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By HEALTH 2.0

Artificial Intelligence and Machine Learning are very buzzy and in the storm of tweets and scandals it’s easy to use the terms interchangeably, as if they are synonyms. They’re not synonyms, but here’s a rule of thumb: All Machine Learning is AI, but not all AI is Machine Learning.

Examples of Machine Learning in everyday life abound, and for all the attention aimed at the behemoth Facebook, and their epic fail of data protection and privacy, the benefits of Machine Learning generally outweigh the bad. Here we explore the opportunity within Healthcare for AI and ML to do good.

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By PAUL KECKLEY

Medicare is a big deal in U.S. healthcare: no doubt.

It’s the $683 billion federal program that provides insurance coverage to 59 million Americans, up 3 million from 2015. It covers 16% of the population and accounts for 20% of total health spending today. By 2020, it will cover 64 million and 81 million by 2030.

Its beneficiaries are a complex population: One in six is disabled, two of three have at least 2 chronic ailments, half have an income less than two-times the federal poverty level ($26,200 in 2016), one in four has less than $15,000 in savings or retirement accounts, and the average enrollee pays 17% of their total income on out of pocket health costs (30% for those above 85 years of age).

It’s a complicated program: Medicare Part A covers hospital visits and skilled nursing facilities, Part B covers preventative services including doctor visits and diagnostic testing and Part D covers prescription drugs.

So, Medicare is the federal government’s most expensive health program. It gets lots of attention from politicians who vow to protect it, hospitals and physicians who complain its reimbursement stifles innovation and seniors who guard it jealously with their votes. But policymakers and many in the industry might be paying too much attention to it. After all, 84% of the U.S. population and 80% of our total spending falls outside its span of coverage and responsibility.

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By HANS DUVEFELT, MD

I can’t help myself from telling patients how things really work in health care. But I feel they have a right to know.

When I see new patients their jaw usually drops when I sit down with them next to the computer with a stack of papers held together with a rubber band or a gigantic clamp and with yellow sticky notes protruding here and there with words like LAB, ER and X-RAY.

Patients always assume that medical records transfer seamlessly between practices. They don’t, even between clinics that use the same EMR vendor. The stack of papers gets scanned in, as images or PDFs, but they don’t appear in searchable, tabular or report-compatible form. Often, they don’t each get labeled, but are clumped together under headings like “Radiology 2010-2017”.

In one of the clinics I work in, a Registered Nurse enters patients’ medical history in the EMR before each new patient’s first appointment. In the other, it is my job. In both cases, only a fraction of he information is usually carried over from one EMR to the other, and the patient’s life story risks getting diluted, even distorted.Continue reading…

By ROBERT WACHTER and JEFF GOLDSMITH

After a blizzard of hype surrounding the electronic health record (EHR), health professionals are now in full backlash mode against this complex new tool. They are rightly seen as a major cause of professional burnout among physicians and nurses: Clinicians are spending almost half their professional time typing, clicking, and checking boxes on electronic records. They can and must be made into useful, easy-to-use tools that liberate, rather than oppress, clinicians.

Performing several tasks, badly. The EHR is a lot more than merely an electronic version of the patient’s chart. It has also become the control panel for managing the clinical encounter through clinician order entry. Moreover, through billing and regulatory compliance, it has also become a focal point of quality-improvement efforts. While some of these efforts actually have improved quality and patient safety, many others served merely to “buff up the note” to make the clinician look good on “process” measures, and simply maximize billing.

Mashing up all these functions — charting, clinical ordering, billing/compliance and quality improvement — inside the EHR has been a disaster for the clinical user, in large part because the billing/compliance function has dominated. The pressure from angry physician users has produced a medieval solution: Hospital and clinics have hired tens of thousands of scribes literally to follow clinicians around and record their notes and orders into the EHR. Only in health care, it seems, could we find a way to “automate” that ended up adding staff and costs!

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By SAURABH JHA, MD

Intrigued by many things in my first few days in the U.S., what perplexed me the most was that there seemed to be a DaVita Dialysis wherever I went; in malls, in the mainstreet of West Philadelphia, near high rises and near lower rises. I felt that I was being ominously followed by nephrologists. How on earth could providers of renal replacement therapy have a similar spatial distribution as McDonalds?

After reading Friedrich Hayek’s essay, Use of Knowledge in Society, I realized why. In stead of building a multiplex for dialysis, which has shops selling pulmonary edema-inducing fried chicken, DaVita set shop where people lived or hung out. It wasn’t a terribly clever business plan but its genius was its simplicity, its humility. If the mountain will not come to Muhammed, Muhammed must go to the mountain. DaVita went to the masses.

The link between Hayek’s wisdom and DaVita’s business plan may seem tenuous. But Hayek has been misunderstood, particularly in healthcare. Many a times and oft in the policy world Hayek has been rated about money and usances. This is because of a misperception that Hayek was all about profit and loss, which are anathema to healthcare. Hayek’s message was simple: local knowledge can’t be aggregated. From this premise sprouts others – dispersed agents in certain times and places possess fragments of knowledge which don’t come easily to central planners.

For Hayek, socialism and capitalism weren’t moral but epistemic issues. Socialism would fail because of a coordination problem – markets would succeed because they could use price signals to coordinate. Healthcare doesn’t use price signals to coordinate, not explicitly, at least. Nor does it capitalize on dispersed agents – on local knowledge. Hayek, a supporter of universal healthcare, didn’t specifically discuss healthcare in his essays. Nonetheless, it would be a useful intellectual exercise to speculate how Hayek might have applied his wisdom to modern healthcare.

What does local knowledge in healthcare even mean? Stated in a rather unlettered way, it is the provision of healthcare locally. AEDs are no good if they aren’t located where people congregate. The value of local presence of medical facilities, particularly in poor neighborhoods, is hardly rocket science. Just as great cities grew near rivers, great hospitals germinated in poor neighborhoods. But, with growing centralization of healthcare, with hospitals becoming multiplexes, futuristic cities with a distinct architectural phenotype, different from the neighborhoods they serve, the value of decentralization can be missed.

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