Architecting Future Health with DocAi: Accelerating Health as a Service

?? Struggling with Healthcare: Nearly everyone I talk to is struggling with the U.S. healthcare system. People describe it as chaotic, disconnected, delayed, error-prone, expensive, unequal, and biased by systemic racism.

Disconnected services and lack of continuity are significant issues in healthcare today. Healthcare services are often siloed, resulting in poor communication and coordination between different providers, such as primary care physicians, specialists, and hospitals. This fragmentation can lead to repeated tests, conflicting treatments, and gaps in care. Additionally, patients frequently experience a lack of continuity in their care, with medical history and treatment plans not being consistently followed or communicated across different healthcare settings. These challenges highlight the need for a more integrated and cohesive approach to healthcare delivery.

Healthcare Providers Are Also Victims: Healthcare providers and nurses share this frustration, struggling within the same dysfunctional system.

?? Connecting with Doctors: Many patients have difficulty even getting in touch with their doctors. Time off work or family duties is often necessary to see a physician or get a test, only to face delays or cancellations. This often results in devastating delays in care, leading many to default to the emergency room.

Health as a Service (HaaS): Instead of disrupting patients' lives, why not provide Health as a Service (HaaS)? This approach could leverage AI to bring healthcare to patients wherever they are.

Introducing DocAi: Revolutionizing Healthcare with AI

24/7 Availability: DocAi, a digital AI doctor, is available around the clock, providing immediate medical advice and triage services, ensuring timely care regardless of location or time.

Optimal Clinical Decision Support: DocAi integrates personal health data from wearables, understands health history, and coordinates symptoms with the best medical data available to offer immediate answers and formulate a plan.

Internet of Things (IoT): DocAi can coordinate the execution of plans, integrating them into the patient's life and schedule, providing an optimal clinical treatment plan.

Full-Service Provider: DocAi supports both mental and physical health, integrating complete data sets (including genetic and biologic data) to recommend optimal testing for upcoming health challenges, shifting the paradigm from reactive to proactive health management.

?? Empowering Patients with Technology: With about 5.3 billion people using cell phones globally, technology like the iPhone, coupled with wearables, can give patients autonomy over their medical records. This is crucial during crises, such as accidents or climate-related events.

Overcoming the Frustrations of Physical Visits with AI

?? Patient Frustration with Physical Visits: Many people are frustrated with needing a physician's help but having to take time off work and go through the hassle of physical visits. This process is disruptive and often leads to delays in receiving care.

?? DocAi to the Rescue: The current system of 1:1 doctor-to-patient interaction is outdated and insufficient. There aren't enough doctors, and the system is akin to the old country doctor house call model, except now patients are the ones traveling. To offer an alternative, we need to leverage technology with strategies like "Smart Scheduling" and reducing administrative burdens through automation.

AI-Driven Scheduling: An AI scheduling system can optimize appointment bookings by analyzing patient needs, provider availability, and urgency of care. This minimizes wait times and ensures timely access to the appropriate healthcare provider.

Dynamic Rescheduling: AI can adjust schedules dynamically to accommodate emergencies, cancellations, and overbookings, improving the overall efficiency of healthcare services.

AI-Powered Documentation: AI can automate the documentation process by transcribing and summarizing medical consultations, filling out forms, and managing billing and coding tasks. This allows healthcare providers to focus more on patient care.

Streamlined Claims Processing: AI can simplify insurance claims and reimbursement processes by automatically verifying coverage, detecting errors, and submitting claims, reducing delays and administrative costs.

Concrete Example: How DocAi Helps with Colorectal Cancer Detection

?? Aging Population and Colorectal Cancer: With an aging population, many people aged 45 and over are at higher risk for colorectal cancer. Let's explore how DocAi can optimize their health pursuit using the Health as a Service (#HaaS) model.

?? DocAi and Recent FDA Approvals: Recently, the FDA approved several blood tests that can detect cancer, including the Guardant Health Shield test for colorectal cancer screening. This test detects circulating tumor DNA (ctDNA) in the bloodstream, allowing for non-invasive detection of colorectal cancer.

Another significant development is the approval of liquid biopsy tests like Guardant360 CDx and FoundationOne Liquid CDx. These tests analyze blood samples to identify specific genetic mutations associated with various cancers, helping to guide treatment decisions. These liquid biopsies are particularly useful for patients with metastatic cancer or those unable to undergo traditional tissue biopsies.

The Galleri Test: The Galleri test by GRAIL is a promising multi-cancer early detection (MCED) test that can identify signals for over 50 types of cancer through a simple blood draw. This test detects specific DNA fragments shed by cancer cells, allowing for the early detection of cancers that typically lack routine screening tests, such as pancreatic, esophageal, ovarian, and liver cancers. However, it's important to note that the Galleri test has not yet received FDA approval. It is currently available for clinical use under the Clinical Laboratory Improvement Amendments (CLIA) regulations, meaning it can be ordered by a healthcare provider but is not officially FDA-cleared or -approved. The Galleri test is intended for individuals at an elevated risk for cancer, particularly those aged 50 or older, and is used in conjunction with other recommended cancer screenings like mammography and colonoscopy.

Studies like the PATHFINDER trial have shown that the Galleri test can significantly improve the early detection of multiple cancer types, which may lead to better patient outcomes and potentially lower overall cancer mortality rates. Nonetheless, ongoing studies and clinical trials, including those conducted in partnership with NHS England, aim to further validate its effectiveness and safety.

???? Cologuard: A Non-Invasive Option: Cologuard, FDA-approved in 2014, is a non-invasive stool-based test used to screen for colorectal cancer in people aged 45 and older at risk for colon cancer. It detects DNA mutations and blood in the stool, which can indicate the presence of cancer or precancerous polyps. The test involves collecting a stool sample at home, which is then sent to a lab for analysis. It combines DNA testing with a fecal immunochemical test (FIT) to detect abnormal DNA markers and blood that might indicate cancer. Cologuard has a high sensitivity for detecting colorectal cancer and advanced adenomas. It has a sensitivity rate of about 92% for colorectal cancer and 42% for advanced adenomas, with a specificity of 87%. However, non-invasive and invasive tests can have false positives (indicating you have something you don't) and false negatives (failing to detect an existing condition).

???? Comparing to Colonoscopy: While non-invasive tests like Cologuard are convenient, they must be compared to the gold standard, colonoscopy. For colonoscopy, the sensitivity (ability to detect disease if present) for detecting cancer is 95%, and for polyps, it depends on size. Polyps larger than 10mm have a 95% detection rate, and for 6-9mm polyps, the rate is 75-85%. The specificity (ability to tell if disease is not present) for colonoscopy is over 90% for colorectal cancer and generally above 90% for polyps.

???? Requirements for Non-Invasive Tests to Compete: To compete with colonoscopy as a screening method, non-invasive tests need higher sensitivity and specificity, broader cancer detection, and fewer false positives and false negatives. Current blood tests like Guardant Health Shield and the Galleri test need improved accuracy in detecting early-stage cancers and precancerous polyps. Sensitivity for detecting colorectal cancer is around 83%, lower than colonoscopy's ~95%. Tests like Cologuard have shown sensitivity rates of about 92% for detecting colorectal cancer but only around 42% for advanced adenomas (precancerous polyps). These rates need to be closer to colonoscopy's sensitivity for larger polyps (>95%) to be competitive.

???? Insurance Coverage: Cologuard is generally covered by Medicare and many private insurance plans, making it accessible to a wide range of patients. Some liquid biopsies for cancer are approved for payment by insurance in the U.S., depending on the specific test and the insurer.

???? Why Develop Alternatives?: Despite the high accuracy of colonoscopy, alternatives are being developed because people often avoid colonoscopies due to the unpleasant prep, cost, inconvenience, and limited access to skilled practitioners in rural areas. The risk of bowel perforation and bleeding, though rare, and the necessity of bowel prep are significant deterrents.

???? Impact on Healthcare Providers: The anticipated shift towards greater use of non-invasive colorectal cancer screening tests is likely to lead to an overall increase in screening rates and a corresponding decrease in the number of colonoscopies performed. This shift could result in substantial cost savings for the healthcare system while maintaining or even improving patient outcomes through earlier detection and treatment.

Summary: How DocAi Can Help

Risk Assessment Models: AI algorithms can use large datasets to predict an individual's likelihood of developing colorectal cancer based on their unique profile.

Personalized Recommendations: By integrating data from electronic health records, genetic tests, and patient-reported outcomes, AI can provide personalized screening recommendations.

Decision Support Systems: AI-driven decision support systems can assist healthcare providers by presenting tailored screening options during patient consultations.

Monitoring and Follow-Up: AI can monitor patient compliance with recommended screenings and follow-ups, sending reminders and analyzing data to adjust future recommendations.

By enhancing the accuracy and efficiency of screening strategies, AI can contribute to better health outcomes and more effective prevention of colorectal cancer. This proactive approach, powered by AI and digital health solutions like DocAi, is a game-changer in the healthcare landscape.

Conclusion: Embracing the Health as a Service Paradigm Shift

The shift from invasive to non-invasive methods and from mid-to-late detection and treatment to early intervention represents the core of the Health as a Service (#HaaS) paradigm. By understanding people in the context of their lives and focusing on proactive, continuous health maintenance, we can achieve a revolutionary transformation in healthcare.

To reach this new horizon, we must look beyond our self-interests and empower individuals to take charge of their health futures. Some may feel tempted to "circle the wagons," a strategy destined to fail in the long run. Instead, we must innovate and evolve because it is our duty as healthcare providers.

Historically, we've focused on treating disease. Now, we must turn our attention to the future. We must establish an ethical business framework that views people as partners in health, not just patients with diseases. This partnership is essential for creating a sustainable and effective healthcare system.

Furthermore, the applicability of the HaaS paradigm extends beyond borders, offering significant potential to improve global health outcomes. By leveraging AI and digital health technologies, we can provide accessible, personalized care to underserved populations worldwide, addressing disparities and enhancing overall health equity. In many ways, countries with less developed healthcare systems have the opportunity to "leapfrog" traditional, costly practices and adopt these innovative solutions directly, avoiding the entrenched inefficiencies present in more established systems like that of the United States.

As the saying goes, "Physician, heal thyself: then wilt thou also heal thy patient. Let it be his best cure to see with his eyes him who maketh himself whole."

By embracing this shift, we can create a healthcare system that is more responsive, personalized, and ultimately, more effective for everyone, both locally and globally.