IGF 2024-Day 4 - Workshop Room 3 - DC-DH- Health Digital Health & Selfcare - Can we replace Doctors in PHCs

The following are the outputs of the captioning taken during an IGF intervention. Although it is largely accurate, in some cases it may be incomplete or inaccurate due to inaudible passages or transcription errors. It is posted as an aid, but should not be treated as an authoritative record.

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>> Rajendra Pratap Gupta:  Our goal as IGF is, you know, to shape the Internet we want, and it's a constant body of the United Nations that advises UN on Internet‑based issues.

I'm Dr. Rajendra Pratap Gupta, and I share the dynamic coalition on digital health, digital economy and environment.

This session is the dynamic coalition digital health session.

With me, I have Dr. Peter Preziosi from United States, the president of CGFNS.

I have Dr. May Siksik of the Innovation Network Canada.

I have Mevish Vaishnav, President of Digital Health Associates and Head of Patients' Union.

I have Zaw Ali Khan from the American University of Barbados.

And I have not missed anyone. I am myself here with you.

So let me first walk you through why this is important session. Because all throughout, we have been talking about technology, technology, technology. And every sector has embraced technology. Health care is the last one but look at the impact it can create.

So I want to take you back to history.

Let me check in the slides move.

So this is the session we hosted last year at IGF in Kyoto, Japan, where we talked about conversational AI and low‑income and (?) Settings.

The whole idea was to check the level of awareness people have on the word "conversational AI," and what is the relevance?

To most of us who are in this field, it's chatbots.

But, trust me, despite asking people we couldn't get a speaker from our vast network when we wrote we needed speakers on conversational AI, so‑called president of the Association in Digital Health said, We do not know this field.

Actually, it is chatbots.

We had a very good panel with us that time, the head of AI at WHO, the president of Humans.ai, Sabine Dino, who is the CIO of United Nations top pension fund, and Dr. Oliver (?) From Nigeria.

We ran a good session.

A year now, we're actually talking about will AI replace doctors.

But let's go back 10 years into history.

I think I need to check.

Can you move the slides, please.

As the chairman of the board for (?) India, 10 years ago, I told doctors that the future is ‑‑ this is what the slide was, that technology eliminates middlemen. Today, few doctors don't need technology and technology won't need them in the future.

Ten years fast forward, we're headed into 2025, just a decade after, and look at what has happened. Let me also go back to share what I presented at that point in time.

I think I need more clicks.

There's some issue with the presentation. We're just going to sort it out.

I think whenever we talk about doctors and AI, some technological glitch comes in. I'm not surprised. They're a very powerful stakeholder in this discussion.

Can we manually move the slides, please? Can we?

Let me tell you, technology moves faster than I can. I'm sorry. That's the way it is.

Sort it out?

So ‑‑ no, no, no.

So look at this slide. There's few who have used the booths to go and make calls and the long‑distance calls, and what happened when the cell phone moved ‑‑ technology moved from analog to digital? We can make cell phones wherever we want whenever we want. So now you can use your watches to make phones. So technology has progressed, and what it has done is eliminated the middle person. You don't need to go to a booth. You don't need to use (?) To make a call. Sometimes I don't use my phone at all.

Next slide, please.

And this is another interesting slide on the entertainment sector. We had a huge antenna. Sometimes it was 70 feet. You need to connect to watch maybe seven or eight channels. What happened with when it moved from analog to digital? You moved to a set‑top box. Now, anything you want to watch, you just pay for it, and it's at your convenience.

What it does is technology is taking that middleman away.

Again, it took the middleman away. You don't need a set‑top box. You don't need a provider of the service in the area. You're connected directly through the satellite system.

Next slide, please.

This is my most favorite slide. At one time, Kodak and Fuji were fighting for the color of the prints.

Canon is actually the one which came in. What appeared was both of them literally became bankrupt, but that was not the end of the story.

We have mobile phones which have the camera. So you can look at what has happened. We have moved a whole generation, moving analog to digital.

Now, in everything you see, we eliminated the middleman. Same happened with libraries and the bookstores. Today, you have your kindle or book reader, and you can read whatever you want. I carry hundreds of books on my kindle.

Technology gets you closer to the user and eliminates the connector.

Now, if I take these slides back to my health, what I believe is that when a product service or a sector undergoes a digital transition, analog to digital, intermediaries (?) Health care has a lot of intermediaries right now.

I think the faith of the clinicians is a foregone conclusion. This is what I've been saying for over a decade. I'm going to stop here and look at asking my expert panel, which is with me, what do we feel about the future? Are we going to have a day where AI will see you now is going to happen instead of the doctor will see you now?

So I'm going to put this question to Dr. Peter Preziosi.

Dr. Peter, thank you for joining us. I think it's too early or too late in the night for you to join us. I'm sorry for the hour but thank you for taking our time.

Peter Preziosi is the president of CGFNS Global, and he has done extensive work in terms of trying to provide relief to people where clinicians are in short supply through nurses.

Dr. Peter Preziosi, what is your experience of working in Rwanda? What do you want to share with us?

>> Peter PREZIOSI:  Sure, definitely, and I'll be very brief. But, Rajendra, I agree. I think it's here and it's coming. I agree with you about the displacement as we look at these medical brains that are coming that are powered by AI and AI engines that are looking at technology.

Just for background, I lead a 50‑year‑old global assessment and certification organisation supporting the mobility of nurses and allied health professionals worldwide. Earlier this year, we began searching for the right partners to evaluate some technology‑enabled new models of care in the primary care and public health space.

Working with the Society for Family Health in Rwanda and a remote patient monitoring device manufacturer MedWand, what we did is set out to establish a model of nurse‑led primary care that would be easily replicated across the globe, cost‑effective, co‑dependent on technology, and one that promotes access to care and prevention.

This model will contribute to already existing task shifting initiatives that help to bring care closer to the communities.

The Society For Family Health is Rwanda's premier organisation for providing health care to rural communities in Rwanda, operated by nurses. Under our protocols that we've developed, we've embarked on a journey that we believe will impact health promotion and prevent care around the globe.

We see this by empowering nurses, community health workers and other allied health professionals by equipping them with the right tools to give care and the seek a second opinion when they have to.

This is still emerging, what we're looking at. We believe this care solution will reduce the number of referrals that are transferred to upstream health facilities that are already crowded and lack adequate resources and make the model an integral part of primary health care.

The model will contribute to job creating by allowing nurses to increase their health care portfolio and entrepreneurship.

So far, we're in five remote locations that have been identified in rural Rwanda that center around designated health posts and district hospitals.

Health care workers at those locations have been trained on the med wan device that captures vital signs and is critical in providing primary care.

So within this remote patient monitoring device, it includes a thermometer, stethoscope, ECG/EKG, pulse oximeter, a high‑definition camera that can be used to view inside the ear, nose, throat, skin, as well as integrate with any blood pressure monitor, glucometer, and spirometer.

The device is synced with a tablet which is used to capture, store, and transmit information and also make it possible to have real‑time consultations via video conference.

Early indicators have been very positive. The health post workers have shown the ability to adapt to the technology and have communicated the anticipated decrease of time needed for diagnosis with the ability to send data real time to advance practice nurses.

The community has shown an increase to receptiveness and indications of better compliance when diagnosis is accelerated. Travel times and distance are reduced significantly.

The staff receiving information in hospitals in the major hubs are less burdened to have to track data, and their response time is reduced on their behalf as well.

So, overall, we're confident that our original intent will have the strong and empirical data needed to impact the lives of many by reducing cost, improving health, increasing reach, and empowering a new upskilled health workforce.

Over the next few months, we'll be gathering hard data to prove that the nurse‑led primary health care models can have an impact in rural communities in Africa and also beyond in other continents.

Thanks, Rajendra.

>> RAJENDRA PRATAP GUPTA: Thank you so much, Peter. I think you made very important points of moving from a doctor‑centric system to other health professionals like nurses. And we have our work that we're doing with nurse and pharmacists, and we believe the future of health care lies in digital health plus nurses or digital health plus pharmacists and not just necessarily doctors.

That being said, are you also leveraging artificial intelligence and empowering nurses to take on smart decisions with regard to patients' queries, needs, and serving them?

>> Peter PREZIOSI:  We have a new initiative actually funded through Johnson & Johnson that will be started in Ghana. It's AI‑powder sonograms to detect hypertension in pregnant women to prevent the maternal child deaths that are so prevalent in Ghana.

So we're looking at that. There are other initiatives, some point‑of‑care solutions that we want to test if other areas. And, actually, we started to talk with you and would love to work with you on looking at various primary care providers that could really help.

I think nutrition, registered dieticians, it will be very useful. You know, I'm pleased to see that the International Patients' Union is on this panel because I think that's an important role to really look at this from a consumer perspective.

I think what we are going to have to look at is helping to provide self‑care solutions to the patient community before they even need to get to nurses, allied health professionals, and others.

>> RAJENDRA PRATAP GUPTA: Thank you so much, Peter. I think it makes my job easier to switch to the Patients' Union representative here.

Mevish, you run the Patients' Union. Is there something you want to share with this panel on the prospects of replacing the need for doctors in settings where you just need medications or acute‑care problems, and what are you doing in the area?

>> MEVISH VAISHNAV: Good morning, everyone. This is Mevish, and I lead the International Patients' Union. In the health care sector, if you see everybody is organised, be it doctors, nurses, pharmacists. But patients are the one who are unorganised. Nobody hears them.

So at international patients' union, we have a platform, the Patients' Union, where we provide a platform for the patients to voice their opinions and share their views. They can share their views with other patients so they can get well managed for their diseases. And if you see at Patients' Union, we're making artificial intelligence the authentic intelligence.

Medical science is a science. So if you say, I have a fever ‑‑ I give you the medicine. If you have a cold, I give you the medicine for pain. If you have pain, I give you medicine that's for pain, a painkiller.

If this can be put into a system, an AI bot, it can help doctors as well as patients. Patients don't need to travel from 40 kilometers or 30 kilometers for primary care. The doctors can be saved from their timing to see these secondary care and tertiary care surgeries. And through this system, we at Patients' Union are developing a program. We have launched the Patient (?) Index through which every system has been put like the symptoms of the diseases. If you just open your app and say, I have the following symptoms for my knee pain ‑‑ it will tell you the diseases and the right prescriptions for it. So we can save time for doctors.

So, yes, AI is important and can be helpful in the primary care.

>> RAJENDRA PRATAP GUPTA: So you're saying, Mevish, that patients in India will be able to get their information about health care needs not from the net, which is unverified but from the Patients' Union without even needing a doctor? Is that right?

>> MEVISH VAISHNAV: Yes.

>> RAJENDRA PRATAP GUPTA: So, effectively, this is the first experiment of its kind where patients can get information about primary care from an artificial intelligence‑backed system.

>> MEVISH VAISHNAV: Yes. Yes. It's an authentic data that will help them.

>> RAJENDRA PRATAP GUPTA: Fantastic.

Zaw Ali Khan is with us from the American University of Barbados. You run an academy (?) But you also are a tech czar in terms of bringing new tech to health care.

Given what's going on around the world, do you think it's time for us to prioritise where we invest clinicians' time and how much of the role it plays with technology? What is your view on that?

>> ZAW ALI KHAN: Thank you, Dr. Rajendra, for inviting me to this session.

I feel there are certain many use cases where the clinician's role can completely be eliminated, not just for the sake of providing convenience to the patient but also for reducing the workload of the doctors themselves. So there are plenty of use cases that would see the replacement of doctors for technology altogether, but there are certain, I feel, challenges where it's a softer approach, which will help, because as far as the regulatory issues are concerned, you need to have doctors onboard to approve these tools. In order to have them onboard, you need to make them feel safe and give them the confidence to use these tools.

So, for that, I feel the role of academic organisations is paramount because the doctors that have already practiced their whole life in a certain way, asking them to change, asking them to adopt a new thing, means that you're telling them that whatever they've been doing so far, there's limitations in that. That's a very hard pill to swallow.

Instead of that, if you highlight their own challenges and how tools and technologies are sorting those issues, then they would be more onboard with this idea, and this is what I'm talking about, the more experienced doctors who are at the tail end of their career. But, of course, they are the stalwarts. If they were to join these pioneering efforts, then everyone else would follow.

At the same time, you need a new generation of doctors who are capable of navigating these digital tools.

So over there, again, the academic organisations have a role of making sure, first of all, these academic organisations, any of the teaching hospitals, they themselves need to adopt more and more digital health solutions so they can demonstrate to the students. Unless they adopt it themselves, they won't be able to demonstrate.

Secondly, once they have demonstrated all of that, they need a structural course for that. We have been fortunate enough to partner with the Digital Health Academy for providing our students with an elective for digital health. There's experts from around the world ‑‑ more adoption of health tools by making sure the providers are not threatened from the get‑go. It's not a threat. The main problem you're trying to solve is the shortage of health care workers. A related problem you're trying to solve is health care worker burnout.

So if you're solving burnout, every health care worker would help you achieve that goal.

So focus on burnout. Focus on burnout from the perspective of patients and health care providers. From the perspective of health care organisations or health care systems. Focus on the shortage of health care workers. It's the same problem, just with three different angles.

And once you've done that, all the stakeholders will come together to adopt more of these solutions and ultimately, of course, everyone, once they start seeing the benefits, I'm sure that one or two generations down the line, they would be surprised that, oh, we used to have PHCs?

That's the future I envision, and I hope we're able to accelerate that.

>> RAJENDRA PRATAP GUPTA: This is very interesting, the point that you make. And, you know, at the Academy of Digital Sciences, where we run courses on the doctors, our experience has been very different. The doctors take classes with 30, 40 years' experience. When they pass the course after one year, they're as excited as kids, sending what they created to their sons, grandsons, and their unfounded fierce become the forces that help them.

So that's what we've seen in doctors.

What is a call to action for clinicians, everyone, I guess, is like the slides I showed, you know, the technology didn't wait for the sector to evolve. It just disrupted it.

So the fact is whether doctors adopt it or not, the technology is going to invade their turf. That's a fact of life.

It's shown that some of the specialties will get totally replaced, which is a very strong statement to make, but when I look back at the statements made 10 years back, they actually come true.

I think fields like radiology, dermatology, AI can do a phenomenal job there, but there are surgeries where robotics plus surgeons are needed. Specialists may be needed for neurology and other cardiology sectors. But AI is getting mature with time. I mean, that's what we've been seeing.

Now let me get to Debbie Rogers, a journalist from Africa.

Debbie, you run a village outreach in Africa, and countries like India, Africa, and other LMIC countries, there's a huge shortage of doctors. What do we do? Do we wait for doctors to get prepared and, you know, be BBS, MD, MS, or do we bring technology? Because there's nothing that exists.

What do you say?

>> Debbie ROGERS:  I definitely am a proponent of bringing technology into the mix to relieve some of the burden on the health care system. In sub‑Saharan Africa, we have 14% of the world's population but 25% of the world's disease burden and only 3% of the health workers.

So if you look at those stats, it's very easy to see if we just keep trying to train more and more health care workers, we're not going to get anywhere. We have to be using technology to be able to augment the work of the health workers.

And the way we think about this is we think about moving care from the facility that a lot of workers happen to move care into community with community health care workers, but you can move things to one's own home. We use simple technology, like SMS and WhatsApp. We use it to access services at the right time.

We've been running this program for 10 years in Africa called Mom Connect. Every mother who goes in for a visit is signed up on the platform. It's to help her understand how to better care for her baby. We've seen great results both on self‑care, so things like better nutrition and uptake of breastfeeding to access to services like uptake of family planning and improved attendance of A&C visits. So something as simple as an engaging platform. You don't have to have training. It's something you can communicate to your friends and family. It can alleviate a lot of burden on the health care system. The health care workers can be doing the work that they really need to be doing and not the work that can be taken over by technology.

I think, for me, I don't know if we can say, necessarily, that we will replace doctors, but I certainly believe that doctors who use AI and use technology will definitely be replaced by those who don't. I mean over the way around. Those that don't will be replaced by those that do because I think it's going to make their work so much more efficient and effective. It's going to make patient experience much better, and people are going to (?) With their feet, and they're going to go where the patient experience is better.

I think that's definitely where I see things going. It's very much more task shifting. Different tasks going to different cadas health workers, and those who use AI and use technology are definitely going to be replacing those who don't.

>> RAJENDRA PRATAP GUPTA: Debbie, you have been always saying that (?) But do you think there could be an extension of this saying that the health care workers who use technology will replace doctors who don't?

You know, because I can tell, you know, this is not coming just because I'm sitting on this dais and (?) Idea what I'm saying. There's hospitals where they segregate the high‑risk pregnancies with normal pregnancies, and I was told by the chairman of that hospital ‑‑ who is a doctor ‑‑ this hospital has been around for 76 years ‑‑ that in normal pregnancies, the mother does not see a doctor even after delivery. It is the nurses who handle it. And they use technology.

Just imagine how much precious time of the doctor is saved because the delivery happens only through nurses, and this is not a small number. I mean, I'm talking of India, and this hospital has been doing it.

I'm getting to the stage to conclude. I've always been an evangelist of technology. I was a skeptic, in the beginning, thinking it will not happen. But, as I've seen over the last few decades, I think technology has been showing itself with great commitment and efficacy now.

Do you think other health care professionals, like our friend Dr. Peter is doing in Uganda.

I see your numbers. India has the same problem. You have 25% of the disease and 3% of the workers No. Where on earth are you going to match them in the next few decades. No way.

>> Debbie ROGERS:  Yeah, I agree there's going to be massive task‑shifting and things that we were previously deemed as only able to be done by certain specialists is going to be able to be done by somebody who does not have the same amount of training plus technology. So I do think that task‑shifting and moving from one cada to another is definitely going to happen. And we see it happening already, just out of necessity.

In sub‑Saharan Africa, there's not enough doctors to reach everybody. So a huge amount of the care is already on nurses.

I do think, though, we have to think carefully about the fact that we still have too few nurses and too few community health workers, and we industrial a problem of burnout, which means as fast as we're training people, we're losing them.

And I think we have to think very carefully ‑‑ and I do believe this is an important role of technology ‑‑ removing the burden from health care workers so they can do what they really need to be doing rather than things that can be done by technology.

And I think that's going to help an enormous amount to relieve that huge dearth of health care workers that we have worldwide, not just in sub‑Saharan Africa.

>> RAJENDRA PRATAP GUPTA: Thanks, Debbie. And I'll add to that. We're real lucky to have one of the leaders in India who is the  president of the Indian Nursing Consulate, Dr. Dalip. You know, what we have done at the Academy of Digital Health Sciences, we have partnered with him to train 2 million nurses on digital health and same thing we have now done with pharmacists. We're going to train 400,000 pharmacists on digital health. I think these could do phenomenal work. And I think by next IGF, we'll be able to show the impact we have created. Between now and then, we should aim to touch a half‑million of them trained. Eventually, maybe 3 million nurses and pharmacists will take some of the roles.

Having said that, now I have with me Dr. May Siksik. She runs the Innovation Network Canada.

May, you have been leading the Innovation Network, and you're building a new health care model. Where does technology fit in the model? Is it going to be more dominant than the clinicians or just back again to the same old model? Going by the fact that Canada is among the countries that pioneered digital health. My very dear friend Richard Alvarez was the president and CEO of (?) ‑‑ the first government organisation to implement (?).

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>> MAY SIKSIK: Thanks, Rajendra. I wanted to say that Debbie has brought up really important statistics and some critical information here. Sorry. The demand for health care (?) ‑‑

(Audio is cutting in and out).

>> MAY SIKSIK: ‑‑ and supply (?) So the system is destined to crash at some point. So from my perspective, again, it's going back to these stats. We really need to have technology take care of what is on doctors and nurses. I think that's really important.

So in the system that we've developed, one of the main concerns right now ‑‑

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>> ‑‑ I base diagnosis and so on is the fact that large language models will not hallucinate. This is one of the things we're working on.

(Captioner has lost audio)

>> MAY SIKSIK: One of the things that we really need to address is hallucination. Right now, AI‑based diagnosis cannot be FDA approved or Health Canada approved. Right? So this is one of the things that we're working on right now. I think we need to address that. And we're working actively at Innovation Network with academic organisations to address this issue so that we can actually have an AI‑based system that can be qualified to do such tasks without a human supervising it.

And I think that's really important because then we can save a massive amount of time from health care professionals.

In Canada, doctors get paid by every 15 minutes. Most of the time, it's very difficult to actually address a medical case, especially with complex medical cases, within 15 minutes, which means they're not really able to do their job as well as they can and they should.

The way I think about it is that it's having, for example, AI‑based medical diagnosis is like having a copilot for doctors. You wouldn't set foot on a plane that doesn't have a co‑pilot for redundancy.

We go to doctors ‑‑ I work with a lot of physicians. I hear from them that mistakes are often made, and often they get buried with doctors.

So it's important to have these tools with doctors to empower patients and also empower doctors as well.

Another aspect I want to bring is the fact that I don't think they will ever be able to ‑‑ AI will ever be able to completely eliminate doctors. I think we'll always have ‑‑ but we'll save tremendously, in terms of the time that's needed from doctors.

There are two aspects here. One is the fact that we are human beings, and we often need that interaction and assurance from doctors. We also need to understand, especially for complex medical issues where we need to look at different factors like ethnic background and culture and so on. You need to have that contextual understanding.

Now, having said that that's been a huge source of medical errors that actually led to, you know, fatal issues for patients. So it's double‑edged sword. Doctors can be really good at understanding contextual cases but they can make mistakes because they're drawing patterns and so on. So going back to having the copilot of technology is really important.

>> RAJENDRA PRATAP GUPTA: If you were to start moving from your driver versus automation vehicles ‑‑ would you do that?

>> MAY SIKSIK: Would I use an anonymous driving vehicle?

>> RAJENDRA PRATAP GUPTA: Yeah.

>> MAY SIKSIK: So, in fact, I have actually worked in compliance for a safety standard for anonymous driving vehicles. I've worked very closely in this field. I can tell you my job was actually to really oversee where mistakes can happen and the system could result in fatal issues. It was quite a complex process. And you can see that mistakes could happen, and compliance is extremely important. So you really need to have a standard where you actually have to check things.

So this is going back to we really need qualify AI.

>> RAJENDRA PRATAP GUPTA: And this is the month of May I was in the U.S. delivering the opening address at ADA, and I decided to use an anonymous vehicle. I didn't have a problem. You know?

>> MAY SIKSIK: Yeah.

>> RAJENDRA PRATAP GUPTA: To a doctor, you go once a year, probably twice a year. If you're a chronic patient, multiple times.

>> MAY SIKSIK:  Yeah.

>> RAJENDRA PRATAP GUPTA: But in heavy traffic, in the United States, in the morning or evening, you won't drive and take the risk. But I decided to do that. Let me tell you, it was pretty safe.

If I can trust a driverless car and reach there ‑‑ again, going back to the presentation I made 10 years ago, what essentially technology is doing is taking the middleman away. There's no driver on the car. I reach the destination on time. And the driver doesn't take a different road and charge me more. I go to my destination. If we trust a driverless car, why don't we trust robotic surgery.

>> MAY SIKSIK: I agree with you, but driverless cars have standards they must comply with. It's a very, very complex and big process. So you've got auditors that come and make sure it's compliant.

And we can do that, Rajendra, but we're getting close. We're not 100% there. We cannot qualify it yet, but we need to get there. We need to have a standard. We need to be able to say we're compliant with the standard.

>> RAJENDRA PRATAP GUPTA: Yeah, I agree.

And going to Mevish. You know, you're talking of patients. Are patients ready to accept this kind of technology?

Mevish, I wanted to throw this question that you're on Patients' Union. Are patients ready to accept AI as a doctor? So if you say AI first, doctor later, would patients accept it?

>> MEVISH VAISHNAV: Yes. So there is a study that states six out of 10 patients know digital health. But two out of 10 doctors know of digital health.

>> RAJENDRA PRATAP GUPTA: It's about knowing, Mevish. It's about knowing.

>> MEVISH VAISHNAV: It's the awareness that's important.

Doctors are more prone to ‑‑ I can share an experience with you. My family member went to a doctor, and she was asked can you prescribe DDX (phonetic)? She asked, What is that?

If a doctor does not know about this technology, how will she be able to help me in managing my diabetes. Yes, patients are more prone, and they're more accessible to AI. They would love to be a part of AI where there are zero errors. I would not say zero errors but negligible errors.

>> RAJENDRA PRATAP GUPTA: Thanks, Mevish.

This brings me to a very important point about the empathy.

So, May, today, my social media knows more about me than my doctor. You know, they track me, what I do, using my phone. It tracks me what I do using my computer, what I like, what I don't like. Through my phone when I talk. So it could be more personable to me, in terms of peronalising the content, what I like and how many seconds I need a response.

So if I have an AI doctor, it won't get angry because I get angry very often. Do you see technology is better with empathy than a human doctor?

>> MAY SIKSIK: Actually, yes, but, having said that, I do think that technology can be better than doctors, in terms of empathy. But having said that, sometimes a patient at a hospital will need, for certain cases, humans. So all I'm saying is we cannot eliminate doctors, in terms of empathy. I want to say that, I mean, using AI‑based tech for medicine is critical, actually, right? We are actually losing lives right now because people can go to a clinic and not have access to the right diagnosis.

I talked about the tiny bit of hallucination that an AI system does, but humans make way more errors, way more errors than doctors ‑‑

>> RAJENDRA PRATAP GUPTA: You're making my job easy. Thank you.

>> MAY SIKSIK: We need to talk about all aspects of this. Right?

>> RAJENDRA PRATAP GUPTA: That's a reality check.

So going to Zaw, Zaw is running an academic organization where you do the research and work across multiple countries, what do you think about AI being more empathetic, being more accurate? These are two challenges that come in the way of creating trust for technology.

>> ZAW ALI KHAN: Thank you, Rajendra.

As far as AI knowing more about me than I know about myself, I would frame it that way, I recently got to know that if you ask ChatGPT how would a typical day ‑‑ based on what you know about me, if you give ChatGPT the prompt saying, Based on what you know about me, what would my desk look like? What would my workplace look like?

So it's able to create that quite accurately because of the frequency and detail of interactions that we're having with these AI models.

So imagine if we were to have health‑related interactions with these AI models as frequently as we're having work‑related interactions. That would be many times more ‑‑ I mean, in terms of magnitude, I would say exponentially more personalised than anything a health care worker or doctor can provide. It's not physically or humanly possible for doctors to provide that level of personalisation. Doctors are getting 15 minutes with a patient. In the UK, I heard they got seven or eight minutes, on average. So it's impossible to diagnosis conditions in that short amount of time, let alone give a personalised empathetic care to the patients.

So I agree that the digital tool has that potential.

>> RAJENDRA PRATAP GUPTA: Of the timing, some countries, they get 34 seconds. If I remember correctly, it was Bangladesh where   a doctor gets 34 seconds or so. So even if it's any other country, 34 seconds, you can't even pronounce the name and the problem of the patient. How were you diagnosed?

That means you made up your mind to prescribe something, and the patient has just come in on time. That technology won’t do, by the way, because there will be a digital footprint of what you do.

Peter, coming to you, given your global experience and you're a nurse by training.

>> Peter PREZIOSI:  That's correct.

>> RAJENDRA PRATAP GUPTA: I think you are closest to the patient than the doctor. That's how they call it. Like doctor is still close to God. Nurses are closest to the patient. How do you see this relationship between technology and patient and the clinician evolving?

>> Peter PREZIOSI:  I agree with many, many of the comments that were stated earlier. I think the challenge is we tend to be focused throughout the world on a medical model, and the challenge that we face in communities is that clinicians are not working at the top of their capabilities and for a variety of different reasons.

Many times, if you're talking about physicians, nurses, pharmacists, they are struggling with the morass of administrative paperwork that takes them away from clinical care.

As the panelists were mentioning, these AI‑enabled digital health tools are partners to really enable people, clinicians, to be able to work at the top of their capability. But there's so much more that happens, and it's very different based on the jurisdictions that you're talking about, the different countries that you work in from a regulatory legislative perspective, there are professional turf battles. And why I'm so thrilled to see the Patients' Union here, we talk a lot about patient‑centered care, but we've got to really bring that patient involved and engaged in the services that are being provided because they should be much more empowered, in terms of what it is they need to do because if you look at it, just take the issue of obesity. Obesity is ramped now around the world because people are not eating properly. They're not exercising properly. Aging is a challenge that there's no cure for, really. Maybe there will be a digital cure into the future, but the issue is that there are many health issues that don't succumb to a traditional medical model. So we just have to start to begin to turn some of that upside down and look at the appropriateness of care.

I think it was Debbie that said earlier, you know, looking at the right care at the right time at the right place, these are the issues that we have to get better. I do believe digital health solutions will help to augment and assist us in moving more into those areas.

>> RAJENDRA PRATAP GUPTA: Thank you, Peter, so much.

And to those who have joined online, I will say to leave your questions in the chat. We're going to dedicate a substantial amount of time to questions.

This brings me to Debbie.

Debbie, you know that countries like Africa and India with billions of population and with so much less resource in terms of doctors.

Of course, India, in the last few years, has done phenomenal, in terms of adding doctors. We add now 175,000 doctors every year, which effectively means that in the next five years, we would double the number of doctors we already have.

Having said that, now with technology taking a dominant role, a number of doctors coming up more and now going take back to Africa where some patients may not have seen a doctor in their lifetime, how will they understand the difference between the technology and a doctor? I mean, if I present them, hey, look, here's a doctor you're talking to and, you know, I put a disclaimer there's a doctor‑‑ an AI‑based doctor ‑‑ they haven't spoken to a real doctor. What do you feel would be an opportunity or a challenge for a country like Africa where someone gets addressed empathetically through technology? How will they differentiate? What will be their response on this? They have not seen a doctor. They're not talked to very well. They get 30 minutes in they want. They can chat and tell all their problems, and the AI will tell them this is your thing.

If they get the right advice ‑‑ I think as you said and as others have said, you get the right advice, they would come back to this for more because they would start trusting the voice that talks to them, and it will be the voice that they probably like the most.

What do you think about that, Debbie?

>> Debbie ROGERS: I think you bring up an incredibly important topic of trust. We provide digital health solutions, and we work very, very hard to make sure they are trustworthy, that people love the services, that they understand the service is there to support them. And, in doing so, we are able to get them to change their behaviour in a way that they wouldn't be able to if they didn't trust the source that it was coming from. Now, I haven't done the research around whether people will trust AI or doctors more. I think it's probably going to be down to a personal perception, but I do believe that people can trust AI, and people can trust digital health solutions, and I think that's incredibly important when you're building these solutions.

As an example, we integrated a diagnosis engine into Mom Connect. It's a diagnosis engine that we didn't develop. It's called Aida Health. We had a higher completion rate of going through diagnoses on Mom Connect than on the AIDA Health app.

The best we can put it down to is the moms trust the service.

Another example of trust is we get inundated on Mother's Day with pictures of people's babies and messages thanking us for the support they have been given and good morning, Mom Connect and goodnight messages. You can build trust and you can get people to engage with them.

Sometimes, they believe there is a person on the other end, and sometimes they believe it's AI on the other end, and that depends on the usage of the person as to what you want to try and encourage.

You know, for example, in our sexual reproductive health and rights platforms, we found youth want to speak to AI and not a person because they've been judged so much by people.

And so in that instance, for example, it actually is very helpful for us to have AI.

So I absolutely believe that people will be able to engage with AI, trust AI, knowing that it is AI, they may trust it even more than doctors at times, depending on what their experience has been in the past.

>> RAJENDRA PRATAP GUPTA: I think you bring a very important point of the world engagement. I think technology with no denominator of money at the point in time and not being a human, it could actually spend time ‑‑ probably the patient wants to spend with, and engagement would lead to maybe better outcomes, if the advice is right, based on standard clinical protocols, which means, as you said, AI will be trusted more.

I've seen your work. I really admire what you have done.

People feel there's someone with them when they want it, and that's what is missing in health care today. I think Peter would (?) To this.

Peter, given the fact that we have nurses ‑‑ and there are success stories of the nurse and how they touched and transformed lives. Do you think that the future of health care lies with leveraging this workforce, nurses and technology, together and maybe somewhere where technology ‑‑ what is your take on this?

>> Peter PREZIOSI:  That's a great way of putting it, is liberating all clinicians. Given that there are 29 million nurses worldwide, the largest profession, absolutely, we need to start with them, but there's so much more out there, like the work you're doing with pharmacists and others.

We're doing much work around rehabilitation care with the World Health Organization. We're actually in Ethiopia looking at rehab care, driving that into primary care. A quarter of the world's population needs some form of rehab care, yet so many clinicians are so ill‑prepared to tackle this. When you're taking the look at challenges around war and conflict and working in these zones where you've got traumatic amputees and trying to reintegrate people into a quality of life, rehab care is incredibly important.

Liberating through ‑‑ you know, there's no magic bullet. Are these the magic bullet? Absolutely not. As many people have talked about here, engagement. There are a variety of issues that need to help. But there's nothing, obviously, to be afraid of with the technology evolution and emerging that as true partners. Again, I will emphasise that it's almost as important to liberate the consumer, the patient, and their families equally with these technologies.

>> RAJENDRA PRATAP GUPTA: I think it's still a very important part of liberating the clinicians from too many tasks that can be handled and also the consumers.

Let me jump and open this to questions from the audience. I have some questions which I will ask the panel again.

If there are questions from the audience, we'll be very happy to take that.

Can someone provide a mic to the audience?

Sakshi, if you have online questions, please read out to us.

>> SAKSHI PANDITA: Sure. That was a very nice discussion.

We have a few questions online. I'll just read them out for you. First one is from (?) She asks if we are planning to replace doctors with digital health tools, how do we make sure they're not compromising the quality of care?

>> RAJENDRA PRATAP GUPTA: Peter, over to you.

>> Peter PREZIOSI:  This is one of the reasons we're going slow and really testing these point‑of‑care solutions. There are high‑income countries, Canada, the U.S. ‑‑ India has done, you know, a great deal of this kind of work where you're looking at testing out these solutions, integrating that into clinical workflows.

I don't think replacing is the right word but augmenting. There are AI‑powered medical brains now that are helping to augment 92% of the workloads of clinicians in practices. And most of this is administrative burdens.

As said before, when you have a physician that only has 34 seconds to go in and they don't even have time to pronounce the patient's name and the diagnosis. It's looking at the work differently and testing those solutions out and seeing what is best with the consumer to be able to optimise human potential.

>> RAJENDRA PRATAP GUPTA: Thank you, Peter.

In fact, I would very much agree with you on that point. Recently, in our office building, we had a plumber who always came and told us that his wife has low weight and she's coughing. We said, Okay. Why don't you get tuberculosis check done?

So he went and got a check done, and the sputum was negative, but the x‑ray showed that it was tuberculosis. The doctor would not start the treatment because the sputum was negative.

So we did a telemedicine consultation through a tertiary care facility, and he suggested other treatment. It's evidently clear that there is tuberculosis.

So it was technology that came to the rescue, but the conventional system of diagnosis and treatment and consultation didn't work. But sometimes it is augmentation. Sometimes it's replacement. And sometimes it's just the doctor.

Having said that, what do you feel will create the trust that's missing in technology for now?

>> Peter PREZIOSI:  I want to comment on one thing. You're right. Trust and engagement is so critically important. Prior to being at CGFNS, I was at the World Health Organization actually during the pandemic. There was a lot of vaccine hesitancy around the world. A lot of individuals don't trust the treatments that are out there, the vaccines that will prevent the spread of infectious disease and pandemics that are popping up. This is a real challenge we have. It's not just around digital health. It's around the entire value chain that we see across the health care system because, as it was said earlier, health care is very contextual and highly personal. These are the things we have to focus on. To your point earlier, you know, AI really understands us in a lot of ways that maybe other humans may not.

What Debbie was saying around sexual and reproductive health issues where teenagers might feel more comfortable, less judged by talking to a bot.

So these are really important issues that we have, but you can't just make these blanketed statements around the world because there are a lot of different cultural nuances. Over.

>> RAJENDRA PRATAP GUPTA: Zaw?

>> ZAW ALI KHAN: Yeah, Rajendra. So about the issue of trust, I feel in the context of communities where doctors are not available at all. So in that vacuum, of course, any solution will be taken very spontaneously by the patients. But as far as systems where people are used to doctors, if you're able to emphasise the advantages of technology, which they're already seeing ‑‑ like in India, next‑day delivery used to be considered very fast. And now we have same‑day and hyperfast deliveries. So there's this convenience that consumers are getting used to.

If you see patients as consumers in the health care system, then eventually they're going to demand that same kind of convenience in health care as well.

Along with that, of course, they would also want high quality. For high quality, they would want to spend more time with doctors. They would want more counseling and coaching. But, of course, since that's not physically possible, then the next best thing would be technology. Technology can actually build more trust because it's capable of counseling and coaching patients in a much more personalised manner, as we already discussed.

But, more importantly, it comes with the added advantage of being potentially very transparent about where they're getting the information from, why they're recommending a specific course of treatment, why they have concluded a specific diagnosis.

So the technology can actually explain all of that much more better than any of our other health care workers can. It can also provide the evidence‑based data to support their recommendations.

I will just stop right here. One more point. Lifelong learning, even if we train or nurses, doctors, health care providers, to be good at lifelong learning, we can't expect them to absorb the huge oceans of knowledge that's being created continuously in the medical science sector whereas AI can absorb all of that, assimilate it, and always be up to date with the latest evidence.

>> RAJENDRA PRATAP GUPTA: Thank you, Zaw. And the question is very important, that how do we maintain the quality without compromise. I was on the (?) Committee of the Government of India for hospitals, still accredited on the same parameters of doctors to bed and nurses to bed and what we do, but there was no objective parameters. So in technology, at least I can say for sure, that you will have a digital footprint of all you do. So I can say at what point did the patient enter the system and exit and readmitted. So we'll redefine the parameters of quality. In the AI system, the number of hallucinations per a patient's life journey would be an important quality. To me, if you ask me, I'm not saying I'm excited about it, but I would say technology will be able to manage care better than the traditional model. It tracks everything. Everything you dos have a digital footprint.

I will ask my colleague, Dr. May, what she feels about it.

>> MAY SIKSIK: I completely agree, Rajendra. And this kind of reminds me of the empathy point we brought up a little bit earlier. I want to mention that one of the projects we're working on was First Nations. First Nations have an issue with the way the medical system is set up in Canada, for example, because you can only go to the doctor with one issue, but the way their culture is, when you go in, you need to talk about the full picture, and they have multiple things they talk about. It's just a very cultural thing.

And this is something that can be completely taken care of with an AI‑based system. So I completely agree with you. This can completely be helpful in this regard and develop that trust with populations who would normally avoid going to doctors. In Canada, I know that creates big problems because that means conditions get worse and manifest into something serious, and it costs the system, in terms of not just dollar value but also societal impact and cost lives.

>> RAJENDRA PRATAP GUPTA: May, I remember in one of the books I wrote, in one of the provinces in Canada, they run a lottery to be attended by doctors. So if that's the seriousness, you know, it's really tough for me to ignore not giving technology to said populations.

Mevish, from a patient's standpoint, how do you see quality in technology versus a traditional doctor?

>> MEVISH VAISHNAV: So if you see a (?) Patient would be more happy to get time from a doctor, but a doctor should be able to understand my condition well. My history, he should know my history. If I don't get that much time, how will I trust the doctor. But if I go to AI and I say, okay, these are my symptoms, what best options ‑‑ what treatment can you provide me? I would get better outcomes from that because it has, as you said, a complete standard operating protocols and the treatment guidelines from where it can take out the data, collate it, and share it with me. So I would trust the AI more than a doctor.

>> RAJENDRA PRATAP GUPTA: Debbie, what is your take on the quality that we're talking about in the technology age?

>> Debbie ROGERS:  I absolutely believe that quality, from a technology perspective, could be better than individuals. In many cases, it has been.

One of the things I want to point out is we need to be very careful with technology increasing the digital divide. For example, LLMs, at the moment, are primarily trained on western culture, medicine, languages, nations, cultural context, and that is not going to be appropriate for rolling out in Rwanda, for example. And we need to spend a lot more time ensuring that the quality is not just high quality for certain communities but high quality for all communities, particularly those who are underrepresented at the moment.

So while I think it's possible that it will get to that point, I think we need to be conscious in how we are approaching improving quality within these things to ensure that we do it in an equitable way.

>> RAJENDRA PRATAP GUPTA: Thank you, Debbie, so much.

We have a question from the audience.

Please tell about yourself and ask the question.

>> Can you hear me?

>> Yes.

>> MELODY MUSONI: My name is Melody Musoni. I was happy with the conversation that we're having here, and I learned a lot. I guess mine are more of concerns, and I think Debbie has touched on one issue when it comes to digital divide because my fear is the more we digitalise the health care system, we are going to leave so many people behind, even just to give the Mom Connect example that Debbie was demonstrating and showcasing. You have to have a phone for you to be able to register and to use it. And if you don't have that phone already or automatically excluded. If we start thinking about how we're incorporating AI in digital health care, we also need to bear in mind the issues of digital divide and marginalisation. That's the first point I wanted to make.

And then the second point I also wanted to make is perhaps we also need to think about the option of opting in to a digitalised service and opting out because I think you mentioned the other speaker about the importance of human interactions. Personally, I think (?) Wants to go to a human doctor, if I have the opportunity to do so, instead of relying on a technology. So I think as we're advancing in our innovation on health care, we also need to make room for people who may still want to have access to physical doctors or real doctors.

The other thing I wanted to mention ‑‑ I think the speaker online kind of touched on it. Now, with Generative AI, there's a lot of misinformation and fake news that flies around, especially around fad diets. I know people have used Oprah a lot. I was using this product and after using it in two months, I lost weight. And a lot of people are falling for that misinformation, and a lot of people are buying these products.

So I think we also need to find ways in which we can address the issues of misinformation and fake news, and I think the example you gave about patients going to doctors and requesting for medication and the doctor is not aware is a good example of that because they're seeing all of these things on social media, and they expect all doctors to know. So there should be a way in which we address issues on fake information, especially around use of certain health care services, for example.

I'll stop there. Thank you.

>> RAJENDRA PRATAP GUPTA: Very important points raised. I think this is what Peter and others were alluding to, you know, that while we get to implement technology at scale, we should be careful about the don'ts more than dos because that's something that we need as frameworks to implement.

Yes? You have a question?

>> I think an important point that we messed up on was basically how doctors are limited. That's been addressed, of course, but computers are growing at a larger scale than ever. It grows two times every year. Now it's four times, and the cost is going down with GPUs and, you know, multiple computer systems.

At the same time, you have computer systems that can run AI models on a system that's as cheap as $20 but give you an accurate response in six seconds.

This will help a lot of places where you need instant care. The compute costs is a lot for these large models. I see them as superpowers.

Also, touching on the point of empathy that we discussed, I remember the movie "WALL‑E." I'm not sure if everyone has watched it, but, basically, they learned everything from what they saw. So I think empathy is a social model because now what you see is what you believe in. So if you start seeing an AI doctor, you won't probably go to a normal doctor and wonder if it's AI. Although, that's very dystopian, but I think that's how it comes to be.

You said you addressed ChatGPT as "him." We started addressing AI models as a person instead of just being on the cloud or somewhere else. That's something we've started doing in a matter of two years. So I think that's something we need to consider as well, yeah.

That's it.

>> RAJENDRA PRATAP GUPTA: Thank you so much. It's very important point. I keep concluding with the way the world is changing that this is not a technology change. It's a societal change. Society is changing. You know, don't think that we need to adopt technology. The society has already adopted technology. We are all learning without barriers.

Today, a teacher is not the main custodian of the information to deliver to the student. It's a YouTube. Any lecture you want on any topic that you want, you can go and watch.

Same thing patients watch programmes. People go to the doctor and say, hey, I watched ‑‑ I saw (?) Why would someone believe their doctor. They would believe the best man that's an icon. I use (?) My sugar is controlled. Now, tell me who is making a choice. We used to say in health care that doctor is the (?) And patient is the consumer.

Now it's being changed from customer to consumer directly, which was never thought of for centuries. It was doctor decided. Now, I know more about my treatment than my doctor.

Being a health minister to my country, my doctor didn't know about (?) She was very experienced but didn't know. When I used CGM (?) She didn't prescribe me. You have all kinds of things like that. I think it's a big societal change.

This brings me to ‑‑ I would still take one online question, Sakshi, before I go back to my panellists, based on what we have discussed.

>> SAKSHI PANDITA: Sure. So the next question is: How can we ensure the accessibility of digital tools in rural areas?

>> RAJENDRA PRATAP GUPTA: Okay. I think I will go to Debbie first.

>> Debbie ROGERS:  There are things we need to address to ensure digital health can be used in rural areas. Just the fact of what the previous audience member mentioned, even with Mom Connect, you have to have a phone. There's barriers to digital health technology. This includes things like electricity. If there's no electricity where you can charge a device, you're not going to be able to have a digital health solution. If you don't have any mobile penetration in that area, it's going to be very challenging. You can do offline, but it's very challenging.

And the other thing, from a cost perspective, you know, just thinking about AI, for example, on Mom Connect, it's 20 cents per user per year (U.S.) to run the programme.

If we shifted that to Iowa, it would be $10.20. I hear the previous audience member about the cost going down. The cost is also prohibitive for these. Costs will go down. Various things like electricity will go up, but we have to be more conscious about this in ensuring that those who need the services most are not left behind because, unfortunately, just market forces line have not solved all of these problems.

>> RAJENDRA PRATAP GUPTA: The cost of the technology, of course, not what I'm saying may apply now, but when cell phone came ‑‑ at least in my country ‑‑ I used to pay a very heavy cost of call airtime and cell phone usage. Today, you only pay for data. You don't pay for calls. We're the cheapest data. Technology, not only the computing power goes up, the cost goes down, but you have raised a big point in the digital divide.

If (?) One of the goals I'm putting to my (?) Coalitions that 2.7 million people are not connected to the Internet. One out of three people has no access to the Internet. We are very privileged people to be talking about these things. We should always understand that we are privileged, and, therefore, we are supposed to deliver in these forums, talk the real issues and not ignore anything that matters.

So I totally understand what you are saying is very important and as IGF community, you know, which is responsible for putting its views to the UN on these matters, this is a very important part given that health is a determinant for living. You know, it's not something that is a choice that you have. It's a right. And technology makes the right possible.

So that being said, I will move this to Peter.

Peter, you're working in Rwanda and now Ghana. What is your take on this?

>> Peter PREZIOSI:  I would close by saying that technology is exciting. It's a new horizon of opportunity, but we have to be conscious of the unintended consequences, the ethical dilemmas, the digital divide issues. We have to look at governments around the world taking money from health education and welfare and putting it into defence spending. We're looking at isolationism, and that will be a challenge. If we think about not just the health worker being mobile, the work is becoming mobile. So it's going to really democratise in many ways the opportunity for access to good care.

If we pay attention to the digital divide discussion that was talked about.

>> RAJENDRA PRATAP GUPTA: Here I would go back to all my panellists on a very important point. I've seen all the discussion that you've made important points, including questions from the audience.

What came out is technology is going to move to a non‑doctor‑dependent model. It could be a clinician, non‑clinician, citizen doctor. Having said that, all of us agree on a few points. Cost is going to come down because of technology. It's going to be convenient. You can have it when you want. It's going to have better engagement and better empathy and better quality and a better experience and better repository of knowledge.

My question to each of my panellists is to justify why will technology not replace a doctor.

Starting with Peter, please.

>> Peter PREZIOSI:  Yeah. Again, I think the human touch is incredibly important. I think we're going to find so many other types of technologies. Looking at precision medicine, I will bring that up as well because we have not talked about treating people at the (?) Level. Again, looking at the divide that exists between the higher‑resource countries to the lower‑resource countries, and how do we begin to democratise that?

So I think having the future health professional will succeed and evolve with technology, not without it.

Those will be the individuals and the patients that will be able to succeed and do much better in the world.

>> RAJENDRA PRATAP GUPTA: Thank you, Peter.

Mevish, from the patient standpoint, will technology replace doctors?

>> MEVISH VAISHNAV: It's been years for me that I have gone to bank. So if bank is on mobile, why not AI doctor on mobile? So, yes, I am for it. AI will actually help doctors to enable treatment. So, yes, AI will replace doctors.

>> MAY SIKSIK: I think that AI will replace the majority of doctor visits.

>> ZAW ALI KHAN: So as far as the title of this panel discussion is concerned, I feel, yes, AI will definitely replace (?), first and foremost, and perhaps some of the other specialised‑use cases as well.

But (?) Because over there, it's not actually replacing doctors ‑‑ if I were to rephrase this to make it more satiable for our health care workers, it's not that technology is replacing them but, rather, it's making room for them to do their job more effectively.

So that way I feel it's a win‑win for doctors, patients, health care systems around the world.

And one more thing that I would like to add on that is about the regulatory standards and the need to define them with the participation of all stakeholders, particularly because one of the audience members mentioned about the risks of AI, particularly about Generative AI. But I think there would be risks in other use cases as well.

Over there, I would emphasise that the role of academic organisations ‑‑ academy is like the Academy of Digital Health Sciences or AUB, American University of Barbados. And organisations need to make sure and other organisations need to make sure that we're training the next generation of doctors and our faculty members, our stalwarts in a way that they are not cynical because if our experts are cynical, they might advocate for hasher standards, and that might decelerate this transition from doctor‑centric health care to a non‑doctor‑centric health care.

Thank you.

>> I just want to clarify that they will replace the majority of doctor visits, but even for the visits that they cannot replace, they need to be ‑‑ AI will need to be at the table as part of that interdisciplinary team, and that's going to be quite important.

>> Debbie, your take?

>> Debbie ROGERS:  I'm going to use your example of the kindle. There's been a resurgence of bookstores. Even if it makes these things easier, I don't think we're going to replace human touch entirely, and there are definitely going to be people who prefer human touch. It may even be that for a while we have a drop in the number of people who are accessing doctors but that it will resurge again when people realise the advantages you can get from the human touch that you just cannot get from technology. I do not believe they will be entirely replaced. I do believe it's going to make the lack of health care workers a far smaller problem, and I do believe that it's going to be critical that AI is a part of the team, as you mentioned, Mei, but I don't believe it's going to replace doctors entirely, despite being a technologist.

>> RAJENDRA PRATAP GUPTA: Thank you, Debbie.

It's been a great discussion. Every year at IGF, at Digital Health, we discuss how technology is shaping health care and how health care is shaping technology, both ways.

I really thank Dr. Peter Preziosi for being awake late at night and joining us and sharing his valuable insights, which are going to shape the way we look at health. Mr. Zaw Ali Khan, from the American University of Barbados; Dr. May SikSik; Mevish; and Debbie Rogers, thank you all so much and Sakshi Pandita, who has been moderating us online and for all the viewers who joined us and asked us important questions.

Next year, we'll present you the findings of what AI did to health care.

Thank you so much. I wish you a very happy holiday season. Merry Christmas and a great year ahead.

>> Thanks.

>> Thank you.