Reimagine Care Delivery with GenAI

Perspectives on Health and Tech

Generative AI is a known disruptor in healthcare today. Will this transformational technology be embraced by clinicians, patients, and healthcare organizations? Listen in as two experts from Accenture Healthcare and Oracle discuss the difference between traditional AI and GenAI, the opportunities that GenAI is presenting to the industry, and the need to lean in to utilize technology as an enabler and a change agent. Hear how care delivery can be reimagined with GenAI and how this technology has the potential to be applied to help reduce clinician burnout, augment the clinician-patient relationship, bridge workforce shortage gaps, reduce margin pressure, and more.

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Episode Transcript

00:00:00:17 - 00:00:22:10 Michelle You're listening to Perspectives on Health and Tech, a podcast by Oracle with conversations about connecting people, data and technology to improve health for everyone. Hi, I'm Michelle Flemings. I'm the industry executive director for Health Care for North America Cloud Infrastructure at Oracle. Glad that you're here. We're in the age of artificial intelligence.

00:00:22:12 - 00:00:41:29 Michelle The opportunities that we're presented with using A.I. as an industry are truly groundbreaking. And to be honest, I think we're just getting started. I want to focus today on a subset of traditional AI and want to talk a little bit about generative AI, some of the ramifications, some of the risks, benefits and what does it mean to health care.

00:00:42:01 - 00:00:47:29 Michelle I am delighted to sit across today from Tej Shah and I'll have him introduce himself.

00:00:48:01 - 00:01:08:00 Tej Thanks, Michelle Tej Shah I'm an emergency medicine doctor, a managing director, and Accenture's global health care practice. I've got a ton of experience working across different parts of health care as a consultant, obviously, but also as a venture capitalist, investing in companies and most recently starting a company in the health tech space.

00:01:08:00 - 00:01:16:07 Michelle We're talking about AI and we always have to start with what is the comparison between traditional versus generative AI?

00:01:16:09 - 00:01:17:21 Michelle How would you put that?

00:01:17:23 - 00:01:41:11 Tej We've been talking about AI for 50 plus years. This is not a new thing. We've been talking about how we can leverage data to get insights going from analytics to AI to GenAI. Really the difference is, you know, before with AI we were able to extract data and insights from data so we could figure out what the next obvious data point was going to be.

00:01:41:13 - 00:02:19:03 Tej And in 2017 there was an article that was published by Googlers around attention is all that matters, right? And what happened with that papers is we came up with a completely new framework where we're now able through GenAI to not just predict what's the next data point, but understand what's the next word that we can generate. And it's taking into consideration the context of the sentence to be able to make that prediction so that it's actually appropriate and it's opened up a whole bunch of opportunities that we're going to talk about today that is really transformative.

00:02:19:05 - 00:02:30:03 Michelle Let's get into some of those opportunities. I think it's fascinating that it's been as long ago that A.I. came about and the general public really doesn't know.

00:02:30:03 - 00:02:35:14 Michelle let's talk about some of the opportunities in patient care that exists because of where we are now.

00:02:35:14 - 00:02:40:28 Michelle With A.I.. We do a lot around documentation. Where else should we be going?

00:02:41:00 - 00:03:08:03 Tej Back in 1996, you know, we started using search engines and it wasn't really until early 2000 when Google came around and the search bot search box became our librarian and around that time there was an article that was published by Will Carr in The Atlantic called Is Google Making Us Stupid and what he really meant.

00:03:08:03 - 00:03:33:29 Tej when you read the article was, are we thinking differently? Are we using our brains in the same way or reading as deeply as we did before? And obviously the answer is no. I think we continued to use our brains and we continue to, but we were using this tool as a librarian. We were using it to identify information quickly and be able to access it, you know, more readily.

00:03:34:01 - 00:04:04:19 Tej And what GenAI has done for us is start to be an advisor. It's enabling this transformation from technology, being a librarian to an advisor and that's what we're using AI for now. And GenAI today, right? So this idea of documentation and this is all relevant because the next sort of wave of what we're going to do with GenAI is it's going to start to act as an agent.

00:04:04:21 - 00:04:30:28 Tej It's going to start to enable us to take these tasks away from the from our day-to-day workflows and enable us to operate more efficiently. There is no reason, for instance, that a doctor like you or I should have to, you know, once we've submitted that a patient needs to do a specialist appointment, continue to follow up, make sure that that appointment was scheduled and have a bunch of people that are in that workflow follow up on it.

00:04:31:01 - 00:04:49:27 Tej It should just happen. And I think that generative AI is going to create these agents and these agents are going to be linked to one another. We're going to chain them together and it's going to do that follow up. It's going to make that experience more seamless, really enabling clinicians to do the work that gives us joy.

00:04:49:29 - 00:05:07:07 Michelle Let's drill down on that now, because you said something fascinating there being an agent. How I see it as being is now, I don't have that extra chaos and clutter to remember. As an ER doc, we're in the midst of the chaos we are in and we're trying our best to multitask. And there are fewer of us now.

00:05:07:10 - 00:05:25:16 Michelle There are others that are doing an exit now and then. We also don't have as much of a pipeline because, as you know, some of our residency programs didn't fill out. So three years from now, we're talking a massive deficit. And across the board in health care, there has been an exodus and a shift out of health care to other careers.

00:05:25:19 - 00:05:45:23 Michelle How do you see then us utilizing Gen AI to augment and maybe bridge some of those gaps with our shortages? The agent is great, but can we maybe think about a couple of other things that maybe might be even more magnificent? Like it's maybe front office, back office? Is there opportunity there, you think? Because we don't think about them a lot.

00:05:45:23 - 00:05:47:04 Michelle I do believe, absolutely.

00:05:47:04 - 00:06:10:27 Tej So let me just start. The clinician shortage is durable and it's secular. This is something that I say over and over again. You know, we have projected forward what we anticipate the workforce in health care is going to look like. We know there's going to be a shortage. But if you look at some of the research that's being published now, just at the end of last year, there was a study that published that looked at nurses and doctors that are in school today.

00:06:10:27 - 00:06:43:15 Tej And, you know, you might know that of those surveyed students, between 20 and 30% of them said they're going to drop out. They don't see the future of health care as a promising career that they want to pursue. That's going to be fulfilling in the way that maybe when we were going to school, we saw. And I think that's really disheartening because truly I think that, you know, when the way I thought about health care and the way the reason I pursued a degree is because I wanted to take care of people.

00:06:43:18 - 00:07:05:18 Tej And what's happened along the way is so many things get in the way of that, Right. That joy that we were talking about that I mentioned, that's gone because we've got so much administrative burden, so many distractions that sort of pull us away from that day to day care. It's actually started to deteriorate or continue to deteriorate.

00:07:05:18 - 00:07:28:18 Tej That relationship between the doctor and the patient that I think is so sacrosanct. It's so important. And I think patients want it. Physicians want it that nurses want it back. And so when I think of front office and back office, it's not just agents that are going to be doing this work. What it's going to do is it's going to take those tasks away, but it's also going to start to transform.

00:07:28:25 - 00:07:55:11 Tej What role, as a clinician, I play in the delivery of care, right, where maybe 30, 40% of my time I was it was taken up by doing that administrative work. Now I'm going to have it back to refocus on the patient. And it doesn't just drive productivity improvement, it drives greater engagement, it drives better experience for us as clinicians and for patients.

00:07:55:13 - 00:08:19:10 Michelle So back on Joy, I would love to be back there as well, cause I remember that feeling my first, but the patients and I could do anything and everything and this was going to be magnificent. And then you're right. Little by little, the administrative stuff started to become a burden. With GenAI,, how do you see us being able then, in this world of technology, having unfortunately had that adverse effect?

00:08:19:10 - 00:08:45:15 Michelle And I think it was an unexpected consequence of all of the information coming into the EHR and all of the information coming at us, period, whether it's on our phones, on our on our laptops and still faxes and message centers and inboxes. How do you see Gen AI as being able to be the thing that we can get providers to say, I trust this, I'm going to buy in, I will do this.

00:08:45:17 - 00:08:51:16 Michelle Because the last time we petted the dog, that was technology, it bit us and we have a long memory.

00:08:51:19 - 00:09:23:16 Tej Yeah, you know, the EMR is a beautiful thing, right? It actually transformed and improved the quality of care. It helped us, you know, document how we were taking care of our patients and enabled us to move patients seamlessly from one provider to another. But you're absolutely right. When you look at the data around the impact to productivity of the EMR, there's a 13% reduction in clinician productivity because of it.

00:09:23:18 - 00:09:51:05 Tej And I think, as you said, clinicians have been burned by it. I think we feel as though we were betrayed. We feel as though, you know, it didn't help us do our jobs better. It didn't help us improve the relationships that we have with our patients. And I think as we think about deploying new technology into care delivery, we're going to have to do a much better job of articulating the value proposition of what the technology is.

00:09:51:07 - 00:10:07:24 Tej And we're going to need to pull in clinicians to think about where it gets deployed, what part of the workflow should be addressed by technology and what should it take over. I think there's a lot of work for the industry to do. We're not good at it. We haven't been.

00:10:07:27 - 00:10:11:29 Michelle So how does Accenture then take away that hesitation?

00:10:12:02 - 00:10:35:28 Tej You know, so we're in the early innings of what GenAI is going to be able to do of where technology is going to be deployed. Truly, I think the organizations that are taking the leap forward and adopting and figuring out, you know, how technology is going to be integrated into care delivery, are taking some really basic steps. They need to have a policy on generative AI.

00:10:36:01 - 00:10:59:06 Tej They need to have governance, they need to figure out what is their data architecture and what's that foundation going to look like so that they can access that data to enable their clinicians to deliver care. They're going to need to think about on the back end how they train their clinicians and, you know, when they actually eventually do deploy technology, what is it going to look like?

00:10:59:07 - 00:11:03:26 Tej How is it going to transform the way that they work, the way that they deliver care.

00:11:03:29 - 00:11:25:28 Michelle Wow, transforming the way that we do work? When you say that, I think to myself, gee whiz, it would be marvelous. And in my mind, I would love to be able to be the ER doc seeing the cardiac chest pain patient and the intuitiveness of the system being that it understands who I am, what I do, what's going on with my patient.

00:11:26:00 - 00:11:42:25 Michelle It then brings in from the EHR what I need to know then, but then also helps me to go along with the best practice guidelines and recommendations while not forgetting that other stuff that you were speaking about before. With regard to referrals. Do you think that that's possible?

00:11:42:27 - 00:12:14:07 Tej So when I built my company, the fundamental premise that I was going for is technology should always be in the background. It should not be the reason that we get up in the morning and do anything right. It should be the enabler, it should be the assistant, it should be that third year medical student or third year resident that just enables you to do your job and perform at your peak all the time and think somewhere along the way, you know, we didn't sort of catch on to that.

00:12:14:09 - 00:12:29:12 Tej And I do think that with generative AI that we have the potential to drive that type of experience for clinicians who really are customers and clients of health systems. And we need to start thinking about them that way.

00:12:29:15 - 00:12:52:13 Michelle So I have two questions on that. We also spoke about the P word productivity. And as physicians, especially ER, we know that that can be something of a double-edged sword. So a lot of us want to frame it, couch it, present it more so as efficiency and effectiveness. How do we bring that message across with trust?

00:12:52:13 - 00:12:54:22 Michelle Because there is trust to be rebuilt.

00:12:54:24 - 00:13:20:08 Tej Yeah, you know, it's a great question. I agree that it's a double-edged sword. I think, you know, we productivity is what the organization cares about, but it's not necessarily what a clinician cares about. You know, their schedules are full, they're overloaded already. They're seeing more patients than they want to, and they're stretched way beyond, you know, the schedules that they're supposed to be working.

00:13:20:10 - 00:13:40:09 Tej And it's a lot a large part of why we're seeing the burnout that we're seeing amongst clinicians today. And so I think as we again, as part of how we think about technology and where it gets deployed and how it gets deployed, we have to bring the clinician along. And I think we have to think about what are the messages that are going to resonate.

00:13:40:09 - 00:14:04:12 Tej Just like when you do any sort of change program at any organization, they care about taking care of that patient and how do we articulate it to them that this technology is going to enable that, that this technology is going to power the experience that they want? Again, going back to this idea of the clinician as a customer or a client of a hospital system.

00:14:04:19 - 00:14:27:22 Tej Right. Because 75% of clinicians are employed now. Right. And if we think about them as customers that are, you know, they're producing the outputs that we want, which is units of care, we've got to figure out what resonates with them, what makes them tick, what's going to get them up in the morning and help them use the technologies that we're going to make available.

00:14:27:24 - 00:14:33:28 Michelle What's going to get them back at the table to actually have that conversation right, Because they need to be there. We need to be there.

00:14:33:28 - 00:14:36:07 Michelle So going back to burnout, burnout is not new.

00:14:36:07 - 00:14:52:20 Michelle And the question I have for you there is with regard to burnout and AI, do you think that there is meaningful use in there that we can honestly really tackle that meaningfully and impactfully?

00:14:52:23 - 00:15:00:25 Michelle Or do you believe it's going to take a long time, like decades worth of time to get there? Big questions.

00:15:00:25 - 00:15:24:22 Tej Yeah. And you know what, Michel? I'm not sure I have the perfect answer to it. I think what I'd say is we have to try. I think this technology has the promise to change how we practice, to create the space for us to do the thing that we had intended to do and take away all of that distraction.

00:15:24:25 - 00:15:58:27 Tej But I think we also need to think about ways that the technology can change the roles that we play as clinicians right. And you know, how it can augment us in different ways or automate some of the work that we're doing. And that's going to require real analysis of workflows. It's going to require real, you know, work and effort to rethink and rejigger the jobs for clinicians as a whole.

00:15:59:00 - 00:16:05:22 Michelle So there's a receptiveness there to an acceptance there that we are going to have to change. And we're not known for being change agents now,

00:16:05:22 - 00:16:31:23 Tej There's a lot of fear. I think there's,I want to keep doing things the way that I've done them, but I know that what I've been doing is not working and I think it's going to be a very tricky sort of journey for health systems and for us as we work with them to help them navigate it, because every system is going to be different and you know, it's going to depend on the culture.

00:16:31:23 - 00:16:53:09 Tej But I think we need to get to and this will take a little bit of time is for clinicians to start having the culture of being accepting of change because you know it, I know it. I think everyone that's going to be listening to this knows that this is not the end. This is really the beginning of real transformation.

00:16:53:11 - 00:17:10:01 Tej And the change is going to come fast and furious. And what we need to do is prepare our clinicians and organizations to know and expect that and help them understand how to navigate that. And I think that's going to be a long and durable journey.

00:17:10:04 - 00:17:12:10 Michelle It will be. And you say fear.

00:17:12:10 - 00:17:30:08 Michelle how do we start working to allay some of those fears and trying to get to the point of balancing out even just being straight up facing Gen AI as a functionality that has so much opportunity and then proceeding to that lean in, how do we help people to do that?

00:17:30:10 - 00:17:34:02 Tej I think we're never going to take humanity out of health care.

00:17:34:02 - 00:17:43:12 Tej Health care is about, you know, the clinician and the patient in that relationship and navigating the health and staying and remaining healthy.

00:17:43:12 - 00:17:52:10 Te In the short term and in the medium term, we're in this transition phase from technology being librarian to an advisor.

00:17:52:14 - 00:18:20:17 Tej And it's going to be an advisor for a very long time. That transition to agent is going to happen, you know, very quickly on administrative work, but it won't become an agent on the clinical side because I think we still need to use our judgment. That's what we were trained for. We know what's right for that patient and getting that advice, getting that support being augmented by technology is not outside the realm of what should be possible today.

00:18:20:22 - 00:18:30:02 Tej It's available right now, but that role is going to need to change. Right. What we do every day will change and will shift.

00:18:30:04 - 00:18:55:15 Michelle I love, though, the vision of returning to being that empathetic partner who helps to guide the patient through this journey back to health or to maintaining wellness, that would be phenomenal as opposed to always having people fall into gaps and into holes. And with that, let's talk a little bit about what GenAI may or may not be able to do with regard to access and health equity.

00:18:55:17 - 00:18:57:07 Michelle Let's talk a little bit about that.

00:18:57:07 - 00:19:25:08 Tej Yeah, You know, the shortage of clinicians that we're seeing around the world, it's not just the U.S., right. The projection is 10 million shortage over the next decade. And that disproportionately affects patients who don't have the means to access care. As an emergency medicine doctor, you appreciate the number of patients that come in as a site of last resort because they have no place else to go.

00:19:25:11 - 00:19:52:20 Tej It actually is not very convenient because the wait times are just getting longer and longer. And so what we're seeing is the disproportionate impact of the clinician shortage on populations that, you know, have not historically had. The means to access care. And so what I think and what I believe is with technology, as we scale capacity and we retrain clinicians on what their role is going to be, we're going to create access.

00:19:52:20 - 00:20:03:28 Tej We're going to start to address the health equity challenges and barriers and inequities, really that that we see as a society, not just in the U.S., but everywhere.

00:20:04:00 - 00:20:06:05 Michelle Beautiful, beautiful.

00:20:06:05 - 00:20:25:16 Michelle How do we introduce GenAI to patients and have them accept that sometimes they're not going to be able to talk to the nurse and ask the nurse when the pharmacy is open and understand why that's important and how this technology is also intended to serve them and to help them to do better.

00:20:25:16 - 00:20:43:19 Tej there's really two things that are really important related to AI and how we make it available to patients. One is around having, you know, a framework around responsible AI. And when we make the technology available to patients and for what use cases, because you're not going to it's not general availability for everyone.

00:20:43:21 - 00:21:01:28 Tej And then the second thing is, you know, we have to understand how we segment the patients that we serve, because your 91-year-old aunt may never want to interact with technology in the way that I do or that a 25 year old does. And I think we have to respect that and we have to appreciate it.

00:21:02:00 - 00:21:32:17 Michelle So we've hit now patient, we've hit provider, let's hit the hospital organization. They’re the decision makers ultimately as to what comes in, what gets implemented, what gets discarded or what what's put on by the backlog or the back burner or how do you see the conversation going with hospital decision makers about going forward with a roadmap that includes AI?

00:21:32:17 - 00:21:49:03 Michelle Because a lot of the discussions that I'm having are we want to see somebody else dip their toe in, we want to see somebody else dive in and survive. How do you see that conversation going or how would maybe you approach that conversation with someone who is a bit hesitant and wants to stand back a little bit longer?

00:21:49:03 - 00:22:09:01 Tej the truth is there is not a choice that health systems are going to have to make the investment in AI and GenAI, because we're all facing, you know, really critical workforce shortages. And we need to create capacity right now and we're going to need to do it in a durable, you know, long term way.

00:22:09:04 - 00:22:29:19 Tej The truth is there's a billion different applications of GenAI and, you know, we don't need to explore all of them all at once. Right now. What we need to do is very simple things around the investments in AI. You know, we have to have a responsible framework and governance and a policy for how we're going to deploy it.

00:22:29:21 - 00:22:57:07 Tej What's the oversight going to look like? We need to have that technology foundation and the data foundation to make sure that we're really leveraging all the data that we have. And truly we have to think about how we train clinicians and the rest of our workforce to adopt the technology so that when we get to scale, it's going to be used, it's going to create and have the type of impact and the ROI that we want.

00:22:57:09 - 00:23:17:26 Tej I guess the last thing that I would say is right now, GenAI touches so many different parts of a health care organization. It's not just the chief medical officer, it's not the chief nursing officer, it's not the Chief HR Officer It's not the Chief Operating Officer. It's not the CFO, it's not the CIO, it's not the CTO.

00:23:17:28 - 00:23:43:23 Tej And really figuring out in the context of, you know, an industry wide sort of, you know, crisis around margins, right? Where margins are in the low single digits, you know, and negative for more than half of the health care systems in the U.S.. How do you make this investment in the context of where a lot of other things are burning?

00:23:43:26 - 00:23:59:11 Tej How do you prioritize it and who do you go to and who makes the decision? Who who's going to be accountable? Who's going to drive the transformation? Who's going to drive the training? Who's going to drive the change? I think health systems are trying to figure all of that out and they need help.

00:23:59:14 - 00:24:28:23 Michelle They do. They do. They're going to need a partner who's going to be able to sit with them and understand where they are. More so, though, a lot of other discussions I'm having are people want to just kind of throw air out there as the panacea and the magic wand to fix everything. And there's a real struggle to contain it and say, let's pick one goal, something that is small yet impactful, that doesn't derail the ability to do care, doesn't disrupt your whole organization.

00:24:28:25 - 00:25:00:21 Michelle And those are some of the most impactful and beautiful conversations. And then when you get it right and they have a win under their belt, maybe tomorrow, I in the way of provider satisfaction, retention, patient engagement is better. Those sorts of discussions and those sorts of wins are huge. So I think that it is incumbent upon us and our positions and others out listening to this and similar positions to be that selfless advocate slash partner to your customer and help them along this path because it is complicated.

00:25:00:21 - 00:25:16:00 Michelle Let's talk a little bit then about health care, utilizing technology to catch up with other industries, because other industries are fairly far ahead of us when it comes to tech and efficiency and productivity, using technology.

00:25:16:00 - 00:25:41:12 Tej A lot of us like to say that if you want to know what's coming next in health care, look at what happened in other industries 20 years ago. What's incredible to me is that generative AI is being contemplated and probably more advanced in health care than it is in several other industries today. And it's almost moving at pace.

00:25:41:15 - 00:26:03:14 Tej And I'm not really sure exactly why that's happening. I think that, you know, maybe it's the shortage, maybe it's the margin pressure, maybe it's the potential, maybe it's, you know, some of these thought leaders that are really expounding on its use and its application, its potential in health care. Maybe it's just the burnout that's happening amongst clinicians.

00:26:03:14 - 00:26:17:14 Tej None of my clients on the provider side can afford to wait for the perfect sort of, you know, what are all the use cases and how do I sequence them and everything that I'm going to do for as you said, for the next five or ten years?

00:26:17:17 - 00:26:52:29 Tej I think we have to start now and there's a place to start right now. There are things to do to prepare yourself for that future and I think we're going to be astounded by the creativity of the clinicians that that you and I work with and that work for these organizations on how the technology can be deployed. And I think we have to just be open to it because I think we're going to see the potential and, you know, sitting behind a desk or sitting in a lab, you know, looking at the technology and thinking of use cases, that's going to get us only so far. We have to put it in the hands of

00:26:52:29 - 00:27:04:27 Tej clinicians having the appropriate sort of governance and guardrails. But that's how we're going to learn what it can do and how it can help and how it's going to impact, you know, how we deliver care.

00:27:04:29 - 00:27:09:21 Michelle That sounds like a great call to action. ‘Come to the table, your seats waiting’. Let's do this.

00:27:09:21 - 00:27:13:05 Tej Yeah, let's do it. I mean, ER doc, right? Like, let's go.

00:27:13:12 - 00:27:30:15 Michelle I love it. I love it. Well, thanks for your time today, Tej. Thanks to our listeners. Be sure to subscribe to the Perspectives on Health and Tech podcast for more insights from industry experts, visit Oracle Dotcom Slash Health or follow Oracle Health on social media.