16 ms·

Ontario family doctor says new AI notetaking saved her job

260 points by davidbarker 2y ago

nvy 2y ago
The root cause of this is that the billing system (which varies by Province) by which doctors actually get paid is a fee-for-service model. That means the system incentivizes doctors to see patients by only allowing them to get paid for actually seeing the patient: Give someone a vaccine? $15. Family doctor routine checkup? $34. The system is set up to reward the kind of doctor who sees 6 patients an hour and is on their third marriage because they're at the clinic for 12 hours a day. Those are the family docs who are making high six figures, which is incidentally the opposite of what's good for the patient. You can't have meaningful interactions with a family doctor in ten minute visits, but the billing codes (in BC and Ontario at least) are set up to financially penalize doctors who take 45 minutes with a single patient to really make sure they get to the bottom of things. Anyway, the follow-on effect is that doctors generally don't get paid to do their legally-required paperwork and a litany of other things, so we've arrived at the present where family doctors are using "AI" shitware of questionable quality made by silicon valley techbros of questionable quality, and relying on that software to ensure the accuracy (and privacy!) of patients' health data because they are so overworked and underpaid that there's a constant brain drain of good family doctors leaving family medicine for specialized sub-disciplines or leaving Canada to seek greener (pun only partially intended) pastures where the pay is better south of 49. tl;dr the whole situation's fucked and the fact they're resorting to "AI" garbage should be a source of profound shame, not jubilation
- boxed 2y ago
  The situation is the same in Sweden. New Public Management is a disaster all around.
  - nvy 2y ago
    Here in BC it's just a lack of political will because physicians are expensive, governments are broke after COVID, and so instead of fixing the system (which would cost money), the absolute morons in the health ministry have decided that "nurse practitioners" are 1:1 substitutes for family doctors, despite the fact that they don't go to medical school and thus don't receive any diagnostic training whatsoever. It'll right itself eventually, but I'm not sure what the actuarial tables say about whether I'll be around to see it or not.
    - __turbobrew__ 2y ago
      The best you can do is take care of yourself. Exercise, eat healthy, don’t do overly risky activities. It really is a shame the state we are left in BC. If it was more accessible I would go back to school to become a doctor but the MD programs are far and few between and not really structured for someone with kids. I do meet the entrance criteria for the UBC med program but Im not going to uproot my family back to Vancouver. The newly proposed increased federal tax share from 1/2 to 2/3 on corporate capital gains will also negatively effect many doctors in Canada as well since many of them run their own companies and invest some of the income for desirable tax advantages.
      - nvy 2y ago
        Don't do it. I'm married to a doctor who started in family medicine and bailed out because the work-life balance was awful and the money was mediocre, but she wasn't willing to see 6 patients an hour.
    - boxed 2y ago
      > governments are broke That's just what they tell voters in order to get away with cutting the thing government exists to provide in the first place, all to lower taxes for some weird political-religious ideals. If the government can't basics like health care, that government has no reason to exist.
    - kohbo 2y ago
      Not saying your overall message is wrong about your region but... My wife is an NP and most of her courses and clinical time were focused on diagnostic techniques.
      - nvy 2y ago
        Sorry man, your wife isn't a replacement for a doctor. If she was, she'd have gone to medical school.
- samrus 2y ago
  The problems you point out seem valid, but are you sure they are directly relevant to the core issue this AI is solving? That skilled data entry is critical to medical operations and is very effort intensive. I feel like doctor incentivization and silicon valley's predatory corporate culture aside, this problem does need to be solved if we want to avoid wasting doctors' precious work-hours
  - nvy 2y ago
    >I feel like doctor incentivization and silicon valley's predatory corporate culture aside, this problem does need to be solved if we want to avoid wasting doctors' precious work-hours Your comment presupposes that time spent on data entry is a waste. Relevant, cogent notes written by a human are infinitely better than whatever the rent-seeking intermediary between the physician and OpenAI shits out. The problem is not technical in nature; it's a misalignment of incentives. The solution is to pay physicians for time they spend charting, and then the time is no longer "wasted".
- PlunderBunny 2y ago
  My limited experience with dental practice payors (e.g. the NHS in England) is that it's an ogre's choice: Pay for over-treatment, or pay for neglect.
  - switch007 2y ago
    Damn that is accurate
- msie 2y ago
  The situation in BC just recently changed for family doctors: https://www.cbc.ca/news/canada/british-columbia/bc-doctor-supports-announcement-1.6635200 https://www.cbc.ca/news/canada/british-columbia/bc-doctor-su... "Provincial health officials announced the changes during a Monday news event, saying physicians will be able to stop participating in the current fee-for-service system in early 2023." "The provincial government says a full-time family doctor will be paid about $385,000 a year, up from the current $250,000, under the new three-year Physician Master Agreement reached with Doctors of B.C. last week."
- rpeden 2y ago
  Many family doctors in Ontario don't use the fee for service model. Instead, they have a roster of patients and they recieve a flat fee every year for having a patient on their roster. I'm not sure it changes any of the downsides you mentioned, though, since the yearly flat fee is quite low so doctors still need to minimize the time spent per patient.
r0ckarong 2y ago
I just hope someone is double checking whatever notes are taken. My experience with LLM tells me they're fantastically bad at remembering and even worse at producing factual stuff that can be used without context.
- cjk2 2y ago
  No one will be double checking. On at least three occasions now I’ve had to correct monumental fuck ups in mine and my ex wife’s medical records. One nearly lead to a transfusion of an incompatible blood type. I suspect this will lead to a decline in accountability with there being another party to blame rather than the medical professional. The LLM did it, not me.
  - viraptor 2y ago
    > No one will be double checking. Yeah no, I can tell you from experience with a clinic that things are checked. Let's talk about the real issues and how to enforce double-checking for people who would ignore it. Hyperboly like that is not helpful. But, I wonder if those systems should randomly insert obvious markers to help here. "This has not been read." "Doctor was asleep at the wheel." "Derp derp derp." - like the fake gun images that the airport security has to mark.
    - cjk2 2y ago
      You are really naive if you think checking anything is universally done to any standard anywhere on the planet. And writing it off as hyperbole is dismissive. I’ve literally been in a meeting with a doctor in the last week who wrote something down wrong on the damn computer in front of me. And I’m talking a specialist consultant. I’m sure if I didn’t mention it that the incorrect data would be checked over and over again to make sure it was correctly incorrect…
      - viraptor 2y ago
        You're oversimplifying this. So I'm not a doctor, but close enough to this system. First, you've definitely got professions/situations where checking is done. See flight and surgery checklists. Of course there will be mistakes and we'll never reach 100% compliance, but that's a given. But then, there are secondary effects like how much time will your doctor have and how ready they are. In practice the notes take time. If you're unlucky, you're going to be late, on a busy day, and your notes will be done many hours later from recollection. In that case, even an imperfect system can increase the overall quality if it enables faster turnaround. I know of cases where the automatic notes generation did catch issues which the doctor simply forgot about. The individual stories are brutal, but overall they say very little - was that the only mistake that doctor made in their life, or are they making 10 a day? In general we have to accept mistakes happen and build a system that catches them or minimises the impact.
Scoundreller 2y ago
> The Ford government has been so impressed with the technology that it announced a pilot program to allow 150 family physicians to use AI Scribe as part of their practices. The health minister said the early signs were promising but stressed the government would proceed carefully. What I find fascinating is that doctors are independent contractors but the government appears to be buying their tools to make them more efficient
- mial 2y ago
  When the state subsidizes healthcare, it is in its interest to lower the costs/improve productivity.
h_tbob 2y ago
I talked to a therapist who hated doing notes. So I proposed a solution: Use Microsoft's "seeing AI" to describe the children playing during "play therapy". Then have a camera take a picture every few minutes, and then have chatgpt come up with the story based on the pictures and transcript of the audio, transcribed with openai whisper. Business in a nutshell!
- morjom 2y ago
  Just need to get the parents permission for filming/photographing the children and feeding it to an AI.
  - raihansaputra 2y ago
    not a problem if it's done locally. at least the consent is only to capture/store the images with the practice, not giving it to third-party.
  - number6 2y ago
    Just ask for it, glitter some PR over it, done. People consent into all kind of things.
- cjk2 2y ago
  This is not really how therapists work. It’s how it looks like they work. This is a really big problem with the AI industry. People don’t know the domain well enough and assume it is a fit. Oh look, just throw this at it and done. Simples! Then you find that therapists, of the non quack variety at least, spend years working on how to remove bias from their assessment and learning subtle cues and indicators from their patients. And have to write in a certain prose and have to qualify their results with peers.
  - morkalork 2y ago
    It would probably be easier to teach those domain experts the basics of AI and how to leverage it than teach developers the details of each domain. After all, it's not like asking them to train transformers from scratch, just how to use what is already built. It reminds me of a joke about the movie Armageddon and teaching astronauts to drill rather than drillers to go to space..
torhorway 2y ago
https://www.getfreed.ai/ https://www.getfreed.ai/ has a free trial for an ai scribe if you're interested in trying one out. Saves an avg of 30min to 2hrs each day for some clinicians.
- Zenzero 2y ago
  We don't need any more recommendations of AI scribes. There are already hundreds of them. That business opportunity lasted 5 minutes before becoming fully saturated.
awinter-py 2y ago
> Lall said it takes minutes for AI Scribe to collate the information, allowing her to move on to other patients while the SOAP note is being created in the background. it takes minutes ...
- kitd 2y ago
  ... which, from TFA, adds up to 19 hours (ie >2 extra working days) per week, time that could be (and is) spent seeing other patients.
  - awinter-py 2y ago
    no argument with the benefit for doctors. I know docs who say they are squeezed because their day is engineered in a way to force them to do paperwork later just wondering what computer process takes minutes. is it building the linux kernel every time?
    - vundercind 2y ago
      To be blunt, Enterprise Cloud Architecture is a really good way to make a bunch of fast servers process work slower than a several-generations-old laptop on WiFi. You got trash integrations with all kinds of compromises, queues galore, awful “low-code” solutions somewhere in the mix, cloud VMs with comically tiny network pipes, all kinds of nonsense.
monocultured 2y ago
Just the other day there were news about how many mistakes the AI-assisted journaling caused – wrong names, wrong diagnoses, typos (buksmärta -> kuksmärta which is hilarious but serious). Some of it is surely teething problems, but unless there is a robust check upon implementation it might just add another layer of inefficient new public management make-work to the system. https://sverigesradio.se/artikel/ai-journaler-i-sjukvarden-kritiseras-buk-blev-kuk https://sverigesradio.se/artikel/ai-journaler-i-sjukvarden-k...
- elitan 2y ago
  I wouldn't be surprised if Region Blekinge were using something much worse and much more expensive than Whisper for their transcription. I've been transcribing A LOT of SR (Swedish Radio) shows as part of https://nyheter.sh/ https://nyheter.sh/, and Whisper (self-hosted) has been very accurate.
  - popinman322 2y ago
    Tangent here: really? I've found base Whisper has concerning error rates for non-US English accents; I imagine the same is true for other languages with a large regional mode to the source dataset. Whisper + an LLM can recover some of the gaps by filling in contextually plausible bits, but then it's not a transcript and may contain hallucinations. There are alternatives that share Whisper internal states with an LLM to improve ASR, as well as approaches that sample N-best hypotheses from Whisper and fine-tune an LLM to distill the hypotheses into a single output. Haven't looked too much into these yet given how expensive each component is to run independently.
    - vidyava 2y ago
      I've found that WhisperX with the medium model has been amazing at subtitling shows containing English dialects (British, Scottish, Australian, New Zealand-ish). It not only nails all the normal speech, but even gets the names and completely made up slang words. Interestingly you can tell it was trained from source material with dialects because it subtitles their particular spelling; so someone American will say color, and someone British will say colour. I can't speak to how it performs outside of production quality audio, but in the hundreds of hours of subtitles that I've generated I don't think I've seen a single error.
tomfreemax 2y ago
I think these tools are the solution to the shortage of doctors, and will greatly improve performance by taking more parameters into account. Not sure though if a simple LLM can do that. (Shortage of doctors is a thing at least in DE and CH) Doctors study like 10 years to follow a decision tree based on patient background and symptoms. Especially in countries where education is harder to get by this can be useful, I imagine. Then we transition from doctor to med-tech, like in the sci-fi movies.
- resource_waste 2y ago
  The solution to the shortage of doctors is to stop letting doctors decide the supply of doctors. Its a special interest problem. Doctors organize, bribe/lobby politicians, limit licenses, make extra money/get more power, repeat. The excuse 'there isnt enough surgeries', is a chicken and egg problem. More doctors lower the cost, making surgery more reasonable and not necessarily a last ditch option. Not to mention, we don't stop the number of civil engineers that graduate because 'there arent enough bridges'. You just have more people observing around the table.
  - Pigalowda 2y ago
    Yep. That’s what we do. You hit the nail right on the head. I saunter down to my local US senators house and bribe him, every month or so. Then our group created a fund where we bribe the president of the United States. We organized with all the other groups in the area and bribed the pope. Next we are going to find you in your house and bribe you.
    - amkkma 2y ago
      Why have residency spots shrunk per capita? Why do unmatched grads have to work at mcdonalds but NP's and PA's can practice with more latitude than some residents? (serious questions)
      - Pigalowda 2y ago
        ACR for radiology is going on in Washington DC. Current staffing throughout the country is poor - over utilization of imaging and not enough radiologists. So we are lobbying for an increase in Medicare funding for residency positions (they are paid by Medicare). Also trying to get more J1 visas but that’s kind of dubious as we are taking physicians from another country who likely also needs physicians. I have no idea why unmatched graduates are working at McDonald’s as you say. There’s always primary care positions open for the scramble last I checked. If they can’t get a spot there’s likely a real issue in their education or themselves. It’s a normal distribution of a population, MD or not. I can’t speak to what NP and PA’s do - they have their own PACs and organizations. I know they want to increase their scope of practice and keep their liability low.
flakeoil 2y ago
How about improving the processes and reduce the amount of forms and admin work instead?
- puttycat 2y ago
  This is another version of "use public transport instead of throwing billions on futile self driving cars" -- it's the correct, rational thing to do, but it's not the American way!
  - low_common 2y ago
    It's a Canadian-developed tool used by Canadian doctors. It's popular on the internet to offer up overly-generalized platitudes like yours but do us a favor and at least read the article first.
    - beiller 2y ago
      I don't see how it being Canadian is relevant. First off Canada is part of North America and North America is big geographically. We have similar car culture compared to USA. There are very large subsidies given to battery manufacturing sector in Canada amounting to $43.6 billion over 10 years as part of the latest budget.
  - randomdata 2y ago
    Humorously public transport, for all intents and purposes, only service cities. The very place you don't need transit as you already live within walking distance of everything. There is absolutely no rationality there. Connecting every last rural area by train may have been a thing in the 1800s, but it's not really all that efficient to fire up a humungous train to carry one person. We aren't going back. "Correct and rational" doesn't exactly stand here either.
  - relativ575 2y ago
    Car ownership continue to grow around the world. Maybe not everywhere, but definitely in countries where public transportation is popular, such as the Netherlands. The number can be found easily.
oulipo 2y ago
On that front, there is the cool AquaVoice input method: https://withaqua.com/ https://withaqua.com/ anyone is looking at doing an open-source version of that? I guess with a mini-whisper and mini fine-tuned GPT-like model we could get 99% of the way there
- haskellandchill 2y ago
  that sounds like a great open source project, I'm interested in starting on it if there's nothing out there.
  - Ey7NFZ3P0nzAe 2y ago
    For my personnal use I've been using a minimalist script for a while : https://github.com/thiswillbeyourgithub/Quick-Whisper-Typer https://github.com/thiswillbeyourgithub/Quick-Whisper-Typer don't be afraid to contribute it's a bit rough around the edges
- lannisterstark 2y ago
  3 days later - I sub to Aqua, it's an astonishingly good product. I wish I could insert this on any textbox I wanted to though. Also I wish for an app. Pls aqua people. Keeping my phone's screen on while I transcribe sucks.
- Ey7NFZ3P0nzAe 2y ago
  For my personnal use I've been using a minimalist script for a while : https://github.com/thiswillbeyourgithub/Quick-Whisper-Typer https://github.com/thiswillbeyourgithub/Quick-Whisper-Typer don't be afraid to contribute it's a bit rough around the edges
karmakaze 2y ago
There's no mention of data privacy. Since AI Scribe[0] study is a run by OntarioMD, the digital technology arm of the Ontario Medical Association, it might be okay but it would be nice if it declared it. From the AI Scribe link: > This project is funded by the Ontario Ministry of Health and overseen by Ontario Health. The study is currently underway, with 150 primary care providers already selected from diverse demographic groups, technical backgrounds, and geographic areas. We are no longer accepting participants for the study. Results of the study will be shared later this year. [0] https://www.ontariomd.ca/ai-scribe https://www.ontariomd.ca/ai-scribe
- mysore 2y ago
  would you care about data privacy when you're dead?
  - worthless-trash 2y ago
    Care about anything when you are dead?
  - throwup238 2y ago
    Your living relatives might, considering the hereditary nature of so many things in medicine.
  - sp332 2y ago
    I feel like you were trying to make a point here, but I have no idea what it was.
    - passion__desire 2y ago
      We are made of electrons. Every electron is the same. Electrons have no sense of privacy.
      - sonotathrowaway 2y ago
        Electrons don’t eat food either. Eating food is unnecessary.
_wire_ 2y ago
> Ontario family doctor says new AI notetaking saved her job Lemme rewrite this headline for a more interesting and relevant article that you might actually want to read: "Doctor hails notepad and pen as essential diagnostic tools."
- bashinator 2y ago
  The entire point of the article is that she no longer has to spend upwards of two hours a day using the notepad and pen.
xyst 2y ago
As a person that used to be a “human scribe” but for emergency dept doctors. I would say the ER doctors shared the same experience as the one depicted in the news story. For a doctor that was nearing the age of retirement or had very poor keyboard proficiency. scribes were a godsend. Doctors worried less about documentation and focused more on patient care. Of course they still wrote things like admission orders, prescriptions, and nurse orders. Scribes were often told to avoid doing these but sometimes the doctor was okay with it. I personally just told them to do it. Too much of a legal liability for both of parties. But capturing all of the details of the history of present illness (HPI), patient medical history, review of systems, physical exam, procedures (if any) and medical decision making during patient visit can be a time consuming issue. Time increases with significantly more complex cases, especially one with more than one procedure. Documenting it so that it can be billed appropriately is also crucial. Prior to scribes, doctors would describe forgoing writing documentation all together at the end of the shift and writing it the next day or shift. Obviously, this caused very poor documentation and opened up the doctor to legal issues (if they arise). Ambulance chasers can easily call out these inconsistent details between doctor notes, patient outcomes, and cross check with nursing notes. Additionally, this caused cases to be billed incorrectly or “down coded” as well. I don’t agree with allowing private companies unfettered/unregulated access to what is considered private medical information. But with appropriate controls on the data and who has access to it with full transparency, I think it can help in alleviating physical burn out.
- forgetfreeman 2y ago
  Yeah but you can't get that genie back in the bottle. Once these data are made available to private industry it's only a matter of lobbyists chipping away at whatever protections were initially legislated. See Also: your TV, phone, car, fucking doorbell, and fridge are all spying on you.
  - tim333 2y ago
    The HIPPA rules on health data are fairly strict, otherwise your doctor, hospital and so on could already be doing wrong. Personally I have a dumb TV, car, doorbell and fridge so not much spying there. The phone I'm less sure of.
agentultra 2y ago
Privacy and hallucinations would concern me. It seems likely to me that relying on these tools will mean physicians will "trust" the output of these systems and stop checking the notes for accuracy. Checking the notes will become a burden too. Maybe the real solution is to lower the amount of administrative work required? Or hire people to do it?
- jorlow 2y ago
  I too feel a bit worried about AI making mistakes, but the thing is that a doctor rushing or an assistant can (and do) make mistakes too. These are all just cost vs quality of service tradeoffs. From my experience (having been in and out of hospitals a lot in the last year) it wouldn't surprise me if AI, even with occasional mistakes, would still be a net improvement in overall quality of care and outcomes.
  - agentultra 2y ago
    I’m not a fan of, “but humans make mistakes too,” defense. They do but we don’t consider it an improvement when they are made. The goal isn’t to have mistakes. The goal is to maintain (or improve) outcomes without burning out clinicians. Using an LLM isn’t the only solution and might not be a good one. If this is going to be a thing I hope that policy around it will inform patients when the physician plans to use it and allow a patient to opt out.
- wvenable 2y ago
  In my impression of using AI a lot more recently, hallucinations are a non-issue if you are simply using it to transform data. AI hallucinates when it's being asked to extract data from it's own "memory" but not when it's simply given a task to perform and all the necessary input to do it.
  - genewitch 2y ago
    whisper hallucinates - or is just incorrect - fairly often. I have been transcribing old tv and radio programs just to get a real feeling for how inaccurate it is, and for an example, the tv show JAG's main character is Lieutenant Harmon Rabb, Junior. I prompt "You are transcribing a show called JAG - Judge Advocate General - whose main characters are named Lieutenant Harmon Rabb jr, known as Harm or Rabb, [...]" Maybe 1 time out of 20 it will actually put "Rabb" or "Harm". Even better is stuff like old call in radio shows, the callers are perfectly understandable, but whisper has lots of issues. If there's something better than whisper, i'd love to try it out.
vertis 2y ago
Obviously, Medical and privacy issues in this story that make this case more complex, but anyone on HN not looking into ways that AI can streamline their lives and jobs at this point is doing themselves a disservice. Yes, there are limitations. Yes, there are times when it goes down the wrong path or actually makes things worse, but those are getting fewer and further between. Things like Otter, Aider, Cursor, GPT Vision, Obsidian (Smart Connections), MumurType are all making huge impacts on my life and productivity. I'm now tapping knowledge I've been collecting since the early 2000s.
- yazzku 2y ago
  Medical data shouldn't be going to Microsoft. I'm surprised it's even legal in the context of this story. Your argument is also kind of silly. Yes, go ahead and submit all your life notes since 2k to Big Tech. What does that have to do with the larger context of how these tools are deployed, and specifically in the medical field where people do expect some semblance of privacy and is already regulated to some degree?
- layer8 2y ago
  Not possible for work due to NDAs, not desirable outside work for similar reasons. AI home appliances that aren’t cloud-based seem a long way off.
lacrosse_tannin 2y ago
just make the note input look like anki
- david_allison 2y ago
  Med students don't have the time to make Anki cards
theptip 2y ago
This could be the thing that saves the US healthcare system; currently we pay 2x what a normal developed country would pay for the level of service provided, because there is a thick layer of paperwork, with insurance companies going back-and-forth with medical providers to debate and negotiate billing. Imagine if AIs on each side could run that negotiation process in seconds, at the cost of merely a few hundred thousand OpenAI API calls. Then humans can get back to doing the actual work!
- philipwhiuk 2y ago
  LinkedIn proved that adding a tech layer that should get rid of an industry of paper shufflers is only profitable if those paper shufflers fund the platform. Cue me skeptical that AI really reduces the middle-folk fees.
- ryandrake 2y ago
  Better, more efficient technology rarely reduces the sticker price for customers. If the underlying product or service is cheaper to produce or provide, the price will stay the same (or increase) and the difference will be pocketed by shareholders. This is pretty much always what happens. Same on the employee side. As an employee, if you adopt some technology that makes you 2X more productive, you're not going to get a 2X compensation increase. That delta will be captured and pocketed by the business.
  - deleted 2y ago
    [deleted]
- jewayne 2y ago
  > currently we pay 2x what a normal developed country would pay for the level of service provided, because there is a thick layer of paperwork, with insurance companies going back-and-forth with medical providers to debate and negotiate billing. Oh, sweet summer child. We don't pay 2X because there's too much paperwork. There's too much paperwork because 2X spending can be used to justify a lot of paperwork. The delta in spending is due to the delta in pricing power that the US payer/provider complex has vs what is seen in other countries.
surfingdino 2y ago
Would love to know which AI company got the data or do the developers of Scribe run their own ChatGPT?
- sva_ 2y ago
  I think OpenAI claims they don't use the data that goes through their APIs for training (in contrast to chatgpt)
josephrmartinez 2y ago
Here is a similar open source project: https://github.com/josephrmartinez/soapscribe https://github.com/josephrmartinez/soapscribe Just a starting point. But if you are interested in this space, fork away and build it into something useful! My personal take is that the current tools on the market are too expensive. The cost should go way, way down. This should stay open source. Patients should have easy access to full audio recordings and transcriptions of their medical appointments. One can dream!
- pixl97 2y ago
  Having worked in computing around medical facilities and providers, unfortunately, I believe this is just a pipe dream. Companies that charge a lot for the software will buy up the smaller companies providing services until only a few are left. They'll bundle it up with an expensive price tag. Even more so, providers tend to have protection when they buy a piece of software used by a large number of other providers. They get to bandy about saying "industry standard". I promise you, you do not want to be in front of a medical malpractice jury saying "well we slapped these parts together that we downloaded online", it won't go well for you, even if that's what the big software service did just the same.
  - naasking 2y ago
    They can only buy up companies that are willing to sell. Principles still matter to some people.
    - leetrout 2y ago
      Fewer and fewer it feels like :( The almighty dollar influences a lot of people.
    - hansvm 2y ago
      Salesperson's Perspective (initial introductions, "accidentally" stumbling on the owner's favorite bar/beach/...) Yeah, I'm doing my damndest to make the world a better place. There's all of these great tools for doctors, but they're struggling, getting hit by the crossfire of malpractice suits and interoperability difficulties. (later meetings) We just landed <xyz llc>! They're world-class at helping patients with <abc>, but they didn't have the resources to survive in the current political climate. The founders were floundering pouring their own money in to try to keep their patients happy, but with our help the patients are better off and the founders can finally retire comfortably. (much later) I see how much you care about your business and how it's really about the people you serve; that's why I got into it too. When it's finally time for you to sell, you definitely don't have to go with us, but please try to hand it off the right way to somebody who cares. Private equity vultures don't make anybody happy.
deleted 2y ago
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newsclues 2y ago
Good to know, I’m going to ask my doctor if they use this and who will be liable for errors.
penjelly 2y ago
im from Ontario and see resident physicians regularly. The problem isnt that they dont have time to take notes.. its that they dont have time period. The first thing the supervisor doctor will say to me when theyre invited in is "i havent got much time...". Most likely your diagnosis goes like this, you describe symptoms, resident doctor disappears to the supervising doctor and returns with an action. Usually no longterm plan is given, just a medication or recommendation. Its hard to negotiate the action because youre negotiating with the resident, but the decision is authorized by the supervisor. The problem is systemic and automatic note taking isnt going to solve it. Despite this success story for the doctor, I suspect the patients themselves wont have the same success in Ontario.
classichasclass 2y ago
Maybe I'm old-fashioned, but to this day I don't take notes on the computer when I'm in the room with a patient. I might take a couple notes, but otherwise I do it between patients or after hours. It seems discourteous to me otherwise. That said, I have a prolonged charting period after every clinic. It's not sustainable in daily practice (I don't see patients every day).
- dmix 2y ago
  What the economics of getting a scribe?
davidgu 2y ago
If you're looking to build an AI notetaker for medical use-cases (or others), https://www.recall.ai https://www.recall.ai is a HIPAA compliant API to capture conversations from video conferences. P.S. I'm the founder, so obviously biased :)
486sx33 2y ago
“ mimic doctor’s notes and reduce the amount of paperwork a physician would have to manually compile.” So there is AI making up doctors notes ? That’s extremely contentious. In Ontario doctors are paid per patient per year and then also per visit / procedure. This doctor is just outsourcing her doctor work that taxpayers are footing the bill for - to AI. This is wrong in so many ways. What a lazy practitioner!
- Aromasin 2y ago
  Did we read different articles? Did you just fixate on that line and not read the rest? She was the one doing the examination and verbalising her concerns. The AI disseminated that information the doctor provided and reformatted it into bureaucratic prose just like doctors scribes have been doing for the last few centuries. I don't see the issue here in the slightest. None of the "doctoring" has been outsourced, just the scribe work.
  - stavros 2y ago
    In my line of work (healthcare in the UK), an AI system that would change what a human writes in any way would be considered a medical device, and would require an absolute ton of paperwork to certify. In the case of LLMs, I don't know if certification would even be possible, because you have to show that your system didn't change the intent of the human, which is impossible to do with LLMs.
    - dmix 2y ago
      Its mostly translating dictation and recordings. The doctors are still liable if it's wrong so there's plenty of incentive to simply read the output, which is still a major productivity improvement over writing+reading.
    - brokencode 2y ago
      Sure, if the LLM note were filed straight into the chart without review, it’d be pretty unsafe. But these systems are meant to generate a draft note that the doctor still has to review, edit, and sign. At the end of the day, it’s still up to the doctor to ensure the note is correct.
janandonly 2y ago
Spending 25% of your working hours on “paperwork” sounds about correct for just about everybody who’s had a desk job the last 100 years. I’m not saying it’s a good thing and I’m not saying I’m happy about it. Just that it is so, not just for the medical profession. So what’s the fuss?
- dmix 2y ago
  > I’m not saying it’s a good thing and I’m not saying I’m happy about it. > Just that it is so, > So what’s the fuss? This sort of attitude would make the world never progress. The fuss is a highly trained specialist who is constantly in short supply is spending a quarter of their time doing work not entirely connected with their speciality. In an efficient system there should be a division of labour to another lower paid specialist, a scribe, but medical systems can't afford that for every single doctor, especially tax payer supported ones. Automating that secondary role for every doctor benefits all of us if it means we give doctors more time. Not to mention the documentation itself is almost always at least 25% excessive and duplicative, and computers+good UIs help eliminate that.
  - MichaelZuo 2y ago
    The scribe adds communication and interpretation overhead, they also can make mistakes, etc., so it's not at all clear it would improve overall outcomes per dollar spent.
deleted 2y ago
[deleted]
hansvm 2y ago
There is a 0% chance they aren't slurping up that data to store forever (and "improve their core offerings" or whatever the privacy policy says). Anyone want to take bets on whether the first breach is: (1) A vindictive employee tracks down their ex's information (2) The raw database is breached and wholesaled (3) Somebody embeds the AI's RAG data in HTML for anyone to read (4) The training job's Spark admin portal lives on an ngrok'd laptop for anyone to siphon (5) The mandatory Facebook "like button" on every government website is set up to scan every query (6) They don't "sell personal data", but if you don't opt out (and usually even if you do) a thousand adtech companies have paid to be affiliates to "assist in normal day-to-day operations", where their only "assistance" is downloading your personal data to serve you ads for hemorrhoid-friendly buttplugs or non-magnetic magnetic healing crystals that don't interfere with your pacemaker or whatever (7) Other (please comment)
- moralestapia 2y ago
  This data already exists anyway and has been there for like 50+ years ...
deleted 2y ago
[deleted]

260 points by davidbarker 2y ago

nvy 2y ago

The root cause of this is that the billing system (which varies by Province) by which doctors actually get paid is a fee-for-service model. That means the system incentivizes doctors to see patients by only allowing them to get paid for actually seeing the patient: Give someone a vaccine? $15. Family doctor routine checkup? $34. The system is set up to reward the kind of doctor who sees 6 patients an hour and is on their third marriage because they're at the clinic for 12 hours a day. Those are the family docs who are making high six figures, which is incidentally the opposite of what's good for the patient. You can't have meaningful interactions with a family doctor in ten minute visits, but the billing codes (in BC and Ontario at least) are set up to financially penalize doctors who take 45 minutes with a single patient to really make sure they get to the bottom of things. Anyway, the follow-on effect is that doctors generally don't get paid to do their legally-required paperwork and a litany of other things, so we've arrived at the present where family doctors are using "AI" shitware of questionable quality made by silicon valley techbros of questionable quality, and relying on that software to ensure the accuracy (and privacy!) of patients' health data because they are so overworked and underpaid that there's a constant brain drain of good family doctors leaving family medicine for specialized sub-disciplines or leaving Canada to seek greener (pun only partially intended) pastures where the pay is better south of 49. tl;dr the whole situation's fucked and the fact they're resorting to "AI" garbage should be a source of profound shame, not jubilation

boxed 2y ago
The situation is the same in Sweden. New Public Management is a disaster all around.
- nvy 2y ago
  Here in BC it's just a lack of political will because physicians are expensive, governments are broke after COVID, and so instead of fixing the system (which would cost money), the absolute morons in the health ministry have decided that "nurse practitioners" are 1:1 substitutes for family doctors, despite the fact that they don't go to medical school and thus don't receive any diagnostic training whatsoever. It'll right itself eventually, but I'm not sure what the actuarial tables say about whether I'll be around to see it or not.
  - __turbobrew__ 2y ago
    The best you can do is take care of yourself. Exercise, eat healthy, don’t do overly risky activities. It really is a shame the state we are left in BC. If it was more accessible I would go back to school to become a doctor but the MD programs are far and few between and not really structured for someone with kids. I do meet the entrance criteria for the UBC med program but Im not going to uproot my family back to Vancouver. The newly proposed increased federal tax share from 1/2 to 2/3 on corporate capital gains will also negatively effect many doctors in Canada as well since many of them run their own companies and invest some of the income for desirable tax advantages.
    - nvy 2y ago
      Don't do it. I'm married to a doctor who started in family medicine and bailed out because the work-life balance was awful and the money was mediocre, but she wasn't willing to see 6 patients an hour.
  - boxed 2y ago
    > governments are broke That's just what they tell voters in order to get away with cutting the thing government exists to provide in the first place, all to lower taxes for some weird political-religious ideals. If the government can't basics like health care, that government has no reason to exist.
  - kohbo 2y ago
    Not saying your overall message is wrong about your region but... My wife is an NP and most of her courses and clinical time were focused on diagnostic techniques.
    - nvy 2y ago
      Sorry man, your wife isn't a replacement for a doctor. If she was, she'd have gone to medical school.
samrus 2y ago
The problems you point out seem valid, but are you sure they are directly relevant to the core issue this AI is solving? That skilled data entry is critical to medical operations and is very effort intensive. I feel like doctor incentivization and silicon valley's predatory corporate culture aside, this problem does need to be solved if we want to avoid wasting doctors' precious work-hours
- nvy 2y ago
  >I feel like doctor incentivization and silicon valley's predatory corporate culture aside, this problem does need to be solved if we want to avoid wasting doctors' precious work-hours Your comment presupposes that time spent on data entry is a waste. Relevant, cogent notes written by a human are infinitely better than whatever the rent-seeking intermediary between the physician and OpenAI shits out. The problem is not technical in nature; it's a misalignment of incentives. The solution is to pay physicians for time they spend charting, and then the time is no longer "wasted".
PlunderBunny 2y ago
My limited experience with dental practice payors (e.g. the NHS in England) is that it's an ogre's choice: Pay for over-treatment, or pay for neglect.
- switch007 2y ago
  Damn that is accurate
msie 2y ago
The situation in BC just recently changed for family doctors: https://www.cbc.ca/news/canada/british-columbia/bc-doctor-supports-announcement-1.6635200 https://www.cbc.ca/news/canada/british-columbia/bc-doctor-su... "Provincial health officials announced the changes during a Monday news event, saying physicians will be able to stop participating in the current fee-for-service system in early 2023." "The provincial government says a full-time family doctor will be paid about $385,000 a year, up from the current $250,000, under the new three-year Physician Master Agreement reached with Doctors of B.C. last week."
rpeden 2y ago
Many family doctors in Ontario don't use the fee for service model. Instead, they have a roster of patients and they recieve a flat fee every year for having a patient on their roster. I'm not sure it changes any of the downsides you mentioned, though, since the yearly flat fee is quite low so doctors still need to minimize the time spent per patient.

r0ckarong 2y ago

I just hope someone is double checking whatever notes are taken. My experience with LLM tells me they're fantastically bad at remembering and even worse at producing factual stuff that can be used without context.

cjk2 2y ago
No one will be double checking. On at least three occasions now I’ve had to correct monumental fuck ups in mine and my ex wife’s medical records. One nearly lead to a transfusion of an incompatible blood type. I suspect this will lead to a decline in accountability with there being another party to blame rather than the medical professional. The LLM did it, not me.
- viraptor 2y ago
  > No one will be double checking. Yeah no, I can tell you from experience with a clinic that things are checked. Let's talk about the real issues and how to enforce double-checking for people who would ignore it. Hyperboly like that is not helpful. But, I wonder if those systems should randomly insert obvious markers to help here. "This has not been read." "Doctor was asleep at the wheel." "Derp derp derp." - like the fake gun images that the airport security has to mark.
  - cjk2 2y ago
    You are really naive if you think checking anything is universally done to any standard anywhere on the planet. And writing it off as hyperbole is dismissive. I’ve literally been in a meeting with a doctor in the last week who wrote something down wrong on the damn computer in front of me. And I’m talking a specialist consultant. I’m sure if I didn’t mention it that the incorrect data would be checked over and over again to make sure it was correctly incorrect…
    - viraptor 2y ago
      You're oversimplifying this. So I'm not a doctor, but close enough to this system. First, you've definitely got professions/situations where checking is done. See flight and surgery checklists. Of course there will be mistakes and we'll never reach 100% compliance, but that's a given. But then, there are secondary effects like how much time will your doctor have and how ready they are. In practice the notes take time. If you're unlucky, you're going to be late, on a busy day, and your notes will be done many hours later from recollection. In that case, even an imperfect system can increase the overall quality if it enables faster turnaround. I know of cases where the automatic notes generation did catch issues which the doctor simply forgot about. The individual stories are brutal, but overall they say very little - was that the only mistake that doctor made in their life, or are they making 10 a day? In general we have to accept mistakes happen and build a system that catches them or minimises the impact.

Scoundreller 2y ago

> The Ford government has been so impressed with the technology that it announced a pilot program to allow 150 family physicians to use AI Scribe as part of their practices. The health minister said the early signs were promising but stressed the government would proceed carefully. What I find fascinating is that doctors are independent contractors but the government appears to be buying their tools to make them more efficient

mial 2y ago
When the state subsidizes healthcare, it is in its interest to lower the costs/improve productivity.

h_tbob 2y ago

I talked to a therapist who hated doing notes. So I proposed a solution: Use Microsoft's "seeing AI" to describe the children playing during "play therapy". Then have a camera take a picture every few minutes, and then have chatgpt come up with the story based on the pictures and transcript of the audio, transcribed with openai whisper. Business in a nutshell!

morjom 2y ago
Just need to get the parents permission for filming/photographing the children and feeding it to an AI.
- raihansaputra 2y ago
  not a problem if it's done locally. at least the consent is only to capture/store the images with the practice, not giving it to third-party.
- number6 2y ago
  Just ask for it, glitter some PR over it, done. People consent into all kind of things.
cjk2 2y ago
This is not really how therapists work. It’s how it looks like they work. This is a really big problem with the AI industry. People don’t know the domain well enough and assume it is a fit. Oh look, just throw this at it and done. Simples! Then you find that therapists, of the non quack variety at least, spend years working on how to remove bias from their assessment and learning subtle cues and indicators from their patients. And have to write in a certain prose and have to qualify their results with peers.
- morkalork 2y ago
  It would probably be easier to teach those domain experts the basics of AI and how to leverage it than teach developers the details of each domain. After all, it's not like asking them to train transformers from scratch, just how to use what is already built. It reminds me of a joke about the movie Armageddon and teaching astronauts to drill rather than drillers to go to space..

torhorway 2y ago

https://www.getfreed.ai/ https://www.getfreed.ai/ has a free trial for an ai scribe if you're interested in trying one out. Saves an avg of 30min to 2hrs each day for some clinicians.

Zenzero 2y ago
We don't need any more recommendations of AI scribes. There are already hundreds of them. That business opportunity lasted 5 minutes before becoming fully saturated.

awinter-py 2y ago

> Lall said it takes minutes for AI Scribe to collate the information, allowing her to move on to other patients while the SOAP note is being created in the background. it takes minutes ...

kitd 2y ago
... which, from TFA, adds up to 19 hours (ie >2 extra working days) per week, time that could be (and is) spent seeing other patients.
- awinter-py 2y ago
  no argument with the benefit for doctors. I know docs who say they are squeezed because their day is engineered in a way to force them to do paperwork later just wondering what computer process takes minutes. is it building the linux kernel every time?
  - vundercind 2y ago
    To be blunt, Enterprise Cloud Architecture is a really good way to make a bunch of fast servers process work slower than a several-generations-old laptop on WiFi. You got trash integrations with all kinds of compromises, queues galore, awful “low-code” solutions somewhere in the mix, cloud VMs with comically tiny network pipes, all kinds of nonsense.

monocultured 2y ago

Just the other day there were news about how many mistakes the AI-assisted journaling caused – wrong names, wrong diagnoses, typos (buksmärta -> kuksmärta which is hilarious but serious). Some of it is surely teething problems, but unless there is a robust check upon implementation it might just add another layer of inefficient new public management make-work to the system. https://sverigesradio.se/artikel/ai-journaler-i-sjukvarden-kritiseras-buk-blev-kuk https://sverigesradio.se/artikel/ai-journaler-i-sjukvarden-k...

elitan 2y ago
I wouldn't be surprised if Region Blekinge were using something much worse and much more expensive than Whisper for their transcription. I've been transcribing A LOT of SR (Swedish Radio) shows as part of https://nyheter.sh/ https://nyheter.sh/, and Whisper (self-hosted) has been very accurate.
- popinman322 2y ago
  Tangent here: really? I've found base Whisper has concerning error rates for non-US English accents; I imagine the same is true for other languages with a large regional mode to the source dataset. Whisper + an LLM can recover some of the gaps by filling in contextually plausible bits, but then it's not a transcript and may contain hallucinations. There are alternatives that share Whisper internal states with an LLM to improve ASR, as well as approaches that sample N-best hypotheses from Whisper and fine-tune an LLM to distill the hypotheses into a single output. Haven't looked too much into these yet given how expensive each component is to run independently.
  - vidyava 2y ago
    I've found that WhisperX with the medium model has been amazing at subtitling shows containing English dialects (British, Scottish, Australian, New Zealand-ish). It not only nails all the normal speech, but even gets the names and completely made up slang words. Interestingly you can tell it was trained from source material with dialects because it subtitles their particular spelling; so someone American will say color, and someone British will say colour. I can't speak to how it performs outside of production quality audio, but in the hundreds of hours of subtitles that I've generated I don't think I've seen a single error.

tomfreemax 2y ago

I think these tools are the solution to the shortage of doctors, and will greatly improve performance by taking more parameters into account. Not sure though if a simple LLM can do that. (Shortage of doctors is a thing at least in DE and CH) Doctors study like 10 years to follow a decision tree based on patient background and symptoms. Especially in countries where education is harder to get by this can be useful, I imagine. Then we transition from doctor to med-tech, like in the sci-fi movies.

resource_waste 2y ago
The solution to the shortage of doctors is to stop letting doctors decide the supply of doctors. Its a special interest problem. Doctors organize, bribe/lobby politicians, limit licenses, make extra money/get more power, repeat. The excuse 'there isnt enough surgeries', is a chicken and egg problem. More doctors lower the cost, making surgery more reasonable and not necessarily a last ditch option. Not to mention, we don't stop the number of civil engineers that graduate because 'there arent enough bridges'. You just have more people observing around the table.
- Pigalowda 2y ago
  Yep. That’s what we do. You hit the nail right on the head. I saunter down to my local US senators house and bribe him, every month or so. Then our group created a fund where we bribe the president of the United States. We organized with all the other groups in the area and bribed the pope. Next we are going to find you in your house and bribe you.
  - amkkma 2y ago
    Why have residency spots shrunk per capita? Why do unmatched grads have to work at mcdonalds but NP's and PA's can practice with more latitude than some residents? (serious questions)
    - Pigalowda 2y ago
      ACR for radiology is going on in Washington DC. Current staffing throughout the country is poor - over utilization of imaging and not enough radiologists. So we are lobbying for an increase in Medicare funding for residency positions (they are paid by Medicare). Also trying to get more J1 visas but that’s kind of dubious as we are taking physicians from another country who likely also needs physicians. I have no idea why unmatched graduates are working at McDonald’s as you say. There’s always primary care positions open for the scramble last I checked. If they can’t get a spot there’s likely a real issue in their education or themselves. It’s a normal distribution of a population, MD or not. I can’t speak to what NP and PA’s do - they have their own PACs and organizations. I know they want to increase their scope of practice and keep their liability low.

flakeoil 2y ago

How about improving the processes and reduce the amount of forms and admin work instead?

puttycat 2y ago
This is another version of "use public transport instead of throwing billions on futile self driving cars" -- it's the correct, rational thing to do, but it's not the American way!
- low_common 2y ago
  It's a Canadian-developed tool used by Canadian doctors. It's popular on the internet to offer up overly-generalized platitudes like yours but do us a favor and at least read the article first.
  - beiller 2y ago
    I don't see how it being Canadian is relevant. First off Canada is part of North America and North America is big geographically. We have similar car culture compared to USA. There are very large subsidies given to battery manufacturing sector in Canada amounting to $43.6 billion over 10 years as part of the latest budget.
- randomdata 2y ago
  Humorously public transport, for all intents and purposes, only service cities. The very place you don't need transit as you already live within walking distance of everything. There is absolutely no rationality there. Connecting every last rural area by train may have been a thing in the 1800s, but it's not really all that efficient to fire up a humungous train to carry one person. We aren't going back. "Correct and rational" doesn't exactly stand here either.
- relativ575 2y ago
  Car ownership continue to grow around the world. Maybe not everywhere, but definitely in countries where public transportation is popular, such as the Netherlands. The number can be found easily.

oulipo 2y ago

On that front, there is the cool AquaVoice input method: https://withaqua.com/ https://withaqua.com/ anyone is looking at doing an open-source version of that? I guess with a mini-whisper and mini fine-tuned GPT-like model we could get 99% of the way there

haskellandchill 2y ago
that sounds like a great open source project, I'm interested in starting on it if there's nothing out there.
- Ey7NFZ3P0nzAe 2y ago
  For my personnal use I've been using a minimalist script for a while : https://github.com/thiswillbeyourgithub/Quick-Whisper-Typer https://github.com/thiswillbeyourgithub/Quick-Whisper-Typer don't be afraid to contribute it's a bit rough around the edges
lannisterstark 2y ago
3 days later - I sub to Aqua, it's an astonishingly good product. I wish I could insert this on any textbox I wanted to though. Also I wish for an app. Pls aqua people. Keeping my phone's screen on while I transcribe sucks.
Ey7NFZ3P0nzAe 2y ago
For my personnal use I've been using a minimalist script for a while : https://github.com/thiswillbeyourgithub/Quick-Whisper-Typer https://github.com/thiswillbeyourgithub/Quick-Whisper-Typer don't be afraid to contribute it's a bit rough around the edges

karmakaze 2y ago

There's no mention of data privacy. Since AI Scribe[0] study is a run by OntarioMD, the digital technology arm of the Ontario Medical Association, it might be okay but it would be nice if it declared it. From the AI Scribe link: > This project is funded by the Ontario Ministry of Health and overseen by Ontario Health. The study is currently underway, with 150 primary care providers already selected from diverse demographic groups, technical backgrounds, and geographic areas. We are no longer accepting participants for the study. Results of the study will be shared later this year. [0] https://www.ontariomd.ca/ai-scribe https://www.ontariomd.ca/ai-scribe

mysore 2y ago
would you care about data privacy when you're dead?
- worthless-trash 2y ago
  Care about anything when you are dead?
- throwup238 2y ago
  Your living relatives might, considering the hereditary nature of so many things in medicine.
- sp332 2y ago
  I feel like you were trying to make a point here, but I have no idea what it was.
  - passion__desire 2y ago
    We are made of electrons. Every electron is the same. Electrons have no sense of privacy.
    - sonotathrowaway 2y ago
      Electrons don’t eat food either. Eating food is unnecessary.

_wire_ 2y ago

> Ontario family doctor says new AI notetaking saved her job Lemme rewrite this headline for a more interesting and relevant article that you might actually want to read: "Doctor hails notepad and pen as essential diagnostic tools."

bashinator 2y ago
The entire point of the article is that she no longer has to spend upwards of two hours a day using the notepad and pen.

xyst 2y ago

As a person that used to be a “human scribe” but for emergency dept doctors. I would say the ER doctors shared the same experience as the one depicted in the news story. For a doctor that was nearing the age of retirement or had very poor keyboard proficiency. scribes were a godsend. Doctors worried less about documentation and focused more on patient care. Of course they still wrote things like admission orders, prescriptions, and nurse orders. Scribes were often told to avoid doing these but sometimes the doctor was okay with it. I personally just told them to do it. Too much of a legal liability for both of parties. But capturing all of the details of the history of present illness (HPI), patient medical history, review of systems, physical exam, procedures (if any) and medical decision making during patient visit can be a time consuming issue. Time increases with significantly more complex cases, especially one with more than one procedure. Documenting it so that it can be billed appropriately is also crucial. Prior to scribes, doctors would describe forgoing writing documentation all together at the end of the shift and writing it the next day or shift. Obviously, this caused very poor documentation and opened up the doctor to legal issues (if they arise). Ambulance chasers can easily call out these inconsistent details between doctor notes, patient outcomes, and cross check with nursing notes. Additionally, this caused cases to be billed incorrectly or “down coded” as well. I don’t agree with allowing private companies unfettered/unregulated access to what is considered private medical information. But with appropriate controls on the data and who has access to it with full transparency, I think it can help in alleviating physical burn out.

forgetfreeman 2y ago
Yeah but you can't get that genie back in the bottle. Once these data are made available to private industry it's only a matter of lobbyists chipping away at whatever protections were initially legislated. See Also: your TV, phone, car, fucking doorbell, and fridge are all spying on you.
- tim333 2y ago
  The HIPPA rules on health data are fairly strict, otherwise your doctor, hospital and so on could already be doing wrong. Personally I have a dumb TV, car, doorbell and fridge so not much spying there. The phone I'm less sure of.

agentultra 2y ago

Privacy and hallucinations would concern me. It seems likely to me that relying on these tools will mean physicians will "trust" the output of these systems and stop checking the notes for accuracy. Checking the notes will become a burden too. Maybe the real solution is to lower the amount of administrative work required? Or hire people to do it?

jorlow 2y ago
I too feel a bit worried about AI making mistakes, but the thing is that a doctor rushing or an assistant can (and do) make mistakes too. These are all just cost vs quality of service tradeoffs. From my experience (having been in and out of hospitals a lot in the last year) it wouldn't surprise me if AI, even with occasional mistakes, would still be a net improvement in overall quality of care and outcomes.
- agentultra 2y ago
  I’m not a fan of, “but humans make mistakes too,” defense. They do but we don’t consider it an improvement when they are made. The goal isn’t to have mistakes. The goal is to maintain (or improve) outcomes without burning out clinicians. Using an LLM isn’t the only solution and might not be a good one. If this is going to be a thing I hope that policy around it will inform patients when the physician plans to use it and allow a patient to opt out.
wvenable 2y ago
In my impression of using AI a lot more recently, hallucinations are a non-issue if you are simply using it to transform data. AI hallucinates when it's being asked to extract data from it's own "memory" but not when it's simply given a task to perform and all the necessary input to do it.
- genewitch 2y ago
  whisper hallucinates - or is just incorrect - fairly often. I have been transcribing old tv and radio programs just to get a real feeling for how inaccurate it is, and for an example, the tv show JAG's main character is Lieutenant Harmon Rabb, Junior. I prompt "You are transcribing a show called JAG - Judge Advocate General - whose main characters are named Lieutenant Harmon Rabb jr, known as Harm or Rabb, [...]" Maybe 1 time out of 20 it will actually put "Rabb" or "Harm". Even better is stuff like old call in radio shows, the callers are perfectly understandable, but whisper has lots of issues. If there's something better than whisper, i'd love to try it out.

vertis 2y ago

Obviously, Medical and privacy issues in this story that make this case more complex, but anyone on HN not looking into ways that AI can streamline their lives and jobs at this point is doing themselves a disservice. Yes, there are limitations. Yes, there are times when it goes down the wrong path or actually makes things worse, but those are getting fewer and further between. Things like Otter, Aider, Cursor, GPT Vision, Obsidian (Smart Connections), MumurType are all making huge impacts on my life and productivity. I'm now tapping knowledge I've been collecting since the early 2000s.

yazzku 2y ago
Medical data shouldn't be going to Microsoft. I'm surprised it's even legal in the context of this story. Your argument is also kind of silly. Yes, go ahead and submit all your life notes since 2k to Big Tech. What does that have to do with the larger context of how these tools are deployed, and specifically in the medical field where people do expect some semblance of privacy and is already regulated to some degree?
layer8 2y ago
Not possible for work due to NDAs, not desirable outside work for similar reasons. AI home appliances that aren’t cloud-based seem a long way off.

lacrosse_tannin 2y ago

just make the note input look like anki

david_allison 2y ago
Med students don't have the time to make Anki cards

theptip 2y ago

This could be the thing that saves the US healthcare system; currently we pay 2x what a normal developed country would pay for the level of service provided, because there is a thick layer of paperwork, with insurance companies going back-and-forth with medical providers to debate and negotiate billing. Imagine if AIs on each side could run that negotiation process in seconds, at the cost of merely a few hundred thousand OpenAI API calls. Then humans can get back to doing the actual work!

philipwhiuk 2y ago
LinkedIn proved that adding a tech layer that should get rid of an industry of paper shufflers is only profitable if those paper shufflers fund the platform. Cue me skeptical that AI really reduces the middle-folk fees.
ryandrake 2y ago
Better, more efficient technology rarely reduces the sticker price for customers. If the underlying product or service is cheaper to produce or provide, the price will stay the same (or increase) and the difference will be pocketed by shareholders. This is pretty much always what happens. Same on the employee side. As an employee, if you adopt some technology that makes you 2X more productive, you're not going to get a 2X compensation increase. That delta will be captured and pocketed by the business.
- deleted 2y ago
  [deleted]
jewayne 2y ago
> currently we pay 2x what a normal developed country would pay for the level of service provided, because there is a thick layer of paperwork, with insurance companies going back-and-forth with medical providers to debate and negotiate billing. Oh, sweet summer child. We don't pay 2X because there's too much paperwork. There's too much paperwork because 2X spending can be used to justify a lot of paperwork. The delta in spending is due to the delta in pricing power that the US payer/provider complex has vs what is seen in other countries.

surfingdino 2y ago

Would love to know which AI company got the data or do the developers of Scribe run their own ChatGPT?

sva_ 2y ago
I think OpenAI claims they don't use the data that goes through their APIs for training (in contrast to chatgpt)

josephrmartinez 2y ago

Here is a similar open source project: https://github.com/josephrmartinez/soapscribe https://github.com/josephrmartinez/soapscribe Just a starting point. But if you are interested in this space, fork away and build it into something useful! My personal take is that the current tools on the market are too expensive. The cost should go way, way down. This should stay open source. Patients should have easy access to full audio recordings and transcriptions of their medical appointments. One can dream!

pixl97 2y ago
Having worked in computing around medical facilities and providers, unfortunately, I believe this is just a pipe dream. Companies that charge a lot for the software will buy up the smaller companies providing services until only a few are left. They'll bundle it up with an expensive price tag. Even more so, providers tend to have protection when they buy a piece of software used by a large number of other providers. They get to bandy about saying "industry standard". I promise you, you do not want to be in front of a medical malpractice jury saying "well we slapped these parts together that we downloaded online", it won't go well for you, even if that's what the big software service did just the same.
- naasking 2y ago
  They can only buy up companies that are willing to sell. Principles still matter to some people.
  - leetrout 2y ago
    Fewer and fewer it feels like :( The almighty dollar influences a lot of people.
  - hansvm 2y ago
    Salesperson's Perspective (initial introductions, "accidentally" stumbling on the owner's favorite bar/beach/...) Yeah, I'm doing my damndest to make the world a better place. There's all of these great tools for doctors, but they're struggling, getting hit by the crossfire of malpractice suits and interoperability difficulties. (later meetings) We just landed <xyz llc>! They're world-class at helping patients with <abc>, but they didn't have the resources to survive in the current political climate. The founders were floundering pouring their own money in to try to keep their patients happy, but with our help the patients are better off and the founders can finally retire comfortably. (much later) I see how much you care about your business and how it's really about the people you serve; that's why I got into it too. When it's finally time for you to sell, you definitely don't have to go with us, but please try to hand it off the right way to somebody who cares. Private equity vultures don't make anybody happy.

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newsclues 2y ago

Good to know, I’m going to ask my doctor if they use this and who will be liable for errors.

penjelly 2y ago

im from Ontario and see resident physicians regularly. The problem isnt that they dont have time to take notes.. its that they dont have time period. The first thing the supervisor doctor will say to me when theyre invited in is "i havent got much time...". Most likely your diagnosis goes like this, you describe symptoms, resident doctor disappears to the supervising doctor and returns with an action. Usually no longterm plan is given, just a medication or recommendation. Its hard to negotiate the action because youre negotiating with the resident, but the decision is authorized by the supervisor. The problem is systemic and automatic note taking isnt going to solve it. Despite this success story for the doctor, I suspect the patients themselves wont have the same success in Ontario.

classichasclass 2y ago

Maybe I'm old-fashioned, but to this day I don't take notes on the computer when I'm in the room with a patient. I might take a couple notes, but otherwise I do it between patients or after hours. It seems discourteous to me otherwise. That said, I have a prolonged charting period after every clinic. It's not sustainable in daily practice (I don't see patients every day).

dmix 2y ago
What the economics of getting a scribe?

davidgu 2y ago

If you're looking to build an AI notetaker for medical use-cases (or others), https://www.recall.ai https://www.recall.ai is a HIPAA compliant API to capture conversations from video conferences. P.S. I'm the founder, so obviously biased :)

486sx33 2y ago

“ mimic doctor’s notes and reduce the amount of paperwork a physician would have to manually compile.” So there is AI making up doctors notes ? That’s extremely contentious. In Ontario doctors are paid per patient per year and then also per visit / procedure. This doctor is just outsourcing her doctor work that taxpayers are footing the bill for - to AI. This is wrong in so many ways. What a lazy practitioner!

Aromasin 2y ago
Did we read different articles? Did you just fixate on that line and not read the rest? She was the one doing the examination and verbalising her concerns. The AI disseminated that information the doctor provided and reformatted it into bureaucratic prose just like doctors scribes have been doing for the last few centuries. I don't see the issue here in the slightest. None of the "doctoring" has been outsourced, just the scribe work.
- stavros 2y ago
  In my line of work (healthcare in the UK), an AI system that would change what a human writes in any way would be considered a medical device, and would require an absolute ton of paperwork to certify. In the case of LLMs, I don't know if certification would even be possible, because you have to show that your system didn't change the intent of the human, which is impossible to do with LLMs.
  - dmix 2y ago
    Its mostly translating dictation and recordings. The doctors are still liable if it's wrong so there's plenty of incentive to simply read the output, which is still a major productivity improvement over writing+reading.
  - brokencode 2y ago
    Sure, if the LLM note were filed straight into the chart without review, it’d be pretty unsafe. But these systems are meant to generate a draft note that the doctor still has to review, edit, and sign. At the end of the day, it’s still up to the doctor to ensure the note is correct.

janandonly 2y ago

Spending 25% of your working hours on “paperwork” sounds about correct for just about everybody who’s had a desk job the last 100 years. I’m not saying it’s a good thing and I’m not saying I’m happy about it. Just that it is so, not just for the medical profession. So what’s the fuss?

dmix 2y ago
> I’m not saying it’s a good thing and I’m not saying I’m happy about it. > Just that it is so, > So what’s the fuss? This sort of attitude would make the world never progress. The fuss is a highly trained specialist who is constantly in short supply is spending a quarter of their time doing work not entirely connected with their speciality. In an efficient system there should be a division of labour to another lower paid specialist, a scribe, but medical systems can't afford that for every single doctor, especially tax payer supported ones. Automating that secondary role for every doctor benefits all of us if it means we give doctors more time. Not to mention the documentation itself is almost always at least 25% excessive and duplicative, and computers+good UIs help eliminate that.
- MichaelZuo 2y ago
  The scribe adds communication and interpretation overhead, they also can make mistakes, etc., so it's not at all clear it would improve overall outcomes per dollar spent.

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hansvm 2y ago

There is a 0% chance they aren't slurping up that data to store forever (and "improve their core offerings" or whatever the privacy policy says). Anyone want to take bets on whether the first breach is: (1) A vindictive employee tracks down their ex's information (2) The raw database is breached and wholesaled (3) Somebody embeds the AI's RAG data in HTML for anyone to read (4) The training job's Spark admin portal lives on an ngrok'd laptop for anyone to siphon (5) The mandatory Facebook "like button" on every government website is set up to scan every query (6) They don't "sell personal data", but if you don't opt out (and usually even if you do) a thousand adtech companies have paid to be affiliates to "assist in normal day-to-day operations", where their only "assistance" is downloading your personal data to serve you ads for hemorrhoid-friendly buttplugs or non-magnetic magnetic healing crystals that don't interfere with your pacemaker or whatever (7) Other (please comment)

moralestapia 2y ago
This data already exists anyway and has been there for like 50+ years ...

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