Home / Blog / What’s Up, Doc? Health Care Trends Toward Progress in Hawai‘i

What’s Up, Doc? Health Care Trends Toward Progress in Hawai‘i

Jun 03, 2023Jun 03, 2023

Trend 1

Colonoscopy, once a rite of passage for people over 50, is now recommended among other colon cancer screening for younger people—because that's where colon cancer cases are rising. Honolulu gastroenterologists Dr. Ankur Jain and Dr. Shilpa Jain, a husband-wife team, see patients with this cancer as young as their mid-20s. And while fewer people have been dying from colon cancer, many continue to opt out of colonoscopies and other elective procedures, Ankur Jain says.

What could help change minds is artificial intelligence. AI is making inroads across medicine in Hawai‘i, including by offering a faster and more accurate way to find potentially cancerous polyps. In February, the Pacific Endoscopy Center in Pearl City introduced GI Genius, which uses the same AI technology that cell phones use to identify faces, to search for polyps in the colon. The polyps appear on a computer screen as green boxes. Use of the GI Genius doesn't add any more time to the procedure, which still requires an endoscope, says AnnaLyn Ogata, regional vice president for Covenant Physician Partners, the center's parent company.

At the UH Cancer Center's AI Precision Health Institute, researchers have been using AI to improve cancer treatments and diagnoses since 2018. AI tools can search through records to find text-based medical clues that can lead to diagnosis, says John Shepherd, the institute's co-founder and principal investigator and a professor at the UH Medical School. It can also help with second opinions on medical cases and lead local scientists to case studies. "We have a fairly low enrollment rate of cancer patients into clinical trials," Shepherd says. "AI can search all cases in all medical centers in Hawai‘i for specific criteria for enrollment for hundreds of studies simultaneously."

An example of his team's research is the Hawai‘i Pacific Islands Mammography Registry, which uses AI to identify breast cancer trends, risks and outcomes in outcomes in Asian American, Native Hawaiian and Pacific Islander groups. The registry contains more than 45 million individual images—mammograms, ultrasounds and other procedures performed on 100,000 women over 10 years—connected to breast cancer outcomes and risk factors.

Jain says AI's potential impact on gastroenterology is profound. "We have just recently seen this technology being introduced into clinical practice with AI-assisted colonoscopy. Other applications of AI being studied include risk stratification and early identification of other malignant and nonmalignant lesions of the [gastrointestinal] tract including gastric cancer, GI bleeding, non alcoholic fatty liver disease, and pancreatic cancer," he says. "I am confident that we will see an explosion of AI in health care over the next few years."

Trend 2

The next time you head to a chain grocery store or drugstore, you might want to add a wellness exam to your shopping list. Retailers with in-house pharmacies are beefing up health care offerings far beyond just prescription refills.

Take Longs Drugs CVS Pharmacy, for instance. Its nine O‘ahu in-store MinuteClinics are staffed by nurse practitioners who can provide COVID-19 tests and shots; tuberculosis tests; sports and work physicals; pre-travel health consultations; evaluations of sexually transmitted infections; and routine vaccinations for shingles, hepatitis and more. MinuteClinics recently expanded services to include blood tests; mental health counseling and referrals; chronic disease management for diabetes, high blood pressure and high cholesterol; and screening and treatment for sleep apnea. For common colds, influenza and digestive issues, customers can request virtual appointments at

The nurse practitioners partner with the clinic's CVS Pharmacy to "close gaps in care and recommend more cost-effective drug therapies," says regional director Scott Sutton. "Our pharmacists can also evaluate patients with COVID-19 symptoms and prescribe the oral antiviral medication Paxlovid if the patient is eligible. Also, Hawai‘i is one of 10 states where our pharmacists evaluate patients and prescribe birth control."

Supermarket chain Safeway operates 12 in-store pharmacies statewide that provide health screenings, travel vaccinations, mental health medication administration and routine shots including for COVID-19, influenza and shingles. In February, the chain launched Sincerely Health, a new digital platform that can manage pharmacy orders, schedule vaccine appointments and connect with general practitioners via telehealth. The program starts with an online questionnaire and can track a user's vital signs, medication regimen and overall health. It's compatible with Apple Health, Fitbit and Google Fit.

Trend 3

As COVID-19 infection counts subside, most patients have returned to in-person doctor visits in the Islands, says Dr. Todd Devere, Kaiser Permanente Hawai‘i's medical director for informatics and access. Hawai‘i's largest health care providers report that 75% of doctor visits were held virtually in 2020 and 2021; in 2022, that dropped to 40%.

But telehealth looks like it's here to stay, with many patients and health care providers preferring the convenience and time saved. Kaiser Permanente, the state's largest health maintenance organization, recently augmented its portal. Since last year, in addition to emailing their care teams, engaging in video visits and more, members have been able to access on-demand phone and video services 24/7 through Kaiser Permanente's website and mobile app. Appointments aren't required, and the round-the-clock virtual service helps health care workers decide if a patient needs in-person urgent care, same-day treatment or an appointment with a physician.

"The [virtual] option is still an important one for patients, especially in Hawai‘i where some work two jobs to make a living," says Dr. Sandra Noon, chief of primary care and internal medicine physician for Hawai‘i Pacific Health Medical Group. "People do not have to take time off from work or find someone to watch their young children. Also, older patients who may have challenges can essentially have their doctor visit their home, virtually."

Noon recalls a quadriplegic patient who happily shared his home and daily routine with her on-camera during a virtual appointment. "I learned so much as his physician," she says. "It gave me a valuable perspective into his life and challenges and built upon our relationship."

HMSA was the state's first health plan to launch a telehealth platform—back in 2009. The state's largest health insurer is now testing a digital platform that lets patients use their own devices to manage chronic disease and reach health coaches. "The early results have been very promising," says Matthew Reeves, HMSA senior vice president of clinical integration. "Depending on the success and community receptivity of these pilots, we will look to further expand these offerings."

Trend 4

Dr. Kathryn Taketa-Wong's practice—which falls into the category of complementary and alternative medicine—is booming. As a naturopathic physician and licensed acupuncturist specializing in pediatric autism and attention-deficit/hyperactivity disorder, Down syndrome and other conditions, she looks at physical health, but also considers how mental and emotional stresses impact overall health. "I then make individualized recommendations primarily focusing on diet, vitamins, herbs and other nutrients to treat those underlying medical conditions," she says.

Taketa-Wong recently hired another naturopathic doctor to accommodate a swell of patients over the past two years. When she opened her practice in 2011, she was met with skepticism from conventional doctors; since then, that hesitation's faded and she's seen increasingly more referrals, cooperation and acceptance. There's growing public interest in medicinal use of CBD and cannabis; lā‘au lapa‘au, traditional Hawaiian herbal medicine; and other alternative approaches. While local insurers have yet to broadly cover these practices, signs point to increasing acceptance in the insurance sector too, she says.

Kaiser Permanente Hawai‘i recently expanded its Complementary and Alternative Medicine services, commonly referred to as CAM, says Paula Young, Kaiser Permanente product management director. A supplemental program lets employers bundle acupuncture services with massage therapy and chiropractic services. And Kaiser Permanente members whose plans don't include CAM can now get reduced rates on acupuncture, massage therapy and chiropractic services, she says.

Even smaller providers, such as UHA Health Insurance, now cover some naturopathic visits and some acupuncture, therapeutic massage and chiropractic services. These three are the most common CAM therapies covered by private insurance in Hawai‘i. What's not covered? Herbal medicines and remedies like yoga, tai chi and meditation. In Hawai‘i, eligible patients can use flex-spending or health savings accounts to cover the costs of some CAM services.

Deciding which therapies qualify for coverage is no easy feat for insurers. "Hawai‘i is a unique cultural melting pot, and the Eastern and alternative medical influences are especially strong here," says HMSA's Reeves. But there is "not the same level of scientific evidence and national guidelines for these complementary/alternative treatments that standard medical therapies are measured and vetted by." HMSA is working with national experts and community providers, he says, to "hear about emerging evidence and guidelines for appropriate coverage with a more holistic view of health."

Trend 5

— Dr. Kelley Withy

Physicians who choose to practice—and remain—in Hawai‘i are like precious gems. Hawai‘i is in dire need of more physicians, a situation that hasn't changed since Dr. Kelley Withy and Dr. David Sakamoto published the first Physicians Workforce Report in 2010. The 2022 report pegs the statewide deficit at 776 full-time doctors. "Whenever I talk to groups of people, I remind them to thank their doctors because the ones that are here are working so hard; they’re working for two," says Withy, a professor at the UH John A. Burns School of Medicine and director of the Hawai‘i/Pacific Basin Area Health Education Center, which works to recruit and retain doctors.

What has changed is the breadth and quickening pace of the worker shortage across the health care spectrum. In 2022, the local industry had 3,873 job openings—up 76% from 2019, according to the Hawai‘i Healthcare Workforce Initiative Report and the Healthcare Workforce Initiative published in November 2022. In the same period, the turnover rate for health care workers climbed from 16% to 20%. That includes nurses, nurse aides, medical assistants, phlebotomists, patient service representatives, social workers and others—89 patient-facing roles in total.

"When considering Hawai‘i's health needs, it's important to look at both these professions and the physician workforce," says Hilton Raethel, president and CEO of the Healthcare Association of Hawai‘i. "Despite our hard work in building the workforce pipeline, the pandemic accelerated worker retirements and had people leaving their health care professions faster than they could be replaced."

The local industry is getting creative, with new programs to woo workers. Some examples:

• Glidepath training. A statewide pilot program began in December 2022 to train employed certified nursing assistants to become licensed practical nurses. The first cohort from O‘ahu, Kaua‘i and Maui is scheduled to graduate and take the licensing exam at the end of this year. Students are employees at ‘Ohana Pacific Health and Kaiser Permanente Hawai‘i. Similar glidepath programs are in the works to train employed phlebotomists to become medical laboratory technicians.

• Loan forgiveness. State and federal incentives help doctors repay their student loans. The Hawai‘i State Loan Repayment Program, for instance, pays back loans for primary care and behavioral health doctors who work in nonprofits or areas with shortages of health professionals. The Hawai‘i Dental Association this year donated funds so that more dentists and dental hygienists can receive up to $50,000 a year to repay loans.

• Student recruitment. This past academic year, more than 3,000 students in Hawai‘i high schools and colleges participated in the Pre-Health Career Corps, a free program that exposes them to the health care industry. "We meet with students and help them build their résumé, cover letter and practice with mock interviews. Then we help students connect with a facility," says program director Lark Morin. "We’ve had students shadow pharmacists, pathologists, physician assistants, and so many more that I’ve lost count."


Photo: Courtesy of the Queen's Health System

Thoracic oncology surgeon Dr. Taryne Imai left her job at Cedars-Sinai Medical Center in Los Angeles and is now pioneering robotic technology as The Queen's Health System's thoracic surgery program director. What brought her home was Hawai‘i's last-place ranking in the nation for early detection of lung cancer. "It was time to serve the community that raised, educated and inspired me to become a physician," says the JABSOM graduate, whose mission is to increase the rates of lung cancer screenings for Native Hawaiians and nonsmoking women.


Photo: Courtesy of Rob Ryane Gonzales

A junior at St. Anthony School on Maui, Rob Ryane Gonzales plans to become an anesthesiologist "to see others relieved and free of pain and continue to live happy lives that bring me joy," he says. The Maui teen has witnessed hospitals and clinics "reduced to skeleton crews where doctors and nurses have to resort to piling more responsibilities on top of what they already do to keep our hospitals running," says Gonzales, an intern in the Pre-Health Career Corps and chapter president and state vice president for HOSA, a student group for aspiring health care professionals formerly known as Health Occupations Students of America.


Photo: Courtesy of Princess Jena Santiago

Princess Jena Santiago's goal is to become a general and thoracic surgeon. A junior majoring in biochemistry on the pre-med track at UH Mānoa, she hopes to "increase ethnic and racial diversity in the health care field by building and advocating [for] programs supporting and encouraging students to pursue the industry," she says. As an intern with JABSOM's Hawai‘i/Pacific Basin Area Health Education Center, she mentors younger students interested in health care. Santiago also is the postsecondary president of HOSA.


Photo: Courtesy of Ashley Bulosan

Ashley Bulosan—a Maui mother of two—last December joined Kaiser Permanente's first Practical Nurse Trainee Program, which trains Kaiser employees in Hawai‘i to become LPNs. Not only is she enrolled in five courses, she is raising her family while working as a pediatric medical assistant at Kaiser's Maui Lani Medical Office. "My goal was always to be a nurse, but I never found the opportunity to do so," says Bulosan, who tried several times in the past to pursue nursing studies. Much of her motivation comes from her co-workers. "The people in my department are very supportive—it's awesome!"

Photo: Karen De Borja

Working on this month's medical feature was a labor of love for Cathy Cruz-George, who recently lost two grandparents and is grateful to the health care workers who cared for them. A former editor of HONOLULU Family and Hawai‘i Business magazines, Cathy and husband Justin George raise an artsy daughter and rescue dog in Honolulu.

Trend 1 Pacific Endoscopy Center GI Genius Covenant Physician Partners UH Cancer Center's AI Precision Health Institute Hawai‘i Pacific Islands Mammography Registry Trend 2 Trend 3 Kaiser Permanente Hawai‘i Pacific Health Medical Group HMSA Trend 4 Dr. Kathryn Taketa-Wong UHA Health Insurance Trend 5 UH John A. Burns School of Medicine Hawai‘i/Pacific Basin Area Health Education Center Hawai‘i Healthcare Workforce Initiative Report Healthcare Workforce Initiative Healthcare Association of Hawai‘i • Glidepath training. ‘Ohana Pacific Health • Loan forgiveness. Hawai‘i State Loan Repayment Program Hawai‘i Dental Association • Student recruitment. Pre-Health Career Corps THE UH MEDICAL SCHOOL GRADUATE  Dr. Taryne Imai l THE HIGH SCHOOL STUDENT   Rob Ryane Gonzales HOSA THE COLLEGE STUDENT   Princess Jena Santiago THE WORKING STUDENT   Ashley Bulosan Cathy Cruz-George