Tsunami of change coming in healthcare, US expert says

Marian Chu  Published 2018.04.13  16:47  Updated 2018.04.16 11:16


The global healthcare landscape is changing. Lynda Chin, an internationally renowned physician and executive director of the Real-world Education, Detection and Intervention (REDI) at the University of Texas, says an endless stream of information and continual updates in technology is changing the role of the physician.

Adaption by both hospitals and physicians is the key to thriving in the waves of change that are coming, she said.

Lynda Chin, executive director of the Real-world Education, Detection and Intervention (REDI) at the University of Texas, talks about the future of healthcare industry, during an interview with Korea Biomedical Review held on the sidelines of the Korea Healthcare Congress in Seoul on Thursday.

Chin noted that up to half of cancer cases and other chronic illnesses are preventable, but education for prevention is still lacking. She said gathering data on people’s daily lives and habits would lay the foundation for a comprehensive preventive care system.

Chin stressed the need for patient-centric connected healthcare encryption to deal with chronic diseases as well as trust and transparency when dealing with big data and artificial intelligence (AI). The U.S. healthcare expert made these and other points at the Korea Healthcare Congress 2018 in Seoul Thursday.

Pointing to the need for trust and transparency in using AI and big data at hospitals, Chin said that patients’ trust in physicians has waned. Additionally, rapid, continual scientific and technological advancements make it impossible for a single individual to have the “latest and greatest” information needed for diagnosis and treatment.

In both cases, Chin called for connecting the vast amount of both patient and academic data into a functional service that uses AI. These AI systems can serve to augment the physician’s knowledge and help them become not just a supporting player in medicine but a leading one.

To understand how her assertions can be applied to the situation here and for further details, Korea Biomedical Review had an exclusive interview with Chin. The following is the question and answer of the interview.

Question: You talked about creating a connected health data ecosystem to manage chronic diseases in a vulnerable population and redefining the “care team” to do that. How are U.S. physicians dealing with the changes that come with implementing the ecosystem you describe?

Answer: First of all, there are two parts to the health data ecosystem. Number one is redefining the care team to include doctors, pharmacists, nurse practitioners, nutritionists, coaches, and the patients themselves. The second part is to increase convenience regarding the physical location wherein healthcare happens, moving it to the home or the workplace.

In the U.S., the industry is very interested. A lot of technology companies are building services such as telemedicine and remote monitoring which are tools that help offer options to patients. We’ve heard of telehealth being the front door to the healthcare system, and that’s because there’s a lot of interest there.

So change is happening, and you can’t resist it anymore. It’s like a tsunami so hospitals can’t say they won’t acknowledge it or accept it. The patient is already going there, so physicians don’t have a choice.

Consumers drive change. The patient doesn’t want to wait two hours to see a doctor or spend three hours getting to and back from the hospital. If someone offers an alternative, the doctor can’t stop them from going.

The other “push” in the U.S. is the reimbursement that says, “I’ll pay you if you do nutritional counseling” and the doctor doesn’t know how to do it. They have to be a certified, registered dietitian, which is a license they don’t have. So to get that piece of reimbursement, they need to get that dietitian. Then you have the value-based payment that penalizes or rewards the physician with reimbursement for unhealthy or healthier patients.

Payment reform is what is also driving the change, indeed. The system is no longer paying for doctor visits and services. It’s paying for better outcomes, and that’s starting to show.

Regarding the care team, the doctor only has so many hours a day. They can’t attend to all patients, but they can start extending their care team, so the doctor mainly plays the role of the quarterback who manages the rest of the team. That way, he or she can better control services, so hopefully, the patient comes back.

So in the U.S., the industry is providing an alternative and then the consumer, who is the patient, is starting to look for them. That’s forcing the change.

Q: Korean physicians also sense the need to create a connected health data ecosystem for disease prevention, but most want to play the sole, leading role in it and minimize the role of other caregivers. Can you address this issue?

A: At this point, I would say to leave it to the doctors. Most doctors probably don’t want to lose their position, but better outcomes for chronic diseases require 24/7, everyday care and no physician can do that by themselves. They’re going to need help. In the U.S., physicians are starting to realize that they can’t stop change. Now they’re much more open to think about it.

The second thing is to look at underserved communities. The primary care physician may be hesitant to collaborate with a retailer because they want the patient to come to them. But you have to realize that there aren’t enough doctors and 50 percent of people can’t even get an appointment.

So why would you resist someone else giving an alternative? It’s not exactly losing. In fact, if you have a nurse practitioner taking care of the simple cases, then you can deal with more complex patients. Then you can think about getting reimbursed at a higher level because you see more complex patients.

So it’s a combination of those two things to persuade doctors: to make them realize that they can’t resist change and that they can’t do it all.

What you’re talking about is the culture surrounding the system wherein the doctor does not want to share his territory. The incentive system, for one, definitely needs to change. This is where the payer and the government come in: how can they improve and incentivize the physician to think about better outcomes for the whole population?

Finally, physicians need to understand that the industry offering options serves not as competition (well it is), but the important thing is that it gives options to people. To change the culture, there needs to be a push. It’s not an automatic thing.

Q: Some Korean hospitals implementing AI have been criticized as doing so to “show off” the latest technology or mostly to draw in more patients. Most are smaller hospitals located in provincial areas. What are your thoughts on this phenomenon? Why should hospitals implement AI, if at all?

A: There’s a lot of hype around AI. I would say that 99 percent of the things people throw out there and say is AI is not. It’s overused, and that’s the reality. It’s almost like some use AI as an advertisement to compete, and I don’t think that’s the correct approach.

Putting that aside, small and rural hospitals don’t have specialists but generalists. For cancer, general oncologists often see a variety of lung, colon, breast, and leukemia cancer patients. These physicians can benefit from having their knowledge base augmented by an AI system. When a person with lung or breast cancer shows up, the generalist wants a tool that ensures that he or she knows about the latest and greatest things.

Having that kind of AI system in these hospitals can produce a more prominent “delta” than at big academic centers. So the key is not AI, but the question of the tool used. If you build an AI system just to call it AI, then it has no value.

An AI system that serves to augment the generalist with specialty knowledge - that is particularly valuable for rural hospitals and the impact it could have is greater.

So it’s not that these local hospitals benefit more from “AI” because that’s like saying you benefit from a computer. It’s about helping from a type of system that requires AI. It has everything to do with what you’re building that system to do.

Q: What if doctors become too reliant on AI services? How do you overcome that?

A: I don’t see that as something to be overcome. Do you search for medical literature today without accessing PubMed? Do you determine whether cancer has spread without a CT scan? You’re dependent on it, right? I don’t think there’s anything wrong with it. Before mobile devices, doctors used to carry a book around that had the latest list of medications. Would you not want to have access to that book?

I don’t think there’s anything wrong with having a tool that serves you and counting on that tool to be there. One of the ways I feel about the system that bridges the knowledge gap is to think about a lawyer hiring a paralegal. A poor, single practice lawyer can’t employ a paralegal, so he or she has to do all the research themselves but what if that lawyer had an application that can do the research, then why would the lawyer not use it? Building the right tool benefits the doctor.

Being overly reliant is not a thing. Some people may think that is a problem because AI is imagined as something more than a tool which I don’t see happening in the near foreseeable future. These small AI tools will not take over the world. The idea of AI as the “Terminator” is not there yet. Now it is essential to building the ethical and legal framework in which AI should function. And it’s better to do it now than to try to catch up later on. Obviously, you don’t want to do it as a way to limit its potential. There’s a fine line.

Q: Korean experts also point to the need to create a regulatory framework to safely connect and disclose healthcare data gathered by the national health insurance system. Do you have any advice on addressing regulatory and privacy concerns related to AI and big data?

A: People disclose information because they benefit from it. One of the most important things to do is to show the benefit of why data should be published. Like prescribing medicine, sharing data has risks.

It’s all about that benefit versus risk model. You need to ask, “What is the benefit of having that data” and “Can we show that benefit and realize it for the patient and therefore the whole process?” You also have to ask what risk you are willing to bear.

But to talk about any of this, you have to have the infrastructure. There should be an added level of privacy and security protection for health-related data. We need more privacy and security protection for healthcare data than for any other type.

I think data should be in a closed, private network system, not in an open one like the open Internet. How you create a closed, dedicated private network will be critical. Then you need to consider technology like encryption. Everything needs to be secure.

But just like in real life, accidents happen. To compare it to protect your home, you need a house key and the ability to lock your door. For security protocol, you need the technology to do it, and then the human. If the human doesn’t do it, then it doesn’t work. So if a person gives out the password, there’s apparently no security.

Even if you have both, security is never going to 100 percent. If someone wants to break into a house, they will, no matter how much you lock your door.

Since healthcare data is precious, there are going to be accidents, attacks, and hacks. So a dedicated, serious effort in a lot of things like education, training, and people will need to go into it.

Even when you take all precautions and check that you did everything you could have possibly done to prevent it from happening, it will still happen, but then, you can treat it like any other accident.

When that accident happens, you need to be able to tell the patient that the benefit outweighs the risk. That’s when the government comes in to point towards the benefit.

This is a very complicated process, and it’s not going to be resolved anytime soon. Recently, I see data issues with Facebook adding to the list of concerns. I appreciated how much worse it could get because the tide was starting to turn regarding people thinking about sharing their data. I’ve watched this over the past five years, turning bit by bit but now I think everyone is on edge. Now people can use the whole Facebook case as another excuse. Hospitals that don’t want to share, because of a territorial thing, now have another privacy concern not to.

Overall, it’s going to involve technology, regulatory changes, and education, and finally, the government playing a role at some point.

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