Live data from Hacker News

Why are cancer guidelines stuck in PDFs?

seangeiger.substack.com

111–120 of 163 posts

Re: Why are cancer guidelines stuck in PDFs?

#111
post #3

The fundamental idea here is that doctors find it difficult to ensure that their recommendations are actually up-to-date with the latest clinical research. Further, that by virtue of being at the centre of action in research, doctors in prestige medical centres have an advantage that could be available to all doctors. It's a pretty important point, sometimes referred to as the dissemination of knowledge problem. Curr…

It amazes me that AI isnt a borderline requirement for being a doctor. Think of how much info is outdated or just wrong.

Re: Why are cancer guidelines stuck in PDFs?

#113
post #29
post #28

Earlier quoted context omitted.

>Agreed on importance of portability and durability. I think "importance" is understating it, because permanent consistency is practically the only reason we all (still) use PDFs in quite literally every professional environment as a lowest common denominator industrial standard. PDFs will always render the same, whether on paper or a screen of any size connected to a computer of any configuration. PDFs will almost a…

PDFs generally will look close enough to the original intent that they will almost always be usable, but will not always render the same. If nothing else, there are seemingly endless font issues.

I would assume these decision tree PDF use a commonly available font. Layout and interpreted outcomes should be the same.

Re: Why are cancer guidelines stuck in PDFs?

#114
Why isn't all human knowledge in one big JSON file? Guidelines are decision trees, but they're not written to be applied by rote, because the identical patients with identical cancers posited in the hypothetical don't exist. The guidelines are not written for maverick clinician movie protagonists to navigate the decision tree in real time while racing against an oncological clock, they're for teams of clinicians who are very well trained and used to working with each other, and who have the skills to notice where the guidelines might be wrong or need expansion or modification. That is, they're abstractions of the state-of-the-art.

Now it'd be nice if these could be treated like source code on some sort of medical VCS, to be easily modded or even forked by sub-specialists. But wetware dependencies are way more complicated than silicon ones, and will remain harder to discretize for some time to come.

It's not that the author's aspirations misguided, they're great. But I believe progress in this area is most easily realized as part of a relevant team, because what looks conceptually simple from outside the system only seems that way because of a lack of resolution.

Re: Why are cancer guidelines stuck in PDFs?

#115

Earlier quoted context omitted.

Exactly. The PDF's work . They won't break. You can see all the information with your own eyes. You can send them by e-mail. A wizard-type system hides most of the information from you, it might have bugs you aren't aware of, if you want to glance at an alternative path you can't, it's going to be locked into registered users, the system can go down. I think much more intelligent computer systems are the future in he…

> The PDF's work. They won't break. Not just that, PDFs are one of the few formats, where i'm willing to bet my own money, that they'll still work in 10 or 20 years. Even basic html has changed, layouts look different depending on many factors, and even the -ing doesn't work anymore.

A case specific PDF could be created and stored in the patient's electronic records. Such PDF could just highlight the decision three path.

Re: Why are cancer guidelines stuck in PDFs?

#116

Earlier quoted context omitted.

You could generate the document from the graph and then attach it as data.

> could generate the document from the graph and then attach it as data Much easier for doctors to draft PDFs than graphs.

I have not drafted a PDF myself and I doubt doctors will. They work in a text writer or spreadsheet application and then export or print to PDF would be my guess. An interactive interface could spit out the PDF with the decision three in the end. This solution would still mean the decision tree source is in some software package.

Re: Why are cancer guidelines stuck in PDFs?

#118

Earlier quoted context omitted.

This is the comment I was looking for. You would aim to use CQL expressions inside of a PlanDefinition, in my estimate. This is exactly what AHRQ's, part of HHS, CDS Connect project aims to create / has created. They publish freely accessible computable decision support artifacts here: https://cds.ahrq.gov/cdsconnect/repository When they are fully computable, they are FHIR PlanDefinitions (+ other resources like Ques…

I downloaded and opened an CDS for osteoporosis from the link (as a disease in my specialty), I need an API key to view what a "valueset" entails, so in practice I couldn't assert if the recommendation aligns with clinical practice, nor in the CQL provided have any scientific references (even a textbook or a weak recommendation from a guideline would be sufficient, I don't think the algorithm should be the primary so…

You can register for a free NLM account to access the value sets (VSAC). HL7 standards are approachable for small teams but due to the inherent complexity of healthcare it can take a while to get up to speed. The FHIR Fundamentals training course is a good option for those who are starting out.

https://www.hl7.org/training/fhir-fundamentals.cfm?ref=nav

It might seem tempting to avoid the complexity of FHIR and CQL by inventing your own simple schema or data formats for a narrow domain. But I guarantee that what you thought was simple will eventually grow and grow until you find that you've reinvented FHIR — badly. I've seen that happen over and over in other failed projects. Talk to the CodeX accelerator I linked above and they should be able to get you pointed in the right direction.

Re: Why are cancer guidelines stuck in PDFs?

#119
post #70

Shouldn't the end goal be just to train an ai on all the pdfs and give the doctors an interface to plug in all the details and get a treatment plan generated by that ai? Working on the data structure feels like an intermediate solution on the way to that ai which is not really necessary. Or am I missing something?

AI/ML techniques in medicine have been applied clinically since at least the 90s. Part of the reason you don't see them used ubiquitously is a combination of a) it hasn't worked all that well in many scenarios so far and b) medicine is by nature quite conservative, for a mix of good and not so good reasons.

Re: Why are cancer guidelines stuck in PDFs?

#120
Profit.

I use these guidelines all the time in the PDF format for free, and I'd love to have these in a structured format. For $3000/year you could get 50 users access to PDF prescription templates to speed up their work. That's not bad, but it's still all PDF.

For the nice low price of "contact us for pricing," though, you could have EMR integration. They couldn't justify $$$$ for EMR integration if all this information is easily accessible.

https://www.nccn.org/compendia-templates/nccn-templates-main...

Post reply on HN