Here, I draw on my perspective as an academic gastroenterologist, informatics physician, and member of the "Oregon Trail" micro-generation to consider the mixed effects of healthcare's digitization on clinical medicine and how we can best move forward.

Can we apply today’s most exciting technology (generative AI) to help doctors with one of their most burdensome tasks (responding to patient portal messages)?

Yes! In this article, Justin Norden and I consider how large language models may add value at each step of the messaging process.

In 2020, the healthcare cognoscenti enjoyed predicting where telehealth use would settle: 50% of all visits? 33%? At least 25%!

Well.... today, telemedicine visits account for just 5% of all visits, primarily concentrated in mental health.

Though this far exceeds 2019 levels, it falls way short of predictions.

In this MobiHealth News essay, I consider four reasons the telemedicine genie is mostly back in the bottle:

1. Telemedicine does not always fit our physical bodies.

2. Many physicians do not like practicing online.

3. Patients like telemedicine less than we expected they would.

4. Healthcare pulls strongly towards inertia.

Still, Amara’s law – that “we tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run” – suggests telemedicine will ultimately become a core healthcare feature.

To get there, we must redesign telemedicine beyond video visits alone and reframe telemedicine as a complement to – rather than substitute for – in-person care.

Specialists dominate the US healthcare system. Most use the same processes, resources, and business models to deliver very different services. This “bundling” makes specialty care less accessible, affordable, effective, and pleasant.

In this Harvard Business Review article, I consider why and how specialists should unbundle and optimize their core services -- consultations, co-management, principal care, and procedures.

Forward-thinking practices and upstarts who unbundle specialty care will better align with their advanced primary care partners and better serve their communities.

In this Mobihealth News essay, I consider virtual care in gastroenterology.

Early in the pandemic, gastroenterologists were the 2nd leading adopters of virtual care. Now that stay-at-home orders have long expired, most GI practices have little incentive to provide care away from the office, and even less incentive to use virtual tools to reshape care fundamentally. Today, GI care is back to being delivered almost entirely in person.

Enter a group of virtual care upstarts with entirely different incentives. One group aims to fill the gaps in traditional GI care by addressing psychosocial factors, diet, self-management, and remote monitoring. Because they do not provide direct medical management, their key clinical challenge is integrating with local GI practices.

The other group includes virtual-first providers aiming to diagnose and manage GI conditions remotely. Lacking legacy baggage, they are designing care to be more consumer-friendly, efficient, and even effective. One of their key challenges is defining the right segments to serve. Virtual-first may not be a good fit for those with complex GI conditions who account for the bulk of total spending.

Though I know gastroenterology best, I believe these core issues are relevant across various clinical disciplines.

“Distance is not the opposite of presence: absence is.”