Tag: Clinical Decision Support

The rAIdiologist will see you now


The year is 2019 and Imaging By Machines have fulfilled their prophesy and control all Radiology Departments, making their organic predecessors obsolete.

One such lost soul tries to decide how he might reprovision the diagnostic equipment he has set up on his narrow boat on the Manchester Ship Canal, musing at the extent of the digital take over during his supper (cod of course).

What I seek to do in this short paper is not to revisit the well-trodden road of what Artificial Intelligence, deep learning, machine learning or natural language processing might be, the data-science that underpins them nor limit myself to what specific products or algorithms are currently available or pending. Instead I look to share my views on what and where in the patient journey I perceive there may be uses for “AI” in the pathway.

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Like Air Traffic Control For Healthcare

flying cadeuciiIn December THCB asked insiders and pundits across health care to give us their armchair quarterback predictions for 2015.  What tectonic trends do they see looming on the horizon?  What’s overrated?  What nasty little surprises do they see lying in wait? What will we all be talking about this time next year?  Over the next week, we’ll be featuring their responses in a series of quick takes.

Jacob Reider MD, Former Deputy National Coordinator, HHS

As care providers increasingly embrace shared risk payment models, we will see a rapid growth of interest in care coordination and health IT tools that support shared decisions.

a)     Care Coordination.  While this remains a bit of a buzz word, the need for a toolset that helps a community of clinicians care for a group of people in a coordinated manner is obvious to anyone who has been on either end of the stethoscope.  The current health IT tools and processes weren’t developed for this purpose – and therefore do a terrible job of it.  2015 will see the emergence of technology and services that help teams identify and maintain individual patient goals, optimal pathways toward those goals, and then manage the participants toward shared success.  Think of this as “air-traffic control” for health care. If we know where we’re going.  This toolset (and the humans who use it) can help make sure everyone arrives safely.

b)     Do we know where we’re going? Have we made the right diagnosis?  If so – do we have the right treatment plan?  Clinical decisions need to be shared between care providers, patients, family members and other participants.  2015 will see the next step in the evolution of traditional provider-focused clinical decision support (CDS) tools toward tools that also offer research-based personalized care guidance.  This patient’s unique needs can be defined, understood by all parties, and then acted upon.  If care coordination is air-traffic control, perhaps this personalized decision support will be the Waze for health care.  Like Waze, this will take years to reach the mainstream, but when it does, none of us will leave home without it.

Throwing the EHR Under the Bus …

Given what is now known about how the case of Thomas Eric Duncan at Texas Health Presbyterian was handled, the attempt to blame the hospital’s electronic health record for the missed diagnosis sounds pretty lame.

But people are still doing it:

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Critics of electronic medical records have found a case they will be talking about for years.

Consider this argument from Ross Koppel and Suzanne Gordon:

While it is too early to determine what precisely happened in this case, it is not too early to consider the critical issues it highlights. One is our health care system’s reliance on computerized technology that is too often unfriendly to clinicians, especially those who work in stressful situations like a crowded emergency room. Then there are physicians’ long-standing failure to pay attention to nurses’ notes. Finally, there is the fact that hospitals often discourage nurses from assertively challenging physicians.

Long promised as the panacea for patient safety errors, electronic health records, in fact, have fragmented information, too often making critical data difficult to find. Often, doctors or nurses must log out of the system they are on and log into another system just to access data needed to treat their patients (with, of course, additional passwords required). Worse, data is frequently labeled in odd ways. For example, the results of a potassium test might be found under “potassium,” “serum potassium level,” “blood tests” or “lab reports.” Frequently, nurses and doctors will see different screen presentations of similar data, making it difficult to collaborate.

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What If Doctors Had Instant Access to All Medical Research?

We are asking doctors to help us study what access to all medical research would mean for their practice. To study the value of such access, we are providing physicians who participate in this Stanford University Public Access Study with eleven (11) months of complete access to virtually all medical journals, as well as to an evidence-based clinical decision-support service.

Participating physicians will have free, one-click access to this vast body of research on their computer or tablet, whenever and wherever they are online. The study is intended to inform current discussions and legislation on the state of public and professional access to federally funded medical research.

Demands on Participant:  Participants must be a physician licensed to practice in the United States. Data will be collected on participants’ use of research, with selected participants asked to participate in a 30-minute confidential interview. As a control measure, participants are given an extra month of the evidence-based clinical decision-support service, either prior or following the eleven months of access to the research literature.

To learn more and/or to begin immediate participation (after providing informed consent) in the Public Access Study, follow this link:

The principal investigator of the Public Access Study is John Willinsky, Khosla Family Professor, Stanford University, Stanford CA;

One Day in the Life of a Meaningful User

All the laws have been passed and all the final rulings have been published. In the spirit of the times, you went out and got yourself an EHR. You did your due diligence and sat through many hours of vendor demonstrations. In the end they all started to blend together, so you talked to friends and colleagues and accepted the Hospital’s offer to pay a big chunk of your EHR costs if you picked the one they wanted you to pick.

Your biller quit in disgust, but other than that the implementation was uneventful and the Hospital folks helped a lot. After several hiccups, your Medicare payments are coming in regularly now and your office is adjusting well to the new software. The documentation templates leave a lot to be desired, but you type well and when you find some free time you may take a stab at customizing them a bit. Here and there you run into bugs and a couple of times the EHR was unavailable for a good two to three hours. Not sure exactly why. Maybe it was the Internet that was unavailable.

Anyway, if all goes according to plan, you will be retiring in 10 years and your much younger partner will be bringing in someone who is probably in Medical School right now. Everything seems under control. But today is different…

Today is January 2nd, 2011 and you are driving to work. Today has to be meaningfully different and your first patient is waiting in Exam Room 1.Continue reading…