John Halamka: Telehealth, Apps & AI Make Progress, But Will Everyone Benefit?

Xconomy Boston — 

John Halamka thinks the digital health industry is still “emerging.” But it has come a long way and is starting to deliver after years of hype.

Halamka, a Boston-based physician and healthcare technology expert, says that’s thanks to several coalescing factors: improved technology, more favorable financial incentives for using digital products in healthcare, and growing demand from patients accustomed to tech-enabled convenience in other areas of their lives.

“In 2019, the tech is better, but also the alignment of incentives is better,” says Halamka, who leads innovation at Beth Israel Lahey Health system and is a Harvard Medical School professor.

Over his 30-year career in medicine, Halamka has had a front row seat to advances in healthcare technology, and at times has helped drive them. When he arrived at Beth Israel two decades ago, he pushed it to move its homegrown electronic medical records system to the web—years before “the cloud” entered the tech lexicon. Watertown, MA-based healthtech company Athenahealth acquired Beth Israel’s system in 2015.

Last year, Halamka was named executive director of Beth Israel’s new Health Technology Exploration Center, where a team of clinicians, engineers, and project managers experiment with artificial intelligence software, blockchain systems, and other tools that might have an impact on healthcare.

He says he’s also traveling a cumulative 400,000 miles each year, visiting countries such as Japan and Israel to scout technologies and strategies that might improve healthcare in the US.

All this to say, Halamka has his finger on the pulse of healthcare technology development and implementation worldwide. Xconomy spoke with him recently to take stock of digital health’s progress and map out where it might be headed next. (You can hear more from Halamka on Oct. 22 at “X·CON 2019: Digital Health Gets Real,” an Xconomy conference being held at deCordova Sculpture Park and Museum near Boston.)

Here are four more takeaways from our conversation, spanning the potential of wearables, apps, and AI in healthcare—and their possible pitfalls:

1. Nobody really knows exactly what to do with the tons of health data being collected.

Millions of people wear Apple Watches, Fitbits, and other internet-connected devices that can track their heart rate and other biometrics with health implications. Now what?

“We’re generating all these novel sources of data, but nobody knows quite what to do with it, where to store it, what to trust … and what are the legal and ethical complications,” Halamka says.

For example, let’s say a doctor’s office offers a service where it will store a patient’s wearable device data in his or her electronic health record. But what if the doctor never looks at the wearable data? What if the doctor doesn’t take immediate action if the data seem to indicate an emergency? What’s the right threshold for acting upon the data? “No one has really defined these issues,” Halamka says. “Who is accountable for reviewing and taking action on these novel sources of data?”

It will be important for the medical industry and other stakeholders to develop a set of “community standards” for handling data from wearables, machine learning algorithms, and other digital technologies, Halamka argues.

2. AI won’t replace your doctor. But it is making strides as an assistant in diagnosis and healthcare operations.

The blustery hype around AI’s potential in healthcare has died down somewhat, but the technology is making progress. As an example, Halamka points to Alphabet-owned Google’s (NASDAQ: GOOGL) research demonstrating the capabilities of machine learning algorithms to help diagnose conditions such as lung cancer.

“It’s not that algorithms are smarter [than humans], it’s just that they’re given much more data than a human would have the opportunity to digest,” Halamka says. “They’re very good at helping steer us in a general diagnostic direction.”

Another area of AI advances in healthcare is a boring, but often useful, one: clinical workflow improvements, Halamka says. By that, he means using advanced data analytics to try and predict, say, the chances that a patient will be discharged from the hospital today, or the likelihood someone will show up for their doctor appointment.

“With those kind of workflow refinements, machine learning has worked pretty well,” Halamka says.

So, will AI replace your doctor someday?

“Mmm, probably not,” Halamka says. “Machine learning is very good, but empathy and respect and active listening—that would not be the first use case I would pursue.”

One big opportunity he sees is developing AI technologies to reduce clerical work for caregivers.

“Today, physicians spend about 50 percent of their time typing,” Halamka says. “This has resulted in many clinicians wanting to retire and frustration with electronic health records.”

He suggests machine learning-enabled technologies will be able to listen to conversations between doctors and patients, automatically fill out the patient’s digital chart, and then the doctor would review it and make any necessary corrections. Indeed, companies such as Suki and Nuance Communications (NASDAQ: NUAN) are working on similar products.

3. Patient demand and reimbursement changes will drive the “consumerization” of healthcare.

Today, receiving healthcare isn’t as easy as pushing a few buttons on a smartphone to order food to your doorstep or a ride to the airport. But Halamka believes it will get there, and perhaps soon. He predicts within five years, a “significant percentage of income to healthcare systems will be digital health services that, if you will, are the Uber, Grubhub, and Amazon of digital health,” he says.

He gives a hypothetical future scenario. Say a person notices a spot on her right wrist. She takes a picture of it using her phone and securely shares it online with a healthcare provider, which analyzes the lesion using advanced software. It spits out an assessment: There’s a 90 percent chance the spot is harmless. Just in case, the care provider refers the patient to a telemedicine service for a second opinion, if she wants, for say $25. That care provider reviews the image and data and also says the lesion doesn’t appear to be cancerous, but recommends developing a care plan to watch the spot over the next year for any changes.

It would take relatively little time, energy, and money to provide this type of care, Halamka says. “But yet, [the patient] got good, quality care, and physicians will be reimbursed for providing good expertise,” he adds. (Halamka is an advocate for telemedicine services. A toxicology expert and farmer, Halamka says he sees 900 patients annually via virtual visits, advising them whether the mushrooms or plants they ingested are poisonous or not.)

Achieving this vision will require the healthcare industry to complete its ongoing shift from charging a fee for each service provided, to getting reimbursed based on the outcomes of care given. For some hospital systems, that transformation is nearly finished; Halamka says the majority of Beth Israel’s income is now tied to “value-based purchasing” contracts.

“The notion that doctors will be paid for quality and outcomes, rather than just more healthcare, aligns economic incentives to use these digital health devices, with the idea that we be kept well in the home instead of a hospital,” Halamka says.

Incentives tied directly to digital health products are also on the rise, including expanded access to telehealth benefits for Medicare Advantage patients.

Patient demand is the other key factor that Halamka predicts will drive the healthcare industry to embrace digital technologies that make care more convenient. “If you’ve got two healthcare providers in a city, and one is digitally enabled and one isn’t, they’re going to flock to the digitally enabled one—and the other one will wither,” he says.

4. Beware the digital divide.

As digital technologies proliferate in healthcare, medical providers and other stakeholders need to be careful that some patients don’t get left out, Halamka says. Some people might not be comfortable with digital technologies, while others might have a language barrier or lack the income required to buy connected devices, he says.

“How do we ensure every member of society can take advantage of digital health without creating more inequity?” Halamka wonders. “We need to be very careful that we don’t create a sense of, ‘Well, you need the latest iPhone and $500 worth of digital sensors, and then you’ll get all these great services.'”

Halamka says he’s working on this issue with The Dimock Center in Boston’s Roxbury neighborhood, which provides health and human services to underserved communities. The center and its partners are exploring the development of low-income housing that would incorporate digital health sensors and related services “into the housing project itself,” Halamka says. He acknowledges the idea raises privacy concerns, but he emphasizes that health technologies would only be installed in a home with the tenant’s consent. The proposal is still in the early stages, he adds.

“It will be a longitudinal project that involves academia, government, and industry,” Halamka says.