Like most facets of modern life, human organs, too, are being digitally monitored.
Sensors are well on their way to helping us proactively capture the information needed to predict and prevent disease. Paired with the medical world‘s growing emphasis on wellness and prevention, the digital revolution will help us effectively monitor and address the chronic diseases that have been the Achilles’ heel of the health care system to date.
Jag Singh, M.D., explores these topics and the upswell of virtual care, the evolving role of sensors, and the impact of artificial intelligence in medicine and health care in his new book “Future Care: Sensors, Artificial Intelligence, and the Reinvention of Medicine.”
Dr. Singh is a practicing cardiologist at Massachusetts General Hospital in Boston and a professor of medicine at Harvard Medical School. As a clinician-scientist, his research work has focused on innovative device therapies, sensors, AI and virtual care. He has served in many leadership roles within medicine and on multiple scientific advisory boards for device and digital companies.
Mayo Clinic Press asked Dr. Singh some questions about his book, his writing process, and the opportunities and challenges of using artificial intelligence in health care.
Q: When and how did you realize that you wanted to write this book? Your background is in cardiology — where did the interest in the technologies you describe and investigate come from?
A: I started writing this book a year before COVID hit us. The pandemic then in itself catalyzed the whole process — not just for the adoption of new technologies, but also my writing this book. As a cardiologist and specifically as a cardiac electrophysiologist, I had always been interested in innovative device technologies, and in 2008 I started paying attention to sensor technologies, especially those embedded within the devices (e.g., pacemakers and defibrillators) that I was implanting in my patients for a variety of clinical conditions. I was struck by the potential of remotely monitoring my patients through these sensors and then intervening early, based on this information, to improve their clinical trajectory and outcomes.
The true stimulus for the book came around the time I was leading the clinical operations of the Cardiology Division (this was pre-COVID), when I thought that we could do a much better job at providing patient-centric care and at preventing disease. I felt that we needed to adopt virtual care and sensor technologies in our daily care of our patients. We needed to move away from the conventional transactional practice of medicine to a more holistic continuous care approach. Because of this I also got interested in technologies that provided care beyond just the heart.
The digital transformation was happening across all the industries outside of health care, with the slowest adoption within the hospital systems. Even though this led to many frustrations, I felt motivated to be a part of the movement to facilitate this change. I believe that writing a book covering the broad spectrum of evolving technologies may help readers to understand the essential components of delivering care in the future. This primarily includes virtual care that is aided by sensors and powered by artificial intelligence with sustainable workflows. I thereby became more interested in this broad swath of digital technologies — since it was the only way health care could be more effective, caring and sustainable.
Q: There has been a lot of talk about AI in the media in the last couple of years, and many people have serious concerns about privacy, potential hacks and other nefarious outcomes (including computers taking over the world!). What is your take on the challenges or dangers of AI weighed against its benefits?
A: I think this is a legitimate concern. The unease of privacy-related issues and hackers has been around for a while — right from the very early days of the internet. But we have persisted with all our online activities, because as a society we were able to put guardrails in place to make the internet a safer place. It may still not be completely safe, but safe enough that it has become a part of our daily lives. It is a reasonably well-regulated environment. There will still always be bad actors, and we need to be vigilant and safety measures need to be continually enhanced.
The same applies to the role of AI. I am not worried about computers taking over the world — but at the same time, it is very important to be cognizant of the importance of human oversight even for simple jobs that are completely automated. The use of AI brings with it a higher level of complexity and greater risk for nefarious activities. I think we must be prepared to take on those challenges and find solutions, and not run away from them. The appropriate regulatory processes and guardrails are continually being put into place. I am truly hopeful about the future and do feel that the benefits of AI technology in most circumstances outweigh the risks. It is the only way forward — so it is best to accept it and work to make it more secure.
Q: What was the hardest section or topic in the book to get right? What was the most difficult area to research or get information on, and how did you overcome that?
A: I think the hardest the part was the section on AI, especially since things are changing every day. I had to make a choice in deciding how much research to do and add. I needed to make sure I was not overwhelming my readers with too much technical information. So much of this section had to become a broad overview giving direction of where the future is headed, without sounding dystopian.
The section on the sustainability of our health care system also had the risk of becoming too dense, so trying to punctuate what could be exceedingly drab with real patient stories to elucidate the future of health care was a challenging section to frame — but one that I particularly enjoyed writing. Researching this area was difficult, as there is no clear-cut data or singular pathway of care that has been proven to work best. Having practiced in three very different countries (i.e., India, U.K., and the U.S.), much of this chapter reflects my own experience in the trenches of the hospital wards and the many conversations I have had with leaders across hospital systems throughout the country.
I wish there was one simple straightforward solution to the adoption of these technologies — but unfortunately there is not. I hope “Future Care“ can shine a light on the destination and illuminate some of the paths to get there. Eventually how we get there will be determined by the expectations of our patients, the willingness of our clinicians to adapt, and leadership that can inspire this change and finds ways of making it fiscally viable.
Q: Given the current state of health care and the technological advances being made, are you more optimistic than pessimistic about the future of care? What do you think the sticking points are — financial? Social? Political? Medical?
A: I am an eternal optimist. I will admit that this journey of digital transformation of health care will be a difficult path, with potentially many missteps. The sticking points will be several. Finding the right financial incentives to motivate the system and clinicians to change is going to be the biggest barrier. We must be willing to take risks and invest in a future state, which will reap dividends — way down the line, not immediately. The health care environment will certainly become more complex before it transforms into something exceedingly simple and seamless. There will be many socio-political issues related to ownership of data, privacy, bias and ethics that will need to be addressed along this journey.
Q: What are you currently reading, and what excites you most right now about health care, technology or your job?
A: Besides keeping up to date with medical literature (which has become progressively challenging) I read both fiction and nonfiction books — and try to do this daily. I recently finished “How to Avoid a Climate Disaster” by Bill Gates and “Age of Vice” by Deepti Kapoor and only just started “The Covenant of Water” by Abraham Verghese.
I am very excited about the future and how clinical care will transform over the coming years. There is so much potential in health care towards becoming more accessible and equitable, not just regionally or nationally but globally. Alongside this is the promise of medicine becoming highly personalized with improved clinical outcomes. Every day I walk the corridors of my hospital, I feel incredibly privileged to be a physician and it is an honor to be involved in the care and harbor the trust of my patients. It is something I don’t take lightly. Having the opportunity to influence the conversation on the “future state of care” through my book is very exciting, and I do hope that it starts the dialogue and accelerates our willingness to step out of our comfort zones.
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Future Care
A renowned cardiologist and Harvard professor spells out the future digital shift of medicine — and how it will impact the lives not only of patients and health care professionals but of all humans.
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