The term Esteban Gershanik, MD, MPH, MMsc, uses to characterize the toll on clinicians from ever-changing healthcare dynamics in digital health, AI and machine learning, and financial health is cognitive overload.
Dr. Gershanik wears many hats that tap broad experience in clinical, public health, administrative and informatics realms. A medicine hospitalist at Brigham & Women’s Hospital in Boston, the HIMSS Global Health Equity Network member is also a part-time instructor at Harvard Medical School and a pediatric hospitalist at Children’s Hospital of New Orleans.
Providers now need to grasp disparate aspects of healthcare that include administrative, governmental, policy and technology, among others, he says. Balancing all of them adeptly can pose risks to already-shifting doctor-patient relationships.
“Healthcare has become more and more complex, and there’s so much more for providers to keep up with,” he shared. “To be able to sort it all is nearly impossible, because information coming in nowadays is quick and endless.”
Despite all these advancements, Dr. Gershanik says, many clinicians went into medicine because of the humanity of it. “We have to make sure we don’t lose that because of the systems we work in,” he noted.
Even as physicians’ digital health usage doubled before the COVID-19 pandemic and continued its upward trend as the health crisis continued—with as much as a 300% increase in virtual encounters—providers also became aware of its drawbacks.
The pandemic served to “uncover the digital divide” between patient populations even as some extolled telehealth’s convenience and safety benefits, including improved outcomes, Dr. Gershanik says. Millions don’t have access to the internet, while older adults may be less tech-savvy and require help to log in to web applications.
“Healthcare systems rapidly evolved to increase telehealth services during the pandemic,” he said. “But one concern many of us have had, especially in the face of addressing heath inequities, is that telehealth has created a healthcare divide among many populations. Between those who have resources and those who do not, this creates a greater gap.”
To better navigate post-pandemic healthcare, Dr. Gershanik envisions a more seamless integration of digital health options, including wearable technology and telehealth appointments, to ensure the ease of connectivity between providers and patients.
“One thing we need to think about is how a 24/7 cycle can fit into both providers’ and patients’ workflow, availability and accessibility in what is otherwise a 9-to-5 system,” he said.
In the healthcare industry overall, AI is supporting streamlined patient data and precision medicine approaches. But at a provider level, AI and machine learning are often still mysterious entities, with many providers not fully understanding how it’s used and can impact their practice.
“I’ve seen AI used more on the administrative end of things, but I haven’t seen it used consistently among clinicians,” Dr. Gershanik said. “I think we’re still in the infancy of so much of this. There’s so much promise, but we have to be very conscientious about how we integrate this into practice.”
Notably, some original machine learning algorithms incorporate bias into them in terms of patient characteristics, Dr. Gershanik says. These types of inherent drawbacks must be rectified going forward to inspire provider buy-in.
“There’s a lot of promise and opportunities in AI and machine learning, but those opportunities are also where the challenges arise,” he said. “We have to be careful that AI at the point of care properly serves all our patients and can ensure the trust to providers, patients and systems together.”
As with consumers, a lack of transparency surrounding healthcare costs frustrates and sabotages clinicians, driving a wedge in the doctor-patient relationship. And payers can add to this challenge, requiring paperwork and other administrative work that can continue long after a patient visit.
“Often there’s a presumed notion that many providers know the cost of the needs of our patients, when in reality that’s additional knowledge we need to accrue through the years,” Dr. Gershanik said.
Providers want to be able to answer patient questions about costs but are often unable to do so. “The complexity of the system leads to the inability to know everything, and maybe that complexity is part of the lack of transparency,” Dr. Gershanik said. “But I think a lot of the questions providers and patients have are the same.”
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