Mass General Brigham Launches AI-Supported Telehealth to Combat Primary Care Shortage

Mass General Brigham (MGB), a major hospital network, has introduced Care Connect, an AI-supported telehealth program, designed to address the nationwide shortage of primary care providers. This initiative offers patients remote medical care and video appointments, often available within days, a stark contrast to the longer waits typically associated with in-person services. The launch of Care Connect aligns with the growing integration of artificial intelligence across various healthcare functions, sparking vital discussions about its potential benefits, ethical considerations, and inherent risks, including concerns over privacy, diagnostic accuracy, and the broader impact on human medical professionals.

The program's launch coincides with increasing integration of artificial intelligence across various healthcare functions, sparking discussions about its potential benefits, ethical considerations, and risks, including concerns over privacy, diagnostic accuracy, and the impact on human medical professionals.

The Primary Care Crisis in the U.S.

The United States is grappling with a significant shortage of primary care providers, impacting an estimated 17% of adults nationwide. This challenge is particularly pronounced in Massachusetts, where reports indicate a faster decline in the primary care workforce compared to most other states. Patients in the region often face waiting lists that can extend for a year or longer when seeking a new primary care physician.

MGB's Response: Care Connect Program

In September, Mass General Brigham launched Care Connect as a direct response to these critical access issues. This AI-supported telehealth program aims to bridge gaps in primary care availability by offering virtual consultations.

Bridging the Gap with Virtual Care

The Care Connect process begins with patients describing their symptoms via an app to an AI agent. This agent then compiles a summary for a remotely located primary care doctor, who subsequently provides care through video appointments, often within one to two days.

The program operates 24/7 with a team of 12 remotely located physicians. It is equipped to address common urgent care needs, such as colds, rashes, and sprains, alongside mild to moderate mental health concerns and issues related to chronic diseases. The integrated AI tool further assists doctors by suggesting potential diagnoses and treatment plans.

Program Scope and Future Plans

Currently, Care Connect serves 15,000 MGB patients who do not have a primary care provider. By February, MGB plans to expand the service to all insured residents of Massachusetts and New Hampshire, a move that will necessitate the hiring of additional physicians. Patients can utilize the program for urgent care needs or opt to designate a remote doctor from the service as their permanent primary care provider.

MGB has committed $400 million over five years to primary care services, a sum that includes the Care Connect initiative. Ron Walls, MGB's chief operating officer, emphasized that Care Connect is part of a broader strategy, which also encompasses retaining existing physicians, recruiting new ones, and increasing staffing support. Helen Ireland, a primary care physician managing Care Connect, noted that a segment of patients is expected to value the 24/7 virtual model. It is important to note that the program is not intended for emergency care or physical examinations, referring patients who require tests or imaging to physical clinics.

AI's Expanding Role Across Healthcare

Care Connect represents just one facet of a broader trend seeing AI integrated into various routine medical tasks, including note-taking, reviewing diagnostic results, billing, and supply ordering. OpenAI reports that hundreds of millions of individuals consult ChatGPT weekly for wellness advice, and in January, the company launched ChatGPT Health, described as a platform with enhanced security for medical data sharing. Other AI tools, such as My Doctor Friend, also assist patients in healthcare navigation.

AI's capabilities are increasingly influencing how patients access health information and how medical practitioners diagnose and communicate. Some observers, like cancer survivor Dave deBronkart, suggest that AI can aid in identifying rare conditions due to its capacity for extensive patient inquiry and access to specialized knowledge bases. Patients report using AI platforms for daily well-being and managing chronic conditions, often in conjunction with professional medical care. For instance, Burt Rosen, diagnosed with two types of cancer, reported using AI to manage symptoms, track correlations, explore treatment options, and translate test results, which he stated altered his interactions with his oncologist towards action planning. Dr. Robert Wachter, chair of the Department of Medicine at the University of California, San Francisco, has also noted using AI Scribe, and his colleagues have rapidly adopted OpenEvidence, an AI tool for comprehensive medical knowledge.

Perspectives on AI in Healthcare: Benefits and Concerns

The integration of AI into healthcare has elicited a range of perspectives from patients, providers, and experts.

Arguments for AI Integration

• Proponents suggest AI can alleviate staff burnout and shortages by reducing administrative workloads, thereby increasing efficiency.
• It offers rapid access to care, which is particularly valuable when in-person options are scarce.
• AI-generated chat summaries can enhance physician efficiency.
• Allon Bloch, CEO of K Health (developer of Care Connect's AI platform), asserts that technology and AI are essential for addressing healthcare challenges related to cost, quality, and access.
• Studies indicate that large language models perform competitively with humans in simulated diagnostic tests, with some research noting AI systems' ability to identify difficult cases.
• Dr. Wachter expressed optimism regarding AI's contributions to healthcare, suggesting its benefits may outweigh its risks and viewing it as a necessary aid for a struggling healthcare system.

Key Concerns and Criticisms

• Critics express concern that AI may overlook complex patient details, socioeconomic factors, or a patient's ability to afford or access follow-up care.
• Some primary care doctors within MGB, including those involved in unionizing efforts, have voiced concerns that investment in AI should instead be directed towards increasing salaries and retaining primary care staff. They express fears that Care Connect could inadvertently diminish access to in-person primary care over time, characterizing it as a temporary solution rather than a fundamental fix.
• Concerns have also been raised about patient privacy and the potential for AI to displace human jobs. ChatGPT Health, as a consumer product, is not subject to the same health privacy regulations as clinical medical provider systems. OpenAI is currently involved in multiple lawsuits concerning mental health, including allegations of psychological harm.
• Both patients and medical professionals emphasize that AI should not replace human doctors due to risks of misdiagnosis, misleading advice, or human misunderstanding without clinical oversight. Dr. Wachter described a case where AI incorrectly advised a patient to use ivermectin for testicular cancer, potentially delaying appropriate treatment. Another reported instance involved a patient experiencing paranoia and hallucinations after consuming sodium bromide, reportedly on ChatGPT's advice for salt intake reduction.
• Dr. Steven Lin of Stanford University School of Medicine suggests that AI tools like Care Connect are safest for acute urgent care issues, such as respiratory infections or sprains, while emphasizing that ongoing management of complex chronic conditions benefits significantly from regular in-person human interaction.

Despite the identified hazards, the integration of AI into the healthcare system is described as rapid, with observers noting that future generations of patients and doctors may experience an easier learning curve with AI integration.