Q&A: Dr. Ami Bhatt on Overcoming Challenges in Digital Health Innovation to Improve Patient Care

HEALTHTECH: Give me an overview of your career. How did you become interested in digital health?

BHATT: I started as a medicine and pediatrics resident in the Harvard program. I mostly did it because I had the Norman Rockwell illustration of a physician in mind: able to care for anyone who walked through the door.

Even before then, here was a day at Yale University when I was in med school on the pediatric cardiology service, when we were called urgently to the adult service at Yale Med, which isn’t usual. The way I picture it, we walked in with long white coats flapping in the breeze, arriving on the adult floor to help an adult with congenital heart disease. This patient was born a blue baby but had now grown past age 18.

Then, we were just transitioning from having more kids with congenital heart disease to them doing so well in pediatrics that we had more adults with congenital heart disease. That became a love of mine. I chose to use my medicine and pediatrics career then to further train in cardiology and specifically take care of this population.

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I started practicing in that field in 2009 at Mass General Hospital. Around 2013, it dawned on me that a lot of those young adults live very far away from the major hospital centers in major cities. In addition, they were young, with busy lives, school, and some were recently married with kids and a job. It was quite hard for them to get all the way in to see me.

That was right when stroke care in the Northeast, thanks to Mass General, was changing to a virtual model. We were using telemedicine to help stroke survivors at hospitals in rural areas who didn’t have access by providing supervised medical care. I thought, “Gee, this is great.” So, when they asked, “Does anybody else want to try this virtual visit form of telemedicine?” I said yes, because I wanted to deliver care to my patients in the communities where they lived rather than making them come to me.

That’s how it began. I had a clinic one day a week beginning in 2013, where my patients and I would see each other virtually. That’s how I first came into this idea of innovation in medicine and transformation of the healthcare delivery system. Once you start doing that, you think, “What else can I do for you in the community where you live to optimize the quality of your medical care?”

I progressively became interested in digital health and was focusing on it in addition to my day job of seeing patients in the hospital and being on call. Virtual care became my passion. However, from 2013 to 2020, nobody really wanted to join me in this effort. I tried to tell people how great it was, but the fact that people would have to change their workflows and how they thought about medicine was just too much to take on in addition to the other demands of being a physician.

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Then, in 2020, when COVID happened and people had to see their patients at a distance, suddenly there was an opportunity for those of us who had been innovating on the sidelines to help people understand the value of digital health, telemedicine and innovating healthcare delivery.

It also allowed us to create the workflows and infrastructure that nobody had invested in before. We were able to say, “This kind of innovation is important. Delivering care in the communities where people live is important. Therefore, we will create an infrastructure that makes that happen.” That’s how I ended up where I am today.

HEALTHTECH: What are some of the biggest challenges you’re seeing in today’s digital health space, and what steps do you think healthcare organizations can take to overcome those?

BHATT: I think one of the most important facets of moving forward and being successful in digital health will be crossing silos and working across industries. We’ve done a lot of work independently in academic institutions, startups and engineering schools, but it’s time for us to ensure that when an engineer has an idea, there is a clinician there at the table helping them see how it will reach the patient. There need to be providers, payers or systems at the table saying, “Here is how we can fit this in or create an infrastructure around this to help it actually be delivered to the point of care.”

We need all these groups to work together. Venture capital and private equity are putting a lot of money into some great ideas. They need to meet with individuals or groups like our own that have the clinical insights into what the market looks like and what cardiologists are experiencing. When we put that knowledge together, we’re that much more likely to create models of care and invest in technologies that will be usable.

I think that’s both the biggest challenge and the biggest opportunity. There is so much growth in digital health, but if that growth is running parallel to the practice of medicine and the delivery of healthcare, then to try and shove those two together is going to be very hard.

However, if we co-develop with all the right people working together from the beginning, we can figure out how to implement technology that solves for the question that people need answered right now. Then, you make healthcare better for the patient and the community at the population level. You also increase clinician wellness, because ideally you have created efficiency, quality and a mechanism by which the caregivers and the patients can do what they do best, which is connect.

So, challenge No. 1 is crossing silos. No. 2 is going from episodic care to continuous care. We take chronic diseases that happen 24/7/365 and then we try to manage them annually. Instead, what we need to do is monitor patients through the entire disease process. Then, when things start to change, we need to highlight them to their clinical team and say, “Hey, something is happening here. Now is a good time for us to potentially intervene, so let’s see what’s happening and change course.”

That’s a much better way to practice medicine and, at the end of the day, it feels proactive instead of reactive and is better for the patient, the clinician and the system.

HEALTHTECH: How can technology help increase care access and promote personalized care and health equity? How can healthcare organizations ensure technology doesn’t lead to greater disparities?

BHATT: When we talk about technology and equity, I think we must be specific. There are two different etiologies for disparity. There is access to technology when it is too expensive, too digitally complex, or only offered to certain populations and doesn’t end up reaching all the people who might need it. The second is whether we are using data fairly and equitably and how the data informs all the different technologies we’re using. We refer to these complex data analytics using the new term “collaborative intelligence” because we’re not trying to be artificial about our intelligence. We see computers as collaborating with humans to come up with the best solution for patients, whether it’s individual patients in personalized care or population health.

When we use collaborative intelligence, the analyses may be clinically aligned with our expectations, may show us new knowledge and lead to discovery, or may have missed something our human brain notices, and requires us to iterate on the analytic model. Importantly, we must ensure we are not feeding the system biased data or data that is biased because of omission (not having adequate representation of certain groups). 

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We have to make sure that we are getting data that is representative, and that we’re analyzing the trends we’re seeing and determining whether they make sense and are fair. Once we’ve assessed whether it’s a fair and equitable output from that analysis, then we can apply it.

In the next 12 to 18 months, learning to interpret varied data sources, including the electronic health records, social determinants of health, remote monitoring, wearables and more will be essential to the digital transformation of healthcare. 

Our next step is to align across industries as to what the purpose is for the use of data. We should ensure that we have important patient outcomes in mind. We have a lot of individuals, companies and systems coming to us saying, “We have a lot of data. What can we do now?” The first thing to do is say, “What are the pressing issues in medicine in the U.S. that need an answer?” Some of them are not terribly attractive but can change the face of health, such as with hypertension, which has been declared an epidemic in the U.S. Other areas are those where there is significant urgency to get things right.

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We have the highest rate of maternal mortality of any developed country. That rate is rising, and cardiovascular disease is a big part of that, which is why I, as a cardiologist, feel that we have the responsibility to think about how to keep these people in care as we innovate. What does prenatal care look like? What are the technologies and innovations coming out that can help us diagnose disease earlier or make people safer? There are opportunities to improve upon care in a meaningful way, but once again, as we begin, we have to think very carefully about where we get pregnancy data from and how we use it.

Those are just two examples of where there’s great opportunity to do things right, but where historically there has been an incredible inequity in the treatment of hypertension and maternal mortality in the United States. There’s an opportunity for us to make a difference using innovation.

HEALTHTECH: Are there any technology trends, solutions or use cases that are interesting you right now?

BHATT: There are quite a few groups thinking about the use of analytics and machine learning to analyze a single lead EKG and then tell you whether your heart muscle function is adequate or not. Right now, we do that by looking at you clinically and then getting an echocardiogram (heart ultrasound). To be able to have screening where you could determine which patients may have heart failure using a single EKG is a real game changer for the field of cardiology.

The second may sound like it’s further away, but it’s also equally close. In any field, the more times you do a procedure, the better you get at it. We know that, but the problem is you have to be in a big center to have a lot of volume. What about the rural areas? What about smaller centers? What about globally, where you may have a disease that can be treatable through an intervention, but the people who are practicing may not have the same experience as in the major centers? What can we do?

We can use virtual reality training. You could put on goggles that let you use instruments to practice doing your procedure repeatedly and get feedback that makes you better. It’s well established in certain surgical fields that this really does improve the timing, reduces the likelihood of making mistakes and improves the quality of care you can provide when you do the procedure in the real world.

Wouldn’t it be great if we could use that to increase the number of people who are able to do these procedures and bring the highest-quality care to less-served areas with significant cardiovascular needs?

The last innovation I’m really excited about is the area of food as prescription medicine. If we go back to hypertension as an example, you may find that there is one area that has more hypertension. Then you may say, “We need to have more doctors, nurses, pharmacists and medications available in that area.”

However, it may be a food desert, where there are more preserved foods and fast food than fresh food available. Therefore, there may be more salt-related hypertension in that area. You might need a food intervention rather than dedicating more medications or clinicians at that area. Fully understanding the population, community and medical factors that lead to disease is essential in treating the root causes of chronic disease in our country.

We need to be as open to food as prescription medicine as we are to single-lead EKG algorithms and virtual reality. All of these are equally important innovations, and no one of them alone is enough or more important than the other. That’s the great thing about healthcare innovation today: There are so many ways to be innovative, because being innovative means looking at the same problem through a different and collaborative lens. Rather than asking, “How can I change this,” ask, “How can we change this?”

HEALTHTECH: Are there any final points you want to make?

BHATT: I’ll end with a story. I had a Norman Rockwell illustration on my desk at the office for many years. It goes back to my wanting to do medicine and pediatrics and take care of anyone. I think I’ve learned two things from that.

One is that I always thought sitting with a patient and holding their hand was the most important thing. I still stand by that, but I stand by it thinking about the connection with that patient. I’ve had patients tell me that they want to hear the hardest news at home over a video, because they need to be surrounded by their family. I’ve had patients tell me that they don’t want to drive in to get challenging news, because the ride home alone for three hours is just too much to bear.

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I’ve realized that the Norman Rockwell concept is not necessarily one of the laying on of hands, but one of connecting with my patient and respecting them. Digital health is not what I and many people have been afraid that it is. It’s not a disconnection from your patients. In fact, it’s a way of bringing you closer to them by bringing you into the community where they’re living. It allows you to say to your patient, “I respect you, so I will come to you.”

That’s not what I had originally thought of when I saw the Norman Rockwell painting. Now I look at it and I really see it in a completely different way. I think that’s what the world of innovation has taught me. We need to give ourselves permission to start looking at health through a different lens.