June 25, 2024

Holistic Pulse

Healthcare is more important

The healthcare industry’s future is Hybrid medicine. This is why

8 min read

‘On a technological level, one of the most interesting things happening in the world today is the introduction of artificial intelligence [AI] in the field of medicine, with tools like ChatGPT and Med-Gemini,” says Dr. Tal Patalon, one of the leading figures in the advancement of international medical research and head of the Research and Innovation Center at Maccabi Healthcare Services.

“We are talking about advanced language models that can take free text and extract information from it,” she explained. “About 80% of today’s medical research relies on structured data, such as diagnosis codes, diseases, test results, and prescriptions, excluding the free text that the doctor documents in the system during a visit.

“The use of natural language processing [NLP] models, which have just started to enter the healthcare field, allows access to this free text, in addition to the structured data, and to extract critical information for research and treatment, thus creating more accurate models.”

Patalon is not only a leading figure in the world of medical research, but she is also a family doctor and emergency medicine physician, giving her a close understanding of the mental status of Israeli citizens, many of whom visit her clinic. “Since Oct. 7, there has been a need for immediate response from the entire medical community, and we are experiencing a significant increase in mental health treatments across all circles, from individual, family, community levels, and up to the entire state,” she said.

“Until that day, we recognized what was known or defined in the medical world as PTSD, post-traumatic stress disorder, and there are entire protocols on how to treat it. Now we have moved to dealing with continuous trauma; there is no ‘post’ because it doesn’t end.

“As a country, we are experiencing what I call ‘continuous traumatic stress syndrome.’ I see it in the clinic, in the emergency room. People come in with high levels of stress and anxiety, whether they are people who have experienced bereavement from the first, second, third, or even fourth hand, and also on a national level. There are people who are in constant stress from the threat of rockets and warfare.

“The levels of stress we have been exposed to since then are consistently high, and this has a cost, both mentally and physically. We noticed an increase in the demand for mental health services, as well as a surge in the demand for medications in this area. Therefore, we must be able to provide patients with better, faster, and more personalized solutions to their distress,” Patalon said.

“The challenge for the entire healthcare system is to integrate existing technologies and enable the development of new technologies tailored for quick and accurate mental health treatment. AI models and language models, like ChatGPT, allow us to make a significant leap forward because by incorporating information from free text, we can build AI models for detection, referral, treatment, and personal follow-up that include feedback loops from the patient back to the caregiver.”

In coming years, at least 25% of people will undergo initial diagnosis or treatment online.

“I believe that within five to 10 years, there will be hybrid medicine,” she predicted. “In other words, we will no longer be able to treat without involving advanced technologies in the treatment process in some way.

“Given that there is, and will continue to be, a significant increase in the number of patients, it will be very difficult to diagnose and treat such a large volume of cases without the use of these technologies.

“Already today we are witnessing unprecedented burdens on the healthcare system. At the same time, no doctor can keep up with and get a complete picture of all the research in the international field of medicine, which is published daily. We need help. In the coming years, I estimate that at least 25% of people will undergo their initial diagnosis or treatment online,” she added.

“Today, for example, in the field of mental health, remote treatment via video call is possible, and in the future artificial intelligence will take into account all the information in the patient’s medical file, including genetic information, which will allow doctors to prepare ahead of time for optimal treatment. For example, if I have a selection of antidepressants, which one will be most effective for this specific person, based on existing multi-dimensional data.”

Patalon explained that “Currently, we take all the data we receive from the patient and his or her medical background and try to tailor a treatment. It’s more trial and error – if it works, we proceed; if not, we stop and try something else.“It is important to remember that for the patient, this involves ongoing difficulty until the right treatment is found,” she stressed. “When we can integrate the patient’s genetic information with more comprehensive data, such as medical history, risk factors, lab results, and imaging, we will be able to build models that provide personalized treatment.”

What is the moral value behind the algorithm?

Patalon expounded on the obstacles to completing the technological revolution in healthcare services. “Every algorithm is built based on certain data, in our context, a specific population. For example, take mammography, which is intended to detect breast cancer at an early stage.

“An algorithm developed in Canada for detecting breast cancer in a high-risk population of women is based on local information where women start screening at age 40 (though that can change across provinces and is currently being debated). If we want to implement it in another country where screenings start at age 50, then it will not be accurate. Different populations have different preconditions that affect the accuracy of the algorithm.

“Another example, more relevant to Israel, is if I develop an algorithm and do not include Ashkenazi women with a specific mutation related to breast cancer. The construction of these models needs to be very responsible and specific to the target population on which the model is applied.”

Another important topic, which is not yet discussed at all, is what is the moral value behind the algorithm.“The question is whether those behind the development are thinking about the patient or the needs of the clinic or medical institution. When we enter the guidelines of that algorithm or application, will we decide to send for an additional test or not, based on the patient’s medical needs or perhaps the cost of the test itself? We must ensure that the fundamental principles for the development of the algorithm prioritize the patient’s well-being. This requires very specific skills for testing the algorithm in order to implement it responsibly and in alignment with the organization’s values.

“At Maccabi, every implemented algorithm is tested and reviewed to ensure that it indeed works for the patients’ benefit and improves their health.”

Patalon predicted a dramatic increase in algorithms within the medical field, stressing the importance of choosing the right technology for healthcare organizations. “This has become accessible, and there will be thousands of applications in the medical field from various companies and start-ups. The challenge will be implementing the technology accurately and accessibly.”

“There is no doubt that in the future, digital capabilities will offer many more services in the virtual space,” she asserted.

“For example, Apple Vision Pro advanced glasses utilize augmented reality and have incorporated mindfulness and mental health into the main menu, which gives us an indication of how central mental health care has become in our lives. In Israel, we are still witnessing a significant increase in the demand and need for mental health services, as well as an increase in medical prescriptions in this field.

“Therefore, we need to use technologies that ease the burden and provide practical solutions for patients. Ultimately, the introduction of wearable smart devices into our lives, like smartwatches, allows us to monitor real-time biological signs of patients, such as heart rate, step count, oxygen levels, sleep quality, and more. This will continue to advance in the coming years.

“I don’t think technology, even in the future, will replace doctors, and I also don’t think we should lose the human touch,” she emphasized. “I think that AI, in general, should ultimately provide decision-makers with many more immediate, accurate, and up-to-date tools to rely on when making decisions. Technology will never replace human interaction, which has its own therapeutic and healing power.”

A significant and exciting period in the world of medicinePatalon predicted that we will soon see a leap forward in the virtual medical world, such as the use of augmented reality for treatment and preventive medicine.

“If we do this responsibly, we can tailor personal medications to patients, precisely according to their DNA. We will also be able to prevent and monitor many problematic medical conditions, such as heart disease, atherosclerosis, breast cancer, and more, based on genetic findings.

“This is the future of medicine, and at Maccabi we have today the largest biological sample repository in Israel, including over a million samples for genetic and big data research.

“Existing and developing technologies, such as the use of quantum computers, will enable data processing like we’ve never seen before; and with it, we will undoubtedly experience a fundamental change in how we diagnose and treat in the future. This is a significant and exciting period in the world of medicine.”

She emphasized the importance of these tools, especially against the backdrop of the increasing burnout among healthcare workers in Israel and around the world in recent years, first with the COVID-19 pandemic and now with the ongoing war.

“We are indeed a very demanding system, whether we are dealing with doctors, nurses, social workers, or medical staff who truly work around the clock and feel the burnout. Burnout prevention is one of the significant steps that need to happen in the healthcare system,” she added.

“However, we as citizens also have a personal responsibility. If we recognize signs of burnout or distress in ourselves or those around us, we must address it or refer for treatment. We must not ignore or deny warning signs like depression, lack of motivation, sleep problems, or uncontrollable anger outbursts.

“During the war, Maccabi set up special services to provide support to the families of the hostages, Maccabi members, and employees. Additionally, an online service was opened to the public, allowing access through the app to services such as social workers, psychologists, support from nurses, and even complementary medicine services through Maccabi Tivi. We have taken many steps to make mental health services accessible and provide immediate assistance to those in need.”

Concluding with as much optimism as possible, Patalon looks to the future and what the country should do in the short term. “The Health Ministry needs to emphasize advancing resources invested in mental health and rehabilitation, while simultaneously encouraging the introduction of technologies into the treatment field.”

She concluded, “I am grateful and appreciative of the medical teams in Israel who do dedicated, uncompromising, and exceptional work.

“We have a young generation of doctors who have proven their capabilities in difficult times and serve as a personal example to all of us. I hope and pray for the quick return of the hostages.”

This was written in cooperation Maccabi Healthcare Services.

Translated by Eric Narrow.


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