AI in EM

[EctopicFetus]

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It’s not what people want to hear but AI is coming and the proper program is pretty good. There are some AI scribe companies that are more geared to EM. Also, I recently started using open evidence a little bit.. it’s pretty darn good. The AI scribe program I use has built in EM specific calculators. NIHSS, PERC, Heart etc..

Open evidence answers clinical questions if you have them.. One other thing I like about ChatGPT is if there is a procedure I did but dont have a macro/procedure note it will generate a decent one.. Requires editing but is decent enough.

I dont think you can use a generic LLM or a generic AI scribe and get what we want out of it. I also think one of the issues of most LLMs is they are really designed for clinic notes.. not for what we want in EM.

 

[TooMuchResearch]

It’s not what people want to hear but AI is coming and the proper program is pretty good. There are some AI scribe companies that are more geared to EM. Also, I recently started using open evidence a little bit.. it’s pretty darn good. The AI scribe program I use has built in EM specific calculators. NIHSS, PERC, Heart etc..

Open evidence answers clinical questions if you have them.. One other thing I like about ChatGPT is if there is a procedure I did but dont have a macro/procedure note it will generate a decent one.. Requires editing but is decent enough.

I dont think you can use a generic LLM or a generic AI scribe and get what we want out of it. I also think one of the issues of most LLMs is they are really designed for clinic notes.. not for what we want in EM.

What proper program?
I would try to use it if I could figure it out.

 

[xaelia]

This is a good read re: continued advancements and the underlying "agent" architecture powering the next generation.

From diagnosis to treatment: Advancing AMIE for longitudinal disease management

research.google

The path forward will be a bit bumpy – but we're definitely on the transition curve where humans function increasingly to gather data points to feed AI and rely on the outputs to guide management.

 

[Major]

Anyone use the PalmER AI? It’s pretty steep at $199 month

 

[Restart13]

I’m a big AI scribe believer. I think AI will revolutionize medicine in the medium term once the tech is finessed and EMR’s use AI as physician extenders as one other put it. If I all i have to do is interview patients and do procedures while the AI does the rest of the stuff (writing a note, putting in orders, sending admit texts/messages, organizes transfers) the job could be a lot better.

 

[Tiger26]

We just got access to Abridge and I was impressed using it for the first time yesterday. It did a better job than expected of not including the meaningless babble of an encounter while also crafting a thoughtful and organized narrative.

It was more refreshing to have my note done by the time I got back to the computer and it was freeing to focus less on trying to remember key points, so I felt like I could spend more time connecting with the patient.

 

[gutonc]

We just got access to Abridge and I was impressed using it for the first time yesterday. It did a better job than expected of not including the meaningless babble of an encounter while also crafting a thoughtful and organized narrative.

It was more refreshing to have my note done by the time I got back to the computer and it was freeing to focus less on trying to remember key points, so I felt like I could spend more time connecting with the patient.

Right now, with current tech, I think this is where AI in clinical medicine is most helpful. I only use it for HPI. It's CDM and A/P was mediocre at best (at least Nuance Dax implemented in Epic).

I look forward to the day when it orders up my labs, imaging and follow up.

 

[EctopicFetus]

Right now, with current tech, I think this is where AI in clinical medicine is most helpful. I only use it for HPI. It's CDM and A/P was mediocre at best (at least Nuance Dax implemented in Epic).

I look forward to the day when it orders up my labs, imaging and follow up.

I wonder if it will be able to order tests or if it will just pend them like med students do.

I could see a world where it pends them and then on my phone i ok them. It would be helpful. Thinking of a code and I want to order an x ray. Or post reduction ordering of films etc. I tend to agree. I think it is best for the HPI and to some degree the physical exam.

I think low hanging fruit would be to maximize billing, and EKG interpretation. There are a few Apps out there to help interpret EKGs. I think they could act as a second check and pop out the billable info to include in the note so i don’t have to dictate it.

Obviously would want this integrated and not to use another app to do this work.

The possibilities are vast.. execution is potentially gonna be hard. Im not an IT person so i dont know.

 

[xaelia]

I wonder if it will be able to order tests or if it will just pend them like med students do.

I could see a world where it pends them and then on my phone i ok them. It would be helpful. Thinking of a code and I want to order an x ray. Or post reduction ordering of films etc. I tend to agree. I think it is best for the HPI and to some degree the physical exam.

I think low hanging fruit would be to maximize billing, and EKG interpretation. There are a few Apps out there to help interpret EKGs. I think they could act as a second check and pop out the billable info to include in the note so i don’t have to dictate it.

Obviously would want this integrated and not to use another app to do this work.

The possibilities are vast.. execution is potentially gonna be hard. Im not an IT person so i dont know.

It's coming sooner than later (and some is here already) –

Some of what you describe is a problem of integration, and Epic has decided to just forge ahead with their own ambient technology:

https://www.fiercehealthcare.com/ai-and-machine-learning/epic-adds-ambience-healthcares-ai-its-toolbox-program

That'll ease development of all those idealised augmentations and decision-support shortcuts you've envisioned.

I believe ambient AI is also integrated into the Oracle EHR, with the same goal.

 

[WhatJobDoIPick]

I’m a big AI scribe believer. I think AI will revolutionize medicine in the medium term once the tech is finessed and EMR’s use AI as physician extenders as one other put it. If I all i have to do is interview patients and do procedures while the AI does the rest of the stuff (writing a note, putting in orders, sending admit texts/messages, organizes transfers) the job could be a lot better.

I can handle the orders and documentation. Can it please deal with the patient and family? Thanks.

 

[RustedFox]

I can handle the orders and documentation. Can it please deal with the patient and family? Thanks.

You beat me to it.
I want a hologram version of me (just handsomer) to answer all their ridiculous questions and educate them on to how to act like a reasonable person while I actually get work done.

 

[EctopicFetus]

It's coming sooner than later (and some is here already) –

Some of what you describe is a problem of integration, and Epic has decided to just forge ahead with their own ambient technology:

https://www.fiercehealthcare.com/ai-and-machine-learning/epic-adds-ambience-healthcares-ai-its-toolbox-program

That'll ease development of all those idealised augmentations and decision-support shortcuts you've envisioned.

I believe ambient AI is also integrated into the Oracle EHR, with the same goal.

Yeah Oracle / Cerner is coming. My main worry is the data the hospital will capture that they just cant right now. I also envision they will have more data than they know what to do with but I also worry they will weaponize the data to get the outcomes they want.

 

[Restart13]

It's coming sooner than later (and some is here already) –

Some of what you describe is a problem of integration, and Epic has decided to just forge ahead with their own ambient technology:

https://www.fiercehealthcare.com/ai-and-machine-learning/epic-adds-ambience-healthcares-ai-its-toolbox-program

That'll ease development of all those idealised augmentations and decision-support shortcuts you've envisioned.

I believe ambient AI is also integrated into the Oracle EHR, with the same goal.

Would love to see this. Realistically probably still some years away and then each health system will have it's own bureaucratic process that will take forever to adopt it, but one day🤞

 

[thegenius]

I wonder if it will be able to order tests or if it will just pend them like med students do.

I could see a world where it pends them and then on my phone i ok them. It would be helpful. Thinking of a code and I want to order an x ray. Or post reduction ordering of films etc. I tend to agree. I think it is best for the HPI and to some degree the physical exam.

I think low hanging fruit would be to maximize billing, and EKG interpretation. There are a few Apps out there to help interpret EKGs. I think they could act as a second check and pop out the billable info to include in the note so i don’t have to dictate it.

Obviously would want this integrated and not to use another app to do this work.

The possibilities are vast.. execution is potentially gonna be hard. Im not an IT person so i dont know.

The world will come to a time when you are in a room....and you say "Computer, order a left shoulder xray, limited, indication: reduction:" And like Star Trek the computer will hear your voice, you won't have to put in a silly password, and it will just get done.

That world should come tomorrow. That's what we need.

"Computer: order the TheGenius Chest Pain orderset"

Why can't we have this now. This should be my new company idea.

 

[thegenius]

I’m a big AI scribe believer. I think AI will revolutionize medicine in the medium term once the tech is finessed and EMR’s use AI as physician extenders as one other put it. If I all i have to do is interview patients and do procedures while the AI does the rest of the stuff (writing a note, putting in orders, sending admit texts/messages, organizes transfers) the job could be a lot better.

The big thing to revolutionize medicine is stop spending 1/3 of all our health care money on those in the last 3 months of their life.

AI will make health care be more like Star Trek, which is what it should be now.

 

[Apollyon]

The big thing to revolutionize medicine is stop spending 1/3 of all our health care money on those in the last 3 months of their life.

AI will make health care be more like Star Trek, which is what it should be now.

I thought it was 1/2 of Medicare money in the last 6 months of life. I've been wrong before.

 

[sloh]

I thought it was 1/2 of Medicare money in the last 6 months of life. I've been wrong before.

25% of all Medicare spending goes to patients in their last year of life. More specifically, ~10–12% of total Medicare spending happens in the last 30 days of life, and roughly 25% in the last 90 days. If you extend it to the last 6 months of life, estimates are around 25–30% of Medicare spending.

Still a lot of wasted money either way.

 

[RustedFox]

The world will come to a time when you are in a room....and you say "Computer, order a left shoulder xray, limited, indication: reduction:" And like Star Trek the computer will hear your voice, you won't have to put in a silly password, and it will just get done.

That world should come tomorrow. That's what we need.

"Computer: order the TheGenius Chest Pain orderset"

Why can't we have this now. This should be my new company idea.

I'm on board only if instead of "computer", we can name it what we want.

Think of the possibilities.

 

[VA Hopeful Dr]

25% of all Medicare spending goes to patients in their last year of life. More specifically, ~10–12% of total Medicare spending happens in the last 30 days of life, and roughly 25% in the last 90 days. If you extend it to the last 6 months of life, estimates are around 25–30% of Medicare spending.

Still a lot of more wasted money either way.

Is it though? I think we overlook that it's not all 2 month ICU stays where family flogs meemaw to death with repeated codes, g-tubes, and dialysis.

When my grandmother died 20 years ago, she spent 3 days in the hospital. Comfort care only. The previous 15 years were twice a year doctor visits and 2 prescription meds per day (both generic). So easily 90% of her Medicare costs were in her last 90 days. Wouldn't call it wasteful.

Daily in home hospice care is expensive as well, way cheaper than the hospital certainly but still very expensive. Wouldn't call that a waste either.

 

[EctopicFetus]

The world will come to a time when you are in a room....and you say "Computer, order a left shoulder xray, limited, indication: reduction:" And like Star Trek the computer will hear your voice, you won't have to put in a silly password, and it will just get done.

That world should come tomorrow. That's what we need.

"Computer: order the TheGenius Chest Pain orderset"

Why can't we have this now. This should be my new company idea.

It exists.. hospitals wont allow it to happen (for now).

 

[EctopicFetus]

25% of all Medicare spending goes to patients in their last year of life. More specifically, ~10–12% of total Medicare spending happens in the last 30 days of life, and roughly 25% in the last 90 days. If you extend it to the last 6 months of life, estimates are around 25–30% of Medicare spending.

Still a lot of wasted money either way.

I think the other part is the first yea of life. @Apollyon Something like half of all spending is in the first and last 6 months of life.

 

[Apollyon]

Is it though? I think we overlook that it's not all 2 month ICU stays where family flogs meemaw to death with repeated codes, g-tubes, and dialysis.

When my grandmother died 20 years ago, she spent 3 days in the hospital. Comfort care only. The previous 15 years were twice a year doctor visits and 2 prescription meds per day (both generic). So easily 90% of her Medicare costs were in her last 90 days. Wouldn't call it wasteful.

Daily in home hospice care is expensive as well, way cheaper than the hospital certainly but still very expensive. Wouldn't call that a waste either.

"One got wasted/And the other's a waste"

- Offspring

 

[thegenius]

I thought it was 1/2 of Medicare money in the last 6 months of life. I've been wrong before.

It’s a lot of money in the last little bit of life. We are both right with that statement.

 

[thegenius]

I'm on board only if instead of "computer", we can name it what we want.

Think of the possibilities.

Thinking

My wake would would probably pay homeage to the MILTF from star trek, Dr. Crusher.

"Crusher: Order the cardiac heparin order set. Default settings."

Or maybe I would go with "Picard". But picard didn't know anything about medicine. So not as funny.

But just saying Picard and having the computer sound like Picard would be wonderful.

 

[xaelia]

Thinking

My wake would would probably pay homeage to the MILTF from star trek, Dr. Crusher.

"Crusher: Order the cardiac heparin order set. Default settings."

Or maybe I would go with "Picard". But picard didn't know anything about medicine. So not as funny.

But just saying Picard and having the computer sound like Picard would be wonderful.

I jailbroke our AI scribe pilot to give me a full differential diagnosis and treatment plan ... in the Star Trek universe: