Using AI to help doctors connect with patients

Nashville - It doesn’t take long to figure out that Dr. Nolan Chang relishes being a physician.

Nolan Chang, MD, executive vice president of strategy, corporate development, and finance for The Permanente Federation, says he's encouraged by AI's potential to help doctors deliver better care.

“I love, love, love being a doctor,” he says.

“I'm a family medicine doctor. That's the stuff that really gets me excited. As my practice developed, it was like hanging out with 2,500 of my closest friends, because they knew about me. I knew about them.”

Chang, MD, is now executive vice president of strategy, corporate development, and finance for The Permanente Federation, part of Kaiser Permanente. He’s also excited about the possibilities of using artificial intelligence to help physicians do their jobs better.

He says AI has the potential to help doctors have better relationships with their patients.

“I'm doing my role to hopefully make it easier for physicians to take care of patients,” Chang says. “And in our system, we have the opportunity to look at the entire care delivery system, develop solutions and systems to make it easy to do the right thing that drives better outcomes.

“I'm excited about AI helping us understand our patients in a way that's meaningful, that helps break down barriers, and closes gaps in disparities and outcomes,” Chang says.

While in Nashville for the ViVE digital health conference, he spoke with Chief Healthcare Executive® about his enthusiasm for AI, encouraging success at Kaiser Permanente, and the need to be thoughtful in its development and deployment.

“I genuinely want to make connections with my patients,” he says. He says AI could bring clinical advances, but he also sees the power in helping doctors have more meaningful connections with patients.

“Hopefully technology will help us bridge that gap of moving healthcare into our patients’ lives, not making our patients' lives shift into our world,” he says.

Read more: Mayo Clinic’s John Halamka: ‘We have to use AI’

Doing the right thing

Chang says he’s known for asking patients to think about the five most important people in their lives.

It’s very rare for one of those five to be the doctor.

“They are probably more important to your healthcare outcomes than your doctor in many ways,” Chang says.

He says the challenge is to understand what’s important to the patient, which can be the key to better care. And he says AI can be a part of gaining better understanding.

Kaiser Permanente, like some other health systems, has been introducing AI-powered ambient documentation tools for physicians. The technology records visits with patients and offers physicians a summary of the appointment, saving doctors significant time in documentation. Doctors routinely cite the long hours spent on documentation as a leading source of burnout.

Plus, doctors can have more normal conversations with patients rather than typing on a keyboard. Chang says the early results have been encouraging in reducing stress on physicians.

“While we need to make sure that it's validated, we have been seeing that it's been saving a tremendous amount of time, allowing the physicians to focus on our patients,” Chang says.

With Kaiser Permanente’s focus on value-based care, Chang says the system is looking at longer relationships with its patients. If doctors are having better, richer conversations with their patients, that helps build deeper ties.

“For the physicians, it is making that connection with the patient and wanting to help,” Chang said.

“For our physicians, they want to do the right thing. And in healthcare, oftentimes it seems like you're doing the wrong thing, and that can be really demoralizing and lead to burnout.”

The goal is to use AI, which he also calls “augmented intelligence,” to help clinicians do better, including helping clinicians make better decisions that will lead to better outcomes.

Chang says AI technology can provide a better experience for both patients and physicians.

“If your workforce or your physicians are completely upset, then it's not going to be a great patient experience,” he says.

Read more: Five from ViVE: Takeaways from the digital health conference

A tool, not the solution

Kaiser Perrmanente is proceeding enthusiastically, but cautiously, when it comes to using AI in clinical decision support, Chang says.

With AI, there are still problems with errors or “hallucinations.”

“You might have 20 great notes popped out, but then, with the 21st note, it's like, ‘I didn't say that,’ or ‘This isn't what I meant,’” he says.

At Kaiser Permanente, he says the organization is gathering input from a variety of stakeholders in considering the ways AI should be used. He says conversations go beyond the technology leads and involve doctors, nurses, and patient advocate groups.

He likens AI to using the right tool for home repairs.

“Artificial intelligence is a tool, and it's not the solution in and of itself,” he says. “If you have the right tool, it makes things a whole lot easier. If you have the wrong tool, it can just be painful.”

As the organization looks at using AI in different ways, he says, “It's always going to be the patient at the center.”

“It's the intersection of technology, the workflows, to be able to create an experience and substantively drive outcomes, just making sure that we have everybody's voice there,” he says.

“What I worry about is, when it is a technology solution, people focus like it's the technology that's the answer, but that couldn't be further from the truth, and it will actually set technology up for failure.”

Chang says the healthcare industry is at a crossroads.

“How do we continue to drive better outcomes, with resource restrictions? I think technology will have the potential to be that next big leap,” he says.

“But the biggest driver for me is … how do we meet our patients where they're at? How do we look at social factors and the impacts of those different things and align that with our approach to healthcare? I think that technology as a tool will really be something that we’ll look back on and say, that's when we're able to make a pivot as an organization. So in our organization, being able to look at all the different facets and solve for that so that we can align all the incentives top to bottom, is what I'm excited about,” he says.