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Prakash Jayakumar, M.D., Ph.D., was an orthopedic surgeon in the UK looking for ways to create a broad impact on the field when he accepted a Harkness Fellowship in Healthcare Policy and Practice Innovation in August 2018. The fellowship brought him to the United States, where it quickly developed into a long-term affiliation with the University of Texas at Austin Dell Medical School.
Today, Dr. Jayakumar is an Assistant Professor of Surgery and Perioperative Care at the university, and Director of Value-Based Healthcare and Outcome Measurement.
“In essence, my position allows me to scan our clinical practice and the broader healthcare landscape for challenges and wicked problems in our rapidly evolving field,” he said. “My role spans clinical care, health services research, quality optimization, and the development of high-value solutions for these challenges, using a blend of surgical science, human-centered design, and technology-enabled innovations.”
He will be moderating two TechTalks at the 2022 AAOS Annual Meeting: “Transforming the User Experience in Orthopaedic Care Using Artificial Intelligence, Mixed Reality and Digital Phenotyping” and “How Human Centered Design and Technology Can improve User Engagement in Patient Reported Outcome Measurement.”
We spoke with Dr. Jayakumar to learn more about the evolution of technology in orthopedics, and what excites surgeons about digital developments.
Today’s Orthopedic Digital Technology
You’re moderating talks at AAOS that connect technology and orthopedic care. How do you see AI, mixed reality, etc., transforming orthopedic care in the future?
Dr. Jayakumar: I see these technologies offering the prospect of profoundly transforming user experiences in orthopedics. That’s where the excitement, transformation, and real-world impact comes for me; whether that user is the patient, the surgeon or the clinical team, I think one’s experience is where we’ve got the greatest opportunity.
The transformation is likely driven by three things: greater personalization, enhanced data visualization and developing data-driven approaches, and advancing user engagement by really getting at the heart of what matters to users and what drives them to use these technologies. Having had the benefit of being involved in each of these technologies in various ways, the excitement comes when you see these technologies driving human interactions on the front line at the point of care.
How do you see technology, in general, improving the patient experience and patient outcomes?
Dr. Jayakumar: Technologies are transforming the way we interact with each other and build relationships. I think that’s where the heart lies rather than simply the impressive machine-works on the back end and the increasingly sophisticated data being churned out.
For example, there is an AI-enabled patient decision aid that we’ve been involved in developing that’s designed to transform the shared decision-making experience through precision predicting of an individual’s outcomes before they’ve even had surgery. This allows the patient and surgeon to mark a shared and informed decision ahead of joint replacement surgery, which really is a major life impacting event. We’re trying to build relationships and more personalized medicine through technology and enable visualizations for patients and providers to gauge such outcomes. It levels the information playing field and really allows us to advance engagement with one another through accessing these technologies across the care continuum.
Technology is really enabling what I consider as a ‘patient-generated health data value chain.’ And that is made up of three opportunities: First, it’s allowing us to better understand patient stories and identify those modifiable factors — the things that I can change and modify to achieve better health outcomes through a more personalized care approach.
The second opportunity involves enabling clinical decision support and optimizing shared decision-making and facilitating the right decisions at the right time for the patient, the population and health system.
Thirdly, technology is enabling us to track health outcomes for improving care delivery as part of the system and identifying opportunities for payment and practice innovation. You start looking at the data that’s generated at a population level and that ultimately gets fed back into benefiting the patient experience and patient outcomes.
I think the exciting bit for me is how we’re blending disciplines to make it happen; the cross-over between science, human-centered design, and of course, technology-enabled innovations is driving things nicely.
Considerations for Technology Advancement
Let’s talk about that term “human-centered design.” What does it mean, and how does it relate to the advancements in technology that we’re seeing?
Dr. Jayakumar: I’m glad you picked up on that. When I look at my world as a surgeon scientist, often we are thinking in fairly linear tracks, and human-centered design really gets at the heart of understanding the problem and the problem within a larger system. The process is cyclical, messy, you can make mistakes more readily and learn, and rapid iterations to the process are encouraged in human-centered design. I think it allows us to, in a more natural way, design meaningful and effective solutions for some of our biggest problems.
The design approach (sometimes called the double diamond) involves immersing yourself in understanding the problem and engaging in a phase of discovery. Then comes a definition of the problem you’re trying to solve. You subsequently start the process of developing a range of solution ideas before engaging in focused delivery of one or more solutions. This (sometimes cyclical) process flows from divergent to convergent phases. For me, it feels like a very natural approach to getting to the heart of problems before brainstorming and working on ways to deliver effective and innovative solutions.
There’s been a proliferation of technology in orthopedics in recent years – from industry and surgeon entrepreneurs. What are some of the best ways you’re seeing technology being used to collect outcome measurements? What are ways in which you think the technology needs to advance in the coming three to five years to make it even more meaningful?
Dr. Jayakumar: Technologies are really allowing us to better understand patient stories and capture the full 360-degree view of the patient by both active and passive means. We’ve used patient-reported outcome measures as a self-reported survey-based approach to understanding physical, psychological and social factors that are impacting patient lives. But there’s an explosion of tools, sensor technologies, smartphone-enabled applications and even forms of computer vision that are enabling us to achieve digital phenotypes of individuals.
Digital phenotyping is essentially getting the moment-by-moment quantification of the individual human phenotype. I see technology moving very rapidly in this arena. When it comes to the data points that we gather, it’s not what you know, but what you do with the data that counts. Enabling clinical decision support through technology to help visualize that data, to help get it into usable interfaces depending on the user, can better enhance our decision-making capabilities. Also, this provides a great backdrop for innovation and a testbed for innovation within care delivery.
Going back to human-centered design, that discovery phase is critical to understanding our users. Our clinical teams work with our design team and value institute team to understand what outcomes truly matter to patients. What are the physical, psychological, social and other contextual factors that are really driving and influencing patients’ health and wellbeing?
Once we track that physical activity, both in and out of the care setting in their usual environment, then how do we best capture the psychological factors? We’re growing a strong body of evidence for the importance of psychological factors and specifically different forms of distress such as negative mood and negative pain thoughts and behaviors associated with symptoms like pain.
You have to capture psychosocial outcomes of patients to really be in the game. An area that we’re increasingly exploring involves understanding an individual’s unmet social needs and tracking those in terms of patient outcomes. We’ll need to use different validated measures to capture unmet needs, including housing, food and food security, transport and social mobility and security. We’re striving to really bring together all these data elements into building comprehensive 360-degree data sets to enable clinically meaningful functions.
Future of Digital Technology
Where do you think digital tools are in their lifespan in orthopedics? Do you have an idea of what percent of patients are using digital tools for pre- and post-operative purposes?
Dr. Jayakumar: Many of these latest advances, tools and technologies, are really in a phase of calibration. Take AI, for example. We’re ramping up our understanding of AI and stretching its capabilities beyond where we started off with AI-enabled imaging and other functions.
The last five to 10 years in particular have seen a massive influx of data capabilities. computing power and access to large volumes of data. A strong legacy approach, like a statistical test, could have solved an answer to a given problem. But then as the data evolves, maybe machine learning will offer alternative ways to get at the answers, potentially with greater precision and speed.
With large volume of data, there may be a limit to things that we can do with traditional approaches, but then we might need to use predictive algorithms and AI can potentially ramp up the capabilities. As a field of surgeon, scientist, entrepreneur, technologist, designers generating lots of ideas and solutions, we’re ultimately going to reduce some of the noise and some in on specific tracks of work to avoid technologies and approaches falling by the wayside.
On the patient side, I’ve gauged great expansion in the use of digital tools from patients engaging with their smartphones to their desktops and laptops across the care continuum. And expansion is occurring across socioeconomically, racially, ethnically diverse populations.
What excites you the most about the advancement of orthopedic technology?
Dr. Jayakumar: I’m really excited about the advancement that I’m experiencing today and the technology-enabled strategies that I see coming down the pike. Patient teams and health systems are benefiting from technological advances that harness expansion of different forms of data. We’re putting a lot of effort into collecting the important aspects of patient outcomes data (psychological and social points as well as physical and activity data), and how these build into datasets ready to solve relevant problems alongside imaging data and genomic data.
When you blend that all together and build that into technologies like artificial intelligence and deep neural networks, it promises to generate powerful insights that are truly going to be exciting across the lifespan of individuals. The decision-making capabilities that affords are exciting.
This weaves into another area of excitement for me. We’re building all of this know-how into hybrid models of personalized care, where we are building in virtual care capabilities and blending this with comprehensive in-person care to generate value for patients and outcomes that matter to patients. This kind of blend between virtual and in-person care is going to be exciting based on how technologies are enabling us to capture and apply that data.
We’re also experiencing the opportunity to build data into new realities and broadening our cognitive capabilities. I think that the blend of these data points with AR/VR and telehealth capabilities can enrich these hybrid models of care and even telepresence to redefine our approach to interaction, and how we connect with patients to make those decisions while building strong relationships along the way.
