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Would You Picket Over AI?

By KIM BELLARD

I’m paying close attention to strike by the Writers Guild Of America (WGA), which represents “Hollywood” writers.  Oh, sure, I’m worried about the impact on my viewing habits, and I know the strike is really, as usual, about money, but what got my attention is that it’s the first strike I’m aware of where impact of AI on their jobs is one of the key issues.

It may or may not be the first time, but it’s certainly not going to be the last.

The WGA included this in their demands: “Regulate use of artificial intelligence on MBA-covered projects: AI can’t write or rewrite literary material; can’t be used as source material; and MBA-covered material can’t be used to train AI.” I.e., if something – a script, treatment, outline, or even story idea – warrants a writing credit, it must come from a writer.  A human writer, that is.

John August, a screenwriter who is on the WGA negotiating committee, explained to The New York Times: “A terrible case of like, ‘Oh, I read through your scripts, I didn’t like the scene, so I had ChatGPT rewrite the scene’ — that’s the nightmare scenario,”

The studios, as represented by the Alliance of Motion Picture and Television Producers (AMPTP), agree there is an issue: “AI raises hard, important creative and legal questions for everyone.” It wants both sides to continue to study the issue, but noted that under current agreement only a human could be considered a writer. 

Still, though, we’ve all seen examples of AI generating remarkably plausible content.  “If you have a connection to the internet, you have consumed AI-generated content,” Jonathan Greenglass, a tech investor, told The Washington Post. “It’s already here.”  It’s easy to imagine some producer feeding an AI a bunch of scripts from prior instalments to come up with the next Star Wars, Marvel universe, or Fast and Furious release.  Would you really know the difference? 

Sure, maybe AI won’t produce a Citizen Kane or The Godfather, but, as Alissa Wilkinson wrote in Vox: “But here is the thing: Cheap imitations of good things are what power the entertainment industry. Audiences have shown themselves more than happy to gobble up the same dreck over and over.” 

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THCB Quickbite: Michael Gould, ZeOmega

Michael Gould is AVP of Interoperability Strategy at ZeOmega, a utilization/care management company that predominantly helps payers manage population health for about 50m covered lives including AmeriHealth Caritas, home care company HealPros and more. Since 2016 they have also been in the interoperability game since they bought Health Unity. Since Michael came over to ZeOmega from Independence Blue Cross a few years back he’s been helping the data/API integration that replaces a lot of the fax and phone-based prior-auth. He told me about the cross-sell between the two sides of the company, in part driven by the new CMS regulations about prior auth–Matthew Holt

Burden of Pain

BY JAY JOSHI

We’re seeing a trend of late, where matters in healthcare once deemed to be civil in nature are turning criminal. We see it for nearly every polarizing health issue, from abortion to opioids. And it’s affecting vulnerable patients the most.

We have two separate systems in place, civil and criminal, because we have different standards of behavior. Civil laws determine whether undue harm was caused by one party to another. Criminal laws determine whether someone committed a crime. The threshold is distinctly different. If someone is caught driving ten miles over the designated speed limit, that person committed a civil infraction of traffic laws. But if someone is caught speeding well in excess, say thirty or forty miles over the speed limit, while driving recklessly, that person committed a crime. The extent of the violation determines the applicable law. That’s why traffic laws have distinct civil and criminal laws.

The same logic applies to healthcare. We have civil penalties for undue harm or malpractice and we have criminal penalties for crimes that transpire in the clinical context. The difference between the two, for something to go from civil to criminal, is mens rea, or a requirement of criminal intent.

Criminal intent implies certain violations were committed deliberately – literally as an act of crime. Normal civil violations, such as malpractice claims, offer physicians protection against liability. That protection doesn’t apply for criminal violations. And that’s the point. It explains why the sudden push by regulators, prosecutor offices, and federal agents to investigate otherwise civil matters as criminal is so pernicious.

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THCB Quickbite: Steve Yaskin, Health Gorilla

Steve Yaskin is CEO of Health Gorilla and probably the only non-lawyer who has read the entire 21st Century Cures Act, and decided that there was a business buried in it. If we are going to fix the data access problem and then move that data to where it is needed in the patient care experience, it’s a good bet that Health Gorilla’s health information network will be a big part of that future. Steve told me about the company, its technology for patient identity and matching (among others), and what it means to be an official QHIN exchanging data using FHIR. Will consumers and providers on their behalf demand access to data? Steve & Health Gorilla have raised over $80m to bet “yes”, and are doubling revenue every year–Matthew Holt

Bluesky Ahead

BY KIM BELLARD

I’ve been thinking about writing about Bluesky ever since I heard about the Jack Dorsey-backed Twitter alternative, and decided it is finally time, for two reasons. The first is that I’ve been seeing so many other people writing about it, so I’m getting FOMO.  The second is that I checked out Nostr, another Jack Dorsey-backed Twitter alternative, and there’s no way I’m trying to write about that (case in point: Jack’s Nostr username is: npub1sg6plzptd64u62a878hep2kev88swjh3tw00gjsfl8f237lmu63q0uf63m.  Seriously).

It’s not that I’ve come to hate Twitter, although Elon Musk is making it harder to like it, as it is that our general dissatisfaction with existing social media platforms makes it a good time to look at alternatives.  I’ve written about Mastodon and BeReal, for example, but Bluesky has some features that may make sense in the Web3 world that we may be moving into. 

And, of course, I’m looking for any lessons for healthcare.

Bluesky describes itself as a “social internet.”  It started as a Twitter project in December 2019, with the aim “to develop an open and decentralized standard for social media.”   At the time, the ostensible goal was that Twitter would be a client of the standard, but events happened, Jack Dorsey left Twitter, Elon Musk bought it, and Bluesky became an independent LLC.  It rolled out an invite-only, “private beta” for iOS (Apple) users in March 2023, followed by an Android version in mid-April (again, invite-only).  People can sign up to be on the waitlist.  There are supposedly over 40,000 current users, with some million people reportedly on the waitlist.

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Anil Jain, Chief Innovation Officer, Innovaccer

For a while now Innovaccer has been aggregating data from different databases around health systems (think different EMRs). They have been overlaying information over that data to clinicians and providers for thinks like care gaps. Now they are bringing in claims data to look for patients or plan members, and of course they have their own AI chatbot to help make that data more accessible to clinicians and administrators. Chief Innovation Officer at Innovaccer Anil Jain, who in a former life was at Cleveland Clinic spinoff Explorys (a data pioneer that got sucked into IBM), told me about Innovaccer’s tech and where the providers and payers using their tools are now — Matthew Holt

A Life Well Lived, Fights Well Fought

By KIM BELLARD

I first became aware of Casey Quinlan in 2017, when she published an article in Tincture, which I was helping to edit.  In it, she discussed how she’d had her medical history and advance directive tattooed on her chest, out of frustration with the lack of health information exchange in healthcare.  As she said, “ALL. THOSE. FUCKING. FORMS. ON. CLIPBOARDS.”

Well, I thought: she sounds like an interesting person. 

I started following her on Twitter, enjoying her outspokenness and agreeing with many of her points of view.  Then early in the pandemic Matthew Holt started THCB Gang podcast, and I got to participate in many of them with her as a co-panelist. It was sometimes hard to get a word in edgewise, but when she was on we always knew it was going to be an extra-lively session.  And the stories she could tell…

I never met Casey IRL.  I never worked with her. I never even had a one-on-one conversation with her, unless you count Twitter replies.  There are large parts of her life that I don’t know anything about.  But, boy, the force of her personality, the strength of her will, the sharpness of her intellect, and the fearlessness of her spirit were always clear. 

She fought her cancer as fiercely as she lived her life generally.  We knew the end was inevitable, but it nonetheless was hard to imagine.  There have been outpourings of support on Twitter, on CaringBridge, and elsewhere. I have to mention in particular the efforts of Jan Oldenburg, who was there with her near the end and also took on the various bureaucracies on Casey’s behalf when Casey was no longer able to. 

Casey’s passing is a loss to her friends, her followers, and the patient community at large.  And to those of us who got to know her even a little bit. 

Worms Aren’t So Dumb

BY KIM BELLARD

Chances are, you’ve read about AI lately.  Maybe you’ve actually even tried DALL-E or ChatGPT, maybe even GPT-4.  Perhaps you can use the term Large Language Model (LLM) with some degree of confidence.  But chances are also good that you haven’t heard of “liquid neural networks,” and don’t get the worm reference above.   

That’s the thing about artificial intelligence: it’s evolving faster than we are. Whatever you think you know is already probably out-of-date.

Liquid neural networks were first introduced in 2020.  The authors wrote: “We introduce a new class of time-continuous recurrent neural network models.” They based the networks on the brain of a tiny roundworm, Caenorhabditis elegans.  The goal was networks that were more adaptable, that could change “on the fly” and would adapt to unfamiliar circumstances. 

Researchers at MIT’s CSAIL have shown some significant progress.  A new paper in Science Robotics discussed how they created “robust flight navigation agents” using liquid neural networks to autonomously pilot drones. They claim that these networks are “causal and adapt to changing conditions,” and that their “experiments showed that this level of robustness in decision-making is exclusive to liquid networks.”  

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In Memoriam: Mighty Casey has moved on

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Casey Quinlan, our friend and frequent THCB Gang member, died today. She may have gone quietly but she for sure lived her life way out loud. It’s not unexpected; she was diagnosed with a recurrent stage 4 cancer two years back, and I was lucky enough to have dinner with her on a rare east coast trip last June. She was hoping to come to the West Coast late last Fall but was too sick to make it. It looked like things were getting better and she was on THCBGang in February but soon things turned and she spent the last few weeks in hospice. She leaves a huge hole in the patient advocacy movement and a huge wave of love from her friends today on Twitter. And she remains the only person who has come up to me after I gave a talk and shared a shot of bourbon from her hip flask at 9 am! The talk was about the US health care system. So we both needed it! We’ll miss you Casey… Matthew Holt

THCB Quickbite: Ines Vigil, SVP Transformation & Services, Clarify Health Solutions

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Ines Vigil, SVP Transformation & Services, Clarify Health Solutions talked with me at HIMSS23. A quick discussion about what Clarify Health does, and why the health system needs a huge database of 330m patients. Quick clue is that payment negotiations and benchmarking of clinical performance is the biggest demand, and Ines now actually heads up a consulting group that providers need to be overlaid on that data–Matthew Holt

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