Technology, the human factor, and better healthcare

Dr. James Madara
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In my recent address to the American Medical Association (AMA) House of Delegates, I told an illustrative story about Tesla founder and notable innovator Elon Musk. Last year, his Tesla Model 3 had fallen significantly behind its production schedule, and Musk observed that the underlying reason was related to near-complete reliance on automation. Robots were doing all the work, but Musk realized that there were specific tasks on the assembly line that required actual people for optimization. And so he tweeted, “Excessive automation at Tesla was a mistake, humans are underrated.”

This story captures two principles:

  1. Successfully producing something of value requires performing a complicated series of discrete actions in a highly coordinated way
  2. The best outcomes require powerful technologies optimally mixed with distinctly human capabilities.

Both of these principles are embedded in the work of the American Medical Association (AMA), and they propel the efforts of Health2047.

The first principle — value produced through a progression of coordinated actions — is reflected in our approach to chronic disease and the widespread and significant health burdens of diabetes and hypertension.

These diseases are strong drivers of our nation’s healthcare spending, as well as impediments to our national productivity. The AMA began a concerted effort to address the outsized impact of chronic disease in the U.S. and, over the past few years, has developed pilot programs and tools and initiatives coordinated to aid physicians in meeting this very modern challenge, including:

  • Leveraging the JAMA Network for deeper understanding of chronic disease
  • Creating a Health Systems Science curriculum encompassing new cultural competency, predictive analytics, and longitudinal care capabilities
  • Undertaking an Integrated Health Model Initiative (IHMI) to forge standardized innovation in collecting and delivering clinically valid healthcare data, aligned with CPT-panel-created codes valuated by RUC and accepted by CMS
  • Developing digital learning modules and the robust AMA Ed Hub physician learning platform to disseminate these modules and a host of other assets.

Our collective work ushers in more accurate and organized measurements, greater treatment insights, reduced administrative burden, and added revenue to physicians for evaluating and acting to combat chronic disease. This is harnessing the power of the AMA — expertise across our many units cross-leveraging our many strengths — and doing so in a systematic and coordinated fashion.

As to the second principle — the best outcomes derive from technologies optimally mixed with human capabilities — we need merely review just how far the practice of medicine has come since the AMA was founded in 1847 to observe its effect in action.

Did physicians disappear with the advent of the X-ray, antibiotics, or the pacemaker? Of course not. As we improve our tools and methodologies, we improve our ability to practice. Each time a new technology, treatment or machine replaced a manual task or procedure, we saw the creation of some new and meaningful way to advance clinical care. Later, that new approach would be updated thanks to even newer technologies…ad infinitum.

Today’s new tools — such as AI — are already showing promise in many areas of medicine. But they’re also producing a lot of anxiety about human redundancy. While powerful, these tools are simply the latest iteration in a long cycle of human invention and mastery that has enabled steady advances in diagnosis and therapy. They replace tasks, not jobs, and it is up to us to imagine the new frontiers they can help us reach.

All of which brings me to Health2047. Health2047 combines human action with powerful new technologies in businesses that opens that new frontier and drives healthcare improvement at scale.

For example, to combat chronic disease, Health2047 has already spun out First Mile Care, a Silicon Valley startup designed to amplify and scale the National Diabetes Prevention Program (DPP). An evidence-based lifestyle-change program that can reverse prediabetes, DPP is proven to be clinically effective. But, while DPP has existed for nearly a decade, less than half of one percent of the 84 million people with prediabetes in the U.S. have completed a DPP program.

First Mile Care’s DPP program helps people reverse prediabetes using a community-based approach that enables physicians to deliver preventative care without added work for their practices. The company is currently building a national network of certified DPP coaches who create cohorts at the ZIP-code level, leveraging a platform that makes DPP program participation accessible, convenient, and scalable. Learning where you live and with your neighbors embraces local knowledge confronting the social determinants of health — the specific conditions that affect the wider race of health risks and outcomes.

On another front, the AMA Ed Hub is currently piloting a program with Health2047 to further enhance and personalize physician training, education, and credentialing. Imagine a future where continuing medical education (CME) is customized to what you actually see in your practice, and the hassles of filling out forms for credentialing and licensing disappear. That’s the pathway we’re building.

As technology automates old tasks and aids us in solving pernicious healthcare problems, we’ll take on new challenges. The way we use powerful new technologies will define an era of personalized patient care and physician training. I’m excited about the transformative possibilities unfolding before us, and about Health2047’s role in advancing the AMA’s mission to “promote the art and science of medicine and the betterment of public health.”

— Dr. James Madara is Chairman of the Board at Health2047.

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