DC-DH: Health Digital Health & Selfcare – Can we replace Doctors in PHCs

Summary

This discussion focused on the potential for artificial intelligence (AI) and digital health technologies to replace or augment doctors in healthcare delivery. Participants explored how AI could address healthcare shortages, improve quality of care, and enhance patient experiences. They discussed the advantages of AI, including 24/7 availability, personalized care, and the ability to process vast amounts of medical knowledge. However, concerns were raised about the digital divide, potential loss of human touch in healthcare, and the need for proper regulation and ethical considerations.

The panel highlighted successful implementations of digital health solutions in low-resource settings, such as MomConnect in South Africa, which provides maternal health information via mobile phones. They emphasized the importance of building trust in AI systems and ensuring they are culturally appropriate and accessible to all populations. The discussion touched on how AI could liberate healthcare workers from administrative burdens and allow them to focus on more complex cases.

While some panelists believed AI could largely replace primary care visits and certain specialties like radiology, others argued for a hybrid model where AI augments rather than replaces human doctors. The importance of training future healthcare professionals to work alongside AI was stressed. The panel concluded that while AI will significantly transform healthcare delivery, human touch will likely remain valuable in certain aspects of care. They emphasized the need for continued research, careful implementation, and addressing equity concerns as AI becomes more prevalent in healthcare.

Keypoints

Major discussion points:

– The potential for AI and digital health technologies to augment or replace doctors, especially for primary care

– Challenges around trust, quality, and equity in implementing AI/digital health solutions

– The changing relationship between patients, doctors and technology in healthcare delivery

– The need to address the digital divide and ensure access to digital health tools in rural/underserved areas

– The importance of human touch and empathy in healthcare, even as technology advances

Overall purpose/goal:

The discussion aimed to explore how AI and digital health technologies are reshaping healthcare delivery, and to what extent they may replace or augment the role of doctors, especially in resource-constrained settings.

Tone:

The overall tone was optimistic about the potential of technology to improve healthcare access and quality, while also being thoughtful about challenges and ethical considerations. There was a mix of excitement about technological possibilities and caution about potential downsides or unintended consequences. The tone became more speculative towards the end when panelists were directly asked if AI would replace doctors.

Speakers

– Rajendra Pratap Gupta: Chairman of the board for HIMSS India, moderator of the discussion

– Peter Preziosi: President of CGFNS Global, a nurse by training

– Mevish P. Vaishnav: Leader of the International Patients Union

– Zaw Ali Khan: From the American University of Barbados

– Debbie Rogers: Runs Village Outreach in Africa

– May Siksik: Runs the Innovation Network Canada

Additional speakers:

– Melody Musoni: Works for a think tank called ECDPM

– Sakshi Pandita: Moderating online questions

AI and Digital Health: Transforming Healthcare Delivery

This discussion, moderated by Rajendra Pratap Gupta, explored the potential for artificial intelligence (AI) and digital health technologies to reshape healthcare delivery, particularly in resource-constrained settings. The panel, comprising experts from various healthcare and technology backgrounds, examined how AI could address healthcare shortages, improve quality of care, and enhance patient experiences.

Historical Context and Potential Impact

Rajendra Pratap Gupta opened the discussion by reflecting on his predictions from 10 years ago about technology eliminating middlemen in healthcare and bringing services closer to users. This set the stage for exploring how AI and digital health are now poised to revolutionize healthcare delivery.

The panelists generally agreed that AI and digital health technologies have significant potential to augment and transform healthcare. Peter Preziosi highlighted his work in Rwanda, where remote patient monitoring devices and nurse-led primary care models are being implemented. May Siksik, from the Innovation Network Canada, suggested that AI could provide more personalized and empathetic care than time-constrained doctors, especially for cultural minorities like First Nations.

Debbie Rogers, who runs Village Outreach in Africa, emphasized the potential of digital health tools to improve access to care in underserved areas. She cited successful implementations such as MomConnect in South Africa, which provides maternal health information via mobile phones and has significantly improved maternal health outcomes. Another example mentioned was the use of AI-powered sonograms in Ghana.

Mevish P. Vaishnav, leader of the International Patients Union, introduced the Patient Centricity Index, a tool developed to measure and improve patient-centered care. Interestingly, both Vaishnav and Rogers noted that patients, especially youth, may trust and engage more with AI-powered health services, particularly for sensitive topics like sexual and reproductive health.

Challenges and Considerations

Despite the optimism, the panel identified several challenges in implementing AI in healthcare:

1. Digital divide: Rogers emphasized the need to address inequitable access to digital health tools in rural and underserved areas.

2. Cost and infrastructure: Preziosi highlighted barriers in low-resource settings, while Rogers provided specific cost comparisons (20 cents vs $10.20 per user per year for different AI solutions).

3. Cultural context: Rogers pointed out the need for localization of AI solutions, noting that current large language models are primarily trained on Western culture and medicine.

4. Regulatory and ethical considerations: Zaw Ali Khan stressed the importance of these factors in AI adoption.

5. Maintaining human touch: An audience member raised concerns about preserving empathy and in-person care options.

6. Misinformation: Melody Musoni, an audience member, brought up concerns about quality control in digital health information, particularly around fad diets and miracle cures.

Future Role of Healthcare Professionals

The panel had differing views on the extent to which AI might replace doctors:

– Khan suggested that AI may replace primary care centers and some specialized roles.

– Rogers proposed that doctors who use AI will replace those who don’t.

– Siksik envisioned AI as part of interdisciplinary healthcare teams.

– Preziosi maintained that human touch would remain important for some aspects of care.

– Vaishnav and Siksik believed that AI could replace the majority of doctor visits, particularly in primary care.

There was agreement on the need to train a new generation of doctors to work effectively with AI, as highlighted by Khan. This suggests a future where healthcare professionals work alongside AI technologies rather than being entirely replaced by them.

Key Takeaways and Emerging Trends

1. AI has the potential to reduce medical errors and address healthcare worker burnout.

2. The cost of implementing AI solutions is decreasing while computational power is increasing, as noted by an audience member.

3. AI may provide more transparent explanations for diagnoses and treatment recommendations compared to overworked healthcare workers.

4. There’s a need for academic institutions to adopt digital health solutions and train future healthcare professionals in their use.

5. Despite the rise of digital solutions, there may still be a continued need for human doctors, analogous to the resurgence of physical bookstores despite e-books (as pointed out by Rogers).

Conclusion

The discussion highlighted both the transformative potential of AI in healthcare and the complex challenges that must be addressed for its successful implementation. While there was general optimism about AI’s ability to improve healthcare access and quality, particularly in resource-constrained settings, the panelists also emphasized the need for careful consideration of ethical, regulatory, and cultural factors. As healthcare continues to evolve with technological advancements, finding the right balance between AI-driven efficiency and human-centered care remains a critical challenge for the future of healthcare delivery.

Rajendra Pratap Gupta: conversational AI and low income and source settings. The whole idea was to check the level of awareness people have on the word conversational AI and what is the relevance. To most of us who are in this field, it is chatbots. But trust me, despite asking people, we couldn’t get a speaker from our vast network on LinkedIn. When we wrote we need speakers on conversational AI, so-called president of the associations in digital health said we do not know this field. Actually, it is chatbots. We had a very good panel with us that time, the head of AI at WHO, the president of humans.ai, Sabin Dima, Dinu, who is the CIO of the United Nations Staff Pension Fund, and Dr. Olubosa from Nigeria. We ran a good session. And a year now, we are actually talking about, will AI replace doctors? But let’s go back 10 years into history. I think I need to check. Can you move the slides, please? So as the chairman of the board for HIMSS India, 10 years ago, I told doctors that the future is tech, please, tech, IGF. Tech, please, tech, IGF. This is what the slide was. The technology eliminates middlemen. Today, if your doctors don’t need technology, technology would not need them in the future. And 10 years fast forward, we are in 2024, heading into 2025, which is just a decade after. And look at what has happened. And let me also go back to share what I presented at that point in time. I think I need more. Some issue with the presentation, we’re just going to sort it out. I think whenever we talk about doctors and AI, some technological glitch comes in, which I’m not very surprised because they are a very powerful stakeholder in this discussion. Can we manually move the slides, please? Can we? So let me talk to you, technology moves faster than I can. I’m sorry about that. That’s the way it is. Sorted out? So, no, no, no. So look at this slide. You know, those of you who have used the PCO booths to go and make calls and the long distance trunk calls. And what happened when the cell phone moved analog to the technology move from analog to digital? You know, we can make calls from cell phones wherever we want, whenever we want. And now you can use your watch to make phones. So effectively, technology has progressed. And what it has done is eliminated the middle person. You know, you don’t need to go to a PCO booth. You don’t need to use. Lines for a trunk call, you can use it from your cell phone. I use my cell phone. I sometimes don’t carry my phone at all. Next slide, please. Next. And this is another interesting slide on the entertainment sector. We had this huge antenna. Sometimes it was 70 feet. You need to connect to get to watch maybe seven, eight channels. What happened when it moved? Entertainment moved from analog to digital. You moved to a set-top box. And now, anything you want to watch, you just pay for it. And it’s at your convenience. So what it does, technology is taking that middleman away. Again, it took the middleman away. There is no need for antenna. I don’t need a set-top box. You don’t need a provider of that service in your area. You are connected globally through the satellite system. Next slide, please. This is my most favorite slide. At one time, Kodak and Fuji were fighting for the color of the prints. And they were talking about the quality. Digital photography came in. And Canon actually is the one which came in. And what appeared was both of them literally became bankrupt. But that was not the end of the story. We have now mobile phones which have the camera. So you can look at what has happened is we have moved a whole lot of generation moving analog to digital. Now, in everything you will see is that we eliminated the middleman. Same happened with libraries and the bookstores. Today, you have your Kindle or your e-book reader. And you can actually read whichever book you want. I carry hundreds of books on my Kindle. And what effectively happens is technology gets you closer to the user and eliminates the connector. Now, if I take these slides back to my health, what I believe is that when a product, service, or a sector undergo the digital transition, analog to digital, intermediary goes off. And health care has a lot of intermediaries right now. So I think the fate of clinicians is a foregone conclusion. And this is what I’ve been saying for over a decade. I’m going to stop here and look at asking my expert panel, which is with me, is like, what do we feel about the future? Are we going to have a day where AI will see you now is going to happen instead of the doctor will see you now? So I’m going to put this question to Dr. Peter Pezziosi. Dr. Peter, thanks for joining us. I think it’s too early in the morning or too late in the night for you to join us. I’m sorry for the dot R. But thank you for taking our time. Peter Pezziosi is the president of CGFNS Global. And he’s done extensive work in terms of trying to provide relief to people where clinicians are in short supply through nurses. Dr. Peter Pezziosi, what’s your experience of working in Rwanda? Would you want to share with us?

Peter Preziosi: Sure, definitely. And I’ll be very brief. But, Rahendra, I agree. I think it’s here and it’s even coming. And I agree with you about the displacement as we look at these medical brains that are coming that are powered by AI and AI engines that are looking at technology. Just for background, I lead a 50-year-old global assessment and certification organization supporting the mobility of nurses and allied health professionals worldwide. Earlier this year, we began searching for the right partners to evaluate some technology-enabled new models of care in the primary care and public health space. Working with the Society for Family Health in Rwanda and a remote patient monitoring device manufacturer, Medwand, what we did is we set out to establish a model of nurse care. nurse-led primary care that would be easily replicated across the globe, cost-effective, co-dependent on technology, and one that promotes access to care and prevention. This model will contribute to already existing task-shifting initiatives that help to bring care closer to the communities. The Society for Family Health is Rwanda’s premier organization for providing health to rural communities throughout Rwanda by constructing and equipping health posts operated by nurses. Under our protocols that we’ve developed, we’ve embarked on a journey that we believe will impact health prevention, health promotion and preventive care around the globe. We see this by empowering nurses, community health workers, and other allied health professionals by equipping them with the right technology tools to provide care. And to seek for a second opinion when they have to. So this is still emerging that we’re looking at. We believe this care solution will reduce the number of referrals that are transferred to upstream health facilities that are already crowded and lack adequate resources, and make the model for an integral part of primary healthcare. The model will also contribute to job creation by allowing nurses to increase their healthcare portfolio and entrepreneurship. So far, we’re in five remote locations that have been identified in rural Rwanda that center around designated health posts and district hospitals. Healthcare workers at those locations have been trained on the MedOne device that captures all vital signs and some more functionalities critical in providing primary care. So within this remote patient monitoring device, it includes a thermometer, stethoscope, ECG, EKG, pulse oximeter. a high-definition camera that can be used to view inside the ear, nose, throat, and skin, as well as integrate with any blood pressure monitor, glucometer, and spirometer. The device is synced with a tablet, which is used to capture, store, and transmit information, and also make it possible to have real-time consultations via video conference. Early indicators have been very positive. The health post workers have shown the ability to adapt to the technology and have communicated the anticipated decrease of time needed for diagnosis with the ability to send data real-time to advanced practice nurses. The community has shown an increased receptiveness and indications of better compliance when diagnosis is accelerated. Travel times and distance are reduced significantly. The physician staffs receiving information in hospitals in the major hubs are less burdened to have to track data, and their response time is reduced on their behalf as well. So, overall, we’re confident that our original intent will have the strong empirical data needed to impact the lives of many by reducing cost, improving health, increasing reach, and empowering a new up-skilled health workforce. Over the next few months, we’ll be gathering hard data to prove that the nurse-led primary healthcare model can have an impact in rural communities in Africa and then also beyond in other continents. Thanks, Rajendra.

Rajendra Pratap Gupta: Thank you so much, Peter, and I think you made very important points of moving from a doctor-centric system to a lot of health professionals like nurses. And we have a work which we are doing with nurses and pharmacists, and we believe that the future of healthcare lies in digital health plus nurses or digital health plus pharmacists and not necessarily just doctors. That being said, I think we have to move forward. you also leveraging artificial intelligence and empowering nurses to take on-spot decisions with regard to patients’ queries, needs, and serving them?

Peter Preziosi: We have a new initiative actually funded through Johnson & Johnson that will be started in Ghana. It’s AI-powered sonograms to detect hypertension in pregnant women to prevent the maternal child deaths that are so prevalent in Ghana. So we’re looking at that. There are other initiatives, some point-of-care solutions that we want to test in other areas. And actually, we started to talk with you and love to work with you on looking at various primary care providers that could really help. I think nutrition, registered dieticians will be very useful. And I’m pleased to see that the International Patients Union is on this panel because I think that that’s an important role to really look at this from a consumer perspective. Because I think what we are going to have to look at is helping to provide self-care solutions to the patient community before they even need to get to nurses, allied health professionals, and others.

Rajendra Pratap Gupta: Thank you so much, Peter. And I think it makes my job easier to switch to the Patients Union representative here. Mavish, you run the International Patients Union. And is there something that you want to share with this panel on the prospects of replacing the need for doctors in settings where you didn’t just need OTC-based medications or acute care problems? And what are you doing in that area for the patients?

Mevish P. Vaishnav: Good morning, everyone. This is Mavish from India. And I lead the International Patients Union. In the health care sector, if you see, everybody is organized, be it doctors, nurses, pharmacists. but patients are the one who are unorganized. Nobody hears them. So, at International Patients Union, we have a platform, the Patients Union, where we provide a platform for the patients to voice their opinions, their concerns, and share their views. They can share their views with other patients so that they can get well-managed for their diseases. If you see at Patients Union, we are making artificial intelligence, the authentic intelligence. Medical science is a science. So, if you say, I have a fever, I’ll give you a paracetamol. If you say, I have a cold, I’ll give you the medicine for cold. If you have a pain, I’ll give you the medicine for pain. That’s a painkiller. But, if all these things can be put into a system, which is AI-backed, it can actually help doctors as well as patients. Patients doesn’t need to travel from 40 kilometers or 30 kilometers to just visit a doctor for primary care. The doctors can be saved from their timing to see the secondary care and tertiary care, the surgeries. And through this system, we at Patients Union are developing a program. We have launched the Patient Centricity Index, through which every system has been put, like the symptoms of the diseases. If you just open your app and say, I have following symptoms for my knee pain or something like that, it will throw you with the diseases, the right prescription for it. And this way, we can actually save time for doctors. So, yes, AI is important and can be helpful in the primary care.

Rajendra Pratap Gupta: So, you’re saying, Mehwish, that patients in India will be able to get their information about healthcare needs, not from the net, which is unverified, but from Patients Union without even meeting a doctor, is that right? Yes. So, effectively, this will be probably the first experiments of its kind where patients can get information about primary care from an artificial intelligence-backed system.

Mevish P. Vaishnav: Yes, it is an authentic data that will help them.

Rajendra Pratap Gupta: Fantastic. Zaw Ali Khan is with us from the American University of Barbados. Zoh, you run an academic organization, but you also are a tech czar in terms of bringing new tech to healthcare. Given what’s going around the world, do you think it’s time for us to prioritize where do we invest clinicians’ time and how much of their role we replace with technology? What’s your view on that?

Zaw Ali Khan: Thank you, Dr. Rajan, for inviting me to this session. I feel that there are certainly many use cases where the clinician’s role can completely be… eliminated, not just for the sake of providing convenience to the patient, but also for reducing the workload of the doctors themselves. So there are plenty of use cases that would see the replacement of doctors with technology altogether. But there are certain, I feel, you know, challenges where it’s a softer approach which will help. Because, you know, as far as the regulatory issues are concerned, you need to have doctors on board to approve these tools. And in order to have them on board, you need to make them feel safe and give them the confidence to use these tools. So for that, I feel that the role of academic organisations is paramount. Because, you know, the doctors that have already practised their whole life in a certain way, asking them to change, asking them to adopt a new thing, means you’re basically telling them that whatever you were doing so far was inadequate. There were some limitations in that. And that’s a very hard or very bitter pill to swallow. And instead of that, if you were to highlight their own challenges and how tools and technologies are sorting those issues, then they’d be more on board with this idea. And this is what I’m talking about, the more experienced doctors who are at the tail end of their career. But of course, they are the stalwarts. If they were to, you know, join these pioneering efforts, then everyone else will follow. At the same time, you also need a new generation of doctors who are capable of navigating these digital tools. So over there, again, the academic organisations have a role of making sure, first of all, these academic organisations any of the teaching hospitals, they themselves need to adopt more and more digital health solutions so that they can demonstrate to the students. Unless they adopt themselves, they won’t be able to demonstrate. Secondly, once they have demonstrated all of that, they need a structured course for that. And we have been fortunate enough to partner with the Digital Health Academy for providing our students with an elective for digital health. So that’s a structured course which is delivered by experts from around the world. And lastly, so first thing I said, more adoption of health tools by making sure that the health care workers don’t feel threatened, at least at the get-go. And actually, it is not a threat. Because the main problem that you’re trying to solve is the shortage of health care workers. And a related problem that you’re trying to solve is health care worker burnout. So if you’re solving burnout, every health care worker would help you achieve that goal. So focus on burnout. Focus on, from the perspective of health care workers, focus on burnout. From the perspective of patients, focus on medical errors. From the perspective of health care organizations or health care systems, focus on the shortage of health care workers. It’s the same problem, but just with three different angles. And once you’ve done that, then all the stakeholders will come together to adopt more of these solutions. And ultimately, of course, everyone, once they start seeing the benefits, I’m sure that one or two generations down the line, they’d be surprised that, oh, we used to have PHCs. So that’s the future that I envision. And I hope that we’re able to accelerate that.

Rajendra Pratap Gupta: So this is very interesting, the point that you make. And at the Academy of Digital Health Sciences, where we run courses on doctors, our experience has been very different. The doctors who take courses are like 30 years, 40 years experience. And when they pass the course after one year, they’re as excited as kids, sending what they created to their sons, grandsons. And the unfounded fear becomes forces that help them. So that’s what we have seen in doctors. So we’re going to see a competence divide. But what is a worrying and probably a call to action for clinicians, everyone, I guess, is like the slides that I showed. The technology didn’t wait for the sector to evolve. It just disrupted it. So the fact is that whether doctors adopt it or not, technology is going to invade that. That’s a fact of life. Our studies show that some of the specialties will get totally replaced, which is a very, very strong statement to make. But when I look back at the statements made 10 years back, that actually come true. I think fields like radiology, dermatology may not be doing well with just doctors. AI can do a phenomenal job out there. But there are surgeries where robotics plus surgeons are needed. Specialists may be needed for neurology and other cardiology sector. But AI is getting matured with time. I mean, that’s what we’ve been seeing. And now let me get to Debbie Rogers, who joined us from Africa. Debbie, you run Village Outreach in Africa. And countries like India, Africa, and other LMIC countries face a huge shortfall of doctors. What do we do? Do we wait for doctors to get prepared and be MBBS, MDMS? Or do you bring technology? Because there’s nothing that exists. What do you say?

Debbie Rogers: I definitely am a proponent of bringing technology into the mix to relieve some of the burden on the health care system. In sub-Saharan Africa, we have 14% of the world’s population. but 25% of the world’s disease burden and only 3% of the health workers. So if you look at those stats, it’s very easy to see that if we just keep trying to train more and more health workers, we’re not going to get anywhere. We have to be using technology to be able to augment the work of health workers. And the way we think about this is we think about moving care from the facility. A lot of work has happened to move care into the community with community health workers. But with a mobile phone, you can move care from the facility to the community to somebody’s own home. And so we use very simple technology, technology like SMS and WhatsApp to communicate directly to citizens and to help them from a self-care perspective, but also to access the right services at the right time. An example of this is a program we’ve been running for 10 years in South Africa called Mom Connect. And basically every mother who goes into a clinic for her first ANC visit is signed up to the platform. And throughout her pregnancy and up until the baby is 10 years old, she is able to receive messaging, which will help her to care for herself and to understand better how to care for her baby as well. And we’ve seen really great results both on self-care. So things like better nutrition and uptake of breastfeeding to access to services like uptake of family planning after birth, improved attendance of ANC visits. So we can really see that something as simple as an engaging platform delivered directly to a mobile phone. You don’t have to have any training. It’s exactly what you do to communicate to your friends and family that can have a huge impact on health and it can relieve a lot of the burden on the health care system. So that the health workers can be doing the work that they really need to be doing and not the work. that can be taken over by technology. I think for me, I don’t know if we can say necessarily that we will replace doctors, but I certainly believe that doctors who use AI and use technology will definitely be replaced by those who don’t. I mean, the other way around, those who don’t use it will be replaced by those who do. Because I think it’s going to make their work so much more efficient and effective. It’s going to make patient experience much better and people are going to vote with their feet and they’re going to go where the patient experience is better. And I think that’s definitely where I see things going is very much more task shifting, different tasks going to different caters of health workers. And those who use AI and use technology are definitely going to be replacing those who don’t.

Rajendra Pratap Gupta: David, do you think, you know, we have been always saying that doctors who use digital health replace those who don’t, but do you think there could be an extension of this saying that the healthcare workers who use digital health will replace doctors who don’t? You know, because I can tell you, you know, this is not coming just because I’m sitting on this dais on IGF and I’m saying, there’s a hospital where they segregate the high-risk pregnancies with normal pregnancies. And I was told by the chairman of that hospital, who is a doctor, this hospital has been around for 76 years, that in normal pregnancies, the mother does not see a doctor even after delivery. It is the nurses who handle it. So, and they use technology. So just imagine how much precious time of the doctor, the gynecologist or obstetrician is saved because the delivery happens only through nurses. And this is not a small number. I mean, this is, I’m talking of India and this hospital has been doing it. So, I mean, I’m, you know, getting to the stage to conclude, that India has been an evangelist of technology. I was skeptic, you know, in the beginning, you know, thinking that it will not happen. But as I see over the last few decades, I think technology has been showing itself with great confidence. commitment and accuracy now. So do you think that other healthcare professionals like, you know, our friend, Dr. Peter Preziosi is doing in Rwanda and Ghana, will other clinicians who use technology replace doctors? Because given, I mean, I see your numbers, India has the same problem. You have 25% of disease burden, 3% of workers, no way on earth you’re going to match them over the next few decades. No way. So do you think technology will be…

Debbie Rogers: I agree, there’s gonna be massive task shifting and things that were previously deemed as only able to be done by certain specialists are going to be, is going to be able to be done by somebody who does not have the same amount of training plus technology. So I do think the task shifting and moving from one cater to another is definitely gonna happen. And we see it happening already because just out of necessity, I mean, in Sub-Saharan Africa, there aren’t enough doctors to reach everybody. So a huge amount of the care is already on nurses. I do think though, we have to think carefully about the fact that we still have too few nurses and we still have too few community health workers and we still have a problem of burnout, which means that as fast as we’re training people, we’re losing them. And I think we have to think very carefully about, and I do believe this is an important role of technology, removing the burden from healthcare workers so that they can do what they really need to be doing rather than things that can be done by technology. And I think that’s gonna help an enormous amount to relieve that huge dearth of healthcare workers that we have worldwide, not just in Sub-Saharan Africa.

Rajendra Pratap Gupta: Thanks, Debbie. You know, I’ll add to that, we are very lucky to have one of the leaders in India who is the president of the Indian Nursing Council, Dr. Dilip. You know, what we have done as Academy of Digital Health Sciences, we have partnered with him to train 2 million nurses on digital health. And same thing we have now done with pharmacists, we’re going to train 400,000. on digital health. I think these could do phenomenal work and I think by next year, IGF, we’ll be able to show the impact we have created training of most like, I think within now and then, we should aim to touch half a million of them trained. Eventually we’ll train maybe three million of nurses and pharmacists to take on some of the frontal roles. But having said that, now I have with me Dr. May Seksek. She runs the Innovation Network Canada. May, you have been leading the Innovation Network and you’re building a new healthcare model. Where does technology fit in the model? Is it going to be more dominant than the clinicians or it’s going to be just again back to the same old model? And going by the fact that Canada is among the handful of countries which pioneered digital health. My very dear friend Richard Alvarez was the President and CEO of Canada Infobae which was the first government organization to implement digital health. What’s your take on that?

May Siksik: I want to say sorry Thanks Rajendra. I wanted to say that Debbie has brought up really important statistics and some critical information here. The demand for healthcare is rocketing and supply is still a space. The system is destined to crash at some point. From my perspective, it’s again going back to these stats, we really need to have technology that is able to support the healthcare system We really need to have technology take care of what’s on doctors and nurses. I think that’s really important. So in the system that we’ve developed, one of the main concerns right now based diagnosis and so on is the fact that large language models will not hallucinate. This is one of the things that we’re working on. You can hear me? Okay, perfect. So one of the things that we really need to address is hallucination. Right now, AI-based diagnosis cannot be working on right now. I think we really need to address that. And we’re working actively at Innovation Network with academic organizations to address this issue so that we can actually have an AI-based system that can be qualified to do such tasks without a human supervising it. And I think that’s really important because then we can save a massive amount of time from healthcare professionals. Doctors, for example, in Canada, they get paid by every 15 minutes. And I mean, most of the time, it’s very difficult to actually address a medical case, especially with complex medical cases, within 15 minutes, which means that they’re not really able to do their job as well as they can and they should. So having, I mean, the way I think about it is that it’s having, for example, medical AI-based medical diagnosis is like having a co-pilot for doctors. You know, you wouldn’t set foot on a plane if you don’t know that there’s a co-pilot that’s for redundancy. Yet we go to doctors and who, I work with a lot of physicians and I hear from them that mistakes are often made and often they get buried with doctors. So it’s important to have these tools for doctors to not just empower patients, but also empower doctors as well. Another aspect I wanna bring is the fact that I don’t think they’ll ever be able to, AI will ever be able to completely eliminate doctors. I think we’ll always have, but we’ll save tremendously in terms of the time that’s needed from doctors. I think there are two aspects here. One of them is the fact that we’re always, you know, we are human beings and. We often, we need that interaction and assurance from doctors. We also need to understand for, especially complex medical issues where we need to look at different factors like ethnic background and culture and so on. You need to have that contextual understanding. Now, having said that, this has been a huge source of medical errors that actually literally led to fatal issues for patients. So it’s a double-edged sword. We need, doctors can be really good at understanding contextual context for medical cases, but at the same time, they can also make mistakes because of context, because they’re drawing patterns and so on. So again, going back to having that co-pilot from technology is really important.

Rajendra Pratap Gupta: May, and I would ask you that if you were to start moving from your driver driving you versus a car which is driven autonomous, would you do that?

May Siksik: Would I use an autonomous driving vehicle? Yeah. So in fact, I mean, I have actually worked in compliance for a safety standard for autonomous driving vehicles. I’ve worked very closely on this field and I can tell you, so my job was actually to really oversee where mistakes can happen and the system could result in fatal issues. And because of that back, and it was quite a complex process so I worked with all, so, and you can see that mistakes could happen and compliance is extremely important. So you really need to have a standard where you actually have to check things. So, and this is going back to, we really need to qualify AI.

Rajendra Pratap Gupta: So May, in this May, this is the month of May, I will. in U.S. delivering the opening address at ADA and I decided to use an autonomous vehicle, PIMO. I didn’t have a problem. It’s the worst thing. To a doctor, you go once in a year, probably twice in a year. If you’re a chronic patient, multiple times. But in heavy traffic in the United States, in the morning or evening, you won’t drive and take the risk. But I decided to do that. Let me tell you, it was pretty safe. If I can trust a driverless car and reach there, again, going back to the presentation I made 10 years ago in Hames, what essentially this technology is doing is taking the middleman away. There’s no driver in the car. I reached my destination on time. The driver doesn’t, you know, fleece me by taking a longer road, charging me more. I’m just charged. I go to my destination. So if you trust a driverless car, why won’t we trust a doctorless surgery with a robot?

May Siksik: So I totally agree with you, but driverless cars have a standard that they must be compliant with. And I can tell you, it’s a very, very complex and big process. So you’ve got auditors that come and make sure that it’s compliant. And we can do that, Rajendra, with medical-based diagnosis. And I think we’re getting close to there. We’re not 100% there yet. We’re not, we’re not, we can’t qualify yet, but we need to get there. We need to have a standard and we need to be able to say we’re compliant with the standards.

Rajendra Pratap Gupta: Yeah. And I agree. And going to Mavesh, you know, you’re talking of patients. Are patients ready to accept this kind of technology? I mean, Mavesh, I want to throw this question that you run Patients Union. Are patients ready to accept AI as a doctor? So if you say AI first, doctor later, would they accept it?

Mevish P. Vaishnav: Yes. So there is a study where it states that six out of 10 patients know digital health, but two out of 10 doctors know digital health. So awareness, that is important. And doctors are more prone towards, you know, when a patient, I can share an experience with you. family member went to a doctor and she asked her can you prescribe me DTX she was like what is that so she’s not aware about DTX so it gives a thought or maybe a doubt for a patient that if a doctor doesn’t know about this technology how will she be able to help me in my managing diabetes so yes patients are more prone and they are more accessible to AI they would love to be a part of AI where there are zero errors I would not say zero errors but negligible errors.

Rajendra Pratap Gupta: thanks my wish and this brings me to a very important point that may 6 I grades you know about the empathy so may today my social media knows more about me than my doctor you know they tracked me what I do using my phone it tracks me what I do using my computer what I like what I do like the tone through my phone when I talk so it could be more you know personable to me in terms of personalizing the content the way I speak the way I like and how many seconds I need a response so if I have a doctor that AI doctor would be more empathetic won’t get angry because I get angry very often so do you see that technology is better in terms of empathy than a human doctor.

May Siksik: Actually yes so but having said that I do think that technology can be better than doctors at in terms of empathy but having said that sometimes a patient at a hospital will need for certain cases they will need humans so all I’m saying is that we can’t eliminate doctors in terms of empathy and I want to say that I mean using AI based tech for medicine is is critical actually right we actually are losing lives right now because people can go to a clinic and not have access to the right diagnosis and so I talked about I talked about the tiny bit of hallucination that an AI system does does, but humans make way more errors, way more errors than, than, than doctors. I just, just to be making my job easier.

Rajendra Pratap Gupta: Thank you.

May Siksik: It’s true. I just, I mean, I need to, uh, we need to talk about all aspects of this. Right.

Rajendra Pratap Gupta: So that’s a reality check. So going to ZAW, that’s all running an academic organization where you do research and you work across multiple countries, what do you think about AI being more empathetic, being more accurate, because there’s a two challenges that will come in the way of creating trust for technology.

Zaw Ali Khan: Yeah. Thank you, Rajenji. Uh, so as far as AI, uh, knowing more about me than I know about myself, I would frame it that way. Uh, I recently got to know that, uh, you know, if you ask chat GPT, uh, uh, how would a typical day, uh, based on what you know about me, if you give a chat GPT prompt prompt saying that, uh, based on what you know about me, what would my desk look like, or what would my workplace look like? So it’s able to recreate that quite accurately based because of the, uh, frequency and detail of interactions that we are having with these, uh, AI models. So, uh, imagine if we were to have health, uh, related, uh, interactions with these AI models, uh, as frequently as we are having work related, uh, uh, interactions, uh, that would be, uh, many times more, um, I mean, in terms of magnitude, I would say exponentially more personalized than any, what any doctor or healthcare worker can provide. Uh, it’s of course not physical. It’s not a physically or humanly possible for doctors to provide that level of personalization as. Ms. May said that doctors are getting 15 minutes with the patient and in UK I’ve heard that they get 7 minutes or 8 minutes on average. So it’s impossible to even diagnose many of the conditions in that short amount of time let alone give a personalized empathetic care to the patients. So I agree that digital tool has that potential.

Rajendra Pratap Gupta: Some countries they get 34 seconds. If I remember correctly it was Bangladesh you know where doctor gets 34 seconds or so. So even if it is any other country 34 seconds one minute you can’t even pronounce the name and the problem of a patient you know how will you diagnose. That means you have made up your mind to prescribe something and the patient has just come in on time. Yeah so that’s another that technology won’t do by the way because there will be a digital footprint of what you do. So Peter coming to you given your global experience and you are a nurse by training. That’s correct. And I think you are closest to the patient than the doctor. That’s why I call it like doctor says still close to God doctor and nurse is closest to the patient. How do you see this relationship between technology patient and the clinician evolving?

Peter Preziosi: I agree with many many of the comments that were stated earlier. I think the challenge is that we tend to be focused throughout the world on a medical model and the challenge that we face we face in communities is that clinicians are not working at the top of their capabilities and for a variety of different reasons. Many times if you’re talking about you know physicians, nurses, pharmacists, they’re they’re struggling with the morass of administrative paperwork that’s not necessary for them, takes them away from clinical direct clinical care. As a number of the panelists were mentioning, these AI-enabled tools, digital health tools, are partners to really enable people, clinicians, to be able to work at the top of their capability. But there’s so much more that happens, and it’s very different based on the jurisdictions that you’re talking about, the different countries that you work in. From a regulatory, legislative perspective, there are professional turf battles. And why I’m so thrilled to see the patient’s union here is that we talk a lot about patient-centered care, but we’ve got to really bring that patient involved and engaged in the services that are being provided because they should be much more empowered in terms of what it is that they need to do. Because if you look at it, just take the issue of obesity. Obesity is rampant now around the world because people are not eating properly. They’re not exercising properly. Aging is a challenge that there’s no cure for, really. Maybe there will be a digital cure into the future. But the issue is that there are many health issues that don’t succumb to a traditional medical model. So we just have to start to begin to turn some of that upside down and look at the appropriateness of care. I think it was Debbie that said earlier, looking at the right care at the right time, right place. These are the issues that we have to get better, and I do believe digital health solutions will help to augment and assist us in moving more into those areas.

Rajendra Pratap Gupta: Thank you, Peter, so much. And to those who have joined online, I would say put your questions in the. we’re going to take questions, we’re going to dedicate substantial amount of time for questions. But you know, this brings me to Debbie and Debbie, you know, that countries like Africa, India with billions of population, and there’s so much less resource in terms of doctors, of course, India in the last few years has done phenomenally in terms of adding doctors, we add now 175,000 doctors every year, which effectively means that in next five years, we would double the number of doctors we already have. Having said that now with technology taking dominant role, and number of doctors coming up more. And now going back to Africa as a region where some patients may not have seen a doctor in their lifetime. How will they understand the difference between technology and a doctor? I mean, if I present them, hey, look, there’s a doctor you’re talking to. And you know, I’ll put a disclaimer, there’s a doctor is AI based doctor, they haven’t spoken to a real doctor. What do you feel would be an opportunity or a challenge for a country like Africa where someone gets addressed empathetically through technology? How will they differentiate? What will be their response on this? I mean, they have not seen a doctor, they get their talk very well. They don’t get 30 seconds, they get 30 minutes if they want, they can chat, they can tell all the problems and the AI will tell them, look, this is your thing. And if they get the right advice, I think, as you said, as Dr. May said, and as Dr. Zaw said, if they get the right advice, they would come back to this for more because they would start trusting that voice that talks to them and it will be the voice that they probably like the most. What do you think about that, Debbie?

Debbie Rogers: I think you bring up an incredibly important topic of trust. And I think we provide digital health solutions and we work very, very hard on making sure that they are trustworthy, that people love the services, that they understand that the service is there to support. And in doing so, we are able to get them to change their behavior in a way that they wouldn’t be able to if they didn’t trust the source that it was coming from. Now, I don’t know whether people, I don’t have the knowledge or have done the research around whether people will trust AI or doctors more. I think it’s probably going to be down to a personal perception. But I do believe that people can trust AI and people can trust digital health solutions. And I think that’s incredibly important when you’re building these solutions. As an example, we integrated a diagnosis engine into MomConnect. It’s a diagnosis engine that we didn’t develop. It’s called Ada Health. And we integrated it via WhatsApp into MomConnect. And we had a higher completion rate of going through diagnoses on MomConnect than on the Ada Health app. And the best we can put that down to is that mothers actually trust the MomConnect service. Another example of trust is we get inundated on Mother’s Day with pictures of people’s babies and messages thanking us for the support that they’ve been giving. And good morning MomConnect and good night MomConnect messages. Whether it’s a piece of technology at the end or it’s a person at the end, you can build trust and you can get people to engage with them. And sometimes they believe that there is a person on the other end. And sometimes they believe that it’s AI on the other end. And that depends on the usage and the person as to what you want to try and encourage. For example, in our sexual reproductive health and rights platforms, we find that youth want to speak to AI and not to a person because they’ve been judged so much by people. And so in that instance… for example, it actually is very helpful for us to have AI. And so I absolutely believe that people will be able to engage with AI, trust AI, knowing that it is AI, they may trust it even more than doctors sometimes, depending on what their experience has been in the past.

Rajendra Pratap Gupta: You bring that very important point of the world called engagement. I think technology with no denominator of money at the point in time and not being a human, it could actually spend time probably the patient wants to spend with and engagement would lead to maybe better outcomes if the advice is right based on standard clinical protocols, which means, as you said, AI could be trusted more. I mean, as they send you pictures, I’ve seen your work and I really admire what you have done is that people feel that there is someone with them when they want it. And that’s what is missing in health care today. And I think Peter Presuzzi would allude to this, but Peter, given the fact that we have nurses and there are success stories of the nurses and how they touched and transformed lives, do you think that the future of health care lies with leveraging this workforce, nurses and technology together and somewhere maybe technology? What is your take on this?

Peter Preziosi: Yeah, that’s a great way of putting it around is is liberating all clinicians, nurses, given that there are twenty nine million worldwide, the largest profession. Absolutely. We need to you know, we start with them, but there there’s so much more out there like the work that you’re doing with pharmacists and others. You know, we’ve got you know, we’re doing much work around rehabilitation care with the World Health Organization. And we’re actually in Ethiopia looking at rehab care, driving that into primary care. A quarter of the world’s population needs some form of rehab care. Yet so many clinicians are ill prepared. to tackle this. And when you’re taking a look at the challenges around war and conflict and working in these zones where you’ve got traumatic amputees and trying to reintegrate people into a quality of life, rehab care is incredibly important. But yes, liberating through, I mean, there’s no magic bullet. Are these digital health and AI solutions the magic bullet? Absolutely not. As many people have talked about here, engagement. There are a variety of issues that need to help. But there’s nothing, obviously, to be afraid of with the technology evolution and emerging that as true partners. Again, I’ll just emphasize, it’s also as important to liberate the consumer, the patient, and their families equally with these technologies.

Rajendra Pratap Gupta: Peter, I think this is a very important point of liberating the clinicians from their too many tasks that can be handled and also the consumers. Let me now jump and open this to questions from the audience. Then I have some questions, which I will ask back the panel again. So if there are questions from the audience, we’ll be very happy to take that. Can someone please provide the mic to the audience? And Sakshi, if you have online questions, please read out to us. Sure, sir.

Audience: So everyone, that was a very nice discussion. We have a few questions online. I’ll just read them out for you. First one is from Ms. Arushi Negi. She asks, if we are planning to replace doctors with digital health tools, how do we make sure they are not compromising quality of care?

Rajendra Pratap Gupta: Peter, over to you.

Peter Preziosi: Well, this is exactly one of the reasons why we’re going slow and really testing these point of care solutions. Many, you know, and there are countries, high-income countries, Canada, the US, India has done, you know, a great deal of this kind of work where you’re looking at, you know, testing out these solutions, integrating that into clinical workflows. I don’t think replacing is the right word, but, you know, really augmenting. And, you know, there are AI-powered medical brains now that are helping to augment 92% of the workloads of clinicians and practices. And most of this is administrative burdens. Rohindra was saying before, when you’ve got a physician that has only 34 seconds to go in and they don’t even have time to pronounce the patient’s name and the diagnosis. So it’s that, it’s looking at, it’s looking at the work differently and testing those solutions out and seeing what’s best with the consumer to be able to optimize human potential.

Rajendra Pratap Gupta: Thank you, Peter. In fact, I would very much agree with you on that point. You know, recently in our office building, we had a plumber who always came and told us that his wife has low weight and she’s coughing. And, you know, we said, okay, why don’t you get a tuberculosis check done? So he went and got a check done and the sputum was negative, but the x-ray showed that it was tuberculosis. And the doctor would not start the treatment because the sputum was negative. So we did a telemedicine consultation through a tertiary care facility. And he said, just start the treatment. It is abundantly clear that, you know, there is tuberculosis. So it was technology that came to the rescue, but the conventional system of diagnosis and treatment or consultation didn’t work. But sometimes it is augmentation, sometimes it is replacement, and sometimes it- would be just the doctor. So having said that, Zaw, what do you feel will create that trust that is missing in technology for now?

Peter Preziosi: I want to comment on one thing, Rehendrik, because you’re right. Trust and engagement is so critically important. I was, prior to being at CGFNS International, I was the World Health Organization, actually during the pandemic. And there was a lot of vaccine hesitancy around the world. A lot of individuals don’t trust the treatments that are out there, the vaccines that will prevent the spread of infectious disease and pandemics that are cropping up. This is a real challenge that we have. It’s not just around digital health. It’s around the entire value chain that we see across the health care system. Because as it was said earlier, health care is very contextual and highly personal. And these are the things that we have to focus on. And to your point earlier, AI really understands us in a lot of ways that maybe other humans might not. And what Debbie was saying around sexual and reproductive health issues, where teenagers might feel more comfortable, less judged by talking to a bot. So these are really important issues that happen. But you can’t just make these blanketed statements around the world, because there are a lot of different cultural nuances. Over.

Rajendra Pratap Gupta: Thank you. Zao?

Zaw Ali Khan: Yeah, Rajenji. So about the issue of trust, I feel in the context of communities where doctors are not available at all. So in that vacuum, of course, any solution would be taken very spontaneously by the patients. But as far as systems where people are used to doctors, if you’re able to emphasize the advantages of technology which they are already seeing, like in India, there used to be next day deliveries used to be considered very fast. And now we have same day deliveries and even 10 minute hyper fast deliveries. So there’s this convenience that consumers are getting used to. And if you see patients as the consumers in the health care system, then eventually they’re going to demand that same kind of convenience in health care as well. Along with that, of course, they would also want high quality. For high quality, they would want to spend more time with doctors. They would want more counseling and coaching. But of course, since that’s not physically possible, then the next best thing would be technology. And technology can actually build more trust because it’s capable of counseling and coaching patients in a much more personalized manner, as we already discussed. But more importantly, it comes with the added advantage of being potentially very transparent about where they’re getting the information from, why they’re recommending a specific course of treatment, why they have concluded a specific diagnosis. So the technology can actually explain all of that much more better than any of our overworked health care workers can. And it can also provide the evidence-based data to support their recommendations. And I’ll just stop right here. Just one more point. Lifelong learning. Even if we train our doctors, our nurses, health care workers to be very good at lifelong learning, we don’t have to be good at lifelong learning. we can’t expect them to absorb the huge oceans of knowledge that is being created continuously in the medical science sector. Whereas AI can effortlessly absorb all of that, assimilate it, and always be up to date with the latest evidence.

Rajendra Pratap Gupta: Thank you, Zou. And the question is very important that how do we maintain the quality without compromise? I was on the accreditation committee of the government of India for hospitals. And of course, we still agreed on the same parameters of number of doctors to bed, nurses to bed, and what we do. But there was no objective parameter. So in technology, at least, I can say for sure that you will be having a digital footprint of all that you do. So I can see exactly at what readings did the patient enter the system, when did they exit, and when did they get readmitted. So maybe we would redefine what are the parameters of quality. In an AI system, I think the number of hallucinations per patient’s life journey would be an important quality yardstick. And to me, if you ask me, I am not saying I’m overexcited about it, but I believe that technology will be able to manage quality better than the conventional care delivery model because it tracks everything in the process. Everything you do has a digital footprint. I will definitely ask my colleague, Dr. May, what she feels about it.

May Siksik: Yeah, I completely agree, Rajendra. And this kind of reminds me of the empathy point that we brought up a little bit earlier, which is I want to mention that one of the projects that we’re working on is with First Nations. And First Nations have an issue with the way the medical system is set up in Canada, for example, because you can only go to the doctor with one issue. But the way their culture is, when you go in, you need to talk about the full picture, and they have multiple things that they talk about. It’s just a very cultural thing. And this is something that can be completely taken care of with an AI-based system. So I completely agree with you that this completely be helpful in this regard and develop that trust with populations who normally would not would avoid going to doctors which creates like I know in Canada that creates big problems because it means that conditions get worse and manifest into something serious and it cost the system in terms of you know not just dollar value but also societal impact and cost lives.

Rajendra Pratap Gupta: May I remember in one of the books I wrote that in one of the province in Canada they run a lottery to be attended by doctors. Lottery system you know by doctors so if that’s the seriousness you know it’s really tough for me to ignore not giving technology to such populations. Mavish from a patient standpoint how would you see quality in technology versus a conventional doctor?

Mevish P. Vaishnav: So if you see I feel patient would be more happy to get time from a doctor but a doctor should be able to understand my condition well my history he should know my history and if I don’t get that much time how will I trust the doctor but if I go to AI and I say okay these are my symptoms and what best options or what treatment you can provide me I would get better outcomes from that because it has as you said it has a complete standard operating protocols and the treatment guidelines from where it can take out the data collate it and share it with me so I would trust the AI more than a doctor.

Rajendra Pratap Gupta: Debbie what’s your take on on the quality that we’re talking of in the technology age?

Debbie Rogers: I absolutely believe that quality from a technology perspective could be better than, could be better than individuals and in many cases have been. One thing I do just want to point out is that we need to be very careful on technology increasing the digital divide. For example, LLMs at the moment are primarily trained on Western culture, medicine, languages, intonations, cultural context. And that is not going to be appropriate for rolling out in Rwanda, for example. And we need to spend a lot more time ensuring that the quality is not just high quality for certain communities, but high quality for all communities, particularly those who are underrepresented at the moment. So while I think that it’s possible that it will get to that point, I think we need to be conscious in how we are approaching improving quality within these things to ensure that we do it in an equitable way.

Rajendra Pratap Gupta: Thank you, Debbie, so much. We have a question from the audience, please. Please tell about yourself and ask the question.

Audience: Can you hear me? Yes. Okay, my name is Melody Musoni. I work for a think tank called ECDPM. So the medical field at all, but I was happy with the conversation that we were having here and I learned a lot. I guess mine are more of concerns. And I think Debbie have already touched on one issue when it comes to digital divide, because my fear is the more we digitalize the healthcare system, we are going to leave so many people behind. Even just to give the MomConnect example that Debbie was demonstrating and showcasing, you have to have a phone for you to be able to register and to use it. And if you don’t have that phone already you’re automatically excluded. So I think as we start thinking more about how we are incorporating AI in digital healthcare we also need to bear in mind the issues of digital divide and marginalization. That’s the first point I wanted to make. And then the second point I also wanted to make is perhaps we also need to think about the option of opting in to a digitalized service and opting out because I think you mentioned the other speaker about the importance of human to human interactions. Personally, I think I would still want to go to a human doctor if I have the opportunity to do so instead of relying on a technology. So I think as we are advancing in our innovation on healthcare, we also need to make room for people who may still want to have access to physical doctors or real doctors. And the third point I also wanted to mention I think the speaker online kind of touched on it. I think now with generative AI there’s a lot of misinformation and fake news that is flying, especially around fat diets. So people I know, especially they use Oprah a lot and they have generated so many videos where they’ll be like, Oprah, you think it’s Oprah. We say, I was using this product and after using it in two months, I lost weight. And a lot of people are falling for that misinformation and a lot of people are buying these products. So I think we also need to find ways in which we can address the issues of misinformation and fake news. And I think the example you gave about patients going to doctors and requesting for a certain medication and the doctor is not aware is a good example of that because they are seeing all these things on social media and they expect all doctors to know. So there should be a way in which we address issues on fake information. information, especially around use of certain healthcare services, for example, and I’ll stop there. Thank you. I think he also had a question.

Rajendra Pratap Gupta: Yeah. Very important points raised. And I think this is what Peter and others were alluding to, you know, that while we get to implement technology at scale, we should be careful about the don’ts more than dos, because that’s something that we need as frameworks to implement. Yes, you have a question.

Audience: Can you hear me? Yes. Yeah. So more than a question. I think it’s just some comments I had written it down so that I don’t forget it. But I think an important point that we missed upon was basically how doctors are limited. That has been addressed, of course. But compute is growing at a larger scale than ever. So it was Moore’s law before where it was, you know, it grows two times every two years. Now it’s four times and the cost is going down with GPUs and, you know, multiple compute systems. But at the same time, you have compute systems that can run AI models on a system that is as cheap as $20, but give you an accurate response in six seconds. So this has been, you know, still not been implemented. And I think this would help a lot of places where you need instant care. And the compute cost is a lot for running these large models. So I see them as superpowers. And also touching upon the point of the empathy that we discussed, you know, I remember the movie Wall-E. I’m not sure if everyone has watched it. But basically, you know, they learned everything from what they saw. So I think empathy is a social model, because now what you see is what you believe in. So if you start seeing an AI doctor, you won’t probably go to a normal doctor eventually thinking, oh, I think that’s a human that won’t be as accurate as an AI, although that’s very dystopian. But I think that’s just how it comes to be, you know, with new technologies. And one interesting point that I noted, Mr. Zoh, you said that you addressed at GPT as him. Now we have started, you know, addressing AI models as a person instead of, you know, just being on the cloud or somewhere else. So that’s something that we’ve already started, you know. started doing and it’s in the matter of two years so I think you know that’s something we need to consider as well yeah.

Rajendra Pratap Gupta: Thank you so much it’s a very important point you know that and I keep concluding you know with the way world is changing that this is not a technology change it’s a societal change society is changing you know don’t think that we need to adopt technology the society has already adopted adopted technology we are all learning without barriers today a teacher is not the main custodian of the information to deliver to the student it’s a YouTube any lecture you want on any topic you want you can go and watch same way patients watch Instagram they go and ask their doctors hey I looked at a star I saw actually a India’s world’s top cricketer talking about a CGM why would someone believe their doctor they would believe the best Batman who is like icon role model talking that I use CGM my sugar is controlled not tell me who is making a choice we used to say in healthcare doctor is the customer and patient is the consumer now technology is changing that role and relationship from customer to consumer directly which was never thought of for centuries it was doctor who decided not today as a patient I know more about my treatment than my doctor knows I mean it’s a real experience I am telling you being in healthcare being an advisor to my health minister of my country my doctor didn’t know about digital therapeutics I decided not to go to her she was a young doctor I mean very experienced very famous known for controlling but she didn’t know when I use a CGM I was told showed the readings I said why do I show to her she didn’t prescribe me you will have patients like me too I mean you’ll have patient who will believe the doctor so all kind of things will exist but I think it’s a big societal change now this brings me to I would still take one online questions actually it is before I want to go back to my panelist again based on what we have discussed sure so so the next question is how can we ensure the accessibility of digital tools in rural areas? I think I would go to Debbie first.

Debbie Rogers: There are a lot of things that we still need to address from an infrastructural perspective and from a cost perspective in order to ensure that digital health can be used in rural areas. Just the fact that what the previous audience member mentioned that even MomConnect, you have to have a phone, there are still major barriers to access to digital health technology. These include things like electricity. If there’s no electricity where you can charge a device, you’re not going to be able to have a digital health solution. If you don’t have any mobile penetration in that area, it’s going to be very challenging. You can do offline, but it’s very challenging. The other thing from a cost perspective, just thinking about AI, for example, we on MomConnect, it’s 20 cents per user, 20 US cents per user per year to run the program. If we were to shift that completely over to generative AI, it would be $10.20. The cost at the moment, and I hear the other previous audience member around the cost of compute going down. The cost at the moment is also prohibitive for a lot of these technologies. Things will go down, access to various things like electricity will go up. But we have to be more conscious about this in ensuring that those who need the services most are not left behind. Because unfortunately, just market forces alone have not actually solved all of these problems.

Rajendra Pratap Gupta: Bringing this point of cost of technology, of course, not what I’m saying may apply now, but when cell phone came in, at least in my country, I used to pay a very heavy cost of called airtime and cell phone usage. Today, you only pay for data. You don’t pay for calls. It’s free. We’re the cheapest data. So I think technology, not only the computing power goes up, the cost goes down, but I think you have raised an important point of the digital divide. Within the IGF, I also lead three dynamic coalitions. So one of the goals that I’m putting to my overall 31 dynamic coalitions is that still 2.7 billion people are not connected to the internet. That means one out of third person on this planet has no access to internet. We are very privileged people to be talking about all these things. And we should always understand that we are privileged and that’s what we are supposed to deliver. And these forums is talk the real issues and not ignore anything that matters. So I totally understand what you’re saying is very important. And as IGF community, you know, which is responsible for putting its views to the UN on this matters, this is a very important bond given that health is a determinant for living. You know, it’s not something that is a choice that you have. It’s a right health is a right. And technology makes that right possible. So that being said, I would move this to Peter. Peter, you working in Rwanda and now Ghana, what is your take on this?

Peter Preziosi: Yeah, I think what has been said, I would close by saying, look, technology, it’s exciting. It’s a new horizon of opportunity. But we have to be conscious of the unintended consequences, the ethical dilemmas, the digital divide issues, the challenges that we continue to see worldwide as as as we’re looking at governments around the world taking money from health education and welfare into defense spending. We’re seeing a sweeping shift in looking at, you know, that, you know, isolationism and that will be a challenge. if we think about not just the health worker being mobile, the work is becoming mobile. So it’s going to really democratize in many ways opportunity for access to good care if we pay attention to the digital divide discussion that was talked about. And here I would go back to all my panelists on a very important point. I have seen all the discussion that you all made in a very important element point, including questions from the audience.

Rajendra Pratap Gupta: What came out is that technology is going to move from a doctor-dependent model to a non-doctor-dependent model. It could be any clinician. It could be a non-clinician. It could be a citizen doctor. But having said that, when all of us agree on a few points, cost is going to come down because of technology. It’s going to be convenient. You can have it when you want. It’s going to have better engagement, better empathy, better quality, a better experience, and a better repository of knowledge. My question to each of my panelists is to justify why will technology not replace a doctor? I mean, starting with Dr. Peter Petrosi, please.

Peter Preziosi: Yeah, I think the human touch is critically important. I think that we’re going to find so many other types of technologies. Looking at precision medicine, I’ll just bring that up as well. We haven’t talked about really treating people at the molecular level, the cellular level, which is going to transform care delivery. And again, looking at the divide that exists between those higher resource countries to the lower resource countries, and how do we begin to democratize that? So I think that having the future health professional will succeed. and evolve with technology, not without it. Those will be the individuals and the patients that will be able to succeed and to do much better in the world.

Rajendra Pratap Gupta: Thank you, Peter. Mavish, from the patient standpoint, will technology replace doctors?

Mevish P. Vaishnav: If you see, it’s been years for me that I’ve gone to bank. So if bank is on mobile, why not AI doctor on mobile? So yes, I am for it. AI will actually help doctors to enable treatment. So yes, AI will replace doctors.

May Siksik: I think that AI will replace the majority of doctor visits.

Zaw Ali Khan: So as far as the title of this panel discussion is concerned, I feel yes, AI will definitely replace PHCs, first and foremost, and perhaps some of the other specialized use cases as well. But PHCs, because over there, it’s not actually replacing doctors. I mean, if I were to rephrase this, to make it more satiable for our health care workers, it’s not that the technology is replacing them. Rather, it’s making room for them to do their job more effectively. So that way, I feel it’s a win-win for doctors, patients, health care systems around the world. And one more thing that I’d like to add in that is about the regulatory standards and the need to define them with the participation of all stakeholders, particularly because one of the audience members mentioned about the risks of AI, particularly about generative AI. But I think there would be risks in other use cases as well. well. And over there, I would emphasize that the role of academic organizations, academies like the Academy of Digital Health Sciences or AUB, American University of Barbados, we need to make sure and other organizations need to make sure that we are training the next generation of doctors and our faculty members, our stalwarts, in a way that they’re not cynical when it comes to technology. Because if our experts are cynical, then they will, they might advocate for harsher standards and that might decelerate this transition from doctor-centric healthcare to a non-doctor-centric healthcare. Thank you.

May Siksik: I just wanted to add that, to clarify that they will replace the majority of hospital, of doctor visits, but even for the visits that they cannot replace, they need to be at, AI will need to be at the table as part of that team, interdisciplinary team. And it’s, that’s quite, going to be quite important.

Rajendra Pratap Gupta: Previously, have you seen the AI before doctor? Yeah. Debbie, your take?

Debbie Rogers: I’m going to use an example that you used of Kindle and how, you know, libraries and bookstores have been replaced by the Kindle. In recent years, there’s actually been a resurgence of bookstores and there’s a huge growth in that market. I personally, even though I’m a technologist, I like to read physical books because I like the way they smell and I like the way they feel. And I’m quite happy to carry around a big tome with me in order to get that advantage. And so I don’t think that even if something is possible, even if it does make these things easier, I don’t think we’re going to replace human touch entirely. And there are definitely going to be. people who prefer human touch. And it may even be that for a while, we have a drop in the number of people who are accessing doctors, but that it will resurge again when people realize the advantages that you can get from the human touch that you just cannot get from technology. So I don’t believe there’ll be entirely replaced. I do believe that it’s going to make the lack of health workers a far smaller problem. And I do believe that it’s going to be critical that AI is a part of the team, as you mentioned, May, but I don’t believe it’s going to replace doctors entirely, despite being a technologist.

Rajendra Pratap Gupta: Thank you so much, Debbie. And it was a great discussion. And every year at IGF at Digital Health, we discuss how technology is shaping healthcare and how healthcare is shaping technology, it’s both ways. I really thank Dr. Peter Preziosi for being awake late night and joining us and sharing his valuable insights, which are going to shape the way we look at health. This is Zohr Ali Khan from the American University of Barbados. May, Dr. May Siksek, Mavish and Debbie Rogers. Thank you all so much. And Sakshi Pandita, who’s been moderating us online and for all the panelists who joined us, all the viewers who joined us and asked those important questions. Next year, we’re going to present you the findings of what AI did to healthcare. Thank you so much and wish you a very happy holiday season. Merry Christmas and a great year ahead. Thank you. Bye, thanks. Thank you.

Agreement Points

AI and technology can augment and assist healthcare workers

Peter Preziosi

Zaw Ali Khan

Debbie Rogers

AI and technology can augment and assist healthcare workers

AI and technology can reduce administrative burdens on clinicians

Digital health tools can improve access to care in underserved areas

The speakers agree that AI and technology can enhance healthcare delivery by supporting healthcare workers, reducing administrative burdens, and improving access to care in underserved areas.

Need to address digital divide and ensure equitable access

Debbie Rogers

Peter Preziosi

Need to address the digital divide and ensure equitable access

Cost and infrastructure barriers in low-resource settings

Both speakers emphasize the importance of addressing the digital divide and ensuring equitable access to AI and digital health solutions, particularly in low-resource settings.

AI will play a significant role in future healthcare delivery

May Siksik

Zaw Ali Khan

Mevish P. Vaishnav

AI can provide more personalized and empathetic care than time-constrained doctors

AI may replace primary care centers and some specialized roles

Patients may trust and engage more with AI-powered health services

These speakers agree that AI will play a significant role in future healthcare delivery, potentially replacing some traditional roles and offering more personalized care.

Similar Viewpoints

Both speakers suggest that technology and AI have the potential to disrupt traditional healthcare delivery models by eliminating intermediaries and bringing services directly to users.

Rajendra Pratap Gupta

Zaw Ali Khan

Technology eliminates middlemen and brings services closer to users

AI may replace primary care centers and some specialized roles

Both speakers emphasize the importance of healthcare professionals adapting to and effectively utilizing AI technologies in their practice.

Debbie Rogers

Zaw Ali Khan

Doctors who use AI will replace those who don’t

Need to train new generation of doctors to work with AI

Unexpected Consensus

Potential for AI to provide more empathetic care

May Siksik

Mevish P. Vaishnav

AI can provide more personalized and empathetic care than time-constrained doctors

Patients may trust and engage more with AI-powered health services

It’s somewhat unexpected that AI is seen as potentially more empathetic than human doctors, challenging the traditional view that empathy is a uniquely human trait in healthcare.

Overall Assessment

Summary

The main areas of agreement include the potential of AI and technology to augment healthcare delivery, the need to address the digital divide, and the significant role AI will play in future healthcare. There is also consensus on the importance of adapting to these technologies and the potential for AI to provide more personalized care.

Consensus level

There is a moderate to high level of consensus among the speakers on the transformative potential of AI in healthcare. This implies a shared vision for the future of healthcare that integrates AI and technology, while also recognizing the challenges that need to be addressed. The consensus suggests a likely acceleration in the adoption of AI in healthcare, but with careful consideration of equity and access issues.

Different Viewpoints

The extent to which AI will replace doctors

Peter Preziosi

Mevish P. Vaishnav

May Siksik

Debbie Rogers

I think the human touch is critically important.

AI will actually help doctors to enable treatment. So yes, AI will replace doctors.

I think that AI will replace the majority of doctor visits.

I don’t believe there’ll be entirely replaced. I do believe that it’s going to make the lack of health workers a far smaller problem.

The speakers have differing views on the extent to which AI will replace doctors. Peter Preziosi emphasizes the importance of human touch, while Mevish P. Vaishnav and May Siksik believe AI will largely replace doctors. Debbie Rogers takes a middle ground, suggesting AI will significantly reduce the burden on health workers but not entirely replace them.

Unexpected Differences

Trust in AI vs. human doctors

Mevish P. Vaishnav

Audience

Patients may trust and engage more with AI-powered health services

Importance of maintaining human touch and option for in-person care

While it might be expected that patients would prefer human doctors, Mevish P. Vaishnav suggests that patients may actually trust and engage more with AI-powered health services. This contrasts with the audience member’s emphasis on maintaining the option for human-to-human interactions in healthcare, highlighting an unexpected difference in perspectives on patient preferences.

Overall Assessment

summary

The main areas of disagreement revolve around the extent to which AI will replace doctors, the challenges in implementing AI in healthcare, and patient preferences for AI vs. human doctors.

difference_level

The level of disagreement among the speakers is moderate. While there is general agreement on the potential benefits of AI in healthcare, there are significant differences in opinions on how much AI will replace human doctors and how to address implementation challenges. These disagreements have important implications for the future of healthcare delivery, medical education, and health policy. They highlight the need for continued research, ethical considerations, and careful planning in the integration of AI into healthcare systems.

Partial Agreements

Both speakers agree on the need to address challenges in implementing AI in healthcare, but they focus on different aspects. Debbie Rogers emphasizes the importance of addressing the digital divide and ensuring equitable access, while Zaw Ali Khan focuses on regulatory and ethical considerations. They agree on the goal of responsible AI implementation but differ on the primary challenges to address.

Debbie Rogers

Zaw Ali Khan

Need to address the digital divide and ensure equitable access

Regulatory and ethical considerations in AI adoption

Similar Viewpoints

Both speakers suggest that technology and AI have the potential to disrupt traditional healthcare delivery models by eliminating intermediaries and bringing services directly to users.

Rajendra Pratap Gupta

Zaw Ali Khan

Technology eliminates middlemen and brings services closer to users

AI may replace primary care centers and some specialized roles

Both speakers emphasize the importance of healthcare professionals adapting to and effectively utilizing AI technologies in their practice.

Debbie Rogers

Zaw Ali Khan

Doctors who use AI will replace those who don’t

Need to train new generation of doctors to work with AI

Key Takeaways

AI and technology have significant potential to augment and transform healthcare delivery, especially in underserved areas

AI may replace or significantly change the role of doctors in some areas, particularly primary care

There are important challenges to address in AI adoption, including the digital divide, quality control, and maintaining human touch

The future of healthcare likely involves interdisciplinary teams that include AI alongside human professionals

Patients may come to trust and prefer AI-powered health services for some types of care

Resolutions and Action Items

Continue testing and implementing AI and digital health solutions, especially in underserved areas

Work on developing regulatory standards for AI in healthcare with input from all stakeholders

Focus on training the next generation of healthcare professionals to work effectively with AI

Unresolved Issues

How to fully address the digital divide and ensure equitable access to AI-powered healthcare

How to balance AI adoption with maintaining human touch in healthcare

The extent to which AI will ultimately replace human doctors versus augment their capabilities

How to effectively combat health misinformation in the age of AI and social media

Suggested Compromises

Implement AI gradually, starting with administrative tasks and primary care, while maintaining option for human doctors

Develop AI solutions that work alongside human healthcare professionals rather than fully replacing them

Focus AI adoption on areas with greatest shortages of healthcare workers

Today, if your doctors don’t need technology, technology would not need them in the future.

speaker

Rajendra Pratap Gupta

reason

This comment provocatively frames the relationship between doctors and technology as potentially adversarial rather than complementary, challenging the traditional view of technology as simply a tool for doctors.

impact

This set the tone for the discussion to explore how AI and technology might replace or fundamentally change the role of doctors, rather than just augment their existing work.

We believe this care solution will reduce the number of referrals that are transferred to upstream health facilities that are already crowded and lack adequate resources, and make the model for an integral part of primary healthcare.

speaker

Peter Preziosi

reason

This comment introduces a concrete example of how AI and technology could reshape healthcare delivery, particularly in resource-constrained settings.

impact

It shifted the discussion from theoretical possibilities to practical applications, prompting others to consider specific use cases and implementations of AI in healthcare.

At International Patients Union, we have a platform, the Patients Union, where we provide a platform for the patients to voice their opinions, their concerns, and share their views.

speaker

Mevish P. Vaishnav

reason

This comment brings the patient perspective into the discussion, highlighting the importance of considering end-users in the development of healthcare technology.

impact

It broadened the conversation to include patient empowerment and engagement, leading to discussion of how AI might directly serve patients rather than just assisting doctors.

For example, in our sexual reproductive health and rights platforms, we find that youth want to speak to AI and not to a person because they’ve been judged so much by people.

speaker

Debbie Rogers

reason

This comment provides a surprising and counterintuitive example of how AI might be preferable to human interaction in some healthcare contexts.

impact

It challenged assumptions about the necessity of human touch in all aspects of healthcare, leading to a more nuanced discussion of when and how AI might be more appropriate than human doctors.

LLMs at the moment are primarily trained on Western culture, medicine, languages, intonations, cultural context. And that is not going to be appropriate for rolling out in Rwanda, for example.

speaker

Debbie Rogers

reason

This comment highlights an important limitation of current AI technology in healthcare, particularly for global applications.

impact

It introduced considerations of equity and cultural appropriateness into the discussion, prompting reflection on how to ensure AI healthcare solutions are truly global and inclusive.

Overall Assessment

These key comments shaped the discussion by moving it from abstract possibilities to concrete applications and challenges of AI in healthcare. They broadened the conversation to include patient perspectives and global equity considerations, while also challenging assumptions about the necessity of human doctors in all healthcare contexts. The discussion evolved from whether AI would replace doctors to a more nuanced exploration of how, where, and for whom AI might be most beneficial in healthcare delivery.

How can we ensure the accessibility of digital health tools in rural areas?

speaker

Audience member

explanation

This is important to address the digital divide and ensure equitable access to healthcare technology.

How can we address issues of misinformation and fake news in digital health, especially around fad diets and miracle cures?

speaker

Audience member (Melody Musoni)

explanation

This is crucial for maintaining trust in digital health solutions and protecting patients from harmful misinformation.

How can we develop AI models that are culturally appropriate for diverse communities, particularly those underrepresented in current training data?

speaker

Debbie Rogers

explanation

This is essential for ensuring AI-based healthcare solutions are effective and equitable across different cultures and contexts.

How can we define regulatory standards for AI in healthcare with the participation of all stakeholders?

speaker

Zaw Ali Khan

explanation

This is important to ensure safe and effective implementation of AI in healthcare while addressing concerns from various perspectives.

How can we reduce the cost of implementing AI-based healthcare solutions in low-resource settings?

speaker

Debbie Rogers

explanation

This is crucial for making AI-powered healthcare accessible in developing countries and rural areas.

How can we integrate AI into medical education to prepare future healthcare professionals?

speaker

Zaw Ali Khan

explanation

This is important to ensure future healthcare workers are equipped to work alongside AI technologies.

How can we balance the use of AI in healthcare with maintaining the human touch in patient care?

speaker

Multiple speakers (Peter Preziosi, Debbie Rogers)

explanation

This is crucial for ensuring that the implementation of AI doesn’t compromise the empathetic aspects of healthcare.