5 ms·

Doctor here, I hate EMRs, they are oppressive, in many ways they make things worse for patients. I think the future of EMR is no EMR. An LLM that takes multimo

Doctor here, I hate EMRs, they are oppressive, in many ways they make things worse for patients. I think the future of EMR is no EMR. An LLM that takes multimodal input (audio, video, images, observations etc etc) and outputs whatever is required (a podcast summary of clinic patients, a checklist relevant to a patient’s condition in preop) is the future. Forcing doctors, nurses and allied health to manually document everything they do in annoying web forms is stupid and soul destroying. Multimodal LLMs will also replace much of medicine and nursing which is good.

39896880 2y ago
Agreed, and honestly this is one of the easiest and best behaving use case for LLMs. We’re not talking replacing any diagnoses, but freeing the humans to do what they do best, using their intuition.
- aprilthird2021 2y ago
  AIs performed better at replacing human diagnoses long ago. Physicians don't like to use them because, well 8-10 years of specialized study tends to make you feel like you know what you're talking about vs some computer
goda90 2y ago
LLMs aren't intelligent. They won't replace an EMR. They'll hallucinate information, associate the wrong details and just generally be not deterministic in the way you want an EMR to be. But they can be a powerful interface that does reduce documentation and time spent hunting down information in an EMR. The future of EMRs is more machine learning models of various kinds(not just LLMs) all built into the EMR to turn it into a medical scribe with great memory and a keen eye for what's important. Nurses and doctors aren't going anywhere until we achieve true artificial intelligence, but until then the goal is to keep their eyes off the computer and on the patient as much as possible.
aprilthird2021 2y ago
> Multimodal LLMs will also replace much of medicine and nursing which is good. You should read up on the history of AI in medicine. 30-40 years ago they had rudimentary (by our current era understanding) systems that basically equalled and beat physicians in diagnosing and prescribing medicine to patients when given a list of symptoms (sources at the end). None of these ever had any uptake because physicians didn't want to use them, even when shown they performed more accurately. Ultimately credentialed professionals like medicine and law will never be replaced by LLMs because LLMs cannot be held responsible for the medical regimes they place patients under (or the legal advice they give). Sources: https://en.m.wikipedia.org/wiki/DXplain https://en.m.wikipedia.org/wiki/DXplain https://www.dhinsights.org/news/does-ai-matter-if-human-clinicians-ignore-it https://www.dhinsights.org/news/does-ai-matter-if-human-clin...
- nradov 2y ago
  In most cases the diagnosis is the easy part. The hard part is gathering the signs and symptoms necessary to make the diagnosis. AI isn't particularly helpful for that.
  - bfung 2y ago
    Yep - and the hardest part about getting the input signs and symptoms data is that patients often don’t know the words to describe what they’re feeling. LLMs are not going to help if the input data is also garbage, let alone hallucinations. “Are you dizzy?” - sometimes, I’m not sure… etc
- oezi 2y ago
  Never is a very strong word. In particular considering what changed in just 100 years in medicine. It is hard to imagine that any kind of textual computer input will persist more than 20 years in the future.
  - gruturo 2y ago
    Always bet on text (http://graydon2.dreamwidth.org/193447.html http://graydon2.dreamwidth.org/193447.html and on HN at https://news.ycombinator.com/item?id=8451271 https://news.ycombinator.com/item?id=8451271) But really. Always, always bet on text. Chances are it'll work in 10000 years if we still exist.
mikeqq2024 2y ago
"Multimodal LLMs will also replace much of medicine and nursing which is good" Mind elaborate how is this done?
- gagagaga7 2y ago
  For starters, ward nurses spend 25-35% of their time doing documentation. This is doing patient notes, transcribing vitals, filling in forms and checklists, logging in and out of workstations, etc etc. Much of this could be replaced by audio/video input. Secondly, if the LLM can identify at risk patients or drug checks, you don’t need a nurse or 2 nurses to dispense medications or identify at risk patients. Multimodal input LLM plus a caring low skilled person can do the necessary things far more often. These 2 factors alone can reduce nursing workload by half. As for family doctors, I would personally be very happy to transfer my basic general care to a good LLM right now. Everything I need is straightforward, protocolised and the hassle of making appointments, delays, waiting rooms, form filling etc is more of a barrier to my healthcare than current LLM deficiencies.
  - FloatArtifact 2y ago
    Sounds like you don't have a very good understanding of what nurses actually do nor do you appreciate them.
    - gagagaga7 2y ago
      Ok, I’ve spent the last 18 years working in hospitals, and the stats in my post are accepted in nursing research. Very open to hear where I’m wrong.
      - mikeqq2024 2y ago
        tech background here. Feel free to drop me a line if you need a teck parter to revamp what you described above
aitchnyu 2y ago
Tangential, will we ever certify current LLMs as "medical grade", for example they reveal suicide steps too easily, pick up Redditor snark as serious content, contatenate parts of random sentences together etc?

39896880 2y ago

Agreed, and honestly this is one of the easiest and best behaving use case for LLMs. We’re not talking replacing any diagnoses, but freeing the humans to do what they do best, using their intuition.

aprilthird2021 2y ago
AIs performed better at replacing human diagnoses long ago. Physicians don't like to use them because, well 8-10 years of specialized study tends to make you feel like you know what you're talking about vs some computer

goda90 2y ago

LLMs aren't intelligent. They won't replace an EMR. They'll hallucinate information, associate the wrong details and just generally be not deterministic in the way you want an EMR to be. But they can be a powerful interface that does reduce documentation and time spent hunting down information in an EMR. The future of EMRs is more machine learning models of various kinds(not just LLMs) all built into the EMR to turn it into a medical scribe with great memory and a keen eye for what's important. Nurses and doctors aren't going anywhere until we achieve true artificial intelligence, but until then the goal is to keep their eyes off the computer and on the patient as much as possible.

aprilthird2021 2y ago

> Multimodal LLMs will also replace much of medicine and nursing which is good. You should read up on the history of AI in medicine. 30-40 years ago they had rudimentary (by our current era understanding) systems that basically equalled and beat physicians in diagnosing and prescribing medicine to patients when given a list of symptoms (sources at the end). None of these ever had any uptake because physicians didn't want to use them, even when shown they performed more accurately. Ultimately credentialed professionals like medicine and law will never be replaced by LLMs because LLMs cannot be held responsible for the medical regimes they place patients under (or the legal advice they give). Sources: https://en.m.wikipedia.org/wiki/DXplain https://en.m.wikipedia.org/wiki/DXplain https://www.dhinsights.org/news/does-ai-matter-if-human-clinicians-ignore-it https://www.dhinsights.org/news/does-ai-matter-if-human-clin...

nradov 2y ago
In most cases the diagnosis is the easy part. The hard part is gathering the signs and symptoms necessary to make the diagnosis. AI isn't particularly helpful for that.
- bfung 2y ago
  Yep - and the hardest part about getting the input signs and symptoms data is that patients often don’t know the words to describe what they’re feeling. LLMs are not going to help if the input data is also garbage, let alone hallucinations. “Are you dizzy?” - sometimes, I’m not sure… etc
oezi 2y ago
Never is a very strong word. In particular considering what changed in just 100 years in medicine. It is hard to imagine that any kind of textual computer input will persist more than 20 years in the future.
- gruturo 2y ago
  Always bet on text (http://graydon2.dreamwidth.org/193447.html http://graydon2.dreamwidth.org/193447.html and on HN at https://news.ycombinator.com/item?id=8451271 https://news.ycombinator.com/item?id=8451271) But really. Always, always bet on text. Chances are it'll work in 10000 years if we still exist.

mikeqq2024 2y ago

"Multimodal LLMs will also replace much of medicine and nursing which is good" Mind elaborate how is this done?

gagagaga7 2y ago
For starters, ward nurses spend 25-35% of their time doing documentation. This is doing patient notes, transcribing vitals, filling in forms and checklists, logging in and out of workstations, etc etc. Much of this could be replaced by audio/video input. Secondly, if the LLM can identify at risk patients or drug checks, you don’t need a nurse or 2 nurses to dispense medications or identify at risk patients. Multimodal input LLM plus a caring low skilled person can do the necessary things far more often. These 2 factors alone can reduce nursing workload by half. As for family doctors, I would personally be very happy to transfer my basic general care to a good LLM right now. Everything I need is straightforward, protocolised and the hassle of making appointments, delays, waiting rooms, form filling etc is more of a barrier to my healthcare than current LLM deficiencies.
- FloatArtifact 2y ago
  Sounds like you don't have a very good understanding of what nurses actually do nor do you appreciate them.
  - gagagaga7 2y ago
    Ok, I’ve spent the last 18 years working in hospitals, and the stats in my post are accepted in nursing research. Very open to hear where I’m wrong.
    - mikeqq2024 2y ago
      tech background here. Feel free to drop me a line if you need a teck parter to revamp what you described above

aitchnyu 2y ago

Tangential, will we ever certify current LLMs as "medical grade", for example they reveal suicide steps too easily, pick up Redditor snark as serious content, contatenate parts of random sentences together etc?