6 ms·

My wife is a doctor and she already has an AI scribe that records visits, transcribes them, summarizes, and prepares her orders. It seems like having that scri

My wife is a doctor and she already has an AI scribe that records visits, transcribes them, summarizes, and prepares her orders. It seems like having that scribe also review lab results wouldn’t be far off, but we are still not ready to let the AI system interpret and inform the patient without human intervention. The problem here wasn’t that a human missed the low platelet count, it’s just that it wasn’t reviewed yet. Both a doctor and an AI system would haven spotted the issue immediately. I am not saying this isn’t a great result, but the AI intervention must come from the patient side, not the care providers side. The providers have too much at risk, while the patient is able to pick and choose their own AI and decide what levels of risk they are able to accept.

atonse 2y ago
I said in another thread that I think that the first step can at least be that an LLM helps triage/prioritize the test results so docs can at least know an order in which to review them, especially with radiology/imaging results which are mostly words-based, rather than the numerical results that often come out of blood tests.
jstanley 2y ago
I can't tell if you're trying to say that ChatGPT hasn't added anything here? Yes I'm sure a human doctor would have noticed the low platelet count -- if they bothered to look at it. Which they didn't (or at least hadn't got around to yet).
- doctoboggan 2y ago
  Sorry, I edited my comment with a final statement. I think chatGPT added a lot and I think the future of AI in medicine is with patients bringing their own AI to help interpret the results.
xnorswap 2y ago
It doesn't need "AI" or a "Scribe" to spot a low platelet count in lab results either, computer systems have been able to do this for decades. There's a systemic failure that a computer wasn't already flagging up the low count for immediate follow-up. What I find interesting is that AI (or more specifically LLMs / chat-GPT ) has had such an impact it's broken down barriers from people who previously would be against any computer involvement or automation. People have gone from, "You must not automate anything" to "We should feed everything into chat GPT".. And from someone who has in the past been interested in statistical modelling, it's dizzying. It's as if statistics were seen as boring and fallible, but "AI" is exciting and wonderful.
- doctoboggan 2y ago
  Most modern EMRs will flag results like this. If it happened to arrive in the middle of the night like the author said, the PCP would have just been asleep. I don’t think there are systems for waking up PCPs for concerning lab results.
  - bombcar 2y ago
    I think the suggestion is that the EMR should flag dangerous conditions like this, and notify the doctor on duty to at least take a look at it.
    - sarchertech 2y ago
      This would be enormously expensive. The number of things an EMR thinks are an imminent threat will vastly outnumber the things that actually are thanks to liability concerns. So now you need an extra on-call doctor just to filter out the false positives, or the on-call doctor gets notification fatigue and ignores them. Or in the best case you send a lot of people to ER in the middle of the night for no reason. Again thanks to liability concerns, but this time on the part of the primary care practice.
    - lr1970 2y ago
      > I think the suggestion is that the EMR should flag dangerous conditions like this, and notify the doctor on duty to at least take a look at it. Or a PA or CRN. They are cheaper. As the last resort you can have an AI doing it :-)
  - sarchertech 2y ago
    And nor should there be. PCPs are basically by definition for non-emergent situations. If the PCP was at all concerned that the patient had something that was an immediate threat, they would have sent them to the ER in the first place. Having someone on-call to deal with routine lab results that just happen to catch a possible imminent threat would be an enormous waste of resources.
- Cthulhu_ 2y ago
Cthulhu_ 2y ago
If the patient agrees to it (and is informed of it), I can definitely see value in automatically recording, transcribing and logging a visit (as long as the doctor does a final approval / editing phase). Part of me wants to enable that by default in some of our Teams meetings too because for some reason they often end up chaotic and emotional (enthousiastic / energetic, I mean, instead of businesslike), and it's difficult to bring it back to some core points.
maxwell 2y ago
How does she disclose that to her patients? How many refuse?
- doctoboggan 2y ago
  Her legal team said they are allowed to get verbal consent. She has a sentence she says verbatim something along the lines of “ I am going to use this computer to record this visit and take notes. Is that OK?” Almost no one refuses.
  - RandomBacon 2y ago
    If I heard that, I would think the person asking is going to take the notes, not feed the recording into a LLM. I do NOT want a transcription ERROR in my medical records. I bet if she says something like "AI will transcribe" then there will be more hesitation, although maybe not more refusals because most people don't know how it can make mistakes.
    - doctoboggan 2y ago
      Anecdotally, she has reported it’s _much_ better than her human scribes. And she is still ultimately responsible for the content and reads it all before signing the note.
      - maxwell 2y ago
        Are audio recordings of patients shared with third parties?
        doctoboggan 2y ago
        I believe so, yes. This is nothing new however as "tele scribe" companies have existed for a long time. These sort of cases are exactly what HIPAA regulations were designed to enable.
  - maxwell 2y ago
Clubber 2y ago
On the provider side, it might be useful to automate the analysis of various patients, particularly ones who have elusive diagnosis. I hear stories of some patients who sent from specialist to specialist trying to figure out what's wrong with them where the symptom is obvious but the cause is not. I had a colleague who had vertigo and it took 6 months to figure out what was going on. She couldn't work or drive. AI/ML might help in that scenario on the provider side. I understand it's pretty good at analyzing imaging as well.
LinuxBender 2y ago
I think there needs to be a third option. Today I can plug a device into just about any vehicle and diagnose / debug tens of thousands of issues. This needs to be a thing for humans. I should be a able to put a few drops of each of my bodily fluids into a set of disposable receptacles or strips and it should be able to test for hundreds of thousands of issues initially and millions of issues in the future. A pocket fictional Dr. House so to speak. This would distribute the testing workload to the people at home or work and give doctors something better to start with than only perceived symptoms and would allow prioritizing patients during triage. It should find everything from the obvious emergencies to the most obscure anomalies that could be addressed at a later time. It should also be able to tell me what to start or stop eating. There should also be a high-risk-accepted mode where the device can make guesses about what is occurring based on all the data it gathered even if it does not have 100% of the scientific data to do so. All this in a sub $1000 device I can buy online without a prescription. This device must not have any way to leak patient data. Connect it to a printer via USB and it just makes a hard copy to hand to a doctor or they could just read this device with their eyeballs. No cell phone required. No wifi or bluetooth. No dial home. No uploading to LLM's. No cloud. Patients can download an updated OS and firmware image for updated medical data and update using a thumb-drive or micro-SD.
- soco 2y ago
  If only we could get some funding for this, and maybe get a charismatic college dropout as CEO to lead it bravely, whatever the results?
  - ashildr 2y ago
    Maybe someone with a really interesting voice?
- ashildr 2y ago
  Yes, you should have a medical tricorder. It’s a scandal these don't exist.
deleted 2y ago
[deleted]

atonse 2y ago

I said in another thread that I think that the first step can at least be that an LLM helps triage/prioritize the test results so docs can at least know an order in which to review them, especially with radiology/imaging results which are mostly words-based, rather than the numerical results that often come out of blood tests.

jstanley 2y ago

I can't tell if you're trying to say that ChatGPT hasn't added anything here? Yes I'm sure a human doctor would have noticed the low platelet count -- if they bothered to look at it. Which they didn't (or at least hadn't got around to yet).

doctoboggan 2y ago
Sorry, I edited my comment with a final statement. I think chatGPT added a lot and I think the future of AI in medicine is with patients bringing their own AI to help interpret the results.

xnorswap 2y ago

It doesn't need "AI" or a "Scribe" to spot a low platelet count in lab results either, computer systems have been able to do this for decades. There's a systemic failure that a computer wasn't already flagging up the low count for immediate follow-up. What I find interesting is that AI (or more specifically LLMs / chat-GPT ) has had such an impact it's broken down barriers from people who previously would be against any computer involvement or automation. People have gone from, "You must not automate anything" to "We should feed everything into chat GPT".. And from someone who has in the past been interested in statistical modelling, it's dizzying. It's as if statistics were seen as boring and fallible, but "AI" is exciting and wonderful.

doctoboggan 2y ago
Most modern EMRs will flag results like this. If it happened to arrive in the middle of the night like the author said, the PCP would have just been asleep. I don’t think there are systems for waking up PCPs for concerning lab results.
- bombcar 2y ago
  I think the suggestion is that the EMR should flag dangerous conditions like this, and notify the doctor on duty to at least take a look at it.
  - sarchertech 2y ago
    This would be enormously expensive. The number of things an EMR thinks are an imminent threat will vastly outnumber the things that actually are thanks to liability concerns. So now you need an extra on-call doctor just to filter out the false positives, or the on-call doctor gets notification fatigue and ignores them. Or in the best case you send a lot of people to ER in the middle of the night for no reason. Again thanks to liability concerns, but this time on the part of the primary care practice.
  - lr1970 2y ago
    > I think the suggestion is that the EMR should flag dangerous conditions like this, and notify the doctor on duty to at least take a look at it. Or a PA or CRN. They are cheaper. As the last resort you can have an AI doing it :-)
- sarchertech 2y ago
  And nor should there be. PCPs are basically by definition for non-emergent situations. If the PCP was at all concerned that the patient had something that was an immediate threat, they would have sent them to the ER in the first place. Having someone on-call to deal with routine lab results that just happen to catch a possible imminent threat would be an enormous waste of resources.
Cthulhu_ 2y ago

Cthulhu_ 2y ago

If the patient agrees to it (and is informed of it), I can definitely see value in automatically recording, transcribing and logging a visit (as long as the doctor does a final approval / editing phase). Part of me wants to enable that by default in some of our Teams meetings too because for some reason they often end up chaotic and emotional (enthousiastic / energetic, I mean, instead of businesslike), and it's difficult to bring it back to some core points.

maxwell 2y ago

How does she disclose that to her patients? How many refuse?

doctoboggan 2y ago
Her legal team said they are allowed to get verbal consent. She has a sentence she says verbatim something along the lines of “ I am going to use this computer to record this visit and take notes. Is that OK?” Almost no one refuses.
- RandomBacon 2y ago
  If I heard that, I would think the person asking is going to take the notes, not feed the recording into a LLM. I do NOT want a transcription ERROR in my medical records. I bet if she says something like "AI will transcribe" then there will be more hesitation, although maybe not more refusals because most people don't know how it can make mistakes.
  - doctoboggan 2y ago
    Anecdotally, she has reported it’s _much_ better than her human scribes. And she is still ultimately responsible for the content and reads it all before signing the note.
    - maxwell 2y ago
      Are audio recordings of patients shared with third parties?
      - doctoboggan 2y ago
        I believe so, yes. This is nothing new however as "tele scribe" companies have existed for a long time. These sort of cases are exactly what HIPAA regulations were designed to enable.
- maxwell 2y ago

Clubber 2y ago

On the provider side, it might be useful to automate the analysis of various patients, particularly ones who have elusive diagnosis. I hear stories of some patients who sent from specialist to specialist trying to figure out what's wrong with them where the symptom is obvious but the cause is not. I had a colleague who had vertigo and it took 6 months to figure out what was going on. She couldn't work or drive. AI/ML might help in that scenario on the provider side. I understand it's pretty good at analyzing imaging as well.

LinuxBender 2y ago

I think there needs to be a third option. Today I can plug a device into just about any vehicle and diagnose / debug tens of thousands of issues. This needs to be a thing for humans. I should be a able to put a few drops of each of my bodily fluids into a set of disposable receptacles or strips and it should be able to test for hundreds of thousands of issues initially and millions of issues in the future. A pocket fictional Dr. House so to speak. This would distribute the testing workload to the people at home or work and give doctors something better to start with than only perceived symptoms and would allow prioritizing patients during triage. It should find everything from the obvious emergencies to the most obscure anomalies that could be addressed at a later time. It should also be able to tell me what to start or stop eating. There should also be a high-risk-accepted mode where the device can make guesses about what is occurring based on all the data it gathered even if it does not have 100% of the scientific data to do so. All this in a sub $1000 device I can buy online without a prescription. This device must not have any way to leak patient data. Connect it to a printer via USB and it just makes a hard copy to hand to a doctor or they could just read this device with their eyeballs. No cell phone required. No wifi or bluetooth. No dial home. No uploading to LLM's. No cloud. Patients can download an updated OS and firmware image for updated medical data and update using a thumb-drive or micro-SD.

soco 2y ago
If only we could get some funding for this, and maybe get a charismatic college dropout as CEO to lead it bravely, whatever the results?
- ashildr 2y ago
  Maybe someone with a really interesting voice?
ashildr 2y ago
Yes, you should have a medical tricorder. It’s a scandal these don't exist.

deleted 2y ago

[deleted]