AI in Psychiatry

[FlowRate]

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At best, it's transcribing notes that you have to spend an equal amount of time editing so does it actually save you any time?

The one we have where I work (Abridge) is really good since their update to have a behavioral health note setting. I spend maybe 5% of time on my HPI for the average patient vs prior, usually due to it still leaving out pertinent negatives. But they just included a new feature where you can give it feedback and it'll update the note, which I haven't had a chance to try quite as much yet.

 

[FatherPsychiatry]

The one we have where I work (Abridge) is really good since their update to have a behavioral health note setting. I spend maybe 5% of time on my HPI for the average patient vs prior, usually due to it still leaving out pertinent negatives. But they just included a new feature where you can give it feedback and it'll update the note, which I haven't had a chance to try quite as much yet.

Roughly how many more minutes has the dramatic decrease in HPI documentation time opened up for you daily? Have you found your daily work has changed as a result? (ie, spending more time talking to patients because you know documentation will not take as long, or just enjoying more free time etc.)

 

[FlowRate]

Roughly how many more minutes has the dramatic decrease in HPI documentation time opened up for you daily? Have you found your daily work has changed as a result? (ie, spending more time talking to patients because you know documentation will not take as long, or just enjoying more free time etc.)

I feel less stressed when a new patient appointment is complex and needs the full hour for interview and treatment discussion (can't end 5-10 before the hour to do documentation.) I haven't started using it for follow-ups but I feel like it would probably net improve the quality of my f/u notes since I leave the hpi pretty sentence fragment/flow-of-appointment-y. It might net add a small amount of time to how long I spend on f/u documentation due to workflow and review time but the improvement in detail retained and quality might be worth the tradeoff.

 

[clozareal]

Abridge looks pretty good. Kaiser, mayo, johns hopkins, duke. Big names implemented it.

 

[Stagg737]

The one we have where I work (Abridge) is really good since their update to have a behavioral health note setting. I spend maybe 5% of time on my HPI for the average patient vs prior, usually due to it still leaving out pertinent negatives. But they just included a new feature where you can give it feedback and it'll update the note, which I haven't had a chance to try quite as much yet.

Abridge looks pretty good. Kaiser, mayo, johns hopkins, duke. Big names implemented it.

My hospital system also has it and I have mixed feelings. I can't use it for transcription (not available inpatient here), but would probably use it for H&Ps as my colleagues do like it for that. Seems to provide minimal extra benefit for f/ups for most.

I will say, that the clinical summaries it produces are severely lacking and will frequently tell me incorrect med regimens an doses when I go in and check as it's essentially just processing all the clinical notes rapidly without looking at actual orders. Has opened my eyes a bit at how often colleagues documentation is bad (either not updated or just wrong about what was ordered), but that still does not help at all when trying to see what the patient is actually receiving and taking or how my treatment plan may need to be altered.

So seems pretty decent for transcribing, but not at all trustworthy for summarization and guiding treatment plans.

 

[FlowRate]

My hospital system also has it and I have mixed feelings. I can't use it for transcription (not available inpatient here), but would probably use it for H&Ps as my colleagues do like it for that. Seems to provide minimal extra benefit for f/ups for most.

I will say, that the clinical summaries it produces are severely lacking and will frequently tell me incorrect med regimens an doses when I go in and check as it's essentially just processing all the clinical notes rapidly without looking at actual orders. Has opened my eyes a bit at how often colleagues documentation is bad (either not updated or just wrong about what was ordered), but that still does not help at all when trying to see what the patient is actually receiving and taking or how my treatment plan may need to be altered.

So seems pretty decent for transcribing, but not at all trustworthy for summarization and guiding treatment plans.

Interesting, I don't think we have the chart review module implemented but I agree that going by note review alone would be very insufficient in pretty much any system. Especially since we often make changes between appointments but the place we document those changes in epic wouldn't show up in note review. (I want to change this but really hard to get the system to align on that change for myriad reasons.) In-office follow-ups are the one visit type where I'm usually not typing during the visit, so it might help me with those a little more than virtual f/u's.

 

[Stagg737]

Interesting, I don't think we have the chart review module implemented but I agree that going by note review alone would be very insufficient in pretty much any system. Especially since we often make changes between appointments but the place we document those changes in epic wouldn't show up in note review. (I want to change this but really hard to get the system to align on that change for myriad reasons.) In-office follow-ups are the one visit type where I'm usually not typing during the visit, so it might help me with those a little more than virtual f/u's.

We have a "clinical summary" button that's supposed to give us the cliffnotes version of recent visits or a hospital course. I've noticed a couple of docs using this to write their discharge summaries (there's actually a little wand symbol next to the paragraphs where this was used) and man is it bad. One note was so bad that the med changes/discharged meds in the brief hospital course section didn't match at all with what was ordered at discharge. Patient was readmitted a couple weeks later to the service (when I saw the previous d/c summary) and I asked the attending if they realized how wrong the hospital course was and they were shocked. Said they would bring it up with their staff and I haven't seen the AI summaries in d/c notes recently, so sounds like they may not be doing it anymore.

Either way, I was surprised at just how bad it was at something that should have been relatively simple (assuming the clinical notes were accurate, which they were in this case). Has definitely made me wary of using it myself, at least for the near future.

 

[lockian]

Like all AI, Abridge needs substantial human oversight. That said, it's been a relief to use it.

Before, I would be efficient at notes by typing the HPI, exam, and parts of the plan as I talked and listened. I was pretty skilled at it -- I could do it without breaking eye contact; my notes were teleghapic at times but all the necessary information was there. Dot phrases helped too.

But it still annoyed me and I hated to do it. Dictation software never understood most things I said, so that was a dud.

With Abridge, the amount of time I spend on a note is reduced, but that not the main factor. Effort is the main factor. I personally find it easier to edit information rather than generate it from scratch, and not having to type during the encounter is a major relief. I feel like I can focus more fully on the discussion.

 

[smalltownpsych]

A new thing I found out about AI is that it really enjoys writing boring insurance required documentation to justify medical necessity and improve reimbursement. Treatment plan objectives and measurable goals. We used to have a postdoc that would do that for us at one hospital I worked at because we would get dinged in audits. AI does it better than she did. Although she was smart and attractive so when she bugged me about what the measurable goals were I didn’t mind too much.

 

[FlowRate]

A new thing I found out about AI is that it really enjoys writing boring insurance required documentation to justify medical necessity and improve reimbursement. Treatment plan objectives and measurable goals. We used to have a postdoc that would do that for us at one hospital I worked at because we would get dinged in audits. AI does it better than she did. Although she was smart and attractive so when she bugged me about what the measurable goals were I didn’t mind too much.

I will often feed my intake note / other documentation to our HIPAA-compliant copilot instance when I need it to do things like "what are the three objectives this patient has for a course of psychotherapy?"

A friend of mine uses a slightly more sophisticated approach to do insurance coverage verification and similar.

 

[Stagg737]

They are in no sense a pilot project at this point in CA, although I take your point about inclement weather. They are expanding extremely rapidly:

Advancements In Self-Driving Cars

Going Full San Francisco

thezvi.substack.com

It definitely isn't a perfect technology, but the statistics are pretty clear. They are dramatically safer and less likely to be involved in accidents, fatal or otherwise, than the average human driver. If we were deciding things purely as a safety issue, we'd be trying to figure out how to make all cars self-driving as fast as possible.

Edit:

For those who have access to the NYTimes, a neurosurgeon makes the same point.

Opinion | The Data on Self-Driving Cars Is Clear. We Have to Change Course.

If we could make this magnitude of improvements across the entire American automotive fleet we would basically eliminate motor vehicle accidents as a major cause of death in the US.

Ironic that my first time in a Waymo city (drove through Atlanta last week) I saw a Waymo get in an accident. Granted, it was a relatively mild one during rush hour like traffic, but still.

 

[oliversacks4thewin]

Ironic that my first time in a Waymo city (drove through Atlanta last week) I saw a Waymo get in an accident. Granted, it was a relatively mild one during rush hour like traffic, but still.

I am honestly shocked to hear this. What was the nature of the accident, if you don't mind sharing?

I recall traveling about a year ago to a Waymo city and was so intrigued to watch a homeless individual, with what I suspect to be active psychosis, standing in front of, shouting at, and weaving around to block a Waymo car in a busy downtown road. The car would edge forward, person would move to block it, and car would stop and back up. It did this over the course of several hours. Yes, I watched for several hours from my hotel room. More interesting/entertaining than what was on the tv lol

 

[Stagg737]

I am honestly shocked to hear this. What was the nature of the accident, if you don't mind sharing?

I recall traveling about a year ago to a Waymo city and was so intrigued to watch a homeless individual, with what I suspect to be active psychosis, standing in front of, shouting at, and weaving around to block a Waymo car in a busy downtown road. The car would edge forward, person would move to block it, and car would stop and back up. It did this over the course of several hours. Yes, I watched for several hours from my hotel room. More interesting/entertaining than what was on the tv lol

It was 6-7 lane highway, I was in a middle left lane that was basically stopped. Waymo was 3-5 cars ahead of us. Lane to our right was moving fairly fast, probably 20mph. Waymo tried to change into that lane and got hit by a car already driving in that lane. I was trying to do the same thing the Waymo was, but was able to look over and see there was a car coming from our Prius. Waymo apparently didn’t see it, looked like the car in the lane made impact with forward part of the front passenger door. I didn’t see the actual crash, but I heard it and recognized the car that hit the Waymo as the one I didn’t change lanes in front of.

Was weird because it was the third Waymo I saw and the first 2 were moving pretty fast compared to the rest of traffic. Not reckless, but way more aggressive than I’d be willing to drive in that kind of traffic. I was a little impressed until the third one…

 

[oliversacks4thewin]

It was 6-7 lane highway, I was in a middle left lane that was basically stopped. Waymo was 3-5 cars ahead of us. Lane to our right was moving fairly fast, probably 20mph. Waymo tried to change into that lane and got hit by a car already driving in that lane. I was trying to do the same thing the Waymo was, but was able to look over and see there was a car coming from our Prius. Waymo apparently didn’t see it, looked like the car in the lane made impact with forward part of the front passenger door. I didn’t see the actual crash, but I heard it and recognized the car that hit the Waymo as the one I didn’t change lanes in front of.

Was weird because it was the third Waymo I saw and the first 2 were moving pretty fast compared to the rest of traffic. Not reckless, but way more aggressive than I’d be willing to drive in that kind of traffic. I was a little impressed until the third one…

Thank you for sharing. That is wild. Glad to hear you remained safe.

I thought I had last heard that the Waymo cars were restricted from being on major interstate highways (typically 6-7 lanes) without a "human autonomous vehicle specialist behind the wheel" Has that changed recently in Atlanta? I know that it has in LA, San Francisco, and Phoenix, I just didn't realize that it had rolled this out to Atlanta so soon...

 

[Stagg737]

Thank you for sharing. That is wild. Glad to hear you remained safe.

I thought I had last heard that the Waymo cars were restricted from being on major interstate highways (typically 6-7 lanes) without a "human autonomous vehicle specialist behind the wheel" Has that changed recently in Atlanta? I know that it has in LA, San Francisco, and Phoenix, I just didn't realize that it had rolled this out to Atlanta so soon...

No idea. We were going through downtown, so idk if that is different. My first time seeing Waymo in person though. Seems like a fairly minor accident, but I imagine it could have been a lot worse if the car in the lane next to us was going much faster.

 

[clausewitz2]

Thank you for sharing. That is wild. Glad to hear you remained safe.

I thought I had last heard that the Waymo cars were restricted from being on major interstate highways (typically 6-7 lanes) without a "human autonomous vehicle specialist behind the wheel" Has that changed recently in Atlanta? I know that it has in LA, San Francisco, and Phoenix, I just didn't realize that it had rolled this out to Atlanta so soon...

There are specific interstates in CA where it appears Waymo has been allowed to operate for the past few months.

 

[PsyDr]

Artificial intelligence will see you now: Bots to prescribe mental health drugs

“Every patient is going to have AI working on their behalf in five years,” Legion co-founder Arthur MacWaters told NYNext.

nypost.com

To paraphrase: Who needs to drive to a psychiatrist's office, pay them $300, every 3 months? AI will do it for all of Utah!

@Wilf is this the "euphoria mongering" you were talking about?