Doctors and machines: Embrace the future


Digitisation and artificial intelligence innovations are becoming catalysts to the evolution of the healthcare industry. Dr Sudeshan Govender describes how tools like Discovery Health's Dr Connect and Health ID augment the doctor-patient relationship

In 2013, globally available digital data weighed in at a staggering 4.4 zettabytes (4.4 trillion gigabytes). It is further predicted that by 2020, the digital universe will multiply tenfold in size on every level.

In what some have called the Fourth Industrial Revolution, advances in digitisation and disruptive technologies are redesigning healthcare systems every second of the day. Today we have access to Electronic Health Records which allow for better analysis and measurement of value-based outcomes as opposed to archaic paper-based processes. Doctors also have access to big data streams from multiple devices including wearable sensors, mobile phones, tablets and desktop computers.

Rapidly improving connectivity, combined with advanced data analytics and algorithms have paved the way for Artificial intelligence (AI) or – a term I prefer – Machine Learning. AI is integral to precision medicine. Consider the applications of computer system IBM Watson when applied to healthcare or the potential held by CRISPR-Cas9 genome editing and leading the advances seen in oncology.

Many of my colleagues meet digital technology in our field with extreme trepidation. I have seen this reflected in the apathy towards early adoption of local digital platforms.

Will A.I replace doctors?

Many doctors fear being replaced by A.I However, I feel that the time has come for our profession to redefine its role. We must be receptive to the way in which digitisation and new technologies in healthcare have become catalysts to our evolution – not our extinction. Tools like Discovery Health's Dr Connect and Health ID don't replace the doctor-patient relationship – they augment it.

Discovery Health's electronic health record – Health ID – provides us with a more complete view of our patient's health history and test results – with patient consent. This improves our patient care and reduces the likelihood of serious medical errors and duplicate or unnecessary pathology tests. Health ID also reduces our administrative burden by making it easy to fill in Chronic Illness Benefit applications, and providing us with the relevant scheme formulary list.

According to a study from the University of Phoenix, Arizona – 59% of adults use online resources in place of primary healthcare. According to International surveys published by Biesdorf and Niedermann of McKinsey in July 2014, this is expected to increase to more than 75% across all age groups. Discovery Health's Dr Connect, a recently launched app-based platform, allows doctors and their patients to communicate on a protected digital platform ensuring privacy, protecting confidentiality and allowing for efficient, cost-effective virtual care where it is needed. The platform allows patients access to a worldwide network of over 105 000 doctors and to a growing library of over five billion doctor-created answers to common medical questions – at no cost to users. All of us want to reduce our patients' exposure to Google where they become entangled in the morass of incorrect medical facts and advice – when they most need accurate input and quality care.

Digital healthcare platforms: enablers of excellence in healthcare

Much of what we once did with our eyes, hands, and ears is now enabled through machines, so extending our ability to help patients. These examples prove the point:

  • AI is removing the need for doctors to perform repetitive, monotonous tasks such as filing prescriptions and investigation requests forms, allowing us to focus on challenging, creative assignments that truly benefit our patients.
  • AI will allow for mining of medical records to create tailored treatment plans, hence improving efficiency and reducing our waiting time.
  • Wearables devices and biosensors like the next generation Apple Watch or Google Contact Lens will relay non-invasive 24-hour glycaemic monitoring to electronic health record platforms – with AI only alerting us to abnormal results in our patients.
  • Heart rate monitoring via devices such as Fitbit activity trackers or Apple Watch will soon monitor cardiac patients for arrhythmias.
  • CardioSleeve – an FDA-approved stethoscope add-on device – can relay Digital Heart Sound and 3-Lead ECG from any point-of-care, to a cardiologist, anywhere in the world, in real-time.
  • TYM by Cupristurns a smartphone into an ostoscope for remote opinion or to share information from point-of-care to a doctor in real time.
  • Portable ultrasound machine, Phillips Lumify transmits ultrasound images from point-of-care to a radiologist allowing for real-time advice – particularly useful in maternity care, abdominal scans and Doppler Ultrasounds.
  • NuvoAir's Air Smart spiro meter measures lung function for chronic respiratory diseases e.g. COPD, at point-of-care, and transmits to clinicians for immediate access to patient health data.
  • Air by Propellar has an in-built AI device that monitors surrounding environmental and atmospheric conditions, and informs asthma patients to appropriately alter a preventer dosage.
  • Recently FDA-approved drugs with digital ingestion tracking systems aim to improve adherence by sending a message from the pill's sensor to a wearable patch which transmits to a mobile application. Patients give consent for physicians to access the information through a web-based portal.
  • Using a patient's GPS coordinates, drone technology can deliver medication or medical devices such as defibrillators to inaccessible areas in emergencies.
  • Recent reports that Amazon is mulling a pharmaceutical-industry entry has the industry wondering how will they leverage expertise for new efficiencies.

With all this on our horizon, we physicians should be optimistic about redefinition of our role and industry. We should remember that it is well-documented that the current global healthcare trajectory is unsustainable on many levels. The burden of non-communicable diseases such as diabetes, cardiac disease and COPD, coupled with poor payment models including fee-for-service and capitation cannot provide for a sustainable healthcare future.

Harvard Business review articles by Michael Porter, Thomas Lee and Robert Kaplan have illustrated the necessity for so-called Integrated Practice Units. This means that our practices become multidisciplinary, patient-centric, disease-specific centres of excellence – with bundled payment and incentives determined by shared-value outcomes. This also means running our businesses on electronic platforms supported through big data analytics and algorithms, via AI systems.

Digital healthcare platforms are the enablers of our inevitable move from hospi-centric to patient-centric care, and from population-based to individualised or precision medicine. They further turn the top-down doctor-patient relationship into a collaborative partnership, so making the patient a part of decision-making around their care. Patients in turn, have ownership of their data and are empowered with relevant information. In South Africa where 80% of the population don't have access to affordable, appropriate and value-based care, digital innovations such as Discovery's HealthID DrConnect or Health Tap's Dr A.I could offer much-needed solutions – even to the challenges faced in implementing the National Health Insurance.

In their new book, Machine, Platform, Crowd: Harnessing Our Digital Future, MIT economists Andrew McAfee and Erik Brynjolfsson capture the divergence of man and machine aptly: "So we should ask not 'What will technology do to us?' but rather 'What do we want to do with technology?' More than ever before, what matters is thinking deeply about what we want. Having more power and more choice means that our values are more important than ever."

- Dr Sudeshan Govender, General Practitioner

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