How does AI improve healthy aging and healthcare access?

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Today’s guests

Deepesh Chandra, senior vice president and chief digital information officer, Montefiore Einstein

Anwesha Dutta, managing director in the Health Care Strategy practice, Deloitte Consulting LLP

Staffing shortages and increasing demands for services are putting the health care system under pressure. The issues are likely to get worse over time, as populations age. Major health systems are turning to technology to ease the strain. 

Deepesh Chandra, senior vice president and chief digital information officer at Montefiore Einstein, said that the technological advances of AI have been “a great load-balancer for the health care delivery side of the house … It has to play an augmenting role to our clinicians, to our nurses, to our caregivers in making sure that we can meet and serve more and more patients and drive much higher level of engagement than we do today.”

We speak with Chandra and Anwesha Dutta, managing director of Deloitte Consulting LLP’s health care strategy practice about empathic AI, Unlimited Reality^TM, and how technology can serve as a bridge.

Anwesha Dutta: If you think about needs such as disability, being in rural settings, folks that are just not comfortable even sharing or talking to anybody about their health care needs, technology can actually customize [these experiences] in a very different way than done before.

Deepesh Chandra: We understand that we have an aging population in front of us, and the gap between unmet health care needs and what we can supply is going to widen out. Technology is going to play a very significant role, not only in closing it, but also closing it in a way that is reflective of the innovation that has happened in 21st century.

Tanya Ott: Think about the last time you interacted with a health care provider. Did you have to travel to another city to see a specialist? Wait a long time to get an appointment or to get into the exam room?

 I’m Tanya Ott, this is the Press Room, and my guests on the show today believe that artificial intelligence technologies will play a key role in making health care more patient-focused.

Ott: Deepesh Chandra is the senior vice president and chief digital information officer at Montefiore Einstein, a large academic medical center based in the Bronx, in New York City. He leads all things technology for the health system—IT, digital technology, data—and what we’re talking about today … artificial intelligence.

Joining us is Anwesha Dutta, managing director of Deloitte Consulting LLP’s health care strategy practice. She also focuses on digital and technology transformation, including the Smart Hospital of the Future and unlimited reality in health care.

I kicked off our conversation by asking about a concept called “unlimited reality.” What does it mean, and what impact could it have on health care delivery?

Dutta: So from a Deloitte standpoint, how we define it is essentially there is no limit to how you think about the immersive experience when it comes to how a patient, or a consumer, interacts with the health care system.

Chandra: Access to care is a growing challenge. And when we think about access to care in this age and with the availability of a different set of technology, we feel that there has to be a multimodal access to health care. That also includes opportunities that unlimited reality bring to the fore and many other digital technologies that have to come together in alleviating all the pain points that we have from the health system perspective. And as we look at different ways to connect with our patient and keep them engaged, I think all these different technology components will come together and form the ways in which we can connect to the patient and give them the right care that they need.

Dutta: So, for example, there are ways to engage patients before a procedure, a complex procedure or a visit, because research shows there's a ton of anxiety¹[around] what’s going to happen when I walk into the hospital. What's going to happen when I walk into the operating room? And patient education is equally important as much as access is. And that's a great way to immerse the patient ahead of time. Especially in pediatrics and patients with chronic conditions, we see that it reduces their anxiety.² Same thing with post-visit or post-surgery follow-up where they have questions [like], how is my condition progressing? How do I get better at this? How do I do therapy?

The other aspect is on the provider side: The care team and the doctors who are interacting with patients in a wide variety of settings. The concept of a smart hospital is no different from a smart home. Just like we could control temperature and lighting and all those aspects of our house, how do you do that in an operating room where a surgeon can do a robotic surgery or even remote surgery?

To Deepesh's point about access, we can have a very specific specialized surgery being done by a surgeon at the other end of the world, and the patient is in a rural setting. That can actually happen today. But at the same time, it requires a whole different way of thinking about this immersive experience and how you use that technology. And we were chatting earlier today with Deepesh as to how these technologies need to work with each other. You cannot just have one way. So unlimited reality is a way to think about a combination of technologies and how you create a new immersive experience.

Chandra: When we look at unlimited reality, we consider these technology forces to be a great load-balancer for the health care delivery side of the house. There is a growing need for health care services, and we feel that technology can play a very big role in meeting those demands for health care. It has to play an augmenting role to our clinicians, to our nurses, to our caregivers in making sure that we can meet and serve more and more patients and drive much higher level of engagement than we do today.

Ott: Paint a picture. When we're talking about unlimited reality and generative AI helping in the healthy aging and even longevity space, what does that look like?

Chandra: I think we can look through the lens of a typical operating room, a bit of a before and after. Think through how different technologies would come together in helping an operating room of the future and the expedience attached to it.

Imagine different aspects of an operating room, where at the front end of a procedure, you are doing a significant amount of capacity planning, managing different delays and cancelations that could adversely affect the availability of an operating room to a patient. Consider staffing. Depending upon different procedures, you have to bring different [kinds of] expertise into an operating room. And these are complex problems that previously have been solved through a lot of manual labor and intervention and calculation to make sure that these things are running optimally.

Some of these tasks can now be easily handled by technology, where I can optimize the resources and the capacity and the staff that you're going to need to conduct a certain procedure, and make sure that you have an operating room that is running at full capacity and could even take in more patients than you have previously been able to serve. It could also predict some unforeseen aspects around a patient care that could trigger a delay either during the procedure or before the procedure happens.

And during the procedure itself, we are seeing a lot of augmented technology coming into an operating room. Just like how a pilot uses AI to fly a plane, we are seeing in a very similar way these augmented technology coming into operating room where there [is] visual guidance given to the surgeon or the caregivers in these operating room.

A lot of procedures are going to be influenced through AI, including during the procedure: You could have ambient listening technology conduct documentation, so a surgeon doesn't have to go back and forth between conducting a procedure and documenting the procedure. And we are seeing amazing examples of [the] use of AI and other technology coming into the patient safety aspect of an operating room as well.

Ott: Where do you see this technology, say, five years from now?

Chandra: I think there are going to be key things that happen in the next five years. I think one would be [the] refinement of the existing technology. They will become faster, cheaper, and better, in the sense that their ability to understand the complexity of the context and the refinement of the answers [they are expected to provide], they are going to get better and better at a very rapid phase.

The second aspect is going to be [that] we are going to see a set of technologies emerge, solving problems that have previously not been solved. The knowledge that it is able to acquire is getting bigger and bigger and the compute that it can consume is getting bigger and bigger. And so [the] combination of these factors would allow a much higher dimension of problem-solving.

Things that were previously associated with purely human intelligence, we are going to see AI begin to handle some of those tougher problem than it is right now. Those would eventually play out in ways of making higher decision-making capability with these software tools that we will begin to deploy in clinical setting or in operational setting. It won't make us irrelevant in any way, but it will find them to be much better companions than they are today.

Ott: I’m sure many people will be very happy to hear it won’t make them irrelevant in the health care space. You talk about this idea of co-mingling in the digital workflow, so there are some things that are done by AI, [and] some things that are not done by AI. You see more things in the future being done by AI. Could you walk me through a process or a procedure that you would imagine that we would see this co-mingling and the shift of things from manual to AI in a more meaningful way.

Chandra: Absolutely. I think that co-mingling is happening at a significant pace when the users of these technologies begin to take a more front-end role in developing these technologies. We see clinical leaders or operational leaders getting engaged with the technology providers or other technology team in co-creating these models, these tools, these workflow enhancement capabilities which, when deployed, helps the clinical leader to shepherd the AI adoption in that workflow. It becomes part of their daily routine, it's not a stand-out AI thing that is happening on the side. You wouldn't recognize what step is human and what step is AI, it becomes so seamless in that process.

So, if I give you an example: We were beginning to talk about an operating room, doing capacity planning. It's a normal, routine process that a lot of our office managers engage in. It's an intensive exercise of looking at all the resources and doing the right level of planning. And the accuracy of that planning effort is significantly important for us so we can accommodate as many as patient possible during that given OR’s schedule.

AI can play a significant role in not only optimizing that algorithm, but also beginning to predict that there are potential situations [where a] delay could happen or a cancelation could happen, which allows the operators and office managers to then proactively handle those cases, triage those cases, and prevent a cancelation and give priority to a patient who might be waiting for a procedure to happen.

What we see in that particular example is how AI is helping in the decision-making process and probably highlighting something that would have otherwise been missed by a person, not by their mistake; [it’s] just that the signal is weak, and we don't pick it [up]. The AI does an amazing job in highlighting that signal to say that you should look into this and probably make a decision based upon what I have found.

Dutta: We have a concept called [a] “clinical command center.”³ Clinicians can have, almost like a, B2B interaction with the command center to say, how do I manage all this throughput and the flow that's coming in and out of the brick-and-mortar facilities to be able to then coordinate care better? From a longevity, a personal health standpoint, the data that's produced, the biohacking that's happening in terms of different tools—how do I [use this] as a focus on healthy aging in place?

Deepesh, what is your thought (on) how do I, as a consumer, look at all these different data points that are now sitting in five different places to improve my own health?

Chandra: Interesting question. When we think about longevity, there is a lot of research to be done in this space: How we can increase [the] human lifespan—how we can make our aging much better in that process. A lot of that data that we need to capture typically [what] would look through decades of a patient's life in order to see what leads to what outcome. In order for us to influence that outcome, that deeper data set is something we are beginning to capture. We have to do a much better job in highlighting and bringing it up front for our research community, for them to conduct [this] research and bring modern science to the front. I think there is a lot more work to be done in capturing and highlighting that data.

I think no. 2 is how artificial intelligence and other related technologies can help find paths and modern therapies of the future: how it can help humans think through those therapies and the potential outcome of those therapies in a very significant way. I think the future of most of these therapies and their development will be significantly influenced by the artificial intelligence advancements that we have been making.

Ott: During the pandemic, we really started to understand the value of telehealth and virtual care. The use and the adoption appears to have stalled a little bit, but do you believe that this is a good opportunity to leverage unlimited reality or other tools that are going to push us out of that brick-and-mortar setting?

Chandra: Of course. We learned through our COVID-19 experience, [with] telehealth being used as primary health care when we couldn't go out. I believe that we do have to think about this in [an] access-to-care-anywhere, anytime-type of a model, where telehealth and all related technologies will continue to play a very significant role.

I think during the COVID-19 period, as telehealth adoption was on a rapid increase, we set this unreal expectation that the adoption growth [would] continue to be at this faster pace in a very unlimited way. Combined telehealth with other virtual care technologies, with in-person care, is going to play a collective role in increasing access to the care that we very much need. I think there [is] some more work needed both on the regulatory and the payment side to make telehealth a lot more accessible and sustainable as we try to incorporate them in all health care–delivery models.

And I also feel that there is going to be an increased role for data interoperability in making sure if you have a provider on the other side of the screen trying to provide you care remotely, they have the right level of information and access to you so that they can make great clinical decisions on that end as well.

Ott: You almost foreshadowed something I was going to ask you, which is I'm aware of a company where telehealth is only covered if it's done by the primary physician, and that's not always the most helpful thing for a person, and obviously they need it covered by their health insurance.

Chandra: Right. And I think it’s just not telehealth, but it’s also how do we be more engaged with our caregivers as well? We all are so much used to [texting] our friends and family when we have questions. How do we create an ecosystem of technologies and humans involved where we can maintain those higher level of engagement beyond the four walls of a doctor's office? We have to [maintain] a balancing act in terms of not creating more burnout and notification burnout for our providers, but at the same time, provide better access to the patients who might need to ask something or have a question in off-hours.

Dutta: A third of the consumers that we have surveyed over the past four years have consistently said that they are even willing to pay for some of these digital interactions, even if they're not covered by insurance.⁴ However, when you flip the coin, and you look at it from the perspective of hospital administrators and the companies that are running these health systems and providers, they are saying, wait a second, I don't have the capacity or the investment to do this because it's a disruption. At the same time, our research also shows that we are producing [fewer] doctors and nurses and clinicians.⁵

Ott: So, I remember seeing a study that found that when people had interaction, I think it was taking a health survey ahead of time, being done by an AI, a chatbot, they were actually more honest and less stressed about it because they didn't feel like there was that judgment on the other side.⁶

Chandra: Yes, those are all positive aspects of using generative technologies. We have taught our AI to be more empathetic. Some of the early-stage products that we are seeing, you can change all aspects, dial up or down on a lot of things, whether it is the formality of the language or how you going to sound empathetic or not. You have so much control in terms of the experience you might want to tailor it for your audience.

Ott: That could be pretty powerful if you're working with very specific audiences, and you need cultural sensitivity in a way with one audience versus another audience.

Chandra: That's true, but it also goes a lot deeper in terms of language barriers that we might have. In New York, our primary service area is a melting pot for so many cultures, so many languages, and we often see patients speaking many languages. We have a lot of translator services available to our patients, but sometimes, as we are deploying these technologies, we can make sure that the technologies have the right context in any language the patients choose to engage with. We are seeing how AI can do a much, much better job in engaging in non-English languages, maintaining the right tone, the right demeanor, all aspect of communication, with the non-English [speaking] population.

Ott: There is a lot of conversation in society right now around generative AI, and the power of it, but also concerns about it. And I'm wondering where your thought process is right now about the acceptance issue by patients, folks who may have a perception of what it is, that is maybe not accurate or certainly not something they're used to.

Chandra: I think with AI, it's going to have the same effect that we have had with many other revolutionary technologies in the past. It takes time for it to mature. There are always going to be early adopters use cases and people finding success in one side of the organization versus the other. It just has to take time to be adopted, both by its user and by patients at large who are going to be benefiting from these technologies.

We are living in a time where these experiments and a gradual adoption of these technologies are happening all [around] us.

I believe as some of these technologies become more front-facing, where they can get deployed in a patient setting, and [the] patient is aware that they are interacting with the AI—they are building their confidence with those interactions. And [when] they have a human being side by side to any AI in this case—could be a doctor, could be a nurse—I think those moments are going to create a higher degree of confidence, with these technologies working in the favor for the patient. And I think we, as a society, will become more and more confident with the use of technology in direct patient-care settings.

Dutta: You know, when virtual health came out—it had been around for more than ten years, but until COVID-19 hit, people weren't used to using it. Now it's become almost an expectation that you would have it. So much so that our research shows customers are willing to even switch if a doctor is offering it versus to a doctor who is not offering it.⁷ There's a decision-making factor, should I go to this doctor, because it's more convenient to connect digitally.

Ott: So as we close out this conversation, I would love for you to just talk about why this matters. Why should we care about this? Who’s it going to benefit, and how significant is that benefit going to be?

Chandra: Let me frame it this way: I think when it comes to technology in health care, there are a range of things we have to do to modernize our infrastructure and keep our information safe from a cybersecurity perspective. The experience that we have with technology in health care, from a lens of a patient or a provider or any other caregiver, is not where it should be—at least this is our general feeling. We see this in several data points. We see this in several consumer surveys and such. So, it matters a lot for us from the perspective of how our access to health care and basic health care services are going to be sustainable in the coming years in a very consumer-friendly way.

We all understand the staffing challenges that we are going to have. We understand that we have an aging population in front of us, and [that] the gap between unmet health care needs to what we can supply is going to widen out. Technology is going to play a role, not only in closing it, but also closing it in a way that is reflective of the innovation that has happened in 21st century. So all of us talking about it, experimenting it, trying to push for its adoption is really, really important from the perspective of closing that access-to-care gap that we all have, and we'll be seeing more and more it in the coming years.

Dutta: Technology’s focus should be in health care for us as consumers and caregivers. Because, if you think about needs such as disability, today, being in rural settings, folks that are just not comfortable even sharing or talking to anybody about their health care needs—technology can actually customize in a very different way.

Ott: Thank you so much for joining us today. It’s been a really interesting conversation, and I can’t wait to see where this goes.

Chandra: Thank you for having me.

Dutta: Thank you.

Ott: Deepesh Chandra is senior vice president and chief digital information officer at Montefiore Einstein, a large academic medical center based in the Bronx, and Anwesha Dutta is the managing director of Deloitte Consulting LLP’s Health Care Strategy practice.

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