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Hey author here! Appreciate the feedback! Agreed on importance of portability and durability. I'm not trying to build this out or sell it as a tool to provide

Hey author here! Appreciate the feedback! Agreed on importance of portability and durability. I'm not trying to build this out or sell it as a tool to providers. Just wanted to demo what you could do with structured guidelines. I don't think there's any reason this would have to be unique to a practice or emr. As sister comments mentioned, I think the ideal case here would be if the guideline institutions released the structured representations of the guidelines along with the PDF versions. They could use a tool to draft them that could export in both formats. Oncologists could use the PDFs still, and systems could lean into the structured data.

Dalewyn 2y ago
>Agreed on importance of portability and durability. I think "importance" is understating it, because permanent consistency is practically the only reason we all (still) use PDFs in quite literally every professional environment as a lowest common denominator industrial standard. PDFs will always render the same, whether on paper or a screen of any size connected to a computer of any configuration. PDFs will almost always open and work given Adobe Reader, which these days is simply embedded in Chrome. PDFs will almost certainly Just Work(tm), and Just Working(tm) is a god damn virtue in the professional world because time is money and nobody wants to be embarrassed handing out unusable documents.
- abtinf 2y ago
  PDFs generally will look close enough to the original intent that they will almost always be usable, but will not always render the same. If nothing else, there are seemingly endless font issues.
  - lstamour 2y ago
    In this day and age that seems increasingly like a solved problem to most end users, often a client-side issue or using a very old method of generating a PDF? Modern PDF supports font embedding of various kinds (legality is left as an exercise to the PDF author) and supports 14 standard font faces which can be specified for compatibility, though more often document authors probably assume a system font is available or embed one. There are still problems with the format as it foremost focuses on document display rather than document structure or intent, and accessibility support in documents is often rare to non-existent outside of government use cases or maybe Word and the like. A lot of usability improvements come from clients that make an attempt to parse the PDF to make the format appear smarter. macOS Preview can figure out where columns begin and end for natural text selection, Acrobat routinely generates an accessible version of a document after opening it, including some table detection. Honestly creative interpretation of PDF documents is possibly one of the best use cases of AI that I’ve ever heard of. While a lot about PDF has changed over the years the basic standard was created to optimize for printing. It’s as if we started with GIF and added support to build interactive websites from GIFs. At its core, a PDF is just a representation of shapes on a page, and we added metadata that would hopefully identify glyphs, accessible alternative content, and smarter text/line selection, but it can fall apart if the PDF author is careless, malicious or didn’t expect certain content. It probably inherits all the weirdness of Unicode and then some, for example.
  - seb1204 2y ago
    I would assume these decision tree PDF use a commonly available font. Layout and interpreted outcomes should be the same.
- deleted 2y ago
  [deleted]
killjoywashere 2y ago
The cancer reporting protocols from the College of American Pathologists are available in structured format (1). No major laboratory information system vendor properly implements them, properly, and their implementation errors cause some not-insignificant problems with patient care (oncologists calling the lab asking for clarification, etc). This has pushed labs to make policies disallowing the use of those modules and individual pathologists reverting to their own non-portable templates in Word documents. The medical information systems vendors are right up there with health insurance companies in terms of their investment in ensuring patient deaths. Ensuring. With an E. (1) https://www.cap.org/protocols-and-guidelines/electronic-cancer-protocols https://www.cap.org/protocols-and-guidelines/electronic-canc...
- all2 2y ago
  > The medical information systems vendors are right up there with health insurance companies in terms of their investment in ensuring patient deaths. Ensuring. With an E. Can you expand on this?
  - righthand 2y ago
    Medical information system vendors only care about making a profit, not implementing actual solutions. The discrepancies between systems can lead to bad information which can cost people their life.
    - ethbr1 2y ago
      As an analogy, imagine if the consequence of Oracle doing Oracle-as-usual things was worse medical outcomes. But they did them anyway for profit. That's basically medical information system vendors. The fact that the US hasn't pushed open source EMRs through CMS is insane. It's literally the perfect problem for an open solution.
      - caboteria 2y ago
        It's worse than that. VistA is a world-class open source EMR that the VA has been trying to kill for decades.
prepend 2y ago
I believe you have good intentions, but someone would need to build it out and sell it. And it requires lots of maintenance. It’s too boring for an open source community. There’s a whole industry that attempts to do what you do and there’s a reason why protocols keep getting punted back to pdf. I agree it would be great to release structured representations. But I don’t think there’s a standard for that representation, so it’s kind of tricky as who will develop and maintain the data standard. I worked on a decision support protocol for Ebola and it was really hard to get code sets released in Excel. Not to mention the actual decision gates in a way that is computable. I hope we make progress on this, but I think the incentives are off for the work to make the data structures necessary.

Dalewyn 2y ago

>Agreed on importance of portability and durability. I think "importance" is understating it, because permanent consistency is practically the only reason we all (still) use PDFs in quite literally every professional environment as a lowest common denominator industrial standard. PDFs will always render the same, whether on paper or a screen of any size connected to a computer of any configuration. PDFs will almost always open and work given Adobe Reader, which these days is simply embedded in Chrome. PDFs will almost certainly Just Work(tm), and Just Working(tm) is a god damn virtue in the professional world because time is money and nobody wants to be embarrassed handing out unusable documents.

abtinf 2y ago
PDFs generally will look close enough to the original intent that they will almost always be usable, but will not always render the same. If nothing else, there are seemingly endless font issues.
- lstamour 2y ago
  In this day and age that seems increasingly like a solved problem to most end users, often a client-side issue or using a very old method of generating a PDF? Modern PDF supports font embedding of various kinds (legality is left as an exercise to the PDF author) and supports 14 standard font faces which can be specified for compatibility, though more often document authors probably assume a system font is available or embed one. There are still problems with the format as it foremost focuses on document display rather than document structure or intent, and accessibility support in documents is often rare to non-existent outside of government use cases or maybe Word and the like. A lot of usability improvements come from clients that make an attempt to parse the PDF to make the format appear smarter. macOS Preview can figure out where columns begin and end for natural text selection, Acrobat routinely generates an accessible version of a document after opening it, including some table detection. Honestly creative interpretation of PDF documents is possibly one of the best use cases of AI that I’ve ever heard of. While a lot about PDF has changed over the years the basic standard was created to optimize for printing. It’s as if we started with GIF and added support to build interactive websites from GIFs. At its core, a PDF is just a representation of shapes on a page, and we added metadata that would hopefully identify glyphs, accessible alternative content, and smarter text/line selection, but it can fall apart if the PDF author is careless, malicious or didn’t expect certain content. It probably inherits all the weirdness of Unicode and then some, for example.
- seb1204 2y ago
  I would assume these decision tree PDF use a commonly available font. Layout and interpreted outcomes should be the same.
deleted 2y ago
[deleted]

killjoywashere 2y ago

The cancer reporting protocols from the College of American Pathologists are available in structured format (1). No major laboratory information system vendor properly implements them, properly, and their implementation errors cause some not-insignificant problems with patient care (oncologists calling the lab asking for clarification, etc). This has pushed labs to make policies disallowing the use of those modules and individual pathologists reverting to their own non-portable templates in Word documents. The medical information systems vendors are right up there with health insurance companies in terms of their investment in ensuring patient deaths. Ensuring. With an E. (1) https://www.cap.org/protocols-and-guidelines/electronic-cancer-protocols https://www.cap.org/protocols-and-guidelines/electronic-canc...

all2 2y ago
> The medical information systems vendors are right up there with health insurance companies in terms of their investment in ensuring patient deaths. Ensuring. With an E. Can you expand on this?
- righthand 2y ago
  Medical information system vendors only care about making a profit, not implementing actual solutions. The discrepancies between systems can lead to bad information which can cost people their life.
  - ethbr1 2y ago
    As an analogy, imagine if the consequence of Oracle doing Oracle-as-usual things was worse medical outcomes. But they did them anyway for profit. That's basically medical information system vendors. The fact that the US hasn't pushed open source EMRs through CMS is insane. It's literally the perfect problem for an open solution.
    - caboteria 2y ago
      It's worse than that. VistA is a world-class open source EMR that the VA has been trying to kill for decades.

prepend 2y ago

I believe you have good intentions, but someone would need to build it out and sell it. And it requires lots of maintenance. It’s too boring for an open source community. There’s a whole industry that attempts to do what you do and there’s a reason why protocols keep getting punted back to pdf. I agree it would be great to release structured representations. But I don’t think there’s a standard for that representation, so it’s kind of tricky as who will develop and maintain the data standard. I worked on a decision support protocol for Ebola and it was really hard to get code sets released in Excel. Not to mention the actual decision gates in a way that is computable. I hope we make progress on this, but I think the incentives are off for the work to make the data structures necessary.