Gaining Trust and Confidence in AI and Automation with Dr. Mohamed Alarakhia, Managing Director of the eHealth Centre of Excellence

A deep passion for innovative technologies and helping clinicians provide better care developed over years of experience for Dr. Mohamed Alarakhia, Managing Director of the eHealth Centre of Excellence. Dr. Alarakhia believes we are on the “Cusp of doing something quite different” in Canadian healthcare through the effective application of automation and artificial intelligence.

Show Summary

For this special edition of Healthcare Change Makers, HIROC is partnering with the Association of Family Health Teams of Ontario (AFHTO) to bring you the voices of health leaders on the cutting edge of advancing emergent technologies in clinical practices.

In today’s episode, we speak with Dr. Mohamed Alarakhia about artificial intelligence (AI), automation in primary care, and what the future of healthcare could look like.

Dr. Alarakhia is a family physician at The Centre for Family Medicine Family Health Team in Waterloo Ontario, a Faculty Digital Health Lead at McMaster University’s Michael G DeGroote School of Medicine, and the Managing Director of the eHealth Centre of Excellence.

When he’s not teaching or caring for patients, Dr. Alarakhia is focused on seizing every opportunity to make clinicians’ work easier by leveraging critical data and equipping clinicians with tools that automate day-to-day processes, such as his robot Bernie.

Although the COVID-19 pandemic inspired many to try innovative technology solutions to assist in rapidly-evolving care conditions, Dr. Alarakhia wants to ensure healthcare staff are better informed of the associated risks and opportunities with evidence-based studies. 

At the 2021 AFHTO conference, Dr. Alarakhia presented a session on “Artificial Intelligence and Robots in Primary Care” alongside Dr. Ervin Sejdić. We encourage you to listen to Dr. Sejdić’s episode of the podcast after this one to get a full understanding and appreciation of the critical work done by these experts.

Mentioned in this Episode

• Association of Family Health Teams of Ontario (AFHTO)
• The Centre for Family Medicine Family Health Team
• McMaster University’s Michael G DeGroote School of Medicine
• eHealth Centre of Excellence

Transcript

Imagine you could step inside the minds of Canada's healthcare leaders, glimpse their greatest fears, strongest drivers, and what makes them tick. Welcome to Healthcare Change Makers, a podcast where we talk to leaders about the joys and challenges of driving change and working with partners to create the safest health care system.

Welcome to Healthcare Change Makers, a podcast produced by HIROC. From communications and marketing, I'm Marc Aiello joined by Philip De Souza. Today we're speaking with Dr. Mohamed Alarakhia. He is a family physician at The Centre for Family Medicine, Family Health team in Waterloo, Ontario, a faculty digital health lead at McMaster University's Michael G. DeGroote School of Medicine, and a managing director of the eHealth Centre of Excellence. In living our vision, here are partners to gather perspectives from across the continuum of healthcare. Through this podcast, we bring you the voices of these leaders.

Marc Aiello: At the 2021 conference from the Association of Family Health Teams of Ontario, Dr. Mohamed Alarakhia and Dr. Ervin Sejdić hosted a session on artificial intelligence and robots in primary care. In this episode, we'll be talking with Dr. Alarakhia about artificial intelligence, automation in primary care, and what the future of healthcare could look like. On another Healthcare Change Makers episode, we also chat with Dr. Ervin Sejdić about how technology and data solutions can be applied to healthcare and his work at North York General Hospital. So we hope you'll check out that episode after this one.

Hello, Dr. Alarakhia, thank you for joining us on Healthcare Change Makers. To begin, can you tell us a bit about where you work and what you do?

Dr. Mohamed Alarakhia: I'm a family physician at a community-based academic family health team in Waterloo, Ontario. I am also the Digital Health and Innovation Faculty Lead at McMaster, the Waterloo Regional Campus of the Medical School. And then the Managing Director of the eHealth Centre of Excellence, which is a not-for-profit organization that works with the Ministry of Health and Ontario Health to deliver tools to help clinicians help their patients. And so those are some of the things that keep me out of trouble.

Marc Aiello: At this year's AFHTO Conference, your talk with Dr. Ervin Sejdić was all about AI and automation in primary care. Considering both the current and future state, can you share an example of how automation and AI are being embraced in today's primary care model?

Dr. Mohamed Alarakhia: Yeah, for sure. So it's interesting the healthcare system is under a lot of strain right now because of the pandemic and a number of other factors. And so people are looking at innovative new ways to do things.

With automation, we've seen clinicians really buy into tools that help make their work easier. And automation has done that through COVID and specifically with COVID vaccinations. We have about 830 physicians and nurse practitioners using automation to help with COVID vaccinations. And that is taking reports that in and documenting it in the patient chart so as that they're aware of that patient's immunization status. With one team, for example, it saved that clinic 87 hours of time by using automation. And that time is then better spent with patients and providing them patient care.

Marc Aiello: Time is extremely valuable in those situations. Where does your interest in what you do stem from? And what excites and motivates you about the work?

Dr. Mohamed Alarakhia: Yeah, I'm a physician and so I see the same struggles that physicians see. And I think as important is the impact on patients. And so what made motivates me is that I know we can do better. We've been able to leverage a number of different tools to help improve patient care, but we've really just scratched the surface. 89% of primary care has electronic medical records. But like our brain, we only use like 10% of their functionality. And so what I'm really passionate about is leveraging the tools that we have to make life easier for clinicians and improve care for patients.

And so every day, I really look at ways to make things easier, leveraging the technology that we have at our fingertips, and look at ways to implement it in not of a disruptive way and really a way that fits with clinician workflow so that they can get the most out of what they have and focus on what they're good at, which is really engaging with patients and providing optimal patient care.

Marc Aiello: One example of a healthcare technology we learned about earlier this year is your eHealth robot, Bernie, a technology that determines the care needs of a patient and then schedules follow-up appointments, which is an amazing development to address provider burnout. How has Bernie been received at your own practice?

Dr. Mohamed Alarakhia: Yeah, so Bernie was named Bernie because Bernie burns out. So clinicians and staff don't burn out. And so I think the first thing is really about understanding why we're doing these things. Why are we looking at automating processes? It's to make things easier for the healthcare team. And so I think once you set that context, people embrace the robots pretty warmly. In fact, we've had some clinicians ask if they could hug the robots because they've helped them so much in their practices.

And so for my practice, I would say a pretty typical patient practice in terms of patient comorbidities. The bots are really helpful to identify patients who have particular conditions and then trigger follow-up actions in the electronic medical records. So for whether a patient needs an immunization, or they need a follow-up appointment, or we've missed some billing for that patient, all that is automated so that we're able to determine, okay, I haven't seen this diabetic patient for a few months and I need to bring them in, I get an alert that allows me to understand that, and then we're able to move forward and get that patient in for appropriate care.

Marc Aiello: It's really great to hear how much these healthcare staff have really been embracing the robots in this way. What is one thing that is holding us back in terms of integration with automation and AI in healthcare?

Dr. Mohamed Alarakhia: Yeah, I do think with artificial intelligence, there is some hesitancy that people have because it's newer in healthcare. It's been around for a long time. And I think it's important for us to make sure that what we do is explainable. So there's something called explainable AI, which really allows a clinician to understand what's behind the hood. Why is the AI or automation doing what it's doing? And I think that's really key for us to gain trust and confidence.

Once we're able to do that, we've been able to spread the tools widely. I think people need to know what it does and be transparent about that. They need to know that it's private and secure. And then it needs to fit in with their workflow. So one of the other key things is to understand where a clinician is at. Clinicians are burdened with a lot of different things, particularly during the pandemic and then really meet them there. So if it's about making a back-office process efficient, then that's what you need to do. If it's about looking at how patients are engaged in a more effective way, then move forward in that area. So it's about really the robot family. We've got Bernie, Cody and Sharon and more coming that really allow clinicians to pick and choose the type of virtual assistant that they want.

Marc Aiello: So the eHealth Centre of Excellence has won several awards, including the Patient Care Innovation Team Award in 2019 from Canadian Health Informatics and an Ingenious Award, also in 2019 from the Information Technology Association of Canada, how would you describe the type of research and work done at the eHealth Centre of Excellence? And how is it helping move healthcare innovation forward?

Dr. Mohamed Alarakhia: Yeah, the eHealth Centre of Excellence is a not-for-profit organization that's really passionate about helping primary care clinicians, as well as integrated care teams, Ontario Health teams in Ontario to implement different enabling technologies to help with the care they need to deliver.

So it's really there as a support for clinicians to get their work done. And that involves being there with clinicians, providing change management support to clinicians to help them incorporate different technologies into their workflow, understanding their workflow, and giving them ideas for how that could be improved, supporting them with some privacy and security aspects of all the different initiatives that are there. And then also the evaluation piece. Clinicians, they value evidence. They want to know why they're doing something, what the benefit is, or lack thereof, of what they do.

And so when we go and talk to clinicians about different technologies like automation, artificial intelligence, we go with evidence about what it has done and where there are gaps and just be very open about that. And so we're able to present them that case and then they decide whether they implement something or not.

Doing research in a clinical context and understanding the impacts on what we call the Quadruple Aim so the patient experience, the provider experience, the impact on population health and the value for money is absolutely critical to explain why someone would do something. And in fact, doing something in the first place because you really wouldn't want to implement something that would make things worse for patients or providers.

Marc Aiello: You're a leader at several organizations, both in healthcare and academia. What's your top advice for other leaders also trying to be effective in the role while wearing different hats?

Dr. Mohamed Alarakhia: Make sure you have a 28-hour day like myself... No, I think it's really important to be passionate about what you do and make sure you're synergizing your different roles and you have that balance in your life. So I think that one can be more effective if they've got their personal life in order and they know when to start and stop doing things and they've done that self-care. So I think that's a big piece right now. A lot of leaders have been going full tilt for so long during the pandemic and they're struggling.

And so I think it's important to have that balance, first and foremost. And then as a leader, it really is not me. It's the group of individuals that you work with and it's the team. And so I think that's another important thing. And I think in the pandemic, it's been great to see people come together, organizations come together and work collectively. And that's what we've seen. It really is the leaders in the organization and the different organizations that I help that really make things move forward. And it's working collaboratively and understanding that you need to leverage everyone's skillset. It's a strengths-based leadership approach. And that's actually the approach that I've taken is looking at my strengths and move forward in that, but also recognize areas where others have strengths and they can fill in some of the areas where I am not as strong.

Philip De Souza: This is Philip here. I can sense that you have this great passion for what you do and how you want to make an impact and how you want to be that change maker. Where did this passion come from?

Dr. Mohamed Alarakhia: Yeah, I think it really is developed over time from seeing the opportunity that we have before us. So obviously through medical training, you experience a lot of different things, a lot of highs and lows in terms of emotion, looking after patients. And I feel that we have a great system, but we can do more. And we have an opportunity to do more to make it easier so that people don't fall through the cracks so that we give clinicians the tools that they need, so that information is flowing and communicate it effectively, so that people are doing value-added work and not repetitive routine tasks that robots can do.

So I think that has really driven me to find different ways. And I've done additional training. I did a master's after my residency in health information science really looking at how can we leverage data and technology to make things better? And I think there's a number of areas where we could do that. So I really feel that we're at the cusp of doing something quite different right now. And I've felt for a while that we have a capability to leverage tools that we're using every day a lot better.

And so I'm one who is opportunistic in that way that we need to move forward and actually make a difference. And I've seen that. I've seen where we've helped individual patients and patient groups. So that's what drives me. And I think it really is something that collectively we can move forward and make a difference, even if it's to one patient at a time.

Philip De Souza: No, it's fantastic. And that movement forward is exactly what we at HIROC want to see our community and our subscribers doing and so we can turn that corner on patient safety. But while you've been on this journey, I'm sure there's always ups and downs, but so how do you, or if you have any advice or maybe you haven't encountered it yet, but if there's some of your peers or colleagues as you're going through this journey who may not see the full potential or the value in how exactly how you said how we can use leverage this information to make people's lives easier, to add that value to the patient and the system perspective, is there something people can do to get that buy-in to bring people along for the journey? Any of those folks who may not be, I guess, have their mind made up yet, or they're like, "Yes, we definitely need to do this. We need to put this as a priority in our strategy?"

Dr. Mohamed Alarakhia: Yeah, I think it's important to have a healthy dose of skepticism with all of these things. It's important for us to understand what works, what may not work, what's right for the situation. And so I think having those conversations with individuals is really important.

I think just like any intervention in medicine, we need to have a particular amount of evidence around it. We need to have a rationale for using it. And we need to demonstrate that it works in a real-life context. And I think that's a journey. It's not often a yes or no. It's really about let's explore how this would work with obviously having the right evidence to start out with and then learn along the way. I think it's important to look at a learning healthcare system as one where you're iterating and continuing to improve. We need to aim for how to make sure that things are safe and that we improve outcomes, but we're also going to learn some things and we need to have a way to incorporate that.

I think once people see that you've got that perspective, it's not about, this is the greatest thing and why aren't you implementing it? It's about, here's another tool in your toolbox that you can use to help yourself and you can use to help patients. And I think once you have those conversations, once you have the conversations about what are the pain points in a person's day, you're able to find some common ground. And I think that's what it is. We're all on a journey to help improve the system. I think we know there's areas where it works well and areas where there are challenges.

And so I think if you frame it in that right context, you can collectively move things forward. And a person may not want to do a particular thing, but there's often something else that's bothering them. And really it's about meeting that person where they're at. So I think we're collectively, and we've seen that in the pandemic. We're collectively in this together. And we're all looking to move things forward. We may have different perspectives and that actually is healthy. And so let's leverage that to try to come up with better solutions.

Philip De Souza: Oh, I appreciate that. It's really good. I like the fact that you're absolutely right. We are a learning system and that's what makes it unique and makes it special. And reframing it so that we understand the pain points of a variety of people who have their hands in the system. So that's great.

Dr. Mohamed Alarakhia: Yeah, absolutely. Yeah, and I think it's really important that we have conversations around this and we learn from each other. So there's a lot of great things that are happening in our system. What we need to do is bring those things together and really look forward to how do we work together to, in a sustainable way, bring the system... Make the system better. So it's like all boats rising at the same time. That's what we need to do. We need to help each other to continue to improve our system.

Marc Aiello: Considering the type of work you do, I just have to ask, do you use AI or have any robots roaming around your house helping with day-to-day tasks?

Dr. Mohamed Alarakhia: You bet. Yeah, absolutely. I think obviously everyone has to do their own chores, but we've got an iRobot or Roomba that helps us out with cleaning around the house and then use assistance as appropriate for different tasks on the various different platforms out there.

So I think in our personal lives, we don't hesitate to use these virtual assistants in many different ways. And I would say in healthcare, there's a need now more than ever to do the same. And of course, we need to understand the different considerations in healthcare around privacy and security, but I see it as no different as our personal lives. We can benefit from the help of these robots in different instances. And so that's what I'm trying to do in healthcare. So yes, I do practice what I preach.

Marc Aiello: That's awesome. Thank you so much, Dr. Alarakhia for joining us on Healthcare Change Makers.

Dr. Mohamed Alarakhia: My pleasure. Thank you for having me.

Marc Aiello: You've just been listening to our interview with Dr. Mohamed Alarakhia. For more on healthcare technology, beta solutions, artificial intelligence and automation, don't forget to download our episode with Dr. Ervin Sejdić.

And while I have you, did you know HIROC has a guide on artificial intelligence? We encourage you to search for it under our website's resource section. For more information about HIROC and to listen to other episodes of Healthcare Change Makers, please visit hiroc.com. Thank you for listening.

Thank you for listening. You can hear more episodes of Healthcare Change Makers on our website HIROC.com and on your favourite podcasting apps. If you like what you hear, please rate us or post a review. Healthcare Change Makers is recorded by HIROC's Communications and Marketing team and produced by Podfly Productions. Follow us on Twitter at @hirocgroup or email us at communications@hiroc.com. We'd love to hear from you.