an assistant, a copilot, if you will, to the physician. At the end of the day, we’re trained to make those clinical decisions and we will continue to make clinical decisions and this will be another tool in our tool belt to enable us to care for patients.

How can AI help physician well-being?

AM: Your point about physicians being on the ground floor and really making sure we are involved in the early implementation here is so critical. I think some physicians have been burned by the implementation of the electronic health record where, let’s be honest, a lot of physicians were not involved, and we feel like that’s not very intuitive. AI is coming whether we like it or not, and as physicians being involved on the ground floor we can at least help frame it and make sure it’s done in a way that’s safe and that works for both patients and clinicians. That’s my 2 cents.

We have our first question in the chat here, which is tied very closely to that. How do you see augmented intelligence really helping to alleviate physician burnout and improve physician wellbeing, both now as well as in the future?

ML: I think one of the most critical ways that it can be incredibly useful is to help alleviate some of the administrative burden. Again, we talk about the cognitive burden that we experience. Part of that is the management of the clinical information, but a lot of it is really administrative burden, things that the computer can take off our plate. I think that the chart review that we do and the processing of information can be summarized. Some of those new tools are just up and coming, and I see a lot of potential in those. The tools that are coming out that are used to help with the in basket that are writing those responses that we can review, we still have the review and we make sure that they’re accurate and that they’re clinically appropriate, but again, takes away some of the administrative burden that we experience.

AM: From my own experience, I’ve been able to use some of these ambient listening tools [during] patient encounters that help create clinical documentation. And honestly, I ask the patient, I put my phone down, I have a conversation with the patient, I don’t look at the computer once, and then I walk out of the room and much of the note is created for me using this technology. For me personally, that’s what I find much more fulfilling about the patient-physician relationship. If anything, this will help prevent us from staring at our computer screens the whole patient encounter and actually be able to connect with the person, which is why I think a lot of us went into medicine. That’s my own brief early experience, so I have to put that caveat in there. But I know that a lot of physicians feel like they’re just tied to the computer, and they can’t actually connect with their patients on a personal level. I think this technology may really help pave the way to get back to that.

ML: That is a really good point. Something that we hear across the board from physicians is that they often will have this experience of being tied to the computer and not being able to pay attention to the patient. So I absolutely agree that the technology can help to actually enhance the patient-physician experience.

How can physicians help shape or influence new technology?

AM: So how can physicians really address some of these benefits and challenges head on? Like I said, the wave has started coming, but what recommendations would you give to individual physicians who want to learn more or want to address these concerns, be it at their clinic, their hospital, the health system level, or even the policy level in the state or nationally? How would you recommend physicians go about addressing some of these concerns or challenges or benefits that might be coming?

ML: As we discussed, the engagement is really critical. So I love that you’re asking this question because a lot of folks may not know how to get engaged. One of the ways that within institutions people can get engaged is to get to know the physicians that are working on this. Most organizations will have a clinical informatics team or a clinical informatics leader. And I do talk a lot about the fact that clinical informatics as a specialty is fairly young, and as we think about technology becoming so integral in our care for patients and everyday lives, it’s really important to have the folks that understand that technology and understand clinical medicine be at the forefront of that.

So, I would encourage all physicians to get to know those teams, to understand what their organizations are doing and to help provide input to the clinicians and those teams that are working with IT departments to implement the technologies so that they are intuitive and that they are implemented in a way that’s most useful in the clinical spaces.

AM: That makes perfect sense. How do you think that physicians should inform patients about the use of AI in the treatment setting?

ML: We talk a lot about transparency and the importance of transparency. Just as it’s important for physicians to understand what technologies are being used in their care for patients, I would say that it’s also very important to be transparent with patients. And that’s why it’s so critical for the physician voices to be engaged in these conversations. I also would add that we at the AMA have put out a document recently with some of the newest trends about AI, so for people who are looking to learn more, that’s another really good resource. We will continue to put out materials to help people stay on top of some of the new trends that are happening in this technology.

AM: Do you think patients are learning about this and aware of this? Again, it’s not just in the health care industry, it seems to be across all industries, this explosion of AI and generative AI in particular. Do you think patients are aware of this or they’re seeking this information out themselves?

ML: I think so. I think patients are reading just like we are. They’re looking at the news and they have a lot of questions: how is this going to be impacting my care? So, I do think it’s critical to address those questions to help people understand. And patients are interacting with some of our clinical technologies, they’re looking at the patient portals, they’re seeing some of that information. I do think it’s going to be really important for that transparency to exist within those tools as well.

Will AI replace physicians?

AM: What do you think about physicians who are worried that AI will replace them and replace their job? Is that something to be concerned about?

ML: I personally don’t think we should be concerned about that. I really do see it as an augmentation tool, and that’s why I really like that terminology because it is there to assist physicians in caring for patients, not to do the work of physicians. But it is important because the burden is clear. We constantly hear about burnout and all the things that are coming at the physicians. So the fact that this technology is going to be there to be assistive in that work is really, really critical. I just do not think it’s there to replace the work that we do because that is going to require a human to be able to process, to diagnose, to care for patients.

AM: I agree with you entirely. I’m not worried about being replaced by a computer anytime soon. And I know a lot of my patients, they really seek that face-to-face interaction, that connection, even though it doesn’t always feel that way from our perspective. I think a lot of patients really want that relationship and computers can’t do that despite how much we’ve tried.

Another great question here in the chat. Where can doctors learn more about this technology and become more expert in new technologies so they have more knowledge about it and can then help understand the limits and the benefits and the implementation?

ML: I don’t think anyone is expecting for physicians to be experts in this field, but I love the question of how can I learn more? Because we all want to at least have the basic understanding of what’s happening. I mentioned some of the tools that the AMA has put out there, and I would encourage you to look at them.

I also would encourage you to speak to the physicians in your organization that are experts. So depending on who your electronic medical record vendor is, for example, there are classes you can take through them. Your informatics team probably has some materials within your organization where you can learn more about that. There are clinical informatics classes that you can take. There’s lots of materials out there, but I think would be most useful to folks when they’re tailored to their clinical space and their institution.

AM: Interesting. I think the key is there’s a lot of different pieces out there. And physicians, by and large, we want to know, we want to understand, we want to learn not just about medicine, but everything adjacent to medicine as well.

I have a question [about] your background in informatics. How do you get involved in informatics and do you encourage other physicians to learn more about medical information technology?

ML: Yeah. Well, of course I am slightly biased, but I am really interested in this field. I do have a computer science degree, but I do not think that’s necessary for this field. And as I came up through my training, we were doing a lot of implementations. That’s when electronic health record systems were just starting to have a presence in the clinical spaces. And I found very quickly that I was the person that could talk to the technology teams and that was able to get our needs met. So, I became the go-to person. That’s how it all started.

What I really enjoy most about this field is solving problems. When a clinician is trying to take care of a patient and they’re frustrated because they can’t get something in the system to work, that is the best opportunity for us to take away some of the friction that exists. So I started doing more and more of that work. I would encourage folks, if you have any interest in this space, to look into these opportunities. I mentioned a few of them, but one of the early things I did is I became a physician builder, so I could actually make changes in the system. There’s lots of these things that you can do within your institutions to make incremental changes.

AM: I’ve always been fascinated by computers. I’m better at using them than building them or fixing them once they break, but the next generation, having grown up with computers, might be better at it than we are. To your point earlier about paper charts, a few years ago, our computer system went down for a couple hours in the middle of clinic and all the residents were freaking out. And then some of our older doctors just brought out a pencil and paper and they just kind of got back to it. So it’ll be interesting, what’s old is new again.

One last question here. What is your biggest concern about AI in clinical medicine?

ML: My biggest concern is that it will be implemented in places without the appropriate due diligence. So, it’s not so much that I’m concerned that these technologies are coming into the clinical spaces, because we’ve had new technologies over the years in all of our clinical medical care. What I think is going to be critical is we talked about having that physician voice, making sure it’s aligned with the workflow, making sure it’s safely integrated so that there is transparency into where it’s used, how it’s used. And really looking at bias and making sure that it is providing the output that we’re expecting.

AM: Yeah. Computers are designed to do exactly what we tell them to do, right? And whether you implement that technology with bias or not can certainly affect the outcome, so that’s an important piece to consider. [That’s] why it’s important that we’re all involved and at the table as we deploy these technologies, to make sure we are collaboratively working to mitigate any implementation bias, which will then result in the end outcome too. Well, we could go on forever and ever, but again, we try to keep these short and high yield. Last question, and perhaps always my favorite question, what makes you most proud to be a physician?

ML: The list is long. I struggled with answering this question with just one thing. I am so proud of all of my colleagues that are out there every day putting in 150% of effort to care for patients and that truly want to do what’s right for the patients in front of them. Over the years, I’ve worked with a lot of physicians, and what I have found is that in our profession, people really, truly are so resilient and are such hard workers. That’s what makes me proud to be a physician.

AM: Wonderful. That’s great. Well, Dr. Lozovatsky, thank you so much for joining us today. I really appreciate your time and your expertise and all your insights.

ML: Thank you for having me. It’s been a pleasure.

The views expressed in this podcast are those of the speaker and are not meant to represent the views of The Permanente Federation, the Permanente Medical Groups, or Kaiser Permanente.

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