"Digital Intern" poised to revolutionize healthcare

Josh Medow, left, medical director of the Neurocritical Intensive Care Unit at UW Hospital and Clinics, discusses a patient Image By: Jeff Miller and Jeff Miller

What do you think about when you imagine the future of medicine?

Many people have images of holographic doctors, robots performing surgeries and cold sterile hospitals devoid of human healthcare staff. But Joshua Medow, associate professor of neurosurgery, director of the UW Neurocritical Care Unit and a specialist in clinical informatics, has a much more welcoming vision of the future of healthcare. He is pushing towards it with the development of his "Digital Intern."

“When we were in the ICU one day, one of the nurses came in and said ‘you know, we need to do a lot more for management of organ donors, because if you’re busy managing two or three other really sick people, the organ donor isn’t going to have the care that they need to optimize their organs,’” said Medow.

Although organ donors and procurement sparked the idea for an automated managing system, it wasn’t long before Medow realized the value of his Digital Intern for a much wider scope of patients.

“It originally started off with the purpose of managing critically ill patients that were organ donors, but it’s expanded now to managing almost any kind of patient,” said Medow.

The implementation of the Digital Intern allowed Medow and his team to understand some of the valuable benefits of the software during the patient’s entire hospital stay.

“This is software that has the capability to improve not only the quality and timing of care delivered to patients, but also reduce the costs of care pretty substantially. That’s because it chooses the right drugs and labs at the right times,” said Medow.

Quality and cost of healthcare are primary targets for improvement in all medical fields. Medow’s unique biomedical engineering background and ability to marry the worlds of technology and medicine will help revolutionize the medical field by allowing doctors to provide better care for their patients and make high quality healthcare more accessible.

“You have engineers who can build anything, but they’re generally not getting medical training. And those that do often don’t use what they’ve learned in engineering to advance healthcare. You have this total disconnect, and that’s where I join the two fields together,” said Medow.

But don’t let yourself jump back to the thought of robots buzzing around hospitals and treating patients. Medow stresses that the Digital Intern is a piece of software, not a robot. He says a lot of people objectify the Digital Intern as a physical robot doctor, but in reality it’s simply a behind-the-scenes interface connecting the vast body of medical research directly with customized patient care.

“The idea is not to replace doctors. The Digital Intern is only an assistant to the medical provider. The doctors still set the parameters that they want for their patients — the software allows them to custom tailor care in an efficient and effective manner that suits the patient’s needs.” said Medow.

The Digital Intern can process hundreds of complex medical algorithms almost instantaneously. Medow demonstrated the Intern’s impressive decision making ability with an algorithm for running a ventilator, a common procedure in the ICU. The 26 page document detailing the algorithm was a tangled mess of a flowchart with constraints and decisions that are almost impossible to run through manually. The Digital Intern processes this algorithm quickly and efficiently, while processing multiple algorithms like this one simultaneously and in a manner that lets them integrate seamlessly.

“It’s like if you’re driving on this really awesome super highway, and there’s all these different exits. You can get off at any exit that you want to, and make your way to the same destination point. But if you do it this way it may be more efficient, that way may be less efficient, and yet another way may have a roadblock so you can’t pass through. This is what the Digital Intern runs through while it makes decisions,” said Medow.

While he is proficient in conceptualizing and implementing medical technology, Medow is an extraordinarily patient-focused doctor. He wants to use this technology to improve the lives of his patients and their families.

“It’s behind the scenes, it’s just like in the electronic medical records, [the patients and their families] don’t really see what’s going on. There’s no reason why they couldn’t though!” said Medow.

In addition to increasing transparency, the Digital Intern will help reduce the financial burden on families with a sick loved one.

“It’ll be critical care patients, general care inpatients and even some outpatient stuff that we’re working on now. I think it’s going to start inside the hospital where the biggest expenses are, and then move toward the outpatient side of things where they can also tackle smaller costs that occur very frequently,” said Medow.

The Digital Intern will help ensure the care that patients receive is value driven and of high quality. Unfortunately, this concept gets muddled in teaching hospitals, where practicing on patients is a major teaching tool. Still, Medow highlights the benefits to certain patients.

“Using the info button to understand why the [Digital Intern] made its decisions could be a great teaching tool too, but it’s sometimes not the same as practicing on an actual patient. Actual patients may not want to be practiced on though,” said Medow.

“There’d just have to be a little more creative thought put into how residents get trained if the Digital Intern was deployed to its fullest extent in a teaching hospital,” he added.

Interestingly, Medow explains that his competition at the moment is coming from neither changes in teaching nor from other companies developing similar products, but from the resistance of doctors to accept a product capable of making complex medical decisions.

“My biggest competition right now is doctors that are afraid of something like this taking their jobs. It will not!” said Medow, “The culture of medicine will play a part in people accepting the Digital Intern. I think a lot of that is starting to change though."

Medow maintains an optimistic view of the future. He believes the next generation of doctors can help change the culture.

“The good news is that the younger generation of physicians is very tech savvy. As the millennials come through all of this, they’re focusing on how to make life better for themselves and their patients,” said Medow.

As we move toward the future that Medow envisions, he knows the Digital Intern will play an increasingly large role. “We keep adding new algorithms to do new things. There will be a lot of outpatient development with time … [the Digital Intern] already covers over 40 algorithms, and it’s going to grow exponentially,” said Medow.

The Intern will help a patient through their hospital experiences and ideally back to health again, but it will also bring comfort to patients with poorer outcomes.

“[The Digital Intern] can manage end-of-life and hospice care. There are a lot of accurate scales out there for things like agitation and pain, and we can just plug those into the system so that the Intern can figure out how to accurately use medications to make the patient most comfortable,” said Medow.

As Medow revolutionizes the future of medicine, he stays focused on his patients and his research. His developments with the Digital Intern scrub away dystopian images of desolate hospitals, and replaces them with the philosophy that everyone can help to ensure a better future for healthcare.

“You just have to find your unique niche, and then hopefully you can make the world better because of what you’ve done,” said Medow.

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