‘I’m the left turn guy’: AI comes to the doctor’s office, Pennsylvania hospitals

Artificial intelligence will be introduced at hospitals in Pennsylvania to diminish the workload of doctors, nurses and others, and to take on some far less mundane tasks including monitoring high-risk patients. — Image by freepik

PENNSLYVANIA: Artificial intelligence is making its way into medical offices throughout Pennsylvania, including those in Pittsburgh, with the tantalising promise of fewer administrative headaches for doctors and better care for patients.

The transition could be bumpy: Among obstacles to widespread adoption of tech that instantly taps vast stores of information will be doctors’ resistance to change how they've practiced medicine, experts say. For patients, the selling point could be more eye contact and better communication during office visits, if doctors aren't tied up with a computer screen, typing notes into a medical record.

But that's just the start.

Google, Microsoft and Nvidia are among the tech giants plowing money into medicine. For the 12 months ending July 30, 2023, the Food and Drug Administration approved 171 AI or machine learning devices for use in medicine, a number that was expected to increase 30% for the year compared to 2022.

Nearly 700 AI-like devices have been approved by the FDA since 1995.

Up for grabs is a market expected to reach US$51.3bil (RM242.18bil) by 2030 from just US$2.9bil (RM13.69bil) in 2022, according to India-based market research firm Insights 10.

In the coming weeks, artificial intelligence will be introduced at the 14-hospital Allegheny Health Network – first with the goal of chipping away at the administrative workload of doctors, nurses and others, and later to take on some far less mundane tasks including monitoring high-risk patients.

AHN rival UPMC has also been adding AI tools in the clinician's office, with the same early goal of freeing doctors from medical record documentation through what's called "ambient listening."

With patients' permission, AI software will "listen" to the physician-patient conversation in the office, then organise the notes into the written medical record. The doctor's role will be reduced to simply editing the software's notes for final entry.

And other, more ambitious, ways to tap the capabilities of artificial intelligence will find their way into the local health care workforce soon.

AHN's 22,000 employees will soon get access to Google's Vertex AI Search and Sidekick software that can, for instance, draft letters to health insurers on behalf of patients who need specialty medications, medical equipment or other care that's not standard in their insurance benefits. The program will be "trained" on internal Highmark Health data rather than publicly available information sources, like ChatGPT and similar tools.

"It's paradoxical, but AI is going to humanise health care," said Ashis Barad, a pediatrician and AHN chief digital and information officer. "It will not replace anybody."

Ford, Seagate, Wayfair and Lowe's are among other corporate users of Vertex AI, a cloud-based platform Google developed in 2021, according to San Francisco online newspaper TechCrunch. Mayo Clinic and HCA Healthcare, which operates more than 2,000 hospitals in the US and Britain, are also Google AI customers.

Highmark and UPMC have long been rivals, so it isn't surprising the two Pittsburgh health care giants have chosen different paths to the world of artificial intelligence.

UPMC has partnered with Google rival Microsoft, subsidiary Nuance Communications and Pittsburgh startup Abridge AI Inc to allow doctors and other care providers to use Nuance's DAX Copilot ambient listening software to organise and write patient exam narratives for medical records.

Privately held Abridge was founded in 2018 and automates clinical notes. The startup has offices in Lawrenceville and elsewhere.

Microsoft acquired Nuance for US$19.7bil (RM93bil) in 2021. Microsoft is also a major investor in OpenAI, the for-profit arm of the San Francisco company founded in 2021 that created all the buzz a year later around generative AI models like ChatGPT.

"Operational efficiency has the potential of being greatly aided by AI," said Robert Bart, a UPMC paediatric intensivist and system chief medical information officer. "It can listen, then create the document for the workflow, creating a much more natural, caring interaction to occur between the doctor and patient."

Figuring out what AI can do

Throughout the US, the industry is going big for artificial intelligence, with academic medical centers tapping AI's vast reserves of information to do things like better identify pre-diabetes, perform retinal exams for early signs of disease and detect an array of cancers as well or better than humans.

Eventually, doctors at both AHN and UPMC envision a far bigger role for AI than the initial documentation tasks, with some of the possibilities growing out of evolving partnerships between Epic Systems and AI vendors. Both health systems use the Verona, Wisconsin, company's services to store patient medical records.

Tasks that artificial intelligence tools could pick up include writing patient progress notes, responding to emailed questions from patients and suggesting medical coding, which is the basis of billing.

Dr Bart envisions the day when such a tool might note a change in the seriousness of a medical problem based on the doctor's conversation with the patient, alert the physician that a certain prescription drug is not covered by the patient's health insurance or even suggest a diagnosis.

"AI is not going to replace who I am as a physician, but I believe physicians who adopt AI will be better prepared to deliver high quality care into their practice," Dr Bart said.

Separately, AHN is preparing to introduce a smart patient room and a digital nursing programme at its Forbes Hospital in the coming weeks.

A 47-bed unit of the Monroeville hospital is being equipped with monitors that will allow a seasoned nurse at a North Shore office – or even at home – to brief new patients in a live chat on what to expect during their stay and also provide discharge instructions before they go home.

Permission from the patient will be required. A doorbell chime will mark the start of the session.

Admissions' briefings typically take 45 minutes and discharge instructions last 20-30 minutes, Forbes Hospital Chief Nursing Officer Lynn Kosar said. That's time that floor nurses could be spending instead with patients, she said.

"These things really help our nursing staff focus more on patients, getting them their meds, making sure patients are getting the best care we can," Ms. Kosar said. "Nurses see the value in it. They're really excited."

AHN nurses spend two hours of every typical 12-hour shift recording test results and other information in patient medical records, according to an internal study, Dr. Barad said. Only 45% of their time is spent on direct patient care, compromising the reason many nurses choose the vocation.

Partnering with Orlando, Florida-based care.ai, a company specialising in virtual medical care systems, AHN is preparing for the day when AI will monitor hospital patients with dementia or who risk falling because of dizziness or other issues. Today, these patients may require someone to be in the room with them at all times, but AHN anticipates high-risk patients could eventually be monitored remotely by AI and sensors on their bed.

Starting at Forbes, smart patient rooms are slated to be rolled out throughout AHN's hospital system.

Change is hard

A 2023 survey by the American Medical Association found that 65% of more than 1,000 doctors surveyed saw advantages to what the medical organisation called "augmented intelligence." But doctors also worried about data privacy issues and legal liability for AI-generated medical errors.

For some doctors, change is just hard, AHN's Dr Barad said, especially older physicians who've been practicing for years. It's his job to make the case for embracing AI to the health system's medical staff.

Dr Barad was reminded of a 2014 study at the University of Bristol that found most ants instinctively turn left when entering unfamiliar places.

Part of the reason may be in seeking strength in numbers since other ants exhibit similar behaviour, an analogy that can be extended to seasoned doctors, he said.

"It's easier to go through the inefficiencies they know," Dr Barad said. "I'm the left-turn guy. My job is empathy." – Pittsburgh Post-Gazette/Tribune News Service

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