Reducing Administrative Burden

According to Elation CEO and co-founder, Kyna Fong, by allowing clinicians to be more efficient and to focus their time on what they do best, AI will help them be able to care for even more patients than they can today underneath all their administrative burdens. A version of this post was recently published on Fast Company. 

Silicon Valley is once again in a frenzy about “robots replacing doctors”—a cyclical debate that always energizes technologists, media, and investors. 

In 2011, reporter Farhad Manjoo predicted it. Vinod Khosla has been one of the louder voices in this decree, since a 2013 statement when he predicted technology will replace 80% of doctors and that “health care is like witchcraft and just based on tradition.” In this latest wave, there have been headlines about AI replacing doctors and tech startup Forward saying, “Healthcare should just be a product. We should just take every single thing that doctors and nurses are doing and just migrate it over to hardware and software because we can scale that healthcare to the planet.” 

Are these futurists right? Can every single thing a doctor and nurse does be converted to technology? Is healthcare truly a product and not a service? 

As a healthcare economist and a technology entrepreneur who has worked my entire career with primary care clinicians, I can say that completely replacing doctors with robots is an approach bound for failure. 

To be clear, there are massive benefits that can be driven by artificial intelligence and automation. Many kinds of care are a transaction, a “product,” and can be helped through “robots” with the goal of improving safety and efficiency. This can include a lab test, a vaccine, routine surgeries, medications, and diagnostic tests. Studies have shown that machine learning can be used to accurately detect pneumonia on X-rays at “a level exceeding practicing radiologists.” Automating critical lab result alerts has reduced time to care for patients. Technology is already good at predicting negative outcomes with joint replacement and hospitalized patients.

However, for these technology advancements to add value to our healthcare system, they must be designed to support and make more time for—not replace—the impactful, human-relationship-driven, trusted care of medical professionals. When physicians and nurses are aided by artificial intelligence so they have more time for the patients in their care, we can truly make a difference in health outcomes.

Vaccines are one prime example of this balance. We have never before had more potent, life-saving immunizations available to patients. Technology and scientific advancement have enabled us to deliver outstanding, safe vaccine products. Further technology innovation can help by making vaccines more easily accessible and can answer basic questions and send timely reminders. Yet, vaccine hesitancy and delays continue to simmer, resulting in an estimated 300,000 vaccine-preventable American deaths due to COVID-19 and the resurgence of polio after three decades of eradication. 

The clinician-patient relationship is a powerful tool for combatting medical misinformation and distrust, making way for better-informed decision making and healthier lives. A recent poll found that 85% of Americans reported trusting their personal physician, consistent across political affiliation. The clinician-patient relationship is not something that can ever be replaced by robots. Instead, robots should make more room for this relationship by clearing away administrative burdens and allowing for better care that is abundantly available, less rushed, and more trustful. 

Skilled physicians and nurses know that core to being an effective healthcare professional is their ability to earn trust, to read subtle signals, to suss out stories, and to build credibility. That relationship is what motivates a patient to do the (sometimes very) unpleasant work of participating in taking care of their own health—getting a colonoscopy, completing an advanced directive, stopping smoking, or taking medications, to name a few. Simply having access to information does not replace the trust needed to understand and use information.

Humans are complex. Getting people to take care of their health is an art as much as it is science. Khosla is, in some ways, right in calling healthcare a tradition of “witchcraft”—there is an element of magic in the way clinicians reassure, persuade, comfort, and cure. There’s a reason that in some of the healthiest countries in the world, people have deep, long-lasting relationships with their physicians. For example, in Japan, it is common to see your primary care doctor two or three times a month. While in America, more than 100 million people (nearly one in three) don’t have regular access to a primary care physician, a quarter of those being children. 

Technology and AI absolutely can and should help address these access issues, expanding quality care to more people. By allowing clinicians to be more efficient and to focus their time on what they do best, AI will help them be able to care for even more patients than they can today underneath all their administrative burdens.

Anyone who has a health problem (or has a loved one who has) knows that care is so much more than a blood test or a prescription. It’s the comfort of being known by your doctor, a kind and gentle touch during a painful procedure, and having the ear of an empathetic expert that matters. Instead of working to replace physicians and nurses, Silicon Valley will only succeed when it finds ways to work with its magic—rather than using technology to replace clinicians, it should liberate them to do more of the things that only a clinician can do.