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Ontario family doctor says new AI notetaking saved her job

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Re: Ontario family doctor says new AI notetaking saved her job

#131

This could be the thing that saves the US healthcare system; currently we pay 2x what a normal developed country would pay for the level of service provided, because there is a thick layer of paperwork, with insurance companies going back-and-forth with medical providers to debate and negotiate billing. Imagine if AIs on each side could run that negotiation process in seconds, at the cost of merely a few hundred thou…

Better, more efficient technology rarely reduces the sticker price for customers. If the underlying product or service is cheaper to produce or provide, the price will stay the same (or increase) and the difference will be pocketed by shareholders. This is pretty much always what happens. Same on the employee side. As an employee, if you adopt some technology that makes you 2X more productive, you're not going to get…

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Re: Ontario family doctor says new AI notetaking saved her job

#132

Earlier quoted context omitted.

>> Documenting it so that it can be billed appropriately is also crucial. This is literally the only reason why scribes, or pretty much any EMR exist. EMRs are an accounting tool. To avoid "down coding" and legal exposure . Plain and simple. There's a reason that doctors would not adopt EMRs for the longest time (at least in the US, don't know other nations) until actual legislation was passed to force them to do so,…

> The EMR, and therefore most note-taking, is not as value add to the patient, or doctor. Its just the only way the doctor will be paid. I don't think this is true as proper note-taking and documentation is required by law in many countries where the doctor is not paid per patient/procedure

OK, but you need to clarify your statement. As you said,

>>> note taking and documentation is required by law.

So then, the EMR not a value add, which is also what I wrote. It just so happens that in the US the primary reason is to get paid, and its also why some doctors still eke out a living without an EMR (but still with some kind of paper medical files)

Re: Ontario family doctor says new AI notetaking saved her job

#133

This could be the thing that saves the US healthcare system; currently we pay 2x what a normal developed country would pay for the level of service provided, because there is a thick layer of paperwork, with insurance companies going back-and-forth with medical providers to debate and negotiate billing. Imagine if AIs on each side could run that negotiation process in seconds, at the cost of merely a few hundred thou…

> currently we pay 2x what a normal developed country would pay for the level of service provided, because there is a thick layer of paperwork, with insurance companies going back-and-forth with medical providers to debate and negotiate billing.

Oh, sweet summer child. We don't pay 2X because there's too much paperwork. There's too much paperwork because 2X spending can be used to justify a lot of paperwork. The delta in spending is due to the delta in pricing power that the US payer/provider complex has vs what is seen in other countries.

Re: Ontario family doctor says new AI notetaking saved her job

#134

Earlier quoted context omitted.

Tangent here: really? I've found base Whisper has concerning error rates for non-US English accents; I imagine the same is true for other languages with a large regional mode to the source dataset. Whisper + an LLM can recover some of the gaps by filling in contextually plausible bits, but then it's not a transcript and may contain hallucinations. There are alternatives that share Whisper internal states with an LLM…

Language detection in the presence of strong accents is, in my opinion, one of the most under-discussed biases in AI. Traditional ASR systems struggle when English (or any language) is spoken with a heavy accent, often confusing it with another language. Whisper is also affected by this issue, as you noted. The root of this problem lies in how language detection typically works. It relies on analyzing audio via MFCC…

Isn't the issue more that traditional ASR systems use US (General American) phonetic transcriptions so then struggle with accents that have different splits and mergers?

My understanding on whisper is that it is using a model trained on different accents, specifically from LibriVox. The quality would depend on the specific model selected.

The MFCC or other acoustic analysis is to detect the specific phonemes of speech. This is well understood (e.g. the first 3 formants corresponding to the vowels and their relative positions between speakers), and the inverse is used for a lot of the modern TTS engines where the MFCC is predicted and the waveform reconstructed from that (see e.g. https://pytorch.org/audio/stable/transforms.html).

Some words can change depending on adjacency to other words, or other speech phenomena (like H dropping) can alter the pronunciation of words. Then you have various homophones in different accents. All of these make it hard to go from the audio/phonetic representation to transcriptions.

This is in part why a relatively recent approach is to train the models on the actual spoken text and not the phonetics, so it can learn to disambiguate these issues. Note that this is not perfect, as TTS models like coqui-ai will often mispronounce words in different contexts as the result of a lack of training data or similar issues.

I'm wondering if it makes sense to train the models with the audio, phonetic transcriptions, and the text and score it on both phonetic and text accuracy. The idea being that it can learn what the different phonemes sound like and how they vary between speakers to try and stabilise the transcriptions and TTS output. The model would then be able to refer to both the audio and the phonemes when making the transcriptions, or for TTS to predict the phonemes then the phonemes as an additional input with the text to generate the audio -- i.e. it can use the text to infer things like prosody.

Re: Ontario family doctor says new AI notetaking saved her job

#135
post #50
post #4

Earlier quoted context omitted.

Here in BC it's just a lack of political will because physicians are expensive, governments are broke after COVID, and so instead of fixing the system (which would cost money), the absolute morons in the health ministry have decided that "nurse practitioners" are 1:1 substitutes for family doctors, despite the fact that they don't go to medical school and thus don't receive any diagnostic training whatsoever. It'll r…

Not saying your overall message is wrong about your region but... My wife is an NP and most of her courses and clinical time were focused on diagnostic techniques.

Sorry man, your wife isn't a replacement for a doctor. If she was, she'd have gone to medical school.

Re: Ontario family doctor says new AI notetaking saved her job

#136
post #92

As a person that used to be a “human scribe” but for emergency dept doctors. I would say the ER doctors shared the same experience as the one depicted in the news story. For a doctor that was nearing the age of retirement or had very poor keyboard proficiency. scribes were a godsend. Doctors worried less about documentation and focused more on patient care. Of course they still wrote things like admission orders, pre…

>> Documenting it so that it can be billed appropriately is also crucial. This is literally the only reason why scribes, or pretty much any EMR exist. EMRs are an accounting tool. To avoid "down coding" and legal exposure . Plain and simple. There's a reason that doctors would not adopt EMRs for the longest time (at least in the US, don't know other nations) until actual legislation was passed to force them to do so,…

> The EMR, and therefore most note-taking, is not as value add to the patient

Since patient’s medical histories are relevant to treating medical issues, having quick access to accurate medical histories is a value add for the patient.

Just the simple fact a pharmacist does not have to decipher chicken scratch to get people the right medicine is a value add for patients.

My family chooses to frequent doctor groups that integrate with the local hospitals’ EMRs because it allows the hospital doctors immediate access to all the information they need in the event of an emergency.

Re: Ontario family doctor says new AI notetaking saved her job

#137
post #53

Earlier quoted context omitted.

Tangent here: really? I've found base Whisper has concerning error rates for non-US English accents; I imagine the same is true for other languages with a large regional mode to the source dataset. Whisper + an LLM can recover some of the gaps by filling in contextually plausible bits, but then it's not a transcript and may contain hallucinations. There are alternatives that share Whisper internal states with an LLM…

I've found that WhisperX with the medium model has been amazing at subtitling shows containing English dialects (British, Scottish, Australian, New Zealand-ish). It not only nails all the normal speech, but even gets the names and completely made up slang words. Interestingly you can tell it was trained from source material with dialects because it subtitles their particular spelling; so someone American will say col…

IIUC, it's trained on LibriVox audio mainly, along with a few other sources. I'm not sure how it is handling spelling as the spelling will depend on the source content being read, unless the source text has been processed/edited to align with the dialect.

Re: Ontario family doctor says new AI notetaking saved her job

#138
post #95

Earlier quoted context omitted.

This seems very similar to self driving cars. At the beginning they will be worse than humans and cause deaths that humans would have prevented while at the same time probably saving lives where a human would make a mistake. But not far down the road they'll become much better than humans even if they do occasionally make a mistake and cause a death that a human wouldn't' have they'll save far more lives due to them…

But not far down the road they'll become much better than humans While I think you're correct, there is no proof this will ever be achieved. It very well may not be possible along our current path. It may take a 100 years, 1000 to get there. And yes it could take only 20 more. But to state this as a certainty? No.

I think its basic certainty that computers will be better at transcribing notes than humans basically now and will continue to get better. I mean we're basically there now, I trust spell check and grammar check more than myself.

That's what we're talking about here. IMHO computers are already better at that, what possibly makes you think this won't happen?

Re: Ontario family doctor says new AI notetaking saved her job

#139
post #113

Earlier quoted context omitted.

The HIPPA rules on health data are fairly strict, otherwise your doctor, hospital and so on could already be doing wrong. Personally I have a dumb TV, car, doorbell and fridge so not much spying there. The phone I'm less sure of.

> The HIPPA rules on health data are fairly strict Depends on how you define "strict". They're pretty onerous to comply with, but they don't really provide patients with anywhere near the level of protection that most people think. It's better than nothing, but in reality, your data is being legally shared with an arbitrary number of entities, without your consent, and without any way for you to even know who has acc…

And what is your recourse? There's no private cause of action for HIPAA violations.

Re: Ontario family doctor says new AI notetaking saved her job

#140
post #108

There's no mention of data privacy. Since AI Scribe[0] study is a run by OntarioMD, the digital technology arm of the Ontario Medical Association, it might be okay but it would be nice if it declared it. From the AI Scribe link: > This project is funded by the Ontario Ministry of Health and overseen by Ontario Health. The study is currently underway, with 150 primary care providers already selected from diverse demog…

would you care about data privacy when you're dead?

I feel like you were trying to make a point here, but I have no idea what it was.
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