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24 January 2024
Epic’s generative AI goes live
Wendy JohnThe EHR maker has made good on its promise, but what does that mean for Aussie health data?
The NSW government’s future electronic health record now has the possibility of using generative AI, but whether or not it will be included is anyone’s guess.
Epic announced last week that its promised generative AI is now fully embedded in its electronic health record. It is being used by more than 150 hospitals and health systems across the US but NSW Health cannot, at this stage, reveal if it will be a part of the state’s new EHR.
Epic’s new feature is provided by Microsoft’s Nuance Dragon Ambient eXperience (DAX). DAX combines Nuance’s conversational and ambient AI – which engages with speech and sensor information – with the problem-solving power of the GPT4 AI model.
The feature will enable clinicians to draft notes automatically from the exam room, or via telehealth, for quick clinical review and completion after each patient visit.
Brent Lamm, CIO at UNC Health, said that DAX enhances the Epic EHR by making clinical documentation “intuitive and straightforward”.
“Patients also say how much they value the conversational interactions they have with their providers and how they truly feel seen and heard during visits while DAX Copilot unobtrusively takes care of the clinical documentation,” he said at the announcement.
However, there is controversy over how far AI should assist with diagnosis. Using AI to assess imaging, and offer diagnoses, is becoming more widespread and some clinical AI tools, both local and from abroad are now assisting doctors with diagnosis during face-to-face-consultations.
Epic came under fire last year after Mayo Clinic published research that spotlighted the poor results of Epic’s AI-based algorithm for predicting the onset of sepsis. Epic’s sepsis AI tool failed to identify two-thirds of the patients who went on to develop sepsis.
Dr John Halamka, president of Mayo Clinic Platform, said those kind of findings “amplify the reservations many clinicians have about trusting AI-based clinical decision support tools”.
eHealth NSW has not yet shared which Epic features are to be included in its contract with the global behemoth but advised in October last year that “work is now starting on the initial design and build of this next generation system”.
An eHealth spokesperson said last year that the new EHR will enable clinicians to access a patient’s clinical records quickly, securely, and safely, regardless of their location.
“The SDPR will also provide simplified clinical workflows in an intuitive, user-friendly system with streamlined technical support,” said an eHealth NSW spokesperson.
The Epic rollout across NSW Health hospitals is expected to take six years with the Hunter New England Local Health District to be the first LHD to go live with the new platform in 2025-26.
More here at this link:
https://www.medicalrepublic.com.au/epics-generative-ai-goes-live/104521
We can only hope it does not turn out to be an expensive add-on NSW Health baulks at!
Sounds like it will be interesting to watch progress.
David.
4 comments:
Indeed, an Additional Invoice (AI) will not be cheap this early in the game. There are certainly use cases to support better areas where human interpretation suffers from specific traits related to how we process data.
Some will flow through in a natural software improvement enhancement manner, and some I would see becoming fee-based - much like robotics. It's all good stuff, and it's fun to watch the hypers and consultants get all excited.
I predict ADHA will re-platform TheirHR as aIHR. With that some of the LLM technology could unlock information and create longitudinal insights which was always a goal of early ehealth.
re "I predict ADHA will re-platform TheirHR as aIHR"
The amount of patient data in MyHR is minimal. It has no history, may or may not have summary information, may or may not contain current test results.
The PCEHR was supposed to address the problem of data fragmentation. In that it, and MyHR have failed miserably.
Deriving useful healthcare information from MyHR is highly unlikely, be it health care providers or AI.
IMHO, the biggest misconception re MyHR is that people (that includes many health professionals as well as the general public) think MyHR is a useful repository of health data. The reason being that the ADHA keeps selling it as such.
Re-platforming MyHR will do nothing to address this issue, no matter how much ADHA spend or try.
The biggest problem, again IMHO, with health information is it can never be complete, or even approximately complete.
Clinical data, which is needed for point of care, is essential but rapidly loses its value. Neither can it be transformed easily into health data. The best is a discharge summary, but that's not a picture of someone's health, it's a record of medical treatment.
There's a conversation re my health record on reddit today
https://www.reddit.com/r/australia/comments/1aknvqj/so_whats_the_consensus_with_myhealthrecord/
Some people find it useful, many others aren't impressed, there is still a lack of widespread trust.
This guy likes it but doesn't seem to think it has much of a future:
https://www.reddit.com/r/australia/comments/1aknvqj/so_whats_the_consensus_with_myhealthrecord/kpah29h/
This chap is certainly not impressed
https://www.reddit.com/r/australia/comments/1aknvqj/so_whats_the_consensus_with_myhealthrecord/kpavsr9/
All other issues aside, MHR provides a vehicle for various forms of abuse with almost no safeguards built in.
For example, a non-custodial perpetrator of family violence is able to create a MHR for a child without knowledge or consent of the other parent. As pharmacies, pathologies etc automatically upload data, this can create a map of where the child & parent are located.
Manipulation and coercion is another concern. Whilst parents are removed from a child’s MHR when they turn 14, they can “voluntarily” re-add their parents as nominated representatives again. An abusive parent would likely insist on this, and the child generally complies to stay safe. This could impact their ability to have open and conversations with a doctor, e.g. about their mental health & abuse at home.
Similarly for intimate partner violence, it’s a lot easier for a doctor to safeguard patient records if a controlling partner is insisting on being present for every medical appointment. The existence of MHR makes it much easier for that abuser to intimidate their partner behind closed doors and gain access to their entire medical history and future - e.g., for the sake of further blackmail/control, or escalating abuse if they attempt to access birth control/abortions.
Elder abuse is also a concern, especially when there is low digital literacy and carers are usually a put in control of the record. Records can be manipulated, with certain parts hidden or removed, to paint a certain picture of a person to health providers that may assist with a carer accessing their money or assets.
Relevant abuse orgs weren’t involving in the planning of MHR, and it shows. There were plenty of submissions outlining the issues, but it was when the gov was gearing up for launch so they were largely ignored.
I guess it’s easy for people to be like, “well that’s just got people who are being abused, that’s not me,” but the thing is that one day it could be you.
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