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Agile Diagnosis (YC S11) Launches: Helping Doctors With Diagnosis

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Re: Agile Diagnosis (YC S11) Launches: Helping Doctors With Diagnosis

#11

Post by moioci »

colonelxc wrote: post #8
Homunculiheaded wrote: post #5

Every time I go to the doctor with anything that isn't obvious I'm always amazed that some basic ML tools aren't part of the standard practice. Especially since the standard reaction now is "here take a bunch of expensive tests, you won't be paying for most of them out of pocket so who cares!" We've had the tools for decades now to at least say "given these symptoms, it's very likely you X, Y or possibly Z". Addition…

re: medical record sharing I don't think it is that ridiculous really. Assuming that the policy to require a signature from the patient stands, fax seems like a pretty natural choice for sending a paper form. Alternatively, they could take the time to scan the form then email it. Ideally, both you and I would probably prefer something completely digital (both forms and health records). Towards that goal, I think the…

Note that in the US, protected health information (PHI) may not legally be transmitted across the internet unencrypted, according to HIPAA, which renders emailing records much more cumbersome than simply faxing them, which is cheap and ubiquitous.

Re: Agile Diagnosis (YC S11) Launches: Helping Doctors With Diagnosis

#12

Post by zasz »

Homunculiheaded wrote: post #5

Every time I go to the doctor with anything that isn't obvious I'm always amazed that some basic ML tools aren't part of the standard practice. Especially since the standard reaction now is "here take a bunch of expensive tests, you won't be paying for most of them out of pocket so who cares!" We've had the tools for decades now to at least say "given these symptoms, it's very likely you X, Y or possibly Z". Addition…

I found this answer on Quora, by a medical student, to be quite illuminating on why machine diagnosis isn't going to be any good, any time soon. http://www.quora.com/Why-is-machine-learning-not-more-widely...

Re: Agile Diagnosis (YC S11) Launches: Helping Doctors With Diagnosis

#13

Post by rjurney »

I have chronic nerve pain in my entire upper body. I used to be a patient of a world class university pain clinic. I left there for an individual pain doctor because... I saw 4 doctors in 4 visits, none of whom knew my diagnosis, read my file, etc.

If this flow chart was on the door of the patient room, my quality of care would have been MUCH better.

Re: Agile Diagnosis (YC S11) Launches: Helping Doctors With Diagnosis

#15

Post by Kadrith »

colonelxc wrote: post #8
Homunculiheaded wrote: post #5

Every time I go to the doctor with anything that isn't obvious I'm always amazed that some basic ML tools aren't part of the standard practice. Especially since the standard reaction now is "here take a bunch of expensive tests, you won't be paying for most of them out of pocket so who cares!" We've had the tools for decades now to at least say "given these symptoms, it's very likely you X, Y or possibly Z". Addition…

re: medical record sharing I don't think it is that ridiculous really. Assuming that the policy to require a signature from the patient stands, fax seems like a pretty natural choice for sending a paper form. Alternatively, they could take the time to scan the form then email it. Ideally, both you and I would probably prefer something completely digital (both forms and health records). Towards that goal, I think the…

Kaiser uses Epic, so they have a system called Intraconnect; now Care Everywhere to share information. This also works between other Epic customers with Care Everywhere installed. For the non-Epic customers there is something called Care Elsewhere.

But there are a LOT of smaller practices without an EMR or that don't want to go through the work of initial integration.

Re: Agile Diagnosis (YC S11) Launches: Helping Doctors With Diagnosis

#16

Post by nradov »

Homunculiheaded wrote: post #5

Every time I go to the doctor with anything that isn't obvious I'm always amazed that some basic ML tools aren't part of the standard practice. Especially since the standard reaction now is "here take a bunch of expensive tests, you won't be paying for most of them out of pocket so who cares!" We've had the tools for decades now to at least say "given these symptoms, it's very likely you X, Y or possibly Z". Addition…

In order for ML to be effective you first have to provide the correct inputs as discrete, coded data that the software can accurately parse. We have a number of different coding systems for observations of patient symptoms such as SNOMED-CT. But you would still need an experienced healthcare provider to figure out what observations to make, and then turn those into specific codes. That's very much a subjective process in many cases, and there are often multiple valid ways to code the same observation.

All of that data entry would take time that physicians don't have. It would only be potentially worth doing for complex cases. Unless you can find a way to pay providers for doing the extra coding and data entry. Insurance generally won't pay extra for data entry beyond what they need for billing, and billing data isn't sufficiently detailed for diagnosis.

ML also doesn't account for human intuition and tacit knowledge. There are many subtle cues which experienced physicians can pick up on to make a diagnosis. It's impossible to codify them all; some are probably only noticed subconsciously.

Re: Agile Diagnosis (YC S11) Launches: Helping Doctors With Diagnosis

#17

Post by gtani »

zasz wrote: post #12
Homunculiheaded wrote: post #5

Every time I go to the doctor with anything that isn't obvious I'm always amazed that some basic ML tools aren't part of the standard practice. Especially since the standard reaction now is "here take a bunch of expensive tests, you won't be paying for most of them out of pocket so who cares!" We've had the tools for decades now to at least say "given these symptoms, it's very likely you X, Y or possibly Z". Addition…

I found this answer on Quora, by a medical student, to be quite illuminating on why machine diagnosis isn't going to be any good, any time soon. http://www.quora.com/Why-is-machine-learning-not-more-widely...

This is an older post describing the subproblem of ontology/vocabularies:

http://lingpipe-blog.com/2008/11/17/accident-involving-space...

Re: Agile Diagnosis (YC S11) Launches: Helping Doctors With Diagnosis

#18

Post by danso »

I'm sure a lot of people here have read Atul Gawande (of the New Yorker) article about The Checklist, in which a simple list of steps before surgery, such as "wash your hands", vastly reduced infections at hospitals. Yet the checklist faced resistance, including from doctors who thought that having such an obvious list was beneath them...even though even the smartest doctors mess these steps up in the rush of an operation. http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_...

This is the mindset that any disruptive enterprise must face. It's not like in the coding community, where spending a substantial amount of time writing seemingly trivial and boring tests -- i.e. an automated checklist -- is considered to be a necessary step in writing software.

Re: Agile Diagnosis (YC S11) Launches: Helping Doctors With Diagnosis

#19

Post by amper5and »

siavosh wrote: post #9
namityadav wrote: post #3

This industry is not very open to change. But, Borna and Eric are very hard working (and equally smart) guys -- just the kind of guys who can bring disruption to the industry. I have very high hopes!

I think it's great that there's an increase in attention to the medical space from smart young folks. From my experience though, being smart and hard working have very little to do with success in the medical-tech space. It mostly has to do with 1) if you can show ROI with the least (can't emphasize this enough) change to anyone's daily workflow, and 2) having a very very hard working sales team

Another critical aspect is to target the tech-savvy younger generation of students and residents, which Agile is doing with their recent offer of free lifetime access for participating medical schools. Almost all of us are using tools like Uptodate on a daily basis on the floors. Agile's algorithmic presentation of the same information makes a compelling case to use their product. Early adoption by trainees can lead to future paradigm shifts in the whole industry.

Re: Agile Diagnosis (YC S11) Launches: Helping Doctors With Diagnosis

#20

Post by tsuraan »

zasz wrote: post #12
Homunculiheaded wrote: post #5

Every time I go to the doctor with anything that isn't obvious I'm always amazed that some basic ML tools aren't part of the standard practice. Especially since the standard reaction now is "here take a bunch of expensive tests, you won't be paying for most of them out of pocket so who cares!" We've had the tools for decades now to at least say "given these symptoms, it's very likely you X, Y or possibly Z". Addition…

I found this answer on Quora, by a medical student, to be quite illuminating on why machine diagnosis isn't going to be any good, any time soon. http://www.quora.com/Why-is-machine-learning-not-more-widely...

It took 3 days of work-up and 4 teams' brains to make the final diagnosis of early Crohn's disease.

3 days and 4 teams working on one guy's stomach ache? Was this guy a Saudi prince? Seriously, I think we've already established that the richest of the rich will always be able to get great health care; for myself, I just don't want to have to convince a doctor that a 103 degree fever and occlusion on a chest x-ray aren't caused by my asthma acting up. I don't want to go into the doctor after vomiting constantly for three days, just to be told "that happens". Personal care from a team (or a few teams) of doctors probably can't be beat, but machine diagnosis can probably beat any health care I've ever received.

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