Live data from Hacker News

Ontario family doctor says new AI notetaking saved her job

globalnews.ca

201–210 of 274 posts

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

#201
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,…

It’s not the sole reason but given that billing is based on it (ICD codes). I can see your point.

I remember the bean counters from the hospital going over with scribes and doctors on how to “properly” document all the necessary elements to bill for a procedure. All of it was very very boring.

“We can bill for ED physician prelim reads of radiology studies but it needs to have at least 3 or more findings documented. “

So let’s say a an ed physician orders a chest xray to r/o pneumonia vs bronchitis. Have to document in chart something like: “3 view chest xray; no infiltrates, no pleural effusion, no pneumothorax; received by X doctor”

In reality, most doctors would just put “reviewed 3v cxr, no infiltrates”. No need to document negative findings that contribute nothing.

Prior to EMRs, hand written notes and charts were absolutely god awful to read. Physician and nurse short hand is not standardized. Plus some doctors handwriting is just atrocious.

EMRs helped standardize communication between multiple parties (both medical and non-medical). Like others have mentioned, it could have been a way to track standards of care across multiple hospitals or across the US. Unfortunately with the gold rush to get a product out there, all we got was 9-10 different proprietary EMR systems that do not have interoperability.

CT scan performed in Virginia and needs to get reviewed by doctor in California? The hardcopy of the images uses some proprietary viewer that is only accessible within the same system the Virginia hospital used. I remember a few cases of this when we had transfers from out of state. Either hospital physician gets their own additional scan and official read or waits for physical images from other hospital to view. I think in a CT this can be hundreds of images/slices. (Don’t quote me on this, this was a decade ago lol)

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

#202
post #44

On that front, there is the cool AquaVoice input method: https://withaqua.com/ anyone is looking at doing an open-source version of that? I guess with a mini-whisper and mini fine-tuned GPT-like model we could get 99% of the way there

that sounds like a great open source project, I'm interested in starting on it if there's nothing out there.

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

#203
post #140

Earlier quoted context omitted.

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

We are made of electrons. Every electron is the same. Electrons have no sense of privacy.

Electrons don’t eat food either.

Eating food is unnecessary.

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

#204
post #157

Earlier quoted context omitted.

Wait—this doesn't make any sense. I'm a physician and have a lot of experience dealing with protected health information. Third parties are required to sign a HIPAA BAA and obligated to uphold privacy/security standards equal to that of your physician and hospital. Can you provide some specific examples of the third parties you're talking about? MyChart itself is a component of Epic (the EMR) and is absolutely HIPAA…

I'm a retired software developer that's worked in just about every healthcare-adjacent industry segment you can imagine with HIPAA compliance being an evergreen issue. I know how this sausage gets made on the back end and let me tell you regardless of what impression has been made to you about compliance and safeguards the reality behind the scenes is always messy. Hundreds of gigs of unanonymized user data lying aro…

Yes, I do believe what you're telling me—the state of healthcare tech is definitely leagues behind general consumer tech. However, I do think this is a meaningfully different class of issue when it comes to patients' perceptions and actual harms. Patients are afraid of having their health data used against them. For example, revealing medical conditions to potential employers, revealing health information to friends/family, etc. There's a growing mistrust of healthcare institutions in recent years, and there are unfounded accusations of healthcare institutions selling data for financial gain like social media companies and even the DMV (https://www.caranddriver.com/features/a32035408/dmv-selling-...). This class of nefarious patient data privacy/security negligence effectively doesn't happen. I've treated patients who are illegal US immigrants, I see patients who use and possess illegal drugs while in the hospital, but they're not reported to anyone. They're simply treated and discharged. Unfortunately, a growing number of patients don't believe this is the case, and we see substantial disparities in levels of care provided to these patients who fear healthcare.

I'm not at all dismissing how terrible it is that healthcare tech companies can be lax with patient data. This absolutely needs to be better! But at the same time, this sounds more like incompetence than active malice. Practically speaking, a patient is extremely unlikely to experience actual harm because a developer accidentally took patient data home on a personal laptop. Although, I would love to hear more about what kinds of violations you've seen in your time in health tech? I work with third party vendors from a healthcare institution, and I absolutely want to figure out how to fix this.

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

#205
Maybe I'm old-fashioned, but to this day I don't take notes on the computer when I'm in the room with a patient. I might take a couple notes, but otherwise I do it between patients or after hours. It seems discourteous to me otherwise.

That said, I have a prolonged charting period after every clinic. It's not sustainable in daily practice (I don't see patients every day).

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

#206
post #161

Privacy and hallucinations would concern me. It seems likely to me that relying on these tools will mean physicians will "trust" the output of these systems and stop checking the notes for accuracy. Checking the notes will become a burden too. Maybe the real solution is to lower the amount of administrative work required? Or hire people to do it?

I too feel a bit worried about AI making mistakes, but the thing is that a doctor rushing or an assistant can (and do) make mistakes too. These are all just cost vs quality of service tradeoffs. From my experience (having been in and out of hospitals a lot in the last year) it wouldn't surprise me if AI, even with occasional mistakes, would still be a net improvement in overall quality of care and outcomes.

I’m not a fan of, “but humans make mistakes too,” defense.

They do but we don’t consider it an improvement when they are made. The goal isn’t to have mistakes.

The goal is to maintain (or improve) outcomes without burning out clinicians. Using an LLM isn’t the only solution and might not be a good one.

If this is going to be a thing I hope that policy around it will inform patients when the physician plans to use it and allow a patient to opt out.

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

#207

Earlier quoted context omitted.

Ok, I’ll bite. List some concrete examples. Otherwise, I have to land on the default that regulation is good and works better than a free-for-all.

>Ok, I’ll bite. List some concrete examples. How generous of you

Hitchen's Razor: what can be asserted without evidence can also be dismissed without evidence.

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

#208

Earlier quoted context omitted.

We are already there with humans. Most people take a doctor at their word and don't bother to get a second opinion.

At that point, you've at least consulted with a medically trained professional who's licensed (which they have to regularly renew), has to complete annual CME, can be disciplined by a medical board, carries medical malpractice insurance, etc. There should be requirements for any AI tool provider in the medical space to go through something like an IRB ( https://en.wikipedia.org/wiki/Institutional_review_board ) given…

In the context described, it's acting as a tool for a doctor. AI scribes are not conducting experiments.

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

#209

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

Digital records are valuable for health in several cases, for example, when the patient needs or wants all their records.

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

#210

Earlier quoted context omitted.

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)

Do EMRs improve the standard of care?

Big time.

In some cases where hospitals do paper charting, it can be mis charted.

or, there can be issues with not recording medication as being given or not, and the patient can miss their dose because a nurse thinks it was given. There is some cases where such confusion is tolerated depending on the patient.

Post reply on HN