Work as an Existential Endeavor

Our labor isn’t just a source of income; it’s a sphere of life that meets varied needs—physical, intellectual, and even spiritual. The study of generative artificial intelligence, particularly the technology behind GPT (Generative Pre-trained Transformer), reveals a staggering impact on how we experience work. Research indicates that GPT not only streamlines tasks but also empowers individuals to approach their jobs with heightened satisfaction and self-efficacy.

Work, in this sense, isn’t merely about churning out results; it’s an existential endeavor that intersects with Maslow’s hierarchy of needs. Self-actualization—the summit of Maslow’s pyramid—becomes not an ideal but an attainable reality. What we observe is a triadic relationship between technology, productivity, and fulfillment. The circle is now complete.

Cognitive Symbiosis: The New Social Contract

We are witnessing an epochal shift from the “man vs. machine” narrative to a symbiotic relationship, reminiscent of the Socratic dialogues. If Socrates’ method of dialectic was designed for a mutual pursuit of truth, GPT serves as a modern analog, albeit with asymmetry. It guides us in refining our ideas, questioning assumptions, and expanding our analytical horizons.

In this mutually beneficial ecosystem, technology becomes less of an external apparatus and more of an extension of our own cognition—a “second brain,” if you will. It’s a form of intellectual outsourcing that doesn’t diminish our capabilities but augments them, fulfilling the Socratic ideal of co-inquiry into the nature of reality.

Transforming Medical Praxis: AI as the New Clinical Partner

In the sphere of healthcare, the advent of cognitive technologies like GPT provides a compelling solution to the paradox of electronic health records (EHRs)—tools that simultaneously facilitate and hinder clinical practice. GPT-embedded EHRs could revolutionize medicine by transforming data collection into an interactive, cognitive process.

This is not mere data processing; it’s akin to clinical jazz—a spontaneous, improvisational dialogue between physician and intelligent system. Imagine a scenario where GPT not only fetches medical histories but also proposes differential diagnoses and even individualized treatment plans, leaving physicians free to focus on empathetic patient care and complex medical problem-solving.

The Alchemy of Joy: A New Dimension of Technological Success

As we cross the threshold into the Cognitive Age, it is crucial to reframe our metrics for technological success. Beyond benchmarks like efficiency and productivity lies an elusive but essential metric: the joy and satisfaction that technology can instill in human lives.

It’s time to embrace a more holistic understanding of technology—one that accounts for the euphoria of discovery, the satisfaction of a problem well-solved, and the existential joy of meaningful labor. After all, the highest realization of technology in this Cognitive Age may lie not in the statistics but in the soul—in our rediscovered ability to combine analytical rigor with creative flourish, personal efficacy with collective well-being.

By embracing this multi-dimensional relationship with technology, we’re not just optimizing work; we are enriching life. And in this profound metamorphosis, we don’t just adapt to the machines; the machines adapt to us, leading to an unprecedented era of cognitive and emotional prosperity.

The post The Cognitive Renaissance: How Technology is Recalibrating Our Minds and Revitalizing Our Workplaces appeared first on Medika Life.

As humans, we are instinctively drawn to ourselves. It’s an inherent trait that defines our existence and makes us who we are. However, as technology advances and becomes increasingly sophisticated, we begin to question whether we can embrace it as am intimate part of ourselves. This is the Scorpion Effect.

The story goes that a scorpion stings because it’s in its nature to do so. Similarly, as humans, we struggle to embrace technology because it goes against our very nature. While technology may be incredibly useful and powerful, it’s also foreign to us. We simply can’t relate to it in the same way that we can relate to other humans.

Perhaps the biggest reason for our reluctance to embrace technology is the belief that it represents an existential threat. Many people fear that technology—particularly AI—will eventually replace humans, making us obsolete or subservient. And others feel that technology robs us of some fundamental aspect of ourselves that historically is the domain of humanity. This can include qualities and emotions such as creativity, musical virtuosity and even love. The rise of artificial intelligence in lens of Hollywood and its dystopian perspective has only fueled these fears.

The emergence of GPT technology, such as GPT-3, exacerbates the problem of the Scorpion Effect by blurring the lines between what is human-generated and what is machine-generated. GPT technology is a form of artificial intelligence that is capable of generating human-like language and responses to various prompts. It’s captured the world’s imagination—for better or worse.

GPT technology can be incredibly useful in a variety of applications, from chatbots to content generation. However, the fact that machines are now able to generate language that is nearly indistinguishable from that of humans raises questions about what it means to be human and how we interact with technology.

Further, GPT technology can be used to generate content at a massive scale, potentially leading to the creation of vast amounts of low-quality, machine-generated content. This could ultimately devalue the role of human creativity and expertise in content creation, as more and more tasks are handed over to machines. And the use of GPT technology in social media and other platforms could lead to the spread of misinformation and fake news. If machines are able to generate convincing language and responses, it becomes more difficult to distinguish between what is real and what is fake.

Another concern is the potential loss of privacy and personalization in our interactions with technology. As machines become more sophisticated at generating human-like responses, it becomes easier to forget that we are interacting with a machine rather than a human. This could lead to a loss of trust and transparency in our interactions with technology.

In addition to the fear of being replaced or subordinated, there is also the issue of the fundamental differences between humans and machines. We are made of flesh and blood, while machines are made of silicon and carbon. While we can certainly create machines that mimic our behavior and thought processes, they will remain different, in both structure and function. This fundamental difference between humans and machines creates a deep chasm that can be difficult to bridge. We may be able to program machines to do certain tasks or behave in certain ways, but will they truly understand what it means to be human?

Moreover, some argue that there is a “spark of life” that separates humans from machines. This spark is what makes us unique and gives us our humanity. It’s what enables us to feel emotions, experience the world around us, and form connections with other people.

Of course, this isn’t a uniform consensus. Many people embrace technology and see it as a powerful tool that can help us improve our lives and make the world a better place. The Scorpion Effect is a reminder that our relationship with technology is complicated and multifaceted. While we may be attracted to technology for its power and utility, we also have a deep-seated fear of what it represents. And the sting of technology—particularly as it advances as a cognitive tool—can be deadly. But the realistic and unrealistic fears that it congers can be even worse.

The post The Scorpion Effect: Why People Struggle To Embrace Technology appeared first on Medika Life.

Medicine is pioneering new technologies that can identify patients at risk for cardiac events through the wireless connection in their hospital beds, alert physicians to possible drug prescribing errors, and enable consumers to use wearables to check their heart rate and rhythm. Yet, our health is too often determined by information technology most people long slated for their town’s dump heap or recycling center — the facsimile machine. Best known as “the fax.”

Would a student at any academic medical center today even know how to operate this tech dinosaur without training? Did they have one in their dorm or library when they first arrived at college? Would one of their peers have ever asked for the day’s class notes with the words: “fax it over?” Ridiculous. Yet, much of a person’s medical information — the stuff that influences life and longevity — is forwarded from provider to provider by way of outdated technology. How can we ever overcome the challenges of “interoperability” and information blocking when we continue to rely on fax to transmit timely patient information? How can patients gain timely access to their own data?

To implement the Cures Act rule and improve access to care, antiquated policies must be revised. Lack of consumer trust in data security inhibits the adoption of ideas that reduce costs, speed medical decision-making and help secure needed treatments. However, medicine’s unrequited love for the faxes is not love at all. 

It is legal anxiety related to staying safely inside the swim lanes of the Health Insurance Portability and Accountability Act (HIPAA). The Department of Health and Human Services (HHS) created HIPAA to set privacy standards for health information; providers recognized the fax and phone as preferred ways to share patient data between providers and among labs, hospitals, specialists, and payers. But, more and more, this system of data transfer limits patient access to the very information their lives depend on.

The Cures Act is designed to help give patients greater ownership and voice over their own medical intellectual property. Yet, the HHS website still lists fax as a preferred path to share medical records, test results, instructions, and treatments.

The Privacy Rule requires that covered health care providers apply reasonable safeguards when making these communications to protect the information from inappropriate use or disclosure. These safeguards may vary depending on the mode of communication used. For example, when faxing protected health information to a telephone number that is not regularly used, a reasonable safeguard may involve a provider first confirming the fax number with the intended recipient. Similarly, a covered entity may pre-program frequently used numbers directly into the fax machine to avoid misdirecting the information. When discussing patient health information orally with another provider in proximity of others, a doctor may be able to reasonably safeguard the information by lowering his or her voice.

Four years ago, faxing remained the “best” HIPAA–compliant way of sending and receiving sensitive patient information. Why? According to the experts: it “can be a more efficient form of written communication because of the trouble and accuracy issues involved with gathering multiple email addresses.” Convenience for patients? Physicians? Regulators? Who?

We need new ways — secure and fast — to share information. Interoperability embraces a world where a consumer’s health history is accessible whether they are at world-class medical centers or community care centers. At a time when we are handwringing about medical costs, diagnostics and blood tests are repeated multiple times because physicians need data that is not readily accessible, despite its existence elsewhere. Information saves lives and keeps costs down. Pioneer companies around the globe are creating Electronic Medical Record Systems (EMR) and cloud-based AI platforms that support interoperability. It’s possible — albeit unlikely — that these companies — some challengers to the behemoths — will be at the forefront of this sorely needed evolution. However, the system has built-in “security” obstacles that will continue to tie health professionals’ hands behind their backs. It is certainly frustrating for physicians. More so, to the people, they seek to heal.

Is HIPAA Advancing Patient Access to Information?

Years ago, when my mother lay dying of cancer, I learned that the OB/GYN at a major New York-metro medical academic center had discovered a new 14 cm tumor one week before her death. That physician told me that she was waiting for the department to “type up the clinical notes,” so that they could be “faxed” to my mother’s oncologist — working in the same hospital system. The oncologist, unaware of the deadly threat posed by the growing tumor, continued to treat as if it didn’t exist. As my mother transitioned from this world to the next, I asked both of these distinguished physicians — OB/GYN and Oncologist — what they had learned. Their answer speaks to the heart of this information challenge. In unison, they replied: “We should have communicated with each other immediately.” Lesson learned! Retire the fax.

HIPAA was created for an important purpose — to maintain people’s medical-record confidentiality. However, this system, created before encrypted email and password-protect communications, is now placing people’s lives at risk. The confirmed examples of HIPAA-snafus goes on and on…

Recently, my almost 90-year old mother-in-law struggled to schedule an appointment with her physician she had not seen for more than a year. At a time when even elderly people who are vaccinated are frightened to venture outside the security of their homes, the visit required her to fill in a multi-page medical update. The problem? The physician’s office insisted that she receive and return their document by fax! Who has a fax in their home today? The unwieldy solution was to send the document by mail and have a home-health aid return the forms prior to the in-office visit. How does that advance someone’s urgent care?

While the fax may be the safest way to keep physicians HIPAA compliant, it creates a behavior inconsistent with their chosen mission — to save lives. Data safety is a priority! No question! However, this outmoded technology is in direct conflict with the physicians’ Hippocratic oath: “Do no harm!” Playing it safe may be harming people. We can invent breakthrough vaccines and therapies that arrest viruses rare diseases and cancers. Somehow, we have yet to find an agreed policy pathway to share information with confidence and speed. This is not our finest moment in medicine.

CMS Administrators have called for an end to physician fax machines. Will our medical system be ready to finally enter the 21st century of medical information sharing? Not really!

While we live in an age of wonder at technological advancements such as fitness apps and precision medicine tailored to an individual’s genetic code, health information technology remains far behind all of the major industries. Healthcare remains in a 1990s-time warp.

Now is the time to use the Cures Act and recognize that information blocking — however it’s done — is no longer acceptable.

What would Dr. Leonard “Bones” McCoy, the famed Star Trek Enterprise’s chief medical officer, say about how we share data from doctor to doctor? Likely, a similar cry from his visit to a state-of-the-art 20th-century hospital: “What is this? The Dark Ages?” Health and Human Services did not deliver on its pledge to retire the fax by 2020. Our lives should not be dependent on the policies or antiquated technologies of the previous century.

Did you get my fax yet?

The post Cause of Death: Fax Not Delivered appeared first on Medika Life.

Hesham is a practicing Intensivist with 17+ years of clinical practice. He is board-certified in internal medicine, pulmonary medicine, critical care medicine, and sleep medicine. Hesham is a Regional Medical Director for Sound Physicians’ critical care practice in the Midwest. He leads and oversees ICU clinical operations in Illinois and Missouri, and he is Medical Director of Respiratory Therapy and Pulmonary Rehabilitation at Rush-Copley Medical Center in Aurora, IL.

He’s an Assistant Professor of Medicine and Course Director for Rush University Medical Center, and he serves as a peer reviewer for multiple medical journals. He has presented research a number of times at national meetings and has also published numerous articles in peer-reviewed medical journals. In addition, Hesham is a prolific writer, with articles appearing in newspapers and websites globally, and has published a medical thriller, “Code Blue.”

Hesham has a dedicated column on Medika Life for his articles, you can follow his work here

Hesham’s experience with Digital

I am a Pulmonary and Critical Care specialist practicing in Illinois. I am Medical Director of the Critical Care program in my hospital and an Associate Regional Medical Director, implementing critical care programs in multiple states in the Midwestern United States. When I first began practice in the ICU, it was the most technologically advanced part of the hospital. But that was not saying much. 

Our documentation was still on paper and pen. Physician orders had to frequently be deciphered by multiple people to ensure the correct drug or test was ordered. I clearly remember a major error being committed because a nurse misread a physician’s illegible handwriting. Invasive procedures were done by feel, and complications were commonplace and sometimes deadly. 

The first major sea change with respect to technological advances was the electronic health record, beginning with computerized physician order entry. No longer is a major error just a physician’s illegible chicken scratch away. It was a game-changer. Orders were transcribed and sent to the appropriate department in a much more timely manner. Patient care was greatly improved. 

Then came electronic documentation, which was another game-changer. It always amazed me that a physician colleague would take the time to write a note in the chart and have that note be completely illegible, so no one could understand what he or she was thinking or doing with a mutual patient. With the EHR, this was also no more, and gone were the days of straining my eyes and turning the chart on its side to try to interpret what a physician had written. 

With respect to direct patient care, the technological advances have exploded. Ultrasound guided invasive procedures revolutionized the field, and made those procedures much safer for patients. Much of the hemodynamic monitoring we did was also invasive, and now I can get detailed and sophisticated measurements completely noninvasively  

The revolution in technology continued with the advent of the smartphone. All the most up-to-date medical information and literature is available in an easy-to-use app. Prescribing medications can be done electronically in the palm of my hand. My patients absolutely loved the fact that, before I left the exam room, their prescription was already sent to the pharmacy. Today, I have the entire EHR on my smartphone as well, and documentation and information gathering has never been easier. 

Point of care ultrasound is also now an app, and I can do a bedside echo with a probe that plugs into my phone and fits in my pocket, with the image being uploaded to the cloud and integrated automatically into the EHR. Of all the technological advances, these two things – the pocket EHR and pocket ultrasound – are the things I use and benefit from the most today. 

That said, all of these technological advances are not without their pitfalls. Yes, with the EHR, notes are legible. But, you can generate a 15 page note that says absolutely nothing with an EHR. Yes, it’s nice to have an ultrasound in my hand. It is still not as clear and beautiful looking as the image that is generated by the big behemoth machine that needs to be rolled into the room from the department. 

Furthermore, in the middle of the Covid-19 pandemic, I was hesitant to bring in my own smartphone and ultrasound probe into the room and potentially contaminate myself. Sure, I can get multiple hemodynamic measurements noninvasively, but are those measurements clinically meaningful? And, the more technologically advanced we become, the more likely we risk becoming further detached from the patients themselves, and that can’t be good for the physician-patient relationship. 

Just in my lifetime, the technological advances in my field have been breathtaking. The question remains, how do we harness this incredible advancement and still keep the healing touch for which many of us answered the call of healthcare in the first place? 

Connect with Hesham

The post Dr. Hesham A. Hassaballa on the Digital Healthcare Equation appeared first on Medika Life.

Dr. Jeff Livingston is an Obgyn practicing in Irving, Texas, in the US. He is the CEO of MacArthur Medical Center, a founder of Medika Life, and EIC of BeingWell. He is an eager adopter of new technology and holds interests in various medical startups.

The More Things Change in Digital Health, the More They Stay the Same

Sharing my 20-year experience in private practice

Will 2021 be a remarkable year for health innovation? Healthcare needed a shove to throw out our fax machines and use new tools to improve our lives and the care we provide.Covid-19 converted digital health into a necessary survival tool. It’s no longer a luxury.

The pandemic forced many technology companies to tap the brakes, but digital health innovators and entrepreneurs are finding opportunities to make meaningful change and impact healthcare.

Will digital health pioneers launch us into the next generation of innovation, or will developers fall into the same old traps of nonintegrated data silos and apps filled with features but devoid of purpose?

I am a full-time practicing Obgyn in Irving, Texas, and also serve as the MacArthur Medical Center CEO. Innovation is one of our companies core values and helped expand our home base in Irving, Texas office from three providers in 2003 to our now 32 providers spread across five locations in Dallas/Fort Worth. We were also able to develop a pediatric service line to continue caring for our brand new little Texans.

No medical practice can be successful without some basic integration of health technology. That being said, the digital health landscape is complex and expensive, making it almost impossible for independent practice to compete with large medical conglomerates and integrated health systems.

While technology is an essential aspect of providing care, the reality is practicing physicians are often emotionally disconnected from the technology touching their fingertips.

Doctors do not want to become technologists. We want to see patients and provide care. But to even open the office doors, a complex mix of disparate technology must be in place and maintained.

Physicians must learn these systems or pay the high price of outsourcing the management to third-party companies.

Basic technology needs for a medical practice

1. Communication platform and phone system
2. Practice management system
3. Electronic Health Record
4. Cloud storage
5. Revenue cycle management system
6. Internet Security system

Without these baseline systems, a medical practice can not function. Also, most medical practices need a:

1. Patient portal
2. Local laboratory interface for direct physician order
3. Electronic prescription system
4. Online scheduling system
5. State vaccine authorities interface like ImmTrac.
6. State narcotic monitoring systems interface
7. Telehealth system

These baseline office technologies lay the foundation for a functional practice. While essential, most of these systems operate in the background. Physicians generally only think about them when something is not working.

A forgotten password or an overnight software update makes physicians’ heads spin.

Electronic Health Records (EHR) needed a major reboot.

In 2005, we made the jump from mountains of paper charts to an electronic health record. EHRs are an essential tool for any private medical practice, but the costs of upkeep, cloud storage, and data security add frustrating overhead expenses.

Most major EHR systems have added minor upgrades over the last decade, but none have upended the entire paradigm to create a patient and provider-friendly user-interface. Instead, health providers spend most of their days as glorified data-entry clerks.

Upcoming requirements by the CURES act may make EHR documentation even worse. The current published guidelines will force health providers to spend even more time entering information instead of providing direct patient care. The CURES act acknowledges the time requirement by incorporating documentation time into the CPT coding level of service. A better approach would have been to improve the EHR experience allowing doctors to spend more face to face with patients.

A few companies offer services to trim around the edges and make marginal improvements for doctors and patients. M-modal offers front-end AI-driven voice recognition to assist in EHR documentation. Vital Interactions helps improve the patient experience by facilitating a HIPPA compliant messaging system that interacts with an office practice management system. Updox helps with automated document sorting of the endless flow of incoming forms, imaging results, and outside medical records.

We use all of these technology add-ons in our practice. While they improve our efficiency and experience, no technology company has changed the game. EHRs are clunky, poorly designed databases more equipped to facilitate billing and coding than to provide an enjoyable user interface for health providers.

Our phone is our most important piece of technology.

Despite all of the health technology innovations, our cell phone is still the most important technological tool we own. We log in to our various hospitals through interface apps like Haiku. We monitor patient progress in labor and delivery through Airstrip Ob. We send electronic prescriptions using dual authenticators. We perform HIPPA compliant virtual visits through Telehealth platforms like Healthtap or Doximity Dialer.

We cross-reference medications on Epocrates and study the latest research on Uptodate.com. We complete most hospital credentialing and peer review processes through Docusign, and hospital department meetings now take place virtually on Zoom.

While these apps are beneficial for practicing physicians, many patient-facing apps still have a long way to go.

Most health apps are not useful.

The explosion of health apps forced doctors into the health technology equation. Patients use apps for weight loss, calorie counting, exercise, ovulation calculation, meditation, and glucose monitoring.

The crazy thing is, in 2021, app developers have still not found a way to make this data available to physicians in a simple and actionable way. Disparate, closed data legacy systems prohibit the seamless integration of patient data. As a result, physicians can not utilize most of the health data collected by patients. Patients collect enormous amounts of data, and their doctors have no practical way of putting it to use.

Physician life was much simpler when all we had was a pager and a stethoscope.

Most health technology developers and companies fail to understand the physician workflow and mindset. Instead, developers focus on an app’s features saying, “Look what this app can do.” None of the features matter if the core purpose is unclear and the usability is not inherently intuitive. Health apps would be best served by focusing on the “Why” and “How.”

Every developer should answer the fundamental question of who the product helps and what problem it solves. Most companies forget this fundamental idea, and as a result, most health apps and health technology fail to gain traction.

Feature-filled products devoid of purpose lead to physicians’ resistance to new technology and health innovations. We love fancy new toys, but we have learned from years of experience to be skeptically cautious with sparkly and shiny objects.

We are exposed to new medications, therapeutics, surgical devices, and novel lab tests. Each “pitch” forces us to decide whether or not to integrate it into our practice. Decisions making involves analyzing safety, efficacy, cost, and utility.

My two rules for technology adoption are simple.

1. The product needs to make physicians’ lives easier.
2. The product needs to make the care we provide our patients better.

Any technology that does not meet these basic ideas gets tossed into the wastebasket.

Technology extends physicians’ care doctors beyond the four walls of the office.

Free tools on the internet house excellent tools physicians can harness to expand their reach. Instead of helping one person at a time, health providers can share knowledge, combat misinformation, and help others at scale.

Most private practices still fail to mobilize the internet’s power and take control of their digital footprint. Instead, their online reputation is created by others through third-party review sites.

Online reputation management is one of the most critical aspects of private practice success. If patients can not find you, you can not help them.

Integrating the creative use of social media as a patient outreach tool is a central element of our 20 years of practice growth. We started in the pre-HIPAA days, navigating our way through the Wild West of the internet. First, there was Myspace. Then, Facebook and Twitter joined the party. Few medical practices were using these platforms, but we found ways to leverage them into patient outreach, education, and new patient acquisition tools.

Now, the options for patient education and outreach have expanded beyond the old school social media platforms. Physicians are finding creating ways to use video through YouTube, Instagram, and Tik Tok. Blogging platforms like Medika Life, Medium, Vocal Media, and Newsbreak expand physician’s reach beyond their practice website.

2021 can be a digital health breakthrough year

The pandemic created a once-in-a-lifetime opportunity for health innovation. Everyone is looking for ways to improve care, cut costs and create a safe workplace. Private practice physicians and large health systems are ready and willing to invest the time and energy to integrate new technology to reach these goals.

I caution all to remember healthcare is about human connection.

When we strip away all the technology bells and whistles, we are left with a patient in need and a doctor to help.

Technology is only a tool to help us get to the powerful moment when a provider looks into a patient’s eyes and says, “How can I help you today?”

Connect with Jeff

The post Jeff Livingston, MD, on the Digital Healthcare Equation appeared first on Medika Life.

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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Junaid is the Chief Medical Scientist at Microsoft Research and a practising physician in the NHS (the UK’s National Health Service). He was previously the Global Lead for Strategic Alliances and Solutions for the Global Digital Centre of Excellence at Merck Sharp & Dohme, where he led a range of strategic initiatives to improve patient care, including establishment of internal partnerships across the enterprise and external partnerships across the health care ecosystem. He cofounded “VelocityHealth” as Europe’s first prevention focused digital-health accelerator, in partnership with Telefonica, and led his team to deliver the “NHS Testbed” in partnership with Verily Life Sciences (part of Alphabet), which the Health Service Journal recognized as the “Best Pharmaceutical Partnership with the NHS” in 2018.

Previously, Junaid has worked across primary care, secondary care, and public health settings in addition to acting as a payer, and policy maker within the UK, where he specialized in informatics, digital transformation, and leadership. He has consulted for health care systems across the US, Australia, New Zealand, Singapore, and Europe, in addition to being seconded by the NHS to work with IBM. Junaid completed his MBA at the Imperial College Business School in London and has studied health strategy and quality improvement at both Harvard and the Institute of Healthcare Improvement in Boston. Academically, he is a Clinical Associate Professor at UCL (University College London), and Visiting Scientist at the Harvard School of Public Health.

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 Sam Shah is Founder and Director of the Faculty of Future Health with Ulster University, where his interests span digital health, clinical leadership, and public health. Sam is a digital health technology advisor to a number of healthcare and technology companies, spanning a range of industries including telecommunications, assessment of apps, scaling new technology into the NHS, and workforce solutions. Sam was previously Director of Digital Development for NHS England and NHSX, where he was responsible for digital development of the ecosystem and leading on a number of national transformation programs.

Sam has worked on a number of initiatives including the flagship project to digitize urgent care in the NHS. Sam headed up the national learning and development program for NHS England, which considered different channels to access healthcare using technology. He has also been involved in the assessment of healthcare technology through a number of grant schemes and accelerator programs. Sam continues to work in the NHS within primary care and champions a range of agendas including improving diversity within the workforce; and reducing health inequalities.

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