Unger: Hello and welcome to the
AMA Update video and podcast. We're back with another
episode in our new What Keeps Me Up series,
where we talk with health care leaders about one thing that's
on their minds right now and what they're doing about it. My guest today is
Dr. Stephen Parodi, the executive vice president
of external affairs, communications and brand at
The Permanente Federation and associate executive director
for The Permanente Medical Group in Oakland, California. I'm Todd Unger, AMA's chief
experience officer in Chicago. Dr. Parodi, it is
always a pleasure to have you on The Update. Dr. Parodi: And it's good
to be with you, Todd, today. Unger: Well, let's get started. What is keeping
you up these days? And why? Dr. Parodi: You know, I would
say that number one on my list here is technology. And within technology, it's
artificial intelligence. And there's both the sort
of promise, hope with it and then concerns. And for me, I think that AI
is going to be significantly transformative. It already is within
our clinical practices and then actually
how we're going to be able to conduct care
and how the health care sort of writ large organizations
are going to be structured. So I think all of
that is on my mind. Keeps me up. Unger: Well, you're not alone. This is kind of technology
week on the AMA Update. And we're talking about
many of these same issues. But before we dig into
your specific concerns, I'd love for you to talk
about some of the benefits that you see for the
care team with AI. Dr. Parodi: Yeah, so
I think that there are a couple of things. One is that, from a
population health perspective, we've already implemented
algorithms and some machine learning and AI
into our practice. So let me give you an example. We use AI for advanced
alerts, both in the hospital and outside of the hospital. So it actually gives us
insight into patients who are at risk for
clinical deterioration. And what's important is that
it's not AI acting on its own. It's really augmenting
our practice. So it's alerting a care team,
in some cases, a hospital team, in some cases, an
ambulatory team, who then can act on those, you know,
sort of alerts and information that we're getting from the AI. And then we've been able
to show mortality benefit both in the hospital
and reductions in emergency visits
and hospital visits if we use it in the
ambulatory setting. So that's number one. Let me give you
a second example. And actually, we've
published on this, which is looking at
AI and radiology, and using it to
augment our ability to detect cancer and
breast cancer in particular with mammography. That's one simple
example where I think you're going
to see that expand into multiple
applications in radiology. So it's not replacing
a radiologist. It's enhancing their ability
to actually provide an accurate diagnosis, help
someone like me who's on the receiving end of
looking at a radiology film in making a quicker diagnosis. You know, so I think that
those are what hold promise when it comes to AI. And of course, the
question is, how do we make sure it's augmenting and
integrating into practice not replacing clinical
judgment and practice? Unger: Well, those are two great
examples that you just gave. And again, I want to just
stress the magic word that you're using there because
we hear this, certainly, here at the AMA and
from a lot of physicians out there is that
word augment, in terms of how the vision for
AI can fit in here. So that's an
excellent perspective. Of course, as you
mentioned, there are issues with AI and
the technology too. What do you think are
your personal top concerns with the technology? Dr. Parodi: So number
one is acceptance of it. So let me give you one other
example that's also a benefit. And we're still learning. So we actually recently,
about two and half months ago, introduced an ambient AI to
listen in on a clinical visit. And what it's able to do is
actually from the patient and from the physician who's
in the patient interaction able to generate a note. So you can imagine from
a clinical documentation perspective, way more efficient. In fact, we're seeing
improvements in, you know, documentation time
by an hour or two in a given day for a clinician. Huge win, right? Unger: That's a
stunning amount of time. Yeah. Dr. Parodi: It raises a
whole bunch of questions. Unger: Yeah, absolutely. Dr. Parodi: It's amazing. Yeah. But on the other hand,
it raises questions around privacy, acceptance. You know, what, from a
regulatory standpoint, is required to make sure
there's accurate documentation and coding with an AI? And so we're going
to have to make sure that that's monitored. So again, it's not as simple
as just introducing it into the milieu. You actually have to then make
sure that you're monitoring it. Meaning the humans
are monitoring the AI and the application of it. When it comes to, what federal
agencies are looking into AI? And which ones
are regulating it? And are they talking to
doctors and getting input on how the AI should
be implemented and how it should be monitored? I think that keeps
me up at night. Third thing is, how are
we going to make sure that it's equitably
used, that we don't have inadvertent sort of redlining
of patients by the application of AI? We want to make sure
that we don't introduce unintended biases
into our practice because of predisposing
assumptions that are in an electronic health
record that AI is scraping. So we've got to have processes
in place for making sure that we do have equity and
that, if we see inequities, that we correct for them. And again, I think that's going
to be critically important that physicians with
our clinical lens, with our operational
lens are involved with this conversation. Unger: You've hit on several
really big topics there. The first one is just the
potential benefits of AI to relieve the burdens
that are getting in the way of patient care. So a score of one
to two hours a day is that would be unbelievable. But of course, you point
out the flip side of that being other concerns around
the implementation and privacy. The second big point
that you talked about is equity with the
use of algorithms and making sure we don't
introduce biases through those. These are big issues. What steps are you taking right
now at The Permanente Medical Group to address
concerns like these? Dr. Parodi: So one of the things
is having an open conversation, making sure that everyone
is aware, you know, whether that's the physicians
or patients that we're being transparent
that we are using AI and how we're using it. The second is actually
setting up some governance, you know, within the
medical group and then with our hospital and
health plan partners that we work with. So that we're
actively dialoguing about what's being implemented,
how it's being implemented. Is it effective? Is it not? What does-- you know,
involving bioethicists, you know, so having the
ethical considerations of implementation in addition to
the operational considerations. This is not just
an IT thing, OK? Let me just be real clear. I mean, this is about
how we actually practice. And so you need the
people that are involved with the actual clinical care,
the people that are involved with back end operations coming
together, just as we would with any other initiative. So think of AI as a tool,
not as a replacement. It's critically important,
from my perspective. And those are really
sort of the actions that we're taking within
the medical group. And then I think there's
a second piece here, Todd, which is engagement in the
broader medical community, right? This is bigger than just The
Permanente Medical Group. And so making sure that
industry players, whether that's technology players, other
health systems, other physician practices, and I mean
all ilk of physician practices, large groups,
small groups, solos, all need to be involved
in this conversation. So we've been engaging
with our medical society within California. And I'm glad to be
engaging with you, Todd. Because I think this is
very much a national issue. Unger: Absolutely. And I love that you pointed
out this is not an IT issue. As I had a discussion with
your colleague Dr. Maria Ansari at The Permanente Medical
Group, co-CEO of the Federation, and I loved her point about
how cultural issues are just so important. We know with any kind of change
that it's not just technology. It's about culture. And the impact of
your work, obviously, going to affect the broader
landscape of medicine. And so tell me what you think
about what needs to happen, so that AI can be safely
used by the care team. Dr. Parodi: So I think there's
a couple of components here. So number one is
making sure that we've got sufficient
engagement of leadership within the medical group. And actually, I'm going
to say within society all the way from the
top to the people that are actually
in the exam room. And having that connection
is critically important. Second is that we
know that regulation is going to be coming
when it comes to AI. And how we write the
rules of the road are going to be critically
important to ensuring, again, digital equity and
to ensure that it's applied in a way that's effective. So we need to have measures. So there actually
is going to have to be a strategy for what
those measures look like. And so you know,
much of the journey that we went on when I think
about the quality journey back in 2000 and setting up
the rules of the road there, we need to have that same
kind of infrastructure for AI. Except, we need to do it fast. Because, Todd,
it's already here. It's already
embedded in society. And in fact, in many
ways, we don't even know that it's running. So I think where we have
an advantage in health care is that we're maybe a few steps
farther behind than the rest of society. So we have an opportunity
to set those-- set the table, if you will, now. But I really think it's now. We can't wait. And like I said, I think the
benefits here are tremendous. But we have to have measures for
what those benefits look like and what actually
we want to avoid. We need to be able
to define that. Unger: You know what's
really encouraging about your leadership
in the field, here is it gets to
a theme that we've been talking about this
week, which is making sure that technology works for
physicians and care teams, not the other way around. And having physicians kind
of drive that conversation, get ahead of the rules,
as you're pointing out, is so important. How do you make sure
that continues to occur? Dr. Parodi: So I think there are
a couple of opportunities here. So one is that,
within the AMA, being able to define those policies
through our House of Delegates and through Interim meetings,
so that we've got clear policy objectives as an
AMA and then being able to go to Capitol
Hill to inform and educate in addition to speaking
specifically to policy. And so what I'm excited
about is that there are meetings that are
occurring with policy makers and with their staffs. And I think that's
critically important to do this year in 2024. I encourage everyone to
also engage with their state medical societies. And you know, there
are many regulations that are going to be formed
at the state level as well. So being able to provide
those real-world stories, some of the ones we were
talking about earlier, Todd, about what good looks like,
what good governance looks like within an organization
to show that actually we in health care are
aware of the issues and know what they need to be in
terms of what good looks like, that's going to be
really important. So I would say
that those are sort of steps one and
two for me when it comes to addressing the needs
that, really, our patients are looking for. They're looking for
us as physicians to lead in this space. Unger: Thank you so much
for the important point that you made there,
which is, if you really want to ensure that
physicians have a say in how this technology is rolled
out, how it's regulated, then participate in the AMA,
participate in your state medical societies. That's where you can really
have a voice in this matter. Dr. Parodi, it is always
so great to have you. I love to hear your
perspective on the issues, in particularly,
technology right now. The AMA also has a wealth
of resources on AI. And we're going
to include a link to some of our latest
in the description of this particular episode. That wraps up
today's AMA Update. Be sure to subscribe for
new episodes and find all our videos and podcasts
at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
