Amazon Health Chief Medical Officer, Vin Gupta, MD, MPA, MSc, a practicing pulmonologist at University of Washington Medical Center, shared his thoughts on “The Key Trends Shaping the Future of Healthcare Delivery” in the Plenary Session on the third day of the RSNA 2023 Scientific Assembly and Annual Meeting.
November 29, 2023 — Following the theme of the Radiological Society of North America Scientific Assembly and Annual Meeting, RSNA 2023, “Leading through Change,” Tuesday’s Plenary speaker leaned into the opportunity to share actionable insights into ways radiologists can lean into the benefits of technology to save time, support better diagnostics and overall patient outcomes.
Presently the Chief Medical Officer with Amazon Health, Vin Gupta, MD, MPA, MSc, is a practicing pulmonologist at University of Washington Medical Center, as well as a Professor of Health Metrics Sciences at the University of Washington Institute for Health Metrics and Evaluation (IHME). A renowned public health expert, his wide-ranging experience includes working with the Apple Health Medical team, as a medical analyst for MSNBC and NBC News, and as a commissioned officer in the United States Air Force medical research corps. In that capacity, he serves as the officer in charge of the critical care air transport capability at Joint Base Lewis McChord. Gupta is a trusted adviser to several of the world's largest organizations, including the National Football League, and Major League Baseball. In addition to sitting on several boards, and being termed member for the Council on Foreign Relations, he has held research roles at the Centers for Disease Control and Prevention, World Bank, the Center for Global Health engagement, and Harvard Global Health Institute. In addition, Gupta has been recognized with several awards, including being named as one of the 40 under 40 national leaders in minority health by the US Congressional Black Caucus, and the American Medical Association.
Highlights and notable quotes from the healthcare futurist are shared here. With his focus on “The Future of Healthcare Delivery: Considerations for Patients and Providers,” Gupta shared innovative technologies, products currently in play to solve for some key pain points in the healthcare arena, and called on the audience to consider the actions that can be taken now in order to create a better future for practitioners and patients living in a digital, data-driven world offering new ways to deliver connected care.
In sharing “perspectives gained across a few different sectors of society,” Gupta identified some of the key trend drivers in healthcare delivery that he believes will ultimately impact everybody in the audience. As with every RSNA Plenary, the Arie Crown Theater hosted a standing room only crowd.
With a delivery that was both engaging and educational, Gupta illustrated examples of innovative products and technologies helping to solve a primary problem in the healthcare delivery system which has resulted from a massive healthcare workforce gap.
“How do we do more with less? How do we deal with this supply demand mismatch?” he pondered. He spoke at length of ways artificial intelligence (AI) is revolutionizing diagnostics and helping to set up virtual early diagnoses and treatment at home. “The question: How do we actually embed a holistic care journey from diagnosis to treatment for patients all within the home environment?”
Smart Mirrors and Heart Seats Support “Frictionless Diagnostics”
In showing what developments are taking shape around the globe, Gupta took the audience on a journey of interesting technology that he thinks is going to define the future. One example was from a company out of Israel that he noted is doing something fascinating: a smart mirror, which a person would walk up to in the morning and interact with it to answer several fairly simple questions about how they are feeling, how they slept, etc. as they carry out their morning routines. This uses photoplethysmography (PPG), which he explained is the same type of sensing technology that is in a smartwatch. It's the sensing technology that's in a pulsometer and he noted that low energy, electromagnetic radiation can be leveraged to embed that technology within a smart mirror, refracted on to an individual that is brushing their teeth in the morning. Through technology, it basically calculates vital signs and, even in some cases, lab values, emphasizing, “This technology is real,” he noted, adding that it’s already being deployed in Switzerland, and South Korea.
He then showed the Casana Heart Seat, which sits atop a toilet, and is in development in Boston, MA, by what he referred to as brilliant cardiologists at Massachusetts General Hospital in collaboration with a private technology company. It features an echocardiogram, a PPG sensor, and an EKG sensor on the actual toilet seat. He offered the following situation that transpires: “This is a US-based technology company that's going through FDA approval right now, where the clinician prescribes a Heart Seat for their patient on two medications for high blood pressure. It gets installed maybe through geek squad from Best Buy Health — that actually has a health program that's already partnering with over 20 health systems. They're installing remote medical grade devices for those that are at high risk for readmission, directly in the homes of these patients, removing all friction. Data is uploaded wirelessly send to the cloud ingested into software platforms into the EHR in a very digestible way. So clinician is not getting pinged a million times a day Mr. Smith's blood pressure's slightly above 140. Now there are preset filters so the doctor gets pinged appropriately. And if something needs to be changed, you can have a prescription sent to a mail order pharmacy to make a change.”
These are simple simple app-based experiences which can be installed in your home. “Because you know what? 85% of the time, it's accurate in detecting at least stage one hypertension,” which he reminded the audience is a major cause of death in the United States. He noted a study from 1990 when high blood pressure was the number one risk factor for death worldwide and offered that there's a new iteration of this study about to be published in The Lancet, early 2024, and said it's going to be the same exact thing.
What these technologies and product teams are getting at is this notion of “frictionless diagnostics.”
Gupta also identified ways that generative AI is actually revolutionizing medical education, noting that minutes from where RSNA 2023 was taking place in McCormick Place, the University of Chicago Pritzker School of Medicine is training first and second year medical students, literally within the last six months, using this technology.
“When we think about the future, it clearly is not going to look any different unless we start to rethink how we think about diagnostics,” said Gupta, using charts, statistics and health data to reinforce the call to action in moving to embrace these new methods of care to support patient health. He reviewed a plan for a continuum of care which can produce greater patient engagement and improve outcomes with the use of innovations for everything from sleep to high blood pressure, loneliness and test-to-treat.
Gupta shared a noteworthy statistic that noted patients with the lowest activation scores — having the least skills and confidence to actively engage in their own healthcare — incurred costs up to 21% higher than patients with the highest activation levels.
In medicine, when it comes to diagnostics, he noted, especially at home diagnostics, one in 10 people should have a preexisting diagnosis of high blood pressure. One in 10 actually utilize the blood pressure cuff that you can purchase online. The other nine don't like the experience, he noted.
In considering whether, how and when AI can be used for something like high blood pressure, he offered this: “I'm not saying I have the answers here. But I do think we're at a moment. When you look at time trends (which he illustrated), what is 2049 going to look like? If we don't start taking some strategic risk here, when it comes to how we think about diagnostics, when it comes to launching a product, maybe with abundant patient education, perhaps for a specific subset of patients on multiple medications for high blood pressure...we are pushing the boundaries of innovation...to help improve outcomes…and that's the future.”
Non-traditional technology finding a foothold in delivery
Gupta pivoted to put on his Amazon hat, saying that he has the pleasure of working with a broad, multidisciplinary team at Amazon Health, which is filled with clinicians and pharmacists who focus on clinical excellence all the time, just in a non-traditional setting.
“What I appreciate about their approach, having a foot in multiple different worlds that are traditional healthcare and non-traditional health care, is that we're really focusing in on that patient experience. In this case, asynchronous telemedicine through Amazon clinic, allowing other telehealth providers to easily access as many patients as possible, as quickly as possible, in some cases under 30 minutes as cheaply as possible.” It’s a retail mindset, a consumerist mindset to retail. I think in some degree, not in every application of medicine, but in some applications of medicine, it can actually help move the needle on patient care.”
Gupta also delved into the issue of costs and the importance of patients knowing what the cost will be for a doctor or hospital visit, prescription, etc. He offered that the way in which people access healthcare and pay for it will be revolutionized with online and telehealth options, offering specific examples of ways patients can access tests and prescriptions more easily and economically advantageous.
He mentioned a startup called Photon, which helps with the issue of medication non adherence. Said Gupta: “They're really leaning into patient engagement. There's patient empowered care, immediate care feeding asynchronous telemedicine, there's price transparency at the point of prescribing, maybe at the point of purchase for a patient. And as a clinician, I can now send the script directly to my patient. This company is integrating with a few health systems, seeing how it's going. I think that's a novel way to increase engagement.”
To the audience, he recommend an article from the New York Times written by Eric Harrell, MD, who he described as a brilliant health policy leader out of the University of Indiana. Gupta reflected on the article, “Covid Drugs May Work Well, but Our Health System Doesn’t,” saying: “He talks about how we're in this moment. And I think we all can acknowledge we're in this moment. As the author points out, at every step of the journey, from triage to treatment, there's a delay. That's why we're talking about virtualizing. Acknowledging that time to treatment really matters, it's the start of the conversation. In under an hour, you can go from potentially getting a triage point to getting treated with something like Tamiflu in under an hour…we'll be creating the very best of what we can do in the four walls of a hospital. But in somebody's home. We're solving for her better diagnostics, and a better way to experience the entire care journey from tests, to triage to treatment.”
He remained focused on prevention, on early and better diagnostics. One problem we are solving with AI diagnostics, is the fact that humanity keeps dying from high blood pressure. He noted, “And either we allow it to happen or we figure out. We have got to take some risks, and be smart about it. But we need to think broadly, think outside the box. To do more with less, he offered that physicians are going to need to lean in on some of these technologies that allow help for overstressed community health care centers, and even health care deserts across the country, where they don't have a partner and care facility to provide evidence-based care.
“This is how we do more with less. And it's already happening. So when people talk to you to ask what's the future look like, not just for radiology, but for broader medicine. Think about those technological solutions that are solving actual problems. Those are the ones that are going to have some traction,” he added.
Addressing the need for streamlining the clinical workflow for all healthcare providers, he discussed the ways Chat GPT is working to save time and take the administrative burden off of already-overwhelmed providers. He noted numerous examples of ways that artificial intelligence is supporting young residents by providing strong resource information which can be tapped by the young physicians in a way that better helps them solve the diagnostic challenges and support treatment for their patients in ways that were not previously available, and the practice-changing impact of this data-packed intelligence.
He closed his presentation with final points on trust, noting he has the privilege of having a platform for public health messaging, offering these thoughts:
“One thing I'll say is that whether it's AI, and radiology, image processing, or whether it's talking to a patient about why they should get vaccinated, we are in a moment here. Most of healthcare delivery is experiencing some degree of digitization and transformation, meaning it might become more and more faceless,” said Gupta. He added, “We need a different way to communicate to patients in this era of technological change. We need to be simple. We need a social media strategy. Most of your patients are receiving most of their health care information in the social media space, or in the digital space. So as we think about making technology, a little bit more healthcare delivery, potentially more faceless, in the name of access, and the name of price transparency, the name of cheaper, more affordable health care, we have to think about how we build trust.”
In the effort to test, triage and treat patients more efficiently with an eye on technology to support patients and providers, Gupta urged the audience to embrace the future-forward technologies available. “This is the future. This is a train that’s moving and it’s not going to stop.”
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