Amanda (Host): Technology and artificial intelligence in health care, is this a blessing or a burden? Joining us today to discuss advantages and challenges of AI in health care is BayCare's chief physician executive, Dr. Sowmya Viswanathan. This is BayCare HealthChat. I'm Amanda Wilde. Dr. Viswanathan, thank you so much for taking the time.

Sowmya Viswanathan, MD: Thank you very much for inviting me.

Amanda (Host): Well, in general terms of blessing or burden, let's talk about some of the benefits when it comes to patients, physicians, and health systems and AI.

Sowmya Viswanathan, MD: Absolutely. AI has taken over the world by a storm, and I have to say all three facets of health care systems and health care delivery have definitely engaged with AI in a way that we have never seen before with technology in general. We can split this out into patient, physician, and health system, just like you appropriately stated.

From a patient perspective, a lot of work has been done with patient engagement. So whether it comes to engaging the patients right from the beginning to having them come over to the physician office, or whether it's an insurance company that is sending over a survey link and saying, “Well, you need to engage with your primary care physician because you are due for certain screening.”

All this used to be manually driven in the past, and now it has been automated. But more so with AI, we are exponentially able to increase the efficiency and the outreach to patients by using these patient engagement tools.

There's also a lot to be said about medical diagnosis and early detection, which has improved the patient care and the patient outcome. Communication between patients and their physicians and their primary care and the specialty offices has enhanced and improved significantly benefiting the patient in many different ways. Patient access to physicians has improved through the patient's scheduling modules. They are now able to self-schedule, whether it's a dentist office, a physician office, or any procedure.

They are able to directly communicate and schedule their own appointments, which was never thought of as possible in the past. These are just some examples from a patient perspective.

And I have to say, from a physician perspective, numerable benefits with AI enhancements. We have seen physicians who have gone through implementation of electronic health record in their offices and in their practices. And that was a wave that we thought we will not be able to survive. But physicians did remarkably well embracing technology. And EMR was just the start.

Now what's happened is burnout was starting to set in amongst the physicians because they felt it was too much technology. And that's when we said, "Okay, we need to give them some kind of help and assistance in the form of a clinical assistant.”

Now we have clinical assistant AIs that are helping physicians in the form of virtual scribes. They are automatically able to document notes from conversations that the physicians are having with their patients. These are virtual scribes who are able to transcribe. We used to have transcriptionists in the offices before and now they are virtual scribes, and now AI is able to take care of a lot of the documentation. A lot of compliance, a lot of care accuracy have also improved with the clinical documentation that physicians are doing.

We're using technology to review physician notes to make sure they haven't missed on some of the diagnosis they need to update for the patients. We are looking at medication adherence, compliance with medication.

Then we do something called clinical decision support. A lot of times physicians are working with clinical decision query builders who basically will query the physicians about notes that they have written, but then they have missed jotting down the fact that the patient did have a colonoscopy, for example, two years ago. And it kind of comes up as a prompt for the physician and alert. I can go on and on about all the work that physicians are doing with AI.

A few other things are advanced imaging. Radiology is one of the fields that has been, I want to say, in the initial phases of engaging with AI. The number of scans that can be read by AI-assisted tools is significant considering what would have been achievable by manual reading of those reports.

Radiologists spend numerous amounts of hours per day reading through reports after reports, and now AI tools are able to scan the reports and produce with almost the same level of accuracy, if not better, with outcomes and results that are mimicking what physicians are able to do. So radiology is one.

We are seeing the same thing with pathology. And we will continue to see a lot of the specialties adopting AI technology, especially where the direct interaction with physicians and patients is not required, where there is more of imaging and documentation that's needed.

Coming to health systems most of the work has been around operational efficiency. We have found that operating rooms and turnover of OR turnaround times, anesthesia utilization, board runners – they call them board runners when they're looking at the schedule for the day, how many minutes do we have between one case going out and another case coming in? All of those minute details of operational efficiency are enhanced using AI technology and allowing them to focus more on patient care.

Physicians are now able to spend more time, real-time making eye contact with patients, which never happened in the past few years because everyone was so focused on documenting in the electronic health record. So the biggest concern that physicians were having has now been alleviated, to a certain extent, with AI-based technology.

We're also seeing improved outcomes with predictive analytics. You probably have heard about robotic-assisted surgeries that are being done with robots. We also have people who have predictive analytic tools that are being implemented. BayCare is using a lot of those tools and we are predicting the outcomes of patients even as they're being rolled into our emergency departments.

We're using sterile medication preparation techniques with AI tools and supply chain support and 3-D printing. So there's just a huge number of AI-assisted tools that are now being implemented across health systems, and we are embracing it as much as any other industry.

Amanda (Host): Dr. Viswanathan, that is a long list of benefits around access, communication, and efficiency. AI has obviously been transformative. This all sounds very innovative and high tech. Probably not possible even a few years ago. What type of AI platforms or machines are you currently using at BayCare to innovate?

Sowmya Viswanathan, MD: So we touch upon a lot of the AI tools that I just mentioned. I will go down the list of a few of them. We use everything from agentic AI to conversational AI to generative AI. All of these tools are critical for us. And, if we break it down into, let's talk about them as themes. One is if you look at EMR optimization or electronic health record optimization, we are using tools which are helping with clinical documentation improvement and queries.

We also use a program that helps to identify, even as physicians are inputting data and inputting order sets, for example, it'll flag the physician to let them know, “Oh, by the way, you just put in for an MRI. Did you know the patient just had an MRI two days ago because he was seen in the emergency department. Do you really want to order another MRI on this patient?”

Those kind of queries were unheard of before because we had to scan the discharge summaries and we had to be up to date on it ourselves and do it manually. Now we have a tool that allows us to look into it. We also have CDI queries, as I had mentioned, and we have medication adherence tools.

From remote patient monitoring, which is another heavy AI-driven platform that's being rolled out nationally. A lot of patients are getting discharged for many of their conditions, especially heart conditions and respiratory lung conditions with tools and gadgets that we can send them home with, and we are able to monitor their progress remotely.

We are engaging with a tool where a patient who has been admitted with a heart condition, has undergone a cardiac surgery or procedure is sent home. In the past, if the patient had a heart attack, the patient had to be scheduled for cardiac rehab. The patient would have to come into the hospital or to the rehab center on a daily basis to get on the treadmill under monitored setting.

Now we are able to send the patient home and with a flick of a button, they are able to hop on their own treadmill at home while they are being monitored by the physician and the cardiac team to make sure that they are going through cardiac rehab at home without having to leave their premises. Huge, huge advancement in how we are managing patients with all these different conditions.

We also have early detection tools. So stroke detection, heart attack. We call it STEMI. STEMI detection. There are AI tools which are able to predict, as I mentioned, and we are working with two companies on those tools.

We have a chronic disease management company that's working with us on preventing the progression of certain conditions like diabetes and hypertension and better controlling them by managing them with AI tools. They do the outreach to the patient. We do asynchronous care so when the patient calls in, we are able to provide telehealth services. And it may be in real-time at the same time, or it could be at a different time. It's called asynchronous care.

We also have chatbots. Chatbots basically walk the patient through their journey. If the patient is admitted for a procedure and a surgery, the chatbot will be able to update the patient and their family and the caretakers on what's going on with the patient while the patient is in surgery.

So it'll constantly be updating them, saying the patient has now gone from the perioperative area into the OR. Patient surgery has gone well. The patient is now coming back into the recovery, should be ready for you to pick them up at this time. That's the kind of service we are looking for with the chatbots and ability to have the conversation with the patients and the families.

We have another one that we are very actively engaging with, which is the Nurse Voice. We talked about the transcription for physicians. We are working with our own ambient listening and ambient transcription. The physician and the patient will have their regular conversation, 15-minute visit or half an hour visit. Eye to eye contact is made. The physician opens the app on his mobile phone, his or hers. Lets the patient know this is going to be a recorded session. The whole thing. Conversation gets recorded and it's transcribed as a note for the physician to sign off.

Now we realize that physicians are getting this. Why not nurses? So we are engaging with the company to do the same thing where a nurse can just literally walk into the patient's room and the whole conversation between the nurse and the patient gets documented, including actions being taken, that need to be taken. If the nurse tells the patient, “I need to do a urine dip stick on you, or I'm going to order a blood set.” The order for the blood set will be inputted into the notes. That's how significant these AI tools can be in improving operational efficiencies.

A lot of work is being done around value-based care, documenting, utilization management, incidental findings in radiology, we talked a lot about this, and many patient engagement tools, including research-based, to engage patients in research and pilots for research and clinical trials. We are talking about an AI tool and rolling that out so that we can engage more patients. So these are some of the areas we are working on.

Conversational AI, I do want to state, we have a lot of work that we have done with Alexa in our patient rooms. They are smart room controls, having the voice activated, we call it the GetWell Loop TV, informs them about how to improve their recovery and Aiva in patient's room with Velsera. I mean, these are just a few examples. Having the shades up, the shades down, turn the TV on, turn the TV off. It's a smart room that we are rolling out at many of our flagship hospitals within BayCare.

Amanda (Host): Doctor, do you ever feel like you're living in the future, seeing how quickly all this technology has emerged and how specific it can be?

Sowmya Viswanathan, MD: It is such a beautiful time because remember the time and internet came into work and everyone was afraid of it, and now we cannot live without internet. It's the same thing that happened with Facebook and all the social media platforms. Now, people cannot live without it. I think it's the same thing with AI adoption.

We will soon be at a point where we will be so immersed in how beautiful this technology is, we won't be able to live without it. It's fascinating times. It will take time for people to adjust and trust AI before we actually say, "Okay, now AI is going to be my helper and it's not going to be a hindrance.”

Amanda (Host): Yeah. I was going to ask, when it comes to patients, why do you think they may not trust AI?

Sowmya Viswanathan, MD: A lot of it is a little bit of fear factor because there is these inherent bias about data privacy and security. They are concerned that their data is going to be taken up and every minute that it's being tracked by another entity, it's going to be used for some purpose that they haven't consented to.

They also have concerns because a lot of us haven't gotten to the point where you trust a machine as you would trust your doctor. The trust factor will take time. So right now when we say AI adoption in health care is improving, AI adoption is only improving where it's assisting the physician's decision-making power, so the physician is able to spend more time with patients.

It's not going to replace physicians interacting with patients. Basically, it's helping me because it helps me make a decision faster and say, “Okay, I've ruled out all these other problems that you have, and now I have been able to confirm the diagnosis for you.” That's what it does.

So I think from a patient perspective, it's that, it's going to take time for them to understand the ethical implications of this, trust the physician, trust the data, all of that has to take place. The biggest piece, although, is the compassion and empathy from a human being. It's definitely different when it's a machine and it's just spitting out data that has been fed into the machine from outside.

So when patients review that, they may sometimes feel like, you are just giving me information because it's there on the internet and you're pulling it from there. It's not coming from deep within you. And physicians definitely as a human being, that over-reliance on technology is going to take some time.

Amanda (Host): So going back to the idea we touched on when we claimed AI could be a blessing or a burden, what other challenges are we facing when it comes to AI moving in so fast? Or is it better to frame those challenges as opportunities? How do you see that?

Sowmya Viswanathan, MD: I see them as opportunities. Definitely. I think we are in a beautiful cusp of a time where we are in that transition phase. We love AI, we love what it does, we are thrilled by it. From a health system perspective, what we are challenged with is the cost. It's the investment that it takes with this over-reliance on technology.

Yes, it improves operational efficiency, but are we able to determine if the operational efficiency we have been able to correct and achieve will overcome the cost of the investment in these technology and tools? Right now, AI tools are super expensive. And there will be a time when that cost will be driven down by more tools coming out in the market and there's market competitive advantages that will level set the cost of these tools.

That's when I think health systems will say, “Okay, I'm willing to move forward with fully implementing technology in all of my hospitals.” Right now, the cost has been prohibitive for us to just - we are picking and choosing which ones will make most sense for patients, for their safety and quality and the great better outcomes.

And that's how we are picking our tools.

Amanda (Host): So you have to be fluid enough to adjust as AI is constantly developing.

Sowmya Viswanathan, MD: One hundred percent. Absolutely.

Amanda (Host): Finally, if you could sum up what you think the future of health care will be in 10 years, what would you say?

Sowmya Viswanathan, MD: In about 10 years, our acceptance of technology in health care will be at a much higher level. We will have adapted to it. We will have adopted technology, embrace it like we have never done before.

And we will still have doctors, but the doctors will be used for a higher level of thinking. They will be used for the critical thinking that's required for very complex decision making. Whereas the menial tasks of the run of the mill, if I'm having a cold and a cough, chatbots will be able to take care of a lot of these things, which right now we go to primary care offices or we go to an urgent care clinic.

In the future, we will not be visiting the doctor as much. We will be limiting the visits to the doctor for complex, really complex cases, really complex procedures that require critical thinking. That's what will end up happening.

I also think that there will be a lot more robotic-assisted procedures that will be out in the market. We have been engaging with robotic-assisted surgeries now for orthopedics, for OB/GYN, for certain specialties, and even for gastroenterology, and a lot more specialties will start engaging with robotics. So we will see that wave of movement into robotics and more robots will be out there.

Amanda (Host): I'm sure we'll check in with you before then, but in the meantime, really appreciate you sharing your insights and bringing context to this very timely topic. Dr. Viswanathan, thank you so much for joining us today on BayCare HealthChat to help us understand the role of AI in health care.

Sowmya Viswanathan, MD: Thank you for this opportunity. Thank you so much.

Amanda (Host): Dr. Sowmya Viswanathan is BayCare's chief physician executive. Head on over to our website at BayCare.org for more information and to get connected with one of our providers. And that wraps up this episode of BayCare HealthChat. Please remember to subscribe, rate, and review this podcast and all other BayCare podcasts.

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