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Featured topic and speakers
Can AI diagnose mental illness? How will technology change pediatricians in the future? How is AI used in medical documentation? Who can diagnose autism in a child?
Our guest is Colleen Kraft, MD, MBA, past president of the American Academy of Pediatrics, a practicing pediatrician, and a professor of pediatrics at the Keck School of Medicine of the University of Southern California. American Medical Association Chief Experience Officer Todd Unger hosts.
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- Reforming Medicare payment
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- Reducing physician burnout
- Making technology work for physicians
Speaker
- Colleen Kraft, MD, MBA, past president, American Academy of Pediatrics; practicing pediatrician; professor of pediatrics, Keck School of Medicine of the University of Southern California
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. One of the AMA's top priorities is making technology work for physicians. Today we're talking about what that means to one physician and her patients. Our guest today is Dr. Colleen Kraft, past president of the American Academy of Pediatrics, a practicing pediatrician and a professor of pediatrics at the Keck school of Medicine of the University of Southern California in Los Angeles. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Kraft, what a pleasure to have you today.
Dr. Kraft: It's great to be on the podcast today.
Unger: Well, looking forward to talking to you about technology. Hard to avoid these days. Lots of discussion about it. Obviously, it can be a tremendous asset to physicians, but it can also be a burden if it's not developed or implemented properly. So let's just start with your own background on how you approach integrating new technology in your own practice.
Dr. Kraft: When I see new technology, I look to see where it first fits in the workflow of my office day. Is it something my nurses can do? Is it something I have to do? How do the patients access the technology?
Second thing is, how does it integrate with what I use day to day? Which is usually my electronic medical record. So if I have to log out and log in to something else, then that technology is really inferior to something that I can just access from where I'm already working. Third thing is payment for technology. I have to be able to bill and code and get paid for it to be able to use it.
Unger: Those are very practical considerations. I know you have a patient success story that illustrates how technology can help patients and, in your case, very young patients, which might be a surprise to folks. Tell us a little bit more about that.
Dr. Kraft: So in my practice as a pediatrician, I take care of a number of children with developmental and behavioral disabilities. And one technology is called Canvas Dx. It's an AI software-mediated developmental assessor and diagnostic for autism, is something that I have piloted in my practice.
I had two children come in a couple of months ago. One was a four-year-old boy with a diagnosis of autism. The other was a two-year-old girl, his sister, who had speech delay, couldn't eat, had difficulty with behaviors. And the task was this—the parents had moved from another state. Insurance was requiring that that four-year-old be re-diagnosed with autism before he could get services. And the family had another child with a clear disability.
What Canvas Dx was able to do, by taking parents' information, my assessment and then videos of the child that the parents took on their phones, was renegotiate that diagnosis of autism with the four-year-old. The four-year-old got the diagnosis, was able to get into the early childhood special education system and able to get into the therapies that really helped him out.
And that two-year-old, as it turned out, did not have autism but had some major difficulty with speech, and Canvas Dx was able to give me a block diagram of her strengths and her challenges so we could sit down with the parents and say, your child really needs to see a speech therapist. And six months later, she was diagnosed with speech apraxia, which is problems with the muscles around the mouth. She was given the right therapy, she was talking and she was eating.
Unger: Well, that's an amazing story. And what a successful case study there in terms of that connection between the implementation of technology and reducing the burdens just on your patients there. I'm curious, also, too, something that we're hearing a lot from pediatricians, primary care providers, is in this arena of mental health and the strain that that's put on, especially in the pandemic and post-pandemic days. Talk to us a little bit about that connection between digital health and technologies and mental health diagnoses. There's traditionally been a gap in addressing mental health issues in children. And if so, how does a new technology like this help to narrow that gap?
Dr. Kraft: That's a great question. I think the first thing that I would point out is that there is the same brain between developmental and behavioral technologies. And what we need to know is that, if a child has developmental disabilities, then you are much more likely to have behavioral problems later on. And this technology took a child who would have had a 9 to 12-month wait to see a specialist and was able to make those diagnoses in days. So the diagnostic part is really, really important.
The therapy part is important, too. And one of the things that we see in mental health that's emerging in technology is self-management. In between your therapy sessions, how could you actually learn some of the cognitive behavioral therapy skills? How could you do some of the speech and language types of things that might be important for that child to grow and to develop? This is something where technology can really, really be helpful for our families.
Unger: Now, we know that technology, when implemented badly, can put a lot of burden on physicians, and that burden can turn into burnout, not surprisingly. In a recent AMA survey, pediatrics was cited as one of the top six specialties for physician burnout. Dr. Kraft, are there any ways that you see technology helping you address not only your patients' needs, but also relieving some of these burdens on pediatricians that may be driving that burnout level?
Dr. Kraft: One of the biggest factors in burnout in pediatrics is not being able to get our patients to the right specialists when we know we need them. So if technology can shorten that process, make it efficient, give us some really great decision analysis, it will help us with our burnout.
The other thing that we really need in technology is for all the different technologies to work together and to do this in a method that is not overbearing and burdensome on what we have to document. So AI-induced help with some of our documentation, being able to edit, knowing that these templates are there and we can document easily but efficiently is something that's going to help us with our burnout.
Unger: Well, with any new technology like that—and you talked a little bit about AI helping you in some of the administrative sides—always going to be challenges with implementation. It's not just the technology. You've got people. You've got workflow, like you talked about before. How do you overcome challenges like that, and do you have any advice for others like you who want to use these new tools to treat their patients?
Unger: I think what's really important to realize is that, as you see something in technology and as you look to see where it can be helpful in your workflow, do a little bit of studying within your practice. Pilot it out. Do it on two or three patients. Very much our quality improvement. If it works for these two or three patients, what worked well? What didn't work well? Is it worth trying again? Or is it something that we should just scrap and do things the way we've been doing them?
Unger: I like that a lot. We talk a lot here internally at the AMA about a test and learn culture, and that's exactly what you're talking about right there. And of course, technology, the pace of change has just been incredible. That's not going to stop. So as you look forward to the coming years, what improvements or innovations would you most like to see in technology that you think you could put to use in your practice?
Dr. Kraft: So I would like to see technology—if you think about diagnosis, think about treatment, think about self-management, those are the areas that I would like to see. So technology that helps me get the right children in the right lines when it comes to specialists is going to be really important, and anything that we can do diagnostically or better screening within primary care that will be efficient and cost effective and take the burden off our patients will be helpful.
In terms of therapy, it takes so long to get in to see therapists. If there are some technologies that can really help out with my children in terms of socialization, in terms of reading, in terms of other types of medical diagnoses that they have, great. Let's bring it on.
And then, finally, self-management. The real cure for a lot of particularly developmental and behavioral conditions is really in teaching the patients what to do, what not to do, and how to practice that in your day to day life. And so technology that will do that will help us, too.
Unger: Absolutely. Dr. Kraft, thank you so much for joining us and sharing your perspective on how those issues around technology impact your patients and your practice. The AMA is working to accelerate the integration of behavioral and mental health care into physician practices through the Behavioral Health Integration Collaborative. The AMA also worked with the Manatt Health to publish a report on how telehealth and digital tools can advance behavioral health integration.
To learn more, check out the links in the episode description. And to support this work and the AMA's efforts to make technology work for physicians, we encourage you to become an AMA member at ama-assn.org/join. That wraps up today's episode, and we'll be back soon with another AMA Update. You can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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