Prentice Tom, CIO & EVP at Medical Affairs Vituity, Discusses Challenges and Adoption of New Health Technologies
Prentice Tom, MD, is Chief Innovation Officer and Executive Vice President of Medical Affairs at Vituity, one of the nation’s premier clinician services and care delivery solutions companies. In these roles, he oversees the development and implementation of healthcare service solutions and the development and adoption of new health and medical technologies.
Dr. Tom previously served as Chief Medical Officer of Vituity dba CEP America, developing highly regarded programs on medical quality, risk, patient experience, and CMS programs. He led a number of nationally recognized breakthrough initiatives, including Rapid Medical Evaluation® (RME) and Vituity’s Emergency Psychiatry Program.
Before joining Vituity in 1993, he was a faculty member at Stanford Medical School. Dr. Tom has volunteered with the International Medical Corps (Bosnia), Emergency International (where he served as long-term project coordinator for the China Project), and the Menlo Park FEMA Urban Search and Rescue Team.
He holds a Bachelor of Arts in medical physics from the University of California Berkeley, a Doctor of Medicine from Harvard Medical School, and completed his residency in emergency medicine at Johns Hopkins Hospital. He was previously a Kaiser Fellow in Health Policy and Management at Massachusetts Institute of Technology.
Sajid Khan: Prentice, thank you very much for taking the time out of your busy schedule for this interview. Can you please share your perspective regarding AI (Artificial Intelligence) in healthcare and how it will impact the industry?
Prentice Tom: Advances in AI will revolutionize healthcare delivery. We have yet to see even the tip of the iceberg, and there will be no end-point. Early on, we will see creation of more standards of practice and algorithmic care that will support clinicians. AI augmented care will, initially, be more passive, requiring clinicians to initiate or seek AI input, and they will be limited in scope. However, as the technology advances, we will see interactive and active AI intervention guiding clinician decisions, and eventually setting the standard of practice for many conditions and clinical scenarios. As automation increases we will see chatbot delivery of AI mediated care, i.e.: care that is fully automated, and again this will only improve in quality and increase in diffusion and scope.
AI will start to impact diagnostic care and knowledge based therapeutics first, but as advanced imaging and robotics improve, we will eventually see AI grow in manipulative therapeutic maneuvers.
Thus, as AI technology advances we will see greater uniformity of care, greater availability of care, care delivery through the most efficient and lowest cost clinician able to provide the same level of care, and up-to-date adherence to diagnostic and treatment algorithms. Quality and value will both improve. These advances will occur within this and the next generation of clinicians. AI supported healthcare will be an enormous win for society, patients and payers, much as greater automation has been a boon for reducing production cost, increasing consistency and increasing availability of essentially all manufactured goods.
As healthcare AI technology progresses, we need to develop and ensure QA processes that can adequately assess care algorithms and ascertain and address pre-existing bias. Care bias as discussed in a recent New York Times article, can be promulgated through AI and these biases can then become standard of practice. Analogous to our QA processes for our current clinical care practices, such QA processes will need to be able to monitor care but also result in improved care as the knowledge base continues to increase. I am wholly optimistic that as AI technology continues to improve, we will develop the necessary QA processes to detect and safeguard against pre-existing bias and unoptimized care, and advance new care algorithms through the accumulation and analysis of exponentially increasing health data acquisition and medical knowledge.
I have one concern about the impact of AI that is at least somewhat troubling. As AI augmented care advances, if our education / training institutions do not keep pace with the speed of this advancement, we will find our next generation of clinicians inadequately prepared for this future practice environment. As knowledge becomes instantly accessible and care becomes more algorithmic and AI supported, we will need to move to shorter duration, more rapid training with a greater focus on clinician-patient, clinician-machine, and patient-machine interactions. Clinicians will need to be adept not only at delivering care but at negotiating and managing an increasingly complex health system, with greater care integration afforded not only by comprehensive AI algorithms, but by greater connectivity and improved data transfer. This more comprehensive approach will mean care providers will also need to have an in-depth understanding and focus on other social determinants of health – an area not fully addressed through current medical education efforts. Our current physician training process which focuses almost purely on medical knowledge accumulation over a many year training program will be outdated and unable to accommodate the rapid growth in knowledge afforded through technological advances.
We will see a broader spectrum of clinicians delivering care, and we will see the growth of non-traditional care providers who can rapidly access information, providing a level of care that previously required physicians who spent many years training. Unless training programs adapt to the rapid growth in medical knowledge afforded by improved data analytics and AI augmented care, we will find next generation clinicians disillusioned by the fact that technology has advanced faster than their training and their knowledge base becoming obsolete faster than they can acquire it. In addition, the commoditization of care with the ability to supplant physicians with other care providers will put significant downward pressure on physician compensation, making it difficult for physicians to repay the significant debt often incurred through the lengthy and expensive medical education/training process.
SK: In your opinion, what have been some of the biggest challenges related to Healthcare Information Technology (HIT) during the last few years?
Prentice Tom: The biggest challenge relating to HIT is our ability to achieve greater interoperability and utilize and analyze the enormous amount of medical data already archived and the much greater amount that will soon be archived. Breaches in security and privacy drive the demand for strict data transfer requirements and protocols. The societal impact on health, morbidity and mortality from not leveraging and fully utilizing available health data is enormous. Absolutely, we need to ensure strict protocols for entities that control and transmit health data. Moreover, we need to also increase the resources used for policing and the penalties that recognize the full negative societal impact of the transgressors who steal and inappropriately or fraudulently use health information. We not only need to ensure our banks are secure, we need greater policing and penalties for the bank robbers that appropriately reflect the severity of their transgressions.
SK: Which fundamental steps should be taken by healthcare service providers to best serve the needs of hospitals/medical care?
Prentice Tom: Health care providers need to actively engage our health technology innovators and vice versa. I see the two camps are frequently at odds and undervalue the need for collaboration. There is significant inertia in healthcare delivery. This is further complicated by our fragmented market and disjointed regional health ecosystems. The long, arduous path to health technology adoption means many innovators creating truly valuable products cannot withstand the difficult and complex business development cycle. Both sides need to ensure the correct incentives are in place, to overcome the inertia necessary for change as well as the perceived threat that technologies may have to current clinical practice.
On the clinician side, provider groups need to identify technology experts and liaisons that can help shepherd in new technologies. In addition, clinical leadership needs to be trained to overcome the inertia of current practices so that their groups can take advantage of new technologies. This inertia includes not only clinical knowledge but also clinical practice patterns and work flow, which are actually disincentives to change. For example, a busy clinician does not want to be interrupted by patient monitoring data in the middle of patient care, even if that information would prove immediately valuable to that patient’s care. Telemedicine is an area where we have not realized the potential value due to lack of the appropriate financial incentives. Re-engineering of clinician practices will need to occur to accommodate advances such as those in data availability, interface with AI driven tools, and virtual health options.
Health technology companies need to be aware and cognizant of how their technologies impact clinician work flow, not just the potential value of their product. EHR adoption should have taught us that failure to do so will significantly impede technology adoption. Many health technology companies still pay only cursory attention to clinician drivers. In my experience, the vast majority still seem to develop their technologies in a vacuum assuming that because their technology provides value it will be adopted and not considering the clinician’s work flow, drivers and incentives. I often encounter new health technology companies that fail to have experienced clinicians as integrated members of their development teams.
SK: What’s been your greatest achievement in your career thus far?
Prentice Tom: I have had a truly personally rewarding career, and have had the opportunity to be involved in creating a wide variety of programs and innovations. Still, the professional activity that has provided me with the greatest personal gratification has been my clinical practice. After the direct provision of emergency medical care as a physician, the creation and oversight of the Vituity Management/Leadership Fellowship is the program that I am most thankful to be associated with. This program has resulted in an amazing success rate for developing next generation leaders including Board members, executive and senior leaders, and innovators. Being part of such an effort, mentoring next generation health contributors is enormously rewarding.
SK: What advice would you offer to our readers who aspire to follow in your footsteps?
Prentice Tom: Don’t follow my or anyone’s footsteps. Make your own. Look upon your own life with compassion and gratitude, and you will find you can approach any endeavor with confidence and optimism.