EP 199: Maximizing The Effectiveness of AI in Health Care

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How can the medical field really maximize the effectiveness of AI? It's something we hear about all of the time. You know, know, in, in day to day business life. AI is everywhere. But it's also everywhere when it comes to, to medical, when it comes to healthcare. And it's something that even for me personally, I've always talked about how AI and in the healthcare field is so far ahead, so many advancements, and sometimes I wonder how, and sometimes I wonder what the future of AI and healthcare is going to look like. So we're going to be talking about that today with actually the president of the American Medical Association. So I'm excited for that and welcome to Everyday AI. If you're new here, thank you for joining us. My name is Jordan Wilson and I am the host and Everyday AI, it's for you, it's for us, it's for everyone. It's helping us all better learn and leverage generative AI to grow our companies and to grow our careers. So before we dive into today's conversation about maximizing the effectiveness of AI in healthcare, let's first start, as we always do, by going over the AI news. All right, so first, a former Google DeepMind researcher has launched an AI startup for agents. All right, so former Google DeepMind AI researcher and his colleagues are launching an AI agent startup. This move could potentially compete with other AI agent startups and may align with Google's interest in developing more conversational AI chatbots. Google DeepMind has previously had high profile AI departures, including three researchers leaving to start an AI lab. Other AI startups founded by Google alumni. I mean, it's a long list, but include some big ones such as Character AI, Mistral, Sakana AI and Rika AI. All right, next, Amazon Alexa officially has a smart AI friend named Rufus. All right, so Amazon has just launched Rufus, a generative AI powered shopping assistant for its mobile app. Rufus can answer customer questions, make recommendations and also facilitate product discovery, all while using AI to improve the shopping experience. So Rufus is currently in beta and will gradually be released to more customers in the coming weeks. All right, last but not least, I'd say a pretty big piece of news after I'd say more than a year of speculation, but Tim Cook has confirmed Apple's AI offerings are coming this year. So Apple CEO Tim Cook has confirmed during a quarterly earnings call that the upcoming iOS 18 will feature comprehensive AI features fueled by deep integration across the entire hardware software platform. So this is in response to obviously these ongoing rumors that Apple is falling behind competitors such as Microsoft and Google and the AI space. So Tim Cook mentions that Apple's investment in AI and promises to share more details at the wwdc, the worldwide Developer conference in June. So Cook's comments seem to be a response to just the ongoing criticism that Apple's falling behind. You know, as you know, the Googles and the Microsofts and the Nvidias of the world and Samsung, you know, everyone's been, been pushing generative AI and now in devices and phones and wearables. And you know, I've always said Apple is never first at the party, but sometimes they're the coolest kid even, even if they show up late. So that should be some exciting news. So if you want to know about that and more, make sure to go to your everydayai.com we're going to have much more on those news stories as well as a recap of today's guest, which I'm extremely happy to talk about. But as a reminder, we have so much other great information on our website, even, you know, probably 5, 6, 7, 8 different healthcare episodes that we've had so far. But I think today's is going to be a great one. So I'm very excited to bring on here in a second the president of the American Medical Association. So let's dive in. If you are joining us live, special treat today. I'm sure all of you have have questions about how AI is being used in healthcare. So make sure to get those questions in. But now let's go ahead and please help me welcome to the show. There we go. We have Dr. Jesse Ernfeld, the president of the American Medical Association. Dr. Ernfeld, thank you so much for joining us.

Thanks for having me. Good morning. That new shopping AI assistant makes me a little frightened, especially if my husband gets a hold of it. Who knows what will happen to our Amazon account.

Yeah, like we needed any more incentives to accidentally buy a lot more at Amazon.

Right.

But Dr. Enfield, well, first of all, thank you so much for taking the time to join us. But maybe just tell us a little bit about, you know, for those that aren't familiar, what is the American Medical association and you know, what is kind of your role as president? What do you oversee?

Yeah, well, thanks for the American Medical association, household name, the largest, most influential group representing physicians across the country. Founded in 1847. Founded back in the day actually, to Professionalize the practice of medicine. Our mission, pretty simple, advance the art and science of medicine, the betterment of public health. And we got our roots stamping out snake oil and quack remedies. And it's come full circle with misinformation and digital snake oil and a lot of junk online that we're trying to get rid of. So we do a lot of work to make sure that patients have access to high quality care and doctors and physicians have access to tools that they need to practice effectively.

You know what, I love that you tied it back to kind of the AMA's origins and going against this snake oil. Because, know, I think that a lot of people have so many misconceptions about artificial intelligence and, you know, in all aspects of their life, but probably one of them is, you know, in medical. Right. It's something that we all experience. We all experience healthcare in different ways. So maybe let's just start like super high level because I know that, you know, pretty, pretty recently, just a couple of months ago, the AMA kind of released, you know, some updated standards or principles on AI. Can you just give everyone just a quick overview on what those, you know, new principles are?

Yeah, no, that's great. And the principles that we released in the fall are building on work that we've been doing for the last six years. Our first AI guidelines were in 2018. So this is not new for us. We're obviously trying to keep up with it. But as the space is evolving, as the federal government, through the President's executive order, is trying to create this whole of government regulatory approach, we want to make sure that we've got the right policy to engage with regulators and support patients and physicians. So the principles focus on, on eight different areas. How should these tools be governed? How should we have transparency? So when you walk into your doctor's office and there's a tool that's being used on you, you know, should you know about that? Right. That the AI is there? What should we require in terms of disclosures about the, the technology and its use itself? There are some special considerations, obviously for generative AI and large language models that are in the principles. There are issues around liabilities. So if you use a tool, your doctor uses a tool and something goes wrong, Right. There's a hallucination in an LLM that causes you harm. Well, who's holding the bag? Right. When there's an injury to a patient, there's stuff in there about privacy, data privacy, cybersecurity, and a little bit of attention to third party Payers, those insurance companies who are using algorithms we know every day to make decisions about who gets care, who doesn't get care. And we're very worried about the potential use of AI in those algorithms that could potentially harm patients. So that's the quick snapshot of the principles. There's a lot there. It's all free. It's on our website, ama-assn.org if people want to check it out.

Yeah, absolutely. And we'll be linking to all of those kind of the different areas that you talked about in the updated guidelines. But, you know, one thing that you kind of mentioned there at the end, Dr. Ernfeld, is, is, you know, the decision making, right. And, you know, making sure that, you know, third parties are using artificial intelligence in a responsible and ethical manner. Can you just talk a little bit about, like, what are the challenges of, you know, even when you have to look at all of the different ways that, you know, because the AMA is, you know, it touches, you know, it touches patients everywhere, you know, throughout the country. So what are some of the challenges with these new regulations and, you know, the enforcement? Because, you know, now I think more than ever, you know, data and security is on everyone's mind. So what are the biggest challenges in actually enforcing that and making sure that, you know, kind of these protections trickle down?

So the biggest challenge is we don't have a regulatory framework today in America that can effectively manage this technology. So there's two spaces. There's the, the regulated product space that the FDA has oversight over, and that will only be a fraction of the market for AI enabled digital tools that are in the health and wellness space. And then there's all the consumer facing product stuff. So I was at the CES meeting in Las Vegas and not only do we have flying cars and robots and all of the big TVs, but CES is now the largest digital health meeting in the world. And there is a flood of consumer facing products that won't fall into that FDA regulated product space. So as the, as the government tries to figure out, what does it need to do to make sure that we only have safe and effective products that are actually helpful in the marketplace, we've got a lot of, a lot of work to do. And our standpoint is that, you know, health AI ought to be designed, developed and deployed in a manner that is ethical, equitable, responsible and transparent. And if we're going to make sure that that happens, there is going to have to be work done on, on the regulatory side.

You know, I'm since you brought it up, I'm just curious, right, because we're, we're all looking at ces, you know, if, if you care about technology, if you care about AI. I think, you know, everyone had their eyes on the conference there, you know, even for you, what kind of caught your eye, you know, and you know, when it came to, I'm sure there's a lot of, you know, medical related companies there, you know, who are launching new products or, you know, software, what caught your eye specifically when it came to, you know, AI innovations in the medical and in the healthcare space.

You know, the one product that really blew me away is an Italian company. They make high end glassware. I don't wear glasses, but they have a set of frames that look like a beautiful set of Italian design frames. They only come in black right now, but they've built in an AI hearing assistive technology. The frame is no larger or wider or thicker than a pair of glasses you'd buy today. But what happens is whoever you're looking at in a crowded room across the dinner table in a conference hall is using some amazing technology to hone in on just that voice and amplify it using bone conduction so that you can hear crystal clear the person that you actually want to have the conversation with. So for people with mild to moderate hearing loss that may not be eligible or need a hearing aid in a regular setting, you think about what that kind of technology can do and how that can be incredibly helpful. So that's obviously a consumer facing thing that is not likely to be regulated by the fda, but potentially very helpful for lots of people like my father in law who sometimes has a hard time hearing what's going on when people are gathered around the dinner table.

Yeah, I think, I think there's so many, you know, ways like that that you might think, oh, you know, this is a nice little upgrade or a nice little product. But yeah, I mean, there's so many, you know, things that can be incorporated into hardware that can really be life changing. You know, one question I had, so, you know, you talked here in November, you know, updating these kind of AI regulations that were in place until 2018. You know, I'm curious, you know, even in the last five years, because, you know, artificial intelligence obviously isn't new in the medical field, but how much, you know, has the, you know, AI, you know, innovations changed in health care in just five years since, you know, that that last, you know, update to those AI policies?

Well, two things have changed. One is we're moving quickly, 38% of US practices are using AI today. Now, it's not for the sexy stuff. It's not for diagnosing Jordan's problem, your stomach ache. It's for backend office operations, supply chain management, scheduling, billing optimization. But the clinical applications are coming quickly. The challenge for us is that they're point solutions, right? There's a very specific tool, a very specifically optimized algorithm for one area of one part of clinical practice. What we're starting to see emerge and where we really need to go if this is going to work at scale are AI platforms with multiple use cases that are more flexible. That's starting to happen. There are a lot of companies working on those kinds of products, but there are still some really, really helpful things. So I will tell you, one of the most widely used types of products right now in healthcare in a professional setting is in ambient dictation. And this is not really exciting for patients, necessarily, but it changes the interaction markedly. And so ambient dictation, just for people who don't know, different versions of this, but often a small device with a microphone that's sitting in the exam room so that when I walk in to see a patient, I don't have to type the note. The note is generated automatically in a beautiful, pristine format, you know, using a large language model on the back end. Or sometimes there are companies that use LLM to do the first path, and then they have scribes that are cleaning the node up so that there's a human in the loop who makes sure that the node is perfect. Those technologies, and there are a bunch of studies on this, are saving tremendous amounts of time. And I'm aware of at least one circumstance where a physician who got this, got one of these devices, one of these products that integrates with the EMR so they don't have to cut and paste. It just shows up cried because for the first time in months, she got to be home with her family for dinner. She didn't have to sit after hours typing all of these notes. And patients, you know, imagine having your doctor actually look at you as opposed to typing away on the keyboard when you're talking about the things that are most important. So there are places that these models are going to be so helpful. We're only scratching the surface today. We want to make sure that we get the regulation right so that we don't stifle innovation, but that we have safety parameters for patients and physicians alike.

What, what you brought up there, I think it's actually worth exploring a little Bit more. Because even when I talk to, you know, business leaders, not in healthcare, they say that that exact same thing is one of the most impactful things for their work. Right. So if you're, a lot of people are in, you know, zoom meetings all day and, you know, yeah, you're either typing notes or you're having to spend, you know, so much time, you know, afterwards trying to follow up with all of that, you know, how, how has even just that one, you know, aspect right there, bringing the, you know, kind of voice dictations and large language models into, you know, offices across the country, how impactful do you think that actually is? And, you know, how does that improve the quality of health care or maybe even patient outcomes?

I think it's really impactful. And look, physicians, nurses are burnt out. We've seen the data. It is awful. At the peak of COVID nearly two out of three physicians were experiencing symptoms of burnout. People saying that they're going to reduce their hours, leave the profession. We already have a workforce crisis. I don't know. Last time, Jordan, you tried to find a new primary care doctor, but, like, good luck, we do not have enough people to deliver care today the way that we've been delivering it for the last 50 years. The only way we're going to get out of this crunch, it's not by doubling the size of medical schools and nursing schools. We're already doing that and it's not helping. It's not fast enough. We're going to have to lean on the technology to boost the capabilities of our teams, to augment our capacity. And that's actually why, anecdotally, the AMA likes to talk about AI in a healthcare context as augmented intelligence, not artificial intelligence. Because we really don't see it as a replacement for our healthcare teams. We, we see it as a force multiplier. How can I see more patients more efficiently, more effectively using these tools?

You know, what, what you brought up there I think is extremely important because, you know, especially, you know, post Covid, you know, I think so many people in the healthcare industry, you know, are, yes, experiencing the burnout, like you just said there. Or maybe, you know, everyone else is just more aware of, you know, the stresses that are on, you know, you know, nurses, physicians, etc. How specifically? You know, aside from, you know, that example that we just talked about, you know, kind of having your doctor notes, you know, dictated so, you know, your doctor can really focus on providing better care and to be less burned out. But what other ways can AI actually help you know, in the future or maybe other, you know, technologies that might make their way into, whether it's the back office or, you know, you know, actually in the room between physician and doctor, between physician and patient. So what are other ways that, you know, we might see some of that release?

You know, there are, there are so many circumstances where, you know, we, we have electronic health records. Theoretically, I should be able to find anything I need about a patient when I walk in. That's not what happens. And let me just give you an example. I'm an anesthesiologist. I walk into pre op holding, I meet a patient, I'm going to take care for surgery. I, you know, I go through all this stuff. I think I'm a pretty sophisticated user of electronic health records. I've looked up her chart. I go in, I wrap up, I'm about to walk out. And she goes, oh, doc, one other thing. And I said, oh, sure, ma', am, what is it? She goes, I just don't want this time happening. What happened the last time? And I said, well, what happened last time? She says, well, I had a cardiac arrest in recovery. And I was like, whoa, tell me about that. So she told me about it and I went back in. Buried in a nursing note, not in any structured field, not in any place that I thought to look, was, yes, this woman had an arrest. And it was obviously very relevant to what we were about to do. And you can imagine a future where these AI tools could surface really important information that's context specific. You know, unfortunately, interoperability and electronic health records, talking across systems and health information exchanges has created accessibility of data, but it's a data deluge. It's not information that's actually actionable or helpful. So you can imagine how AI could help sift through the chart in ways that could elevate information that would be much more relevant and important for the person at the point of care.

And I'm sure that has to be a challenging thing for physicians all over the country. You know, knowing what especially generative AI, you know, you mentioned, you know, oh, you know, that's unstructured. You know, like structured data can probably be a little easier to work with. Unstructured data. Yeah, there's, there's probably other, you know, things that you have to keep in mind. But even when it comes to, you know, the protected health information, you know, that's, that's a big thing. So how do you balance, right, how do you balance the, the need for, you know, smarter technology with AI, you know, There are some great capabilities that you can implement. So how do you balance that with the need of still protecting that data? Because that's obviously some of the most important, you know, data any person has is their health data. So how do you balance that?

Well, it starts with transparency and knowing when a tool is operating and knowing when your data is leaving a protected environment covered by HIPAA and not. And I'll give you the two examples. So, so imagine I walk into an operating room and I turn on a ventilator and I'm giving anesthesia and that ventilator has an AI algorithm built into it that's trying to optimize the ventilation parameters, the rate, the tidal volumes, the pressures. And I don't know that it's doing that and something goes wrong. How can I step in as the human and the loop who's the ultimate backstop to make sure that the patient is not harmed, to supervise and correct if I don't know that there's an algorithm operating. But we've seen this happen in other industries, like with the 737 Max, right, where we lost two aircraft tragically because Boeing put in an AI safety system that the pilots didn't know about, wasn't in the operations manual. Nobody got training on it. We can't do that in healthcare. So we've got to have transparency when these algorithms are built into our workflows. The other issue is privacy. So people think HIPAA solves everything and it protects your data. Well, it does for a covered entity. But as soon as you authorize an app to have access to your health data, that's not a covered entity. Right. They don't deliver healthcare services or an engaged in a way that they fall under those federal protections. You know, the cat's out of the bag and there are opportunities that the federal government, frankly, has not really availed themselves of to put in consumer protections so that when you allow your health data to go outside of a HIPAA protected environment, you have awareness of that. And that's something that I think is going to be really, really important when I think about how transparency needs to be used to protect patients and their privacy.

You know, I think the, the HIPAA aspect is obviously is, is huge, right, when it comes to, you know, ethically using data. But, you know, I'm curious, you know, because even for me personally, right, like, you know, you, you kind of alluded to earlier, like, well, when was the last time you tried to find a primary care? Well, you know, not, not recently, because I know at least for me, it can take months to see a primary care physician, which, you know, I know they're overloaded, the system is overloaded. Might there be a time in the near future, right, where I can say, as a private individual, I can say, yes, health care company, access all my data, but allow me to, or maybe allow my doctor to have a conversation with my data or allow me to kind of similarly to this Rufus Amazon assistant that we talked about for shopping, might that come where we have more personalized AI models that patients can chat with that has access all of their data, but that is still somehow, you know, pseudo official through the healthcare organization? Would that ever be, you know, something we might see, or is there just too much risk in something like that?

We're already seeing it. And what we're seeing, though, are relatively narrow use cases. So there's there, there's a company out right now that is developing basically a virtual nurse, but it's not a nurse that's diagnosing. And the company is very clear about this. They're not there to diagnose, they're not there to treat. They're there to engage patients, to make sure that when they're getting ready for surgery and they have that phone call a week out that they get all the information that they need. And it's trained on thousands and thousands of actual conversations with nurses. It has access to the medical records, so it knows things about you to bring into the conversation and it learns. So if you talk in the first conversation about how you're worried about your pet or something, that comes up the second time that you talk to it. So learn those kinds of technologies that can really help on the engagement side, I think are really, really promising. Obviously, we want people to take ownership of their health, and that means that we can leverage potentially these generative tools to engage people in their conversations in ways that we've never thought possible before.

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You know, it's almost like you were answering this question before it even came up, but you know, very much related. So, you know, Tara here is asking, and thanks for your question and if you have one, please get it in. But Tara's asking how close are we to developing that, you know, Big Hero 6, you know, type, you know, where there's this, you know, nice kind of friendly robot companion, but how close are we to something like that? You said that there's kind of, you know, some of those technologies being, being worked on or some being, you know, kind of rolled out, but how close are we to that and is that kind of where we're headed?

So look, I think these virtual agents are very interesting. They have specific places where they'll be helpful. There's a lot of research about, you know, autonomous agents and lonely elderly people who don't have family and providing support. And I think those use cases will have a, have a place in society in the future. But AI will not replace physicians, but physicians who use AI will replace those who don't.

Yeah. I'm curious, even for yourself, how are you using AI in your practice? And I'd love to even just hear your perspective as a physician. How has that changed things for you, for your practice and for your patients?

So the place that AI has come into my practice personally is, is mostly behind the scenes administrative simplification work. So, you know, our health care system now is using some AI tools to just help with filtering messages, the inbox, making sure that as we're interacting with patients, we can more effectively and more efficiently respond to all of the hundreds of thousands of messages that are peppering our physicians and myself included. Our practice is also using some of these tools sort of for, for backend billing operations and scheduling and supply chain management. I don't use it, but I have colleagues in imaging, radiology and cardiology who are using point solutions to assist with reading films and doing image interpretation. And those kinds of cases are becoming much, much more common and I think it will be not long where we, we have a future where most images are read primarily by a machine with A human then doing the ovary to understand where, where things need to be to be looked at.

Yeah, it's, it's fascinating, you know, it's fascinating to see that, you know, even with, you know, things as simple as, you know, chat GPT, you know, I know a lot of people, you know, there's a very famous kind of post that went viral about, you know, the new vision capabilities, correctly identifying, you know, certain breaks on X rays. So not going to get into that because I don't think, you know, people should be probably using ChatGPT as a, as a doctor at least. But what, what though, should patients though keep in mind about AI? Because I'm sure in the coming months and in the coming years, you know, they're going to see, at their health care systems, they're going to start to see, you know, little offerings pop up that hopefully helps make the, you know, patient, physician experience better. But what should patients keep in mind or what should they know about AI from a medical perspective?

So I think the first thing is that if you put your private medical information into ChatGPT, it is not protected. So that is a bad idea. Please do not do that. So there's just that like how can you protect your own information? And obviously by treating it with love and care and respect and keeping it confidential is important. So don't give it away to any app that you download without really understanding where that information is going. That's the first thing. The second thing is really, you know, companies are going to need to earn the trust of consumers and that's only going to happen if they, you know, adhere to best practices, treat data with care and respect and are transparent about what they're doing. So if you're going to use one of these consumer facing applications that's not really designed for a health care professional, you know, look who's making it, where it's coming from. And if it's a company that is reputable and there's transparency about what they're doing with your data, you're probably going to have a higher likelihood of engaging in a successful way.

You know, great, great question here from, from Brittany. Looks like she's a bsnrn. So Brittany's asking what are the, what are your recommendations for approaching clinicians who are doubtful or maybe not on board with AI? Such a great question. Like what, how do, yeah, so whether it's a nurse or someone, you know, who's working back end in an office, how do you approach someone and maybe talk to them about that?

So look, we Did a nationally representative survey of physicians in August. We released the findings in November. 40% of physicians in the US today are equally excited about AI as they are terrified. So if you're curious and maybe you think there's something there, but also a little anxious, you're not alone. That's where we are today. Because look, physicians, nurses, we've all been burned by bad tech, right? Like the rollout of electronic health records was the most painful experience. It was the number one physician dissatisfier for years running because of so many usability issues, because of so many workflow disconnects, and yet we had billions of federal incentive dollars driving the adoption of a technology that just wasn't ready for prime time. So I think there's a little bit of a lingering reluctance because of that experience. A lot of hype, a lot of promise, a lot of money going towards the adoption of these technologies. We want to make sure that we've got technologies that work. The AMA has put a ton of effort into creating an innovation ecosystem. We have a Silicon Valley based innovation company, Health 2047. We have our AI principles, we have our blueprint for health, which is how do you have equitable innovation including AI? We have our Physician Innovation Network, which by the way, free online platform, there are 18,000 people on it. Plus now it's a way for healthcare professionals, trainees and companies to connect to have those conversations about how do we get really, really good products into the marketplace. So if you're interested in any of those places to plug in or find resources again, you can check out the AMA's website.

Oh, that's fantastic. We'll make sure to definitely include that one in the newsletter. Free resources that educate, I think very, very much needed across all sectors. But so Dr. Efeld, we've talked about a lot in this episode. So you know, we've talked about, you know, the updated AMA guidelines on AI, the importance for protecting data, kind of where the industry is headed in general. But maybe what's your, you know, as we wrap up, what's your one most important takeaway or your best piece of advice? You know, maybe for both patients and for physicians when it comes to maximizing AI in the health care space.

So I think we have to recognize AI for what it is and realize that there are certain things that we should just never ask AI to do, like launch a nuclear weapon. Right? We should not ask AI to be the be all, end all replacement for a physician or a nurse. We should use it to boost our capabilities. You know, you shouldn't use ChatGPT to do math. You know, if you ask it 13 times, 24, it will give you the wrong answer, right? Because it's just trying to predict the next word. As long as you understand what the tool is doing, its limitations, and where it can be useful, you'll be in a good spot.

Such great advice. This was a fantastic conversation. Dr. Jesse Ernfeld, President of the American Medical association, thank you so much for joining the Everyday AI Show. We really appreciate, appreciate it.

Thanks, Jordan.

Hey, as a reminder, so much good information. Dr. Ernfeld mentioned multiple AI resources and education pieces. We're going to make sure to throw that in our newsletter. So thank you for joining. Thank you for tuning in. Go to your everydayai.com Sign up for that free daily newsletter. Thank you for joining us. And we'll see you back for more Everyday AI. Thanks y'. All.

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