About the Author
Allyson is a medical oncologist and attending physician in gastrointestinal oncology at NewYork-Presbyterian Hospital/Weill Cornell Medical Center; Associate Professor of Medicine at the Weill Medical College of Cornell University; and medical oncologist at The Jay Monahan Center for Gastrointestinal Health.
She graduated cum laude from Tufts University and with honors from the Tufts University School of Medicine and completed residency in internal medicine at New York-Presbyterian/Weill Cornell Medical Center. Allyson was chief fellow during her fellowship in hematology and medical oncology at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
She is the author of numerous peer-reviewed articles and abstracts and is an active member of several professional societies, including the American Society of Clinical Oncology, American Society of Hematology, and American Association for Cancer Research. Medika recently selected Allyson as one of the Voices of Healthcare in 2021
Allyson explores her experiences with Digital Health and Technology
In the 1980s I was a young teenager who enjoyed my Walkman, John Hughes movies and Punky Brewster. Although I was good at math and science, I had absolutely zero desire to build a computer out of spare parts. In college in the early ‘90s I had an Apple II computer and a Panasonic word processor. I thought I was really cool, and these workhorses did their jobs. I still wasn’t interested in what made these machines tick. They were simply tools to help me get my work done.
Those early years shaped my current relationship with technology: If it works, that’s great; If it didn’t work, why bother? However, I have become dependent on the current crop of tech. I don’t know how I ever managed to survive without Twitter or my smartphone, which someone will have to pry out of my cold, dead hands.
Technologies like Zoom and my smartphone were vital in the spring of 2020 when the pandemic was ravaging New York City. I’m a GI oncologist at New York Presbyterian-Weill Cornell Medical Center specializing in the treatment of gastrointestinal malignancies, with a special interest in pancreatic cancer. I also am involved as an investigator in numerous clinical trials focused on exploring potentially better treatment options.
On March 1, 2020 New York Presbyterian diagnosed its first case of COVID-19, and the city quickly became the epicenter of the outbreak. My professional life was very problematic initially since oncologists were all trying to figure out how best to treat and maintain communications with our immunocompromised cancer patients while simultaneously trying to keep them safe from this novel virus. I was in constant communication via email, phone calls or social media with patients and colleagues both near and far to see how chemotherapeutic regimens could potentially be changed to minimize the frequency someone would have to come into the hospital. And there were follow-up visits to contend with as well as new patients.
It’s no secret that technologies based on the platforms of telehealth helped mitigate some of our patient care issues. But at the start of the pandemic, telehealth was a disaster. Both patients and physicians were thrown into the telehealth landscape and there was a deep and steep learning curve. There were also regulatory, privacy and reimbursement issues that needed to be worked out, but were remedied very quickly since HHS relaxed rules. The biggest issue was that we were asking patients to become tech-savvy on platforms for videoconferencing that can be intimidating at first for anyone, let alone vulnerable patients dealing with a cancer diagnosis.
Many of my patients are older and some, not all, are hesitant about embracing technology. Many were also separated from adult children or grandchildren who helped them navigate the brave new world of technology during the best of times when they could visit their elder’s homes. These were not the best of times. If something wasn’t working right in EPIC, our electronic medical record system, there was no tech-proficient family member who could come over to fix a problem, even if it was something as simple as resetting the Wi-Fi .
As a physician, I was more prepared, but I soon discovered that even the best videoconference platforms accompanied by the best monitor won’t give you a real feel for your patients. There is no technology currently that can mimic the one-on-one in-person assessment a physician can provide a patient, even in a 15-minute visit. Those subtle clues that a patient might be struggling emotionally or physically can be lost if you aren’t in the same room with them, talking to them and touching them.
To be fair, there was an incredible upside too, the most important of which is that I could keep up with my patients for routine matters while reducing their exposure to Covid-19. That’s priceless, and as we’ve navigated through the past year, more and more of my patients have become comfortable with remote visits. That’s only going to increase.
In my practice Doximity has become my go-to platform, Doximity has been available for a little more than a decade to doctors providing everything from news to messaging to case collaborative capabilities. In May 2020 the company got into telehealth, and pushed out its Dialer Video, a telehealth videoconferencing app that connects me to my patients through a no-reply text message. It’s HIPAA-compliant, works on any cell phone, and my cell number is kept private.
It is so simple and, most importantly, patients find it a lot easier than Zoom, which can be tough for patients to navigate. Plus, it connects seamlessly to EPIC. It’s also very easy to add another participant, which is often very helpful to patients. It saves me time, too, because it alerts me when a patient has joined the call, which is important if you’re trying to check on labs or make notes.
When I’m not with patients on video visits, I’m with colleagues and staff on Zoom. We do Zoom tumor boards, Zoom meetings, Zoom-just-about-everything. It is very reliable, but the so-called “Zoom fatigue” is real. It can be very draining physically staring at a computer screen for hours.
Social media apps like Twitter have played a very important role in my practice over the past five years. An extraordinary woman by the name of Anne Glauber, a former patient of mine who died of pancreatic cancer, was determined to bring news of pancreatic cancer care and research into the homes of others who are facing the disease.
Anne lived longer than many patients with her stage of the disease due, in no small part, to her resourcefulness in seeking out physician-scientists who were willing to push the proverbial envelope in terms of patient care based on ongoing science. Anne thought everyone should know about the work being done.
We teamed up and in 2016 formed a Twitter-platform called #PancChat, based on a survey we commissioned showing that participants felt the best way to disseminate medical information was through Twitter. The monthly chat with physicians who answer patient questions has covered topics including the genetics of pancreatic cancer, nutrition, exercise, surgery, chemotherapy, radiation therapy, and immunotherapy, to name just a few.
Shortly thereafter we opened our WordPress-based website Let’s Win! Pancreatic Cancer (letswinpc.org). Our content manager pushes out new, original copy every three days in designated areas including innovative science, managing pancreatic cancer, clinical trials, and first-person patient stories, for example.
Both #PancChat and Let’s Win! are extraordinarily well-received by the pancreas cancer community and those physician-scientists globally who work on this disease. The simple technologies of Twitter and WordPress have done more to ease anxiety and change the sense of nihilism that often surrounds this disease, much more so than any in-person conference we may have undertaken.
Artificial Intelligence (AI), specifically machine learning or deep learning, is going to be an application that will make a significant difference in the future. We are in an era of data-driven medicine, and there is so much data available that only a computer can parse through it and make sense of it. There is no doubt that AI is going to make a tremendous difference in pancreatic cancer by potentially providing ways to detect the disease earlier when surgery is still an option, identifying pancreatic cysts that are at the highest risk of becoming malignant, and helping with image analysis for more precise diagnoses.
Because we also are gaining a much deeper understanding of the basic biology of the disease, we are steeped in molecular data. AI will help us make sense of that data.
I also believe AI will better help shape the future of telehealth, which is clearly not going anywhere. Patients may be using more medical technologies in the comfort of their homes. That data can be collected, sorted, and analyzed through AI applications. As a physician, I have to say I’m looking forward to seeing what AI brings to the table. I’m pretty sure it’s going to make what we’re doing now in telehealth look as primitive as my old Apple II.
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