March 6, 2025 • 27 mins
While the terms 'tech' and 'AI' might seem overwhelming to the average ophthalmologist and optometrist, the reality is that the future of medicine will certainly be intertwined with these technologies. So what exactly is 'health tech' in the context of eye care? Dr. Lisa Jagan is the founder of Lid Express, an online platform that allows patients to submit photos of eyelid lesions to be reviewed by a team of oculopplastic surgeons in an expedited fashion. She joins the podcast to share her experience developing an oculoplastics tech platform and the lessons she has learned along the way.
Lid Express
Website - https://clarityeye.ca/services/lid-express/
Email - lidexpress@clarityeye.ca
Instagram @lidexpress
This episode is sponsored by Thea Pharma Canada - https://www.theapharma.ca
Become a supporter of this podcast: https://www.spreaker.com/podcast/blind-spot-the-eye-doctor-s-podcast--5819306/support.
Lid Express
Website - https://clarityeye.ca/services/lid-express/
Email - lidexpress@clarityeye.ca
Instagram @lidexpress
This episode is sponsored by Thea Pharma Canada - https://www.theapharma.ca
Become a supporter of this podcast: https://www.spreaker.com/podcast/blind-spot-the-eye-doctor-s-podcast--5819306/support.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:12):
Hey everybody, I'm Xaeo Mednik and welcome to another episode
of Blindspot. This episode is sponsored by THEA Pharma Canada.
THEA Pharma Canada is the Canadian subsidiary of THEA, Europe's
leading pioneering and innovative eye health brand. Founded in nineteen
ninety four by Henri's Schibre. With five generations of history,
the Schibret family has been dedicated to I care for
(00:33):
more than one hundred and fifty years. Their commitment to
improving lives is born of their pioneering spirit. They continue
to lead the worldwide preservative free movement in eye care.
They've created innovative delivery systems. They've focused on making products
accessible and cost effective for patients. They live this mission
every day because everyone should have the same opportunities to
see the world through healthy eyes. So thank you THEA
(00:56):
Pharmer Canada for supporting Blindspot. I'm joined today by oculp
plastic specialist Doctor Lisa Jagen. Doctor Jagan is an ophthalmologist
that specializes in oculoplastic surgery. She's published extensively in the field,
contributes actively to peer review, and is currently co authoring
a procedural Oculoplastics textbook. She's the past vice president of
the Toronto Ophthalmology Society and the director of Express. She's
(01:19):
extremely passionate about health systems, education, and health technology and
has received significant funding from various organizations to execute projects
in these areas. All right, doctor Lisa Jagan, welcome to
the podcast. Thank you so much for joining me, Thanks
for having me today. We're going to talk about health
tech and specifically how that relates to an initiative you've
(01:40):
developed in conjunction with Clarity I Institute in order to
screen for eyelid legions. But for many of us optalmology folk,
who just know the word tech as something fancy that
cool people do in Silicon Valley, what is health tech?
What is the greatest kind of preconception about health tech?
What are we really talking about here?
Speaker 2 (02:02):
You know, Zil, I'm exactly the same as you and
that if someone had asked me about health tech or
artificial intelligence ten years ago, I think my mind would
have automatically jumped to this image of essentially a really
slick robotic arm performing virtual surgery on my patients while
I was on a beach somewhere. And you know, these
(02:24):
sorts of technologies. They're out there, they're being developed, but
the reality is that health technology encompasses a much broader scope,
and the World Health Organization they define health tech as
the application of organized knowledge and skills to solve health
problems and improve quality of life. So perhaps when it
(02:48):
comes to health tech, I think the preconception is that
we tend to think of it as fancy new devices,
new medicines, But it also applies to new system and
new processes. And that's the piece that I essentially want
to bring attention to in our discussion today, because we
don't always think about that as being health tech.
Speaker 1 (03:10):
Yeah, I think we don't. I think most of us
when we think of health tech, think of something that's
a little bit more complex, fancy maybe now, ten years ago,
definitely now, maybe not as much because things are just
advancing so much with AI, so we're not just thinking
about the people making millions and billions of dollars in
Silicon values. I alluded to, Yeah, you initiated something called
(03:33):
lid express, and I think that's a good lens through
which we can understand health tech a little bit better.
Talk to me about lid express, what that is and
then we'll talk about how that utilizes tech.
Speaker 2 (03:46):
Right, So, I mean as a high level description, essentially,
lid Express is it's a service that expedite surgery for
patients who have benign bumps on their eyelids, like a Chilesian.
And the way that the system works is that patients
will go on to our website and they answer a
(04:07):
series of yes or no screening questions which will essentially
only let them progress to the actual application. If they
are appropriate candidates for the program, then they take photos
of their eyelids just with their phone and they upload
these photos directly to our secure online platform. Within one week,
(04:27):
we screen their photos along with some of the basic
medical information they've submitted, and if the patient meets the criteria,
we book a surgery for them within one month, and
on that day we also are doing an assessment, but
they have the ability to just have their surgery done
on the exact same day with an oculo plastic surgeon.
Speaker 1 (04:47):
What were some of the things that prompted this What
were some of the sounds like a very big I'm
not a business person, but this sounds like a business
term of that to use. What were some of the
pain points? So to speak that you identified and other
oculo plastic specialist identified that prompted you to say, this
is a service that would be beneficial.
Speaker 2 (05:07):
Right, So right, pain points, I love it. I think
you know, in terms of the challenges, there were these
recurring pain points that came up for the patients that
were just trying to navigate the healthcare system essentially to
address such a simple issue like having a chilasian or
having an eyelid bump.
Speaker 3 (05:23):
But there were three main points.
Speaker 2 (05:26):
I would say, when is the time that was wasted
from going through multiple referrals and appointments. So patients were
frustrated that they needed to jump through so many hoops,
seeing so many different healthcare providers before finally seeing someone
like an oculo plastic surgeon who could offer a wider
breadth of interventions. Many patients would have taken off somewhere
(05:47):
between you know, twelve to even eighteen hours of work
just to go to all of these different appointments. And
that's if you can imagine that's just for one single
eyelid bump. Imagine if they had multiple other health problems.
Speaker 1 (05:59):
Going on, which they probably do, which.
Speaker 3 (06:02):
They probably do.
Speaker 2 (06:04):
And so that's number one is the time wasted from
the referrals. Number two would just be the lack of
control and scheduling. So you know, within Ontario, when a
referral is sent and you're the patient, there's no real
telling when you're going to get an appointment. It's just
a matter of waiting and seeing. And you also don't
often get to say and when that appointment will be,
so that's really frustrating. The third piece would just be
(06:26):
anxiety and concern because patients have this growth on their eyelid,
they're seeing it all the time and they have no
idea whether it needs to be addressed urgently or not,
or whether it might be a possible skin cancer. And
often when they're waiting many months just to see a specialist,
there's a spaceline level of anxiety that can weigh quite
heavily on patients.
Speaker 1 (06:47):
Yeah, so waste of time kind of to be blunt
delayed diagnosis because referrals take long time for triaging, delayed treatment,
and just all these visits when in reality we kind
of can pretty easily diagnose it, or at least not
necessarily diagnose it, but tell the patient is this something
that we need to be seeing quickly? Is this something
(07:09):
that needs to be seen at all, or is this
something we need to see but we can wait a
couple months. Those are things we could probably do with
a photo.
Speaker 2 (07:16):
You're saying exactly, and that's exactly what we were trying
to address with the lid Express because now knowing what
that process was, basically the patient is only taking time
off work once, right, So they're coming in on after
they've submitted their photos. They're coming in on that day
to get their in person assessment and get their surgery,
(07:36):
and they're also seeing the right specialist that has expertise
and their issue from the get go. Plus, because we
created these sort of parameters, they know when they'll hear
back from our service, they know they'll hear back within
one week about whether they're a candidate, and they know
that they'll get booked within one month.
Speaker 1 (07:52):
So really, really, in some way simple, and some of
us associate the word tech with just this complexity that
we wouldn't be able to really do ourselves, and that
might cause us to veer away from similar initiatives that
are equally impactful and efficient. One of the things that
strikes me, and I'm sure has struck you as you've
(08:13):
developed this program. Is the ways that this could be
extrapolated and expanded on. Patients could send photos in Now
they're being looked at individually by oculoplastic specialist who are
saying yes, I'm concerned, No, I'm not concerned. But with AI,
and as a catalog builds with thousands, even millions potentially
(08:34):
of photos, AI could start making some of these decisions
and reduce the oculoplastics role to an extent, which would
save even more time. AI could kind of spew out
these ones are concerning based on the photographs and biopsy
results we've gotten, and these ones aren't. Where are we
in that process? Is that really really far off? Is
(08:56):
that something that is being used in certain situations to
look at lesions or the AI itself is determining what
our level of concern should be.
Speaker 2 (09:05):
Definitely that we've seen already this technology being used in
the dermatology world. We've also seen it being used to
stage fundus photos with patients who have diabetic retinopathy. AI
is definitely already there. There obviously needs to be some
level of oversight to it, but for the LIT Express program,
that's for sure part of the longer term plan would
(09:28):
be to, you know, sort of have this algorithm that
would allow us to feed the data that we have
into a database so that we can create something where
AI is helping us make those initial triaging decisions, which
would save a lot of time for patients and for
the administrative staff at these multiple clinics. I also think
(09:52):
it would be helpful if you've ever had to do
a scan with your phone where the photo directs you
to kind of hold the phone out and take the
photo at different angles to capture your face better.
Speaker 3 (10:04):
That sort of.
Speaker 2 (10:04):
Facial recognition software can be used to capture these lesions
in a more accurate way. And we could incorporate measuring
tools to grade the size of these lesions, which could
be helpful for serial follow ups so that patients don't even.
Speaker 3 (10:18):
Have to come in.
Speaker 2 (10:19):
So anyway, there's a lot, for sure that can be
done to expand in this area. It's really exciting and
I love thinking about it and talking to people who.
Speaker 3 (10:29):
Have the knowledge on it.
Speaker 2 (10:32):
But at this stage, we are at that infrastructure base
where we're just sort of proving, hey, this is working
and this is a simple solution, but it has a
good jump off for sure.
Speaker 1 (10:44):
I've had as many of us had conversations with colleagues
about AI and tech and how that's incorporated into our practice.
And I think there used to be more hesitancy about
allowing AI to enter into medicine because we were worried
what was this going to take away our job? Sort
of what's our role going to be IFAI is doing everything?
But I do feel like there's a growing sentiment that
(11:06):
no AI is here to stay and it's effective, and
the best thing that doctors and medical professionals can do
is embrace it and utilize these great technologies. One question
I have for you is some people might say, well,
how good is AI at detecting lesions? How good is
AI at diagnosing compared to the human eye? Are there
(11:27):
any studies, and I imagine there are, whether it's specifically
in ocular plastics or dermatology, Are there any studies that
have looked at how good AI is at diagnosing lesions
versus how good the human eye is at diagnosing lesions
when they're stacked up to the end biopsy result.
Speaker 2 (11:47):
That's a good question. I know for sure within the
dermatology field that there are which would be very similar
and the concordance is very high. I don't know the
exact percentage, but it's surprisingly good. If anything, I think
that sometimes it can be better than clinicians in terms
of again using that framework not getting distorted by historical elements.
(12:09):
It is very well regarded, and I know that in
other countries these things are being rolled out more so
as like a preliminary approach is to use AI for
the initial screening only because they're so overwhelmed with the
wait times for getting some of these patients in. So
if you think about it that way, from like a
(12:31):
population based approach, maybe let's just say AI wasn't you know,
was ninety five percent accurate versus I'm ninety eight percent
accurate in determining the likelihood of malignancy. But if using
AI allowed us to screen like five hundred patients whereas
I can only screen twenty in a day, we're still
(12:54):
probably better off with AI, And that needs to go
into the consideration piece.
Speaker 1 (12:59):
Yeah, And I think that's just an important point there
of their complementary right, And I think the best approach
probably is to not try and push AI and tech
away and say no, no, I'm going to do this
the way I've always done it because we've got great
technologies that are really really reliable, especially in the context
of a human looking at it as well.
Speaker 3 (13:21):
I totally agree.
Speaker 2 (13:22):
And the reality is that we are kind of floundering
and are in being overwhelmed by referrals and patients with
particularly eyelid lesions. With our aging population, there's so many
referrals for eyelid bumps that we are so behind, and
it's really disheartening to me sometimes when you know patients
(13:42):
who have quite serious squamos cell carcinomas, had I seen
them four months prior, would have a different outcome, a
significantly different outcome, even like a visually preserving outcome. But
because we're so overwhelmed, we can't get to them in time,
or we can't triage them a prop Really so I
think we need it.
Speaker 3 (14:02):
We're like, we're desperate for AI to help us.
Speaker 1 (14:05):
One thing that strikes me is medical legal concerns. What
is that like? I would think that you're still on
the hook for every patient that sends a photo into
lid Express, for example, if you were to miss something
based on that photo, I'm guessing that makes people worried
about well, I would want to do that, but I
still feel like I need to see them in person
(14:26):
or I'm scared that the medical legal implications of diagnosing
something over the computer are very high. How have you
dealt with that? What are the medical legal implications?
Speaker 2 (14:39):
So there are general guidelines actually that exist for what
sorts of presenting issues can be reasonably assessed by virtual care.
The CMA has something called the Virtual Care Playbook, and
it does have a great framework with a little overview
of the types of issues that can be assessed virtually
in terms of medical legally, the idea is that you're
(14:59):
c decision should be based on a sound reasoning process,
and if you were to tell your other colleagues how
you were coming to your decision, whether they would say
that that was reasonable or not.
Speaker 3 (15:11):
Is it as great?
Speaker 2 (15:13):
Probably not? But is it reasonable in getting to that diagnosis,
That's what you're trying to ask. So with the lid
Express and the high quality photos we're getting, you know,
from my perspective, ninety a very high percentage of the
information I need to make a reasonable decision. So I
feel very comfortable using this approach. And the personal judgment
(15:36):
piece is important. So you might remember during COVID. There
were times that we had no choice but to do
virtual care for issues that I really didn't feel were
amenable to doing virtual care, like looking for hsb iritis.
We rely on our slit lamp finding so much it's
almost impossible to look at a photo and try to
(15:56):
judge something of that nature. So just common sense, and
I think that the legal framework is quite understanding in
that sense, where it's what's reasonable? Do you think you
can defend that? Would your colleagues say the same thing.
Speaker 1 (16:11):
What's great about this topic is that it's relatable to
people of all subspecialties and even outside of ophthalmology, who
are saying, yeah, you know what, maybe I could do something.
I'm a corney specialist for trigiums, right where I could
look at those online because sometimes they're waiting long time
for a consult just for me to confirm what we
all knew was a trigium in the first place, or
for me to say, no, this actually looks a little
(16:32):
more concerning and we should get this in sooner for
a biopsy. So you can extrapolate this to a lot
of different areas of ophthalmology into a lot of different
areas of medicine. When you were developing lid Express, what
was the process, how did you actually go about developing
it Because a lot of people who are listening to
this might think, oh, I'd like to incorporate that into
(16:53):
my practice, but it does seem kind of tough to
develop an interface and to develop the actual tech platform
to do this right.
Speaker 2 (17:01):
So just with regards to the medical legal aspect first,
and then I can talk about the general approach that
I use. But for lid Express, before I did anything,
I did a lot of research up front in terms
of the guidelines published by the CMA, the OME, and
I also spoke to the CMPA, the Canadian Medical Protective Association,
(17:21):
to get advice on some of the important considerations and principles.
And what I took away from that discussion, which I
think is important before embarking on any sort of new
endeavor from a medical legal point of view, is that
there are certain principles that are just the underpinning for
all health policies. So that's things like privacy protection, informed
(17:45):
patient consent, equitable distribution of care, making sure you have
a process for adverse event reporting, strategies for quality improvement.
So those are the base for policies that need to
be considered whenever you're developing something new. And so the
reason I mentioned this is because I think what I
(18:05):
wanted when I first started was to find something that said, Okay,
you're totally one hundred percent fine to create a program
like this, and I couldn't find that. And I, you know,
as a rule abider that wants to feel really safe,
and I'm very risk averse, I felt a bit uneasy
that I couldn't find something said hey, you can go
and create lit Express and you can do this exact thing.
(18:27):
But I realized that if you know, I wait for
there to be this red carpet policy laid out to
advise me on how to do something, then we'll never
be able to move forward and incorporate new technology or processes.
And a lot of times policymakers, you know, the impetus
for them to develop new guidelines is when they see
that many clinicians are trending towards doing something differently, they
(18:50):
realize they need to give some guidance on how to
do it. And so as long as we're being ethically
considerate and conscientious, then I think we can make these changes.
So that's just one piece for the medical legal aspect
of what I did. I just consulted the irrelevant bodies
and I explained what I was thinking, and I thought
about whether it made sense logically. I bounced the idea
(19:11):
off a lot of people who had more experience than
I did, and then in terms of actual implementation, like
within the clinics. So I pitched this idea to doctor
Paul Sangara and doctor Bisir Khan. They're the founders of
Clarity I Institute, And to be fair, I had the
advantage that both Paul and Bisier they're very open to
innovation and so they're already primed to think about different
(19:35):
ways of doing things, which is helpful. But basically my
pitch to them was, you know, cure the strengths within
our existing infrastructure. At Clarity Institute. We have five ocul
plastic surgeons affiliated with our practice. That's way more than
most other practices in our region. That means we have
the capacity and we have the manpower to process all
(19:56):
these lit express patients and also be able to operate
with than a month. The second was that there's already
the right instruments we needed to perform ninety nine percent of.
Speaker 3 (20:06):
These highlight growth removals.
Speaker 2 (20:07):
So we didn't have fancy skin resurfacing lasers, which would
have required a big monetary investment, so that again lit
Express was not going to target these patients for lasers
would be needed. We already had had the right instruments.
And then the last piece was just you know, talking
about how Clarity Institute we are very adept at sort
(20:30):
of scheduling high efficiency surgery days and it's sort of
within our culture to have an efficient pace with patients,
and so I think that that worked well for supporting
an initiative like let Express. And essentially I broke this
all down to say, hey, you know, can we just
change a process? And changing this process doesn't require that much.
(20:52):
It just builds upon all of our existing pieces. It
builds upon the surgeons that we already have, the instruments
we already have, and the high efficiency operating culture that
we already have. We just need to develop the platform
for collecting the information and protecting that information, and then
we can have a different way of doing something that
we've done the same way for decades.
Speaker 1 (21:14):
One of the things that you said that I loved
and that I love about this topic is that of
one of our blind spots is that there is just
this template in general, not just in ophthalmology and in mesine,
but in life that's laid out for you. Like you said,
and you were initially looking for, this is how you
do this. You've got carte blanche one hundred percent. There's
(21:35):
a policy out there that's going to guide you. There's
a book that's going to have a set of rules
that you can follow and then just go there. But
that's not how life works. That's not how projects work.
And that's where you really take a risk and you
jump in and you say, I'm going to start a
new project. I know that there is no template out
there already, but the jump isn't as scary as I
(21:56):
think it is. And in your case, you had an idea.
You were home hoping that you would just go on
to the CMA Canadian Medical Association and they would say
this is how you do it. And it's like that
with a lot of things in medicine and in life
where there isn't. But if you kind of get over
that and realize most things in life are not going
to have templates, especially things related to innovation, then it
(22:17):
gives you that liberty and that freedom to say, Okay, well,
if that doesn't exist, then I'm going to stop searching
for it and I'm just going to do it and
start the journey and see where it takes me. So
I really applaud you for starting lit Express. I mean,
I also work at Clarity on Institute. I mean, we
have international listeners here, but we're talking about this particular
project that was initiated in Toronto and Canada. But it's
(22:38):
been amazing to watch because it already is working and
we're seeing patients submit photos, We're seeing doctors reach out
to help their patients submit photos, and it's really expedited
the process for so many patients and we're already seeing really,
really great results from this. So it's really amazing. I
commend you for that. What are some final thoughts that
(23:00):
you want to share and how can people learn more
about express because it's already very much in use.
Speaker 2 (23:06):
Yeah, thank you soal In terms of final thoughts, I
think that one of the important takeaways would be just
to give yourself a more credit as a clinician for
the unique position we're in to understand the patient experience.
I think there's a little bit of imposter syndrome for
physicians to think that health tech and all this stuff
needs to be done like you said, by people in
(23:27):
Silicon Valley. But we're actually in a great position to
come up with solutions that make practical sense and are
more likely to be adopted by other clinicians without a
business background.
Speaker 3 (23:38):
We were just aware.
Speaker 2 (23:40):
We're aware of real life costs like how much does
a chlazyan clam cost or gut suture or three hours
of a nurse assisting in the operating suite, so we
know how to determine if our project's technically and financially feasible.
The second final thought I would say is I think
in medicine and sort of similar line of thinking is.
Speaker 3 (24:02):
We're always told like this is the way it is.
Speaker 2 (24:05):
And I remember as a trainee, one of my attending
surgeons saying, Lisa, you have to decide what kind of
doctor you're going to be in the future. Will you
see less patients but provide incredible care knowing that you
know there's many more patients waiting to be seen, or
will you see and help more patients, but no, you
might be providing subpar care. And I really hated this
(24:28):
and I used to think about it a lot because
it's like an ethical quandary. But the problem wasn't a
matter of choosing between those two options. The problem was thinking,
you know, those are the only two options that exist.
And I'm optimistic. I believe we can achieve a system
that allows us to keep up with our patient volumes
and provide a high standard of care. But we do
(24:49):
need to change that ingrained nature of accepting you know,
this is the way it is, and we're physicians. We
can't be the ones to spearhead any of these initiatives.
I think our industry CA can be in line with
other leading tech industries, and yeah, just remember that health
tech can be simple and simple solutions can be impactful.
Speaker 1 (25:10):
I absolutely, I absolutely love that, and this is a
perfect example of kind of ameliorating that conflicting situation she
that your attending had laid out for you. Where can
people learn more about lid Express.
Speaker 2 (25:23):
Right www dot lidexpress dot CAA, or you can check
out the Instagram page at lid x It has sort
of everything encapsulated there. But I'm also happy to chat.
If someone wanted to reach out by email, we can
list that it's l Jagan at qmed dot CAA. I'm
always happy to, you know, grab a coffee or jump
(25:46):
on a call if you're thinking of starting something in
your clinic and you just want to bounce ideas off someone.
I think it's helpful to talk through it with different people,
and I was happy to have that as I was
going through it. Yeah, I think you know, it's it's
really exciting for me to explore this world, and I
hope that you would be more open to exploring it
(26:08):
too after listening to us chat about it today.
Speaker 1 (26:10):
Well, I think definitely people will be And I'm so
so glad that you joined me and that we did
this topic because it's it's not our typical episode where
we kind of break down the nuts and bolts of
a clinical problem, which we did in our last episode together.
But it's a different avenue of ophthalmology which is relevant
to everybody and certainly I'm sure piques people's curiosity of Okay,
(26:34):
how can I use my creativity in a different facet
of ophthalmology in a way that is really practical and exciting.
So this is incredible. Thank you so so much for
joining me. I'm going to put all the information regarding
let Express and the episode notes, so please be sure
to check that out. Lisa Jagan, thank you so much
for joining me. Thank you, and thank you everybody for
(26:55):
listening to another episode of blind Spot. Have a great day.
It still susta
Hey everybody, I'm Xaeo Mednik and welcome to another episode
of Blindspot. This episode is sponsored by THEA Pharma Canada.
THEA Pharma Canada is the Canadian subsidiary of THEA, Europe's
leading pioneering and innovative eye health brand. Founded in nineteen
ninety four by Henri's Schibre. With five generations of history,
the Schibret family has been dedicated to I care for
(00:33):
more than one hundred and fifty years. Their commitment to
improving lives is born of their pioneering spirit. They continue
to lead the worldwide preservative free movement in eye care.
They've created innovative delivery systems. They've focused on making products
accessible and cost effective for patients. They live this mission
every day because everyone should have the same opportunities to
see the world through healthy eyes. So thank you THEA
(00:56):
Pharmer Canada for supporting Blindspot. I'm joined today by oculp
plastic specialist Doctor Lisa Jagen. Doctor Jagan is an ophthalmologist
that specializes in oculoplastic surgery. She's published extensively in the field,
contributes actively to peer review, and is currently co authoring
a procedural Oculoplastics textbook. She's the past vice president of
the Toronto Ophthalmology Society and the director of Express. She's
(01:19):
extremely passionate about health systems, education, and health technology and
has received significant funding from various organizations to execute projects
in these areas. All right, doctor Lisa Jagan, welcome to
the podcast. Thank you so much for joining me, Thanks
for having me today. We're going to talk about health
tech and specifically how that relates to an initiative you've
(01:40):
developed in conjunction with Clarity I Institute in order to
screen for eyelid legions. But for many of us optalmology folk,
who just know the word tech as something fancy that
cool people do in Silicon Valley, what is health tech?
What is the greatest kind of preconception about health tech?
What are we really talking about here?
Speaker 2 (02:02):
You know, Zil, I'm exactly the same as you and
that if someone had asked me about health tech or
artificial intelligence ten years ago, I think my mind would
have automatically jumped to this image of essentially a really
slick robotic arm performing virtual surgery on my patients while
I was on a beach somewhere. And you know, these
(02:24):
sorts of technologies. They're out there, they're being developed, but
the reality is that health technology encompasses a much broader scope,
and the World Health Organization they define health tech as
the application of organized knowledge and skills to solve health
problems and improve quality of life. So perhaps when it
(02:48):
comes to health tech, I think the preconception is that
we tend to think of it as fancy new devices,
new medicines, But it also applies to new system and
new processes. And that's the piece that I essentially want
to bring attention to in our discussion today, because we
don't always think about that as being health tech.
Speaker 1 (03:10):
Yeah, I think we don't. I think most of us
when we think of health tech, think of something that's
a little bit more complex, fancy maybe now, ten years ago,
definitely now, maybe not as much because things are just
advancing so much with AI, so we're not just thinking
about the people making millions and billions of dollars in
Silicon values. I alluded to, Yeah, you initiated something called
(03:33):
lid express, and I think that's a good lens through
which we can understand health tech a little bit better.
Talk to me about lid express, what that is and
then we'll talk about how that utilizes tech.
Speaker 2 (03:46):
Right, So, I mean as a high level description, essentially,
lid Express is it's a service that expedite surgery for
patients who have benign bumps on their eyelids, like a Chilesian.
And the way that the system works is that patients
will go on to our website and they answer a
(04:07):
series of yes or no screening questions which will essentially
only let them progress to the actual application. If they
are appropriate candidates for the program, then they take photos
of their eyelids just with their phone and they upload
these photos directly to our secure online platform. Within one week,
(04:27):
we screen their photos along with some of the basic
medical information they've submitted, and if the patient meets the criteria,
we book a surgery for them within one month, and
on that day we also are doing an assessment, but
they have the ability to just have their surgery done
on the exact same day with an oculo plastic surgeon.
Speaker 1 (04:47):
What were some of the things that prompted this What
were some of the sounds like a very big I'm
not a business person, but this sounds like a business
term of that to use. What were some of the
pain points? So to speak that you identified and other
oculo plastic specialist identified that prompted you to say, this
is a service that would be beneficial.
Speaker 2 (05:07):
Right, So right, pain points, I love it. I think
you know, in terms of the challenges, there were these
recurring pain points that came up for the patients that
were just trying to navigate the healthcare system essentially to
address such a simple issue like having a chilasian or
having an eyelid bump.
Speaker 3 (05:23):
But there were three main points.
Speaker 2 (05:26):
I would say, when is the time that was wasted
from going through multiple referrals and appointments. So patients were
frustrated that they needed to jump through so many hoops,
seeing so many different healthcare providers before finally seeing someone
like an oculo plastic surgeon who could offer a wider
breadth of interventions. Many patients would have taken off somewhere
(05:47):
between you know, twelve to even eighteen hours of work
just to go to all of these different appointments. And
that's if you can imagine that's just for one single
eyelid bump. Imagine if they had multiple other health problems.
Speaker 1 (05:59):
Going on, which they probably do, which.
Speaker 3 (06:02):
They probably do.
Speaker 2 (06:04):
And so that's number one is the time wasted from
the referrals. Number two would just be the lack of
control and scheduling. So you know, within Ontario, when a
referral is sent and you're the patient, there's no real
telling when you're going to get an appointment. It's just
a matter of waiting and seeing. And you also don't
often get to say and when that appointment will be,
so that's really frustrating. The third piece would just be
(06:26):
anxiety and concern because patients have this growth on their eyelid,
they're seeing it all the time and they have no
idea whether it needs to be addressed urgently or not,
or whether it might be a possible skin cancer. And
often when they're waiting many months just to see a specialist,
there's a spaceline level of anxiety that can weigh quite
heavily on patients.
Speaker 1 (06:47):
Yeah, so waste of time kind of to be blunt
delayed diagnosis because referrals take long time for triaging, delayed treatment,
and just all these visits when in reality we kind
of can pretty easily diagnose it, or at least not
necessarily diagnose it, but tell the patient is this something
that we need to be seeing quickly? Is this something
(07:09):
that needs to be seen at all, or is this
something we need to see but we can wait a
couple months. Those are things we could probably do with
a photo.
Speaker 2 (07:16):
You're saying exactly, and that's exactly what we were trying
to address with the lid Express because now knowing what
that process was, basically the patient is only taking time
off work once, right, So they're coming in on after
they've submitted their photos. They're coming in on that day
to get their in person assessment and get their surgery,
(07:36):
and they're also seeing the right specialist that has expertise
and their issue from the get go. Plus, because we
created these sort of parameters, they know when they'll hear
back from our service, they know they'll hear back within
one week about whether they're a candidate, and they know
that they'll get booked within one month.
Speaker 1 (07:52):
So really, really, in some way simple, and some of
us associate the word tech with just this complexity that
we wouldn't be able to really do ourselves, and that
might cause us to veer away from similar initiatives that
are equally impactful and efficient. One of the things that
strikes me, and I'm sure has struck you as you've
(08:13):
developed this program. Is the ways that this could be
extrapolated and expanded on. Patients could send photos in Now
they're being looked at individually by oculoplastic specialist who are
saying yes, I'm concerned, No, I'm not concerned. But with AI,
and as a catalog builds with thousands, even millions potentially
(08:34):
of photos, AI could start making some of these decisions
and reduce the oculoplastics role to an extent, which would
save even more time. AI could kind of spew out
these ones are concerning based on the photographs and biopsy
results we've gotten, and these ones aren't. Where are we
in that process? Is that really really far off? Is
(08:56):
that something that is being used in certain situations to
look at lesions or the AI itself is determining what
our level of concern should be.
Speaker 2 (09:05):
Definitely that we've seen already this technology being used in
the dermatology world. We've also seen it being used to
stage fundus photos with patients who have diabetic retinopathy. AI
is definitely already there. There obviously needs to be some
level of oversight to it, but for the LIT Express program,
that's for sure part of the longer term plan would
(09:28):
be to, you know, sort of have this algorithm that
would allow us to feed the data that we have
into a database so that we can create something where
AI is helping us make those initial triaging decisions, which
would save a lot of time for patients and for
the administrative staff at these multiple clinics. I also think
(09:52):
it would be helpful if you've ever had to do
a scan with your phone where the photo directs you
to kind of hold the phone out and take the
photo at different angles to capture your face better.
Speaker 3 (10:04):
That sort of.
Speaker 2 (10:04):
Facial recognition software can be used to capture these lesions
in a more accurate way. And we could incorporate measuring
tools to grade the size of these lesions, which could
be helpful for serial follow ups so that patients don't even.
Speaker 3 (10:18):
Have to come in.
Speaker 2 (10:19):
So anyway, there's a lot, for sure that can be
done to expand in this area. It's really exciting and
I love thinking about it and talking to people who.
Speaker 3 (10:29):
Have the knowledge on it.
Speaker 2 (10:32):
But at this stage, we are at that infrastructure base
where we're just sort of proving, hey, this is working
and this is a simple solution, but it has a
good jump off for sure.
Speaker 1 (10:44):
I've had as many of us had conversations with colleagues
about AI and tech and how that's incorporated into our practice.
And I think there used to be more hesitancy about
allowing AI to enter into medicine because we were worried
what was this going to take away our job? Sort
of what's our role going to be IFAI is doing everything?
But I do feel like there's a growing sentiment that
(11:06):
no AI is here to stay and it's effective, and
the best thing that doctors and medical professionals can do
is embrace it and utilize these great technologies. One question
I have for you is some people might say, well,
how good is AI at detecting lesions? How good is
AI at diagnosing compared to the human eye? Are there
(11:27):
any studies, and I imagine there are, whether it's specifically
in ocular plastics or dermatology, Are there any studies that
have looked at how good AI is at diagnosing lesions
versus how good the human eye is at diagnosing lesions
when they're stacked up to the end biopsy result.
Speaker 2 (11:47):
That's a good question. I know for sure within the
dermatology field that there are which would be very similar
and the concordance is very high. I don't know the
exact percentage, but it's surprisingly good. If anything, I think
that sometimes it can be better than clinicians in terms
of again using that framework not getting distorted by historical elements.
(12:09):
It is very well regarded, and I know that in
other countries these things are being rolled out more so
as like a preliminary approach is to use AI for
the initial screening only because they're so overwhelmed with the
wait times for getting some of these patients in. So
if you think about it that way, from like a
(12:31):
population based approach, maybe let's just say AI wasn't you know,
was ninety five percent accurate versus I'm ninety eight percent
accurate in determining the likelihood of malignancy. But if using
AI allowed us to screen like five hundred patients whereas
I can only screen twenty in a day, we're still
(12:54):
probably better off with AI, And that needs to go
into the consideration piece.
Speaker 1 (12:59):
Yeah, And I think that's just an important point there
of their complementary right, And I think the best approach
probably is to not try and push AI and tech
away and say no, no, I'm going to do this
the way I've always done it because we've got great
technologies that are really really reliable, especially in the context
of a human looking at it as well.
Speaker 3 (13:21):
I totally agree.
Speaker 2 (13:22):
And the reality is that we are kind of floundering
and are in being overwhelmed by referrals and patients with
particularly eyelid lesions. With our aging population, there's so many
referrals for eyelid bumps that we are so behind, and
it's really disheartening to me sometimes when you know patients
(13:42):
who have quite serious squamos cell carcinomas, had I seen
them four months prior, would have a different outcome, a
significantly different outcome, even like a visually preserving outcome. But
because we're so overwhelmed, we can't get to them in time,
or we can't triage them a prop Really so I
think we need it.
Speaker 3 (14:02):
We're like, we're desperate for AI to help us.
Speaker 1 (14:05):
One thing that strikes me is medical legal concerns. What
is that like? I would think that you're still on
the hook for every patient that sends a photo into
lid Express, for example, if you were to miss something
based on that photo, I'm guessing that makes people worried
about well, I would want to do that, but I
still feel like I need to see them in person
(14:26):
or I'm scared that the medical legal implications of diagnosing
something over the computer are very high. How have you
dealt with that? What are the medical legal implications?
Speaker 2 (14:39):
So there are general guidelines actually that exist for what
sorts of presenting issues can be reasonably assessed by virtual care.
The CMA has something called the Virtual Care Playbook, and
it does have a great framework with a little overview
of the types of issues that can be assessed virtually
in terms of medical legally, the idea is that you're
(14:59):
c decision should be based on a sound reasoning process,
and if you were to tell your other colleagues how
you were coming to your decision, whether they would say
that that was reasonable or not.
Speaker 3 (15:11):
Is it as great?
Speaker 2 (15:13):
Probably not? But is it reasonable in getting to that diagnosis,
That's what you're trying to ask. So with the lid
Express and the high quality photos we're getting, you know,
from my perspective, ninety a very high percentage of the
information I need to make a reasonable decision. So I
feel very comfortable using this approach. And the personal judgment
(15:36):
piece is important. So you might remember during COVID. There
were times that we had no choice but to do
virtual care for issues that I really didn't feel were
amenable to doing virtual care, like looking for hsb iritis.
We rely on our slit lamp finding so much it's
almost impossible to look at a photo and try to
(15:56):
judge something of that nature. So just common sense, and
I think that the legal framework is quite understanding in
that sense, where it's what's reasonable? Do you think you
can defend that? Would your colleagues say the same thing.
Speaker 1 (16:11):
What's great about this topic is that it's relatable to
people of all subspecialties and even outside of ophthalmology, who
are saying, yeah, you know what, maybe I could do something.
I'm a corney specialist for trigiums, right where I could
look at those online because sometimes they're waiting long time
for a consult just for me to confirm what we
all knew was a trigium in the first place, or
for me to say, no, this actually looks a little
(16:32):
more concerning and we should get this in sooner for
a biopsy. So you can extrapolate this to a lot
of different areas of ophthalmology into a lot of different
areas of medicine. When you were developing lid Express, what
was the process, how did you actually go about developing
it Because a lot of people who are listening to
this might think, oh, I'd like to incorporate that into
(16:53):
my practice, but it does seem kind of tough to
develop an interface and to develop the actual tech platform
to do this right.
Speaker 2 (17:01):
So just with regards to the medical legal aspect first,
and then I can talk about the general approach that
I use. But for lid Express, before I did anything,
I did a lot of research up front in terms
of the guidelines published by the CMA, the OME, and
I also spoke to the CMPA, the Canadian Medical Protective Association,
(17:21):
to get advice on some of the important considerations and principles.
And what I took away from that discussion, which I
think is important before embarking on any sort of new
endeavor from a medical legal point of view, is that
there are certain principles that are just the underpinning for
all health policies. So that's things like privacy protection, informed
(17:45):
patient consent, equitable distribution of care, making sure you have
a process for adverse event reporting, strategies for quality improvement.
So those are the base for policies that need to
be considered whenever you're developing something new. And so the
reason I mentioned this is because I think what I
(18:05):
wanted when I first started was to find something that said, Okay,
you're totally one hundred percent fine to create a program
like this, and I couldn't find that. And I, you know,
as a rule abider that wants to feel really safe,
and I'm very risk averse, I felt a bit uneasy
that I couldn't find something said hey, you can go
and create lit Express and you can do this exact thing.
(18:27):
But I realized that if you know, I wait for
there to be this red carpet policy laid out to
advise me on how to do something, then we'll never
be able to move forward and incorporate new technology or processes.
And a lot of times policymakers, you know, the impetus
for them to develop new guidelines is when they see
that many clinicians are trending towards doing something differently, they
(18:50):
realize they need to give some guidance on how to
do it. And so as long as we're being ethically
considerate and conscientious, then I think we can make these changes.
So that's just one piece for the medical legal aspect
of what I did. I just consulted the irrelevant bodies
and I explained what I was thinking, and I thought
about whether it made sense logically. I bounced the idea
(19:11):
off a lot of people who had more experience than
I did, and then in terms of actual implementation, like
within the clinics. So I pitched this idea to doctor
Paul Sangara and doctor Bisir Khan. They're the founders of
Clarity I Institute, And to be fair, I had the
advantage that both Paul and Bisier they're very open to
innovation and so they're already primed to think about different
(19:35):
ways of doing things, which is helpful. But basically my
pitch to them was, you know, cure the strengths within
our existing infrastructure. At Clarity Institute. We have five ocul
plastic surgeons affiliated with our practice. That's way more than
most other practices in our region. That means we have
the capacity and we have the manpower to process all
(19:56):
these lit express patients and also be able to operate
with than a month. The second was that there's already
the right instruments we needed to perform ninety nine percent of.
Speaker 3 (20:06):
These highlight growth removals.
Speaker 2 (20:07):
So we didn't have fancy skin resurfacing lasers, which would
have required a big monetary investment, so that again lit
Express was not going to target these patients for lasers
would be needed. We already had had the right instruments.
And then the last piece was just you know, talking
about how Clarity Institute we are very adept at sort
(20:30):
of scheduling high efficiency surgery days and it's sort of
within our culture to have an efficient pace with patients,
and so I think that that worked well for supporting
an initiative like let Express. And essentially I broke this
all down to say, hey, you know, can we just
change a process? And changing this process doesn't require that much.
(20:52):
It just builds upon all of our existing pieces. It
builds upon the surgeons that we already have, the instruments
we already have, and the high efficiency operating culture that
we already have. We just need to develop the platform
for collecting the information and protecting that information, and then
we can have a different way of doing something that
we've done the same way for decades.
Speaker 1 (21:14):
One of the things that you said that I loved
and that I love about this topic is that of
one of our blind spots is that there is just
this template in general, not just in ophthalmology and in mesine,
but in life that's laid out for you. Like you said,
and you were initially looking for, this is how you
do this. You've got carte blanche one hundred percent. There's
(21:35):
a policy out there that's going to guide you. There's
a book that's going to have a set of rules
that you can follow and then just go there. But
that's not how life works. That's not how projects work.
And that's where you really take a risk and you
jump in and you say, I'm going to start a
new project. I know that there is no template out
there already, but the jump isn't as scary as I
(21:56):
think it is. And in your case, you had an idea.
You were home hoping that you would just go on
to the CMA Canadian Medical Association and they would say
this is how you do it. And it's like that
with a lot of things in medicine and in life
where there isn't. But if you kind of get over
that and realize most things in life are not going
to have templates, especially things related to innovation, then it
(22:17):
gives you that liberty and that freedom to say, Okay, well,
if that doesn't exist, then I'm going to stop searching
for it and I'm just going to do it and
start the journey and see where it takes me. So
I really applaud you for starting lit Express. I mean,
I also work at Clarity on Institute. I mean, we
have international listeners here, but we're talking about this particular
project that was initiated in Toronto and Canada. But it's
(22:38):
been amazing to watch because it already is working and
we're seeing patients submit photos, We're seeing doctors reach out
to help their patients submit photos, and it's really expedited
the process for so many patients and we're already seeing really,
really great results from this. So it's really amazing. I
commend you for that. What are some final thoughts that
(23:00):
you want to share and how can people learn more
about express because it's already very much in use.
Speaker 2 (23:06):
Yeah, thank you soal In terms of final thoughts, I
think that one of the important takeaways would be just
to give yourself a more credit as a clinician for
the unique position we're in to understand the patient experience.
I think there's a little bit of imposter syndrome for
physicians to think that health tech and all this stuff
needs to be done like you said, by people in
(23:27):
Silicon Valley. But we're actually in a great position to
come up with solutions that make practical sense and are
more likely to be adopted by other clinicians without a
business background.
Speaker 3 (23:38):
We were just aware.
Speaker 2 (23:40):
We're aware of real life costs like how much does
a chlazyan clam cost or gut suture or three hours
of a nurse assisting in the operating suite, so we
know how to determine if our project's technically and financially feasible.
The second final thought I would say is I think
in medicine and sort of similar line of thinking is.
Speaker 3 (24:02):
We're always told like this is the way it is.
Speaker 2 (24:05):
And I remember as a trainee, one of my attending
surgeons saying, Lisa, you have to decide what kind of
doctor you're going to be in the future. Will you
see less patients but provide incredible care knowing that you
know there's many more patients waiting to be seen, or
will you see and help more patients, but no, you
might be providing subpar care. And I really hated this
(24:28):
and I used to think about it a lot because
it's like an ethical quandary. But the problem wasn't a
matter of choosing between those two options. The problem was thinking,
you know, those are the only two options that exist.
And I'm optimistic. I believe we can achieve a system
that allows us to keep up with our patient volumes
and provide a high standard of care. But we do
(24:49):
need to change that ingrained nature of accepting you know,
this is the way it is, and we're physicians. We
can't be the ones to spearhead any of these initiatives.
I think our industry CA can be in line with
other leading tech industries, and yeah, just remember that health
tech can be simple and simple solutions can be impactful.
Speaker 1 (25:10):
I absolutely, I absolutely love that, and this is a
perfect example of kind of ameliorating that conflicting situation she
that your attending had laid out for you. Where can
people learn more about lid Express.
Speaker 2 (25:23):
Right www dot lidexpress dot CAA, or you can check
out the Instagram page at lid x It has sort
of everything encapsulated there. But I'm also happy to chat.
If someone wanted to reach out by email, we can
list that it's l Jagan at qmed dot CAA. I'm
always happy to, you know, grab a coffee or jump
(25:46):
on a call if you're thinking of starting something in
your clinic and you just want to bounce ideas off someone.
I think it's helpful to talk through it with different people,
and I was happy to have that as I was
going through it. Yeah, I think you know, it's it's
really exciting for me to explore this world, and I
hope that you would be more open to exploring it
(26:08):
too after listening to us chat about it today.
Speaker 1 (26:10):
Well, I think definitely people will be And I'm so
so glad that you joined me and that we did
this topic because it's it's not our typical episode where
we kind of break down the nuts and bolts of
a clinical problem, which we did in our last episode together.
But it's a different avenue of ophthalmology which is relevant
to everybody and certainly I'm sure piques people's curiosity of Okay,
(26:34):
how can I use my creativity in a different facet
of ophthalmology in a way that is really practical and exciting.
So this is incredible. Thank you so so much for
joining me. I'm going to put all the information regarding
let Express and the episode notes, so please be sure
to check that out. Lisa Jagan, thank you so much
for joining me. Thank you, and thank you everybody for
(26:55):
listening to another episode of blind Spot. Have a great day.
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