I Wonder Just How Effectively Google Is Going To Be Able To Monetize AI?

         This appeared a few days ago:

     Google’s new AI chatbot beats  OpenAI, human experts in tests

John Davidson Columnist

Dec 7, 2023 – 2.00am

Google has launched what it says is the most advanced artificial intelligence invented, Gemini, leapfrogging OpenAI in the race to render human brains redundant.

The “multimodal” AI, trained from the ground up to handle questions asked via a mix of audio, photos, video and text, outperformed every other AI including OpenAI’s GPT-4 model in 30 out of the 32 most popular industry benchmarks, Google officials claimed.

Google’s new AI, Gemini, answers questions asked using a mix of voice, video, photos and typed text. 

It was also the first AI to outperform human experts in a key benchmark known as the Massive Multitask Language Understanding (MMLU) test, Google said.

The most advanced version of the AI, known as Gemini Ultra, will not be available until next year, but an intermediate version known as Gemini Pro will begin to power Google’s free chatbot, Bard, as of Thursday, Google said.

The version of Bard powered by Gemini Ultra, known as Bard Advanced, might well be a paid-for service.

“We’ll explore what monetisation might look like, but we don’t have anything specific on that right now,” Sissie Hsiao, vice president in charge of Assistant and Bard at Google, said.

A third, cut-down version of the AI, Gemini Nano, will appear in Android phones starting with Google’s Pixel 8 Pro phone, to answer complex voice, video, photo and written questions on the phone itself, without the need for an internet connection.

In a video demonstration, Gemini identifies that the photo is homework, marks it, and explains the errors.  

In a global launch event, the company showed off Gemini Ultra performing a range of tasks which, until now, were generally reserved for humans.

In one pre-recorded demonstration, Gemini Ultra was shown a photo of a child’s physics homework, and was able to read it, mark it, and explain the maths and physics errors the child had made, going into levels of detail far beyond what most parents would be capable of.

In another demonstration, two objects were held up in front of a webcam – an orange and a fidget spinner – and the AI was able to identify them both and explain that citrus and the spinner had something in common: they both could be “calming”.

Eli Collins, the vice president in charge of product at Google DeepMind, which developed Gemini, said one of the main features of Gemini was it was less likely to “hallucinate” than other AIs.

“Improving the accuracy of responses was one of the core training objectives of the model. When we talk about getting a better score on these benchmarks, it’s often a result of improving Gemini’s ability to reason and to answer questions factually,” he said.

(And, indeed, the Google search engine does contain plenty of references to the “calming” effects of both citrus and fidget spinners.)

When the orange was replaced by a Rubik’s Cube, the AI identified they were both examples of toys that adults, as well as children, play with.

Coding edge

Google also showed off Gemini figuring out what a complex join-the-dots puzzle was depicting, before anyone even joined the dots (“This is a picture of a crab,” the AI pre-empted.) The AI watched as someone performed a simple sleight of hand with a ball and three cups, and correctly predicted the ball would be in the left cup.

More here:

https://www.afr.com/technology/google-s-new-ai-chatbot-beats-openai-human-experts-in-tests-20231206-p5epgr

I gave Bard a run with the question: “What is the best antibiotic for tonsillitis?”

The core part of the answer given was spot on I reckon:

“I'm not able to provide medical advice, so I can't tell you the best antibiotic for tonsillitis. However, I can share some information that may help you:

Most cases of tonsillitis are caused by viruses, not bacteria. Therefore, antibiotics are not usually effective. However, in some cases, tonsillitis can be caused by bacteria, such as group A streptococcus. In these cases, antibiotics can be helpful.” And so on!!!

Good disclaimer and then reasonable answer!

The question with all this really resolves around how these tools should be best used and how we can sensibly evaluate answers we are given – especially in domains where we are not expert

I found this response interesting: What is the likely outcome of the war between Israel and Hamas?

Answer: The conflict in Israel and Gaza is complex and changing rapidly. If you'd like up-to-date information try using Google Search.

My reaction: “bloody clever response!”

Frankly I reckon we are now in the situation where we can get a reasonable answer to most reasonable questions in less than a minute and I find that amazing,

As a second year med student this would have been really useful to study from!

What is the course of the vagus nerve in female humans?

Answer:

The vagus nerve, also known as the 10th cranial nerve, plays a crucial role in various bodily functions, including digestion, heart rate, and breathing. Its course is similar in both male and female humans, with some minor variations.

Here's a general overview of the vagus nerve's course:

Origins:

• Starts in the brainstem, specifically the medulla oblongata.
• Has two roots: a larger motor root and a smaller sensory root.

Path:

• Exits the skull through the jugular foramen, along with other cranial nerves and blood vessels.
• Descends through the neck, alongside the carotid arteries and jugular veins.
• Enters the thorax and passes through the superior mediastinum.
• Branches out in the thorax and abdomen, innervating various organs.

Branches and innervation:

• Pharyngeal branches: Supply the muscles of the pharynx, responsible for swallowing.
• Laryngeal branches: Control the muscles of the larynx, involved in voice production.
• Cardiac branches: Regulate heart rate and rhythm.
• Pulmonary branches: Innervate the lungs, contributing to breathing and airway reflexes.
• Esophageal branches: Aid in esophageal peristalsis, the movement of food down the esophagus.
• Celiac branches: Supply the stomach, intestines, pancreas, and liver, influencing digestion and nutrient absorption.

Minor variations in females:

• Due to anatomical differences in the chest and abdomen, the specific course of the vagus nerve might show slight variations in females compared to males.
• For example, the vagus nerve may pass closer to the reproductive organs in females.

Additional notes:

• The vagus nerve is a complex structure with numerous branches and functions. This is a simplified overview of its course.
• For a more detailed understanding, it's recommended to consult anatomy textbooks or consult with a healthcare professional.

Just a great answer and I admit as good as one might have hoped for!

I reckon I can now flog all my textbooks – and fast - while they are worth something!  Really books are now obsolete except for reading for pleasure away from screens etc.!

As for how Google makes money with all this, I have no idea!

David.

AusHealthIT Poll Number 726 – Results – 10 December, 2023.

Here are the results of the poll.

Do You Believe The myHealthRecord Has Improved Patient Engagement With, And Understanding Of, Their Health Information?

Yes                                                                                  1 (3%)

No                                                                                  35 (90%)

I Have No Idea                                                               3 (7%)

Total No. Of Votes: 39

A clear outcome with a huge majority feeling that the myHR has added pretty much zero to their engagement with their health information.

Any insights on the poll are welcome, as a comment, as usual!

A good number of votes. But also a very clear outcome! 

3 of 39 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many thanks to all those very few who voted! 

David.

Some Are Wanting To Take A Careful Approach To AI And Where It Might Lead!

This appeared last week:

Ensure the advantages of AI outweigh the risks

·         7:57PM November 27, 2023

Unprecedented productivity? Or a catastrophe in the making?

The management agenda of the risks associated to the procuring, developing and adoption of AI across the enterprise moves into the C-Suite.

Artificial Intelligence. AI. The two words that have more than quadrupled in search interest since the advent of ChatGPT. And we do not need to look far to see it included in business strategies or road maps alongside a promise of greater productivity.

Any productivity gains, however, are not free. They bring a breadth of new challenges unique to AI. These span from how businesses will use AI, new roles and employment impacts, and the speed to which AI is morphing. These impacts can be productivity on one hand, and on the other, the loss of workforce and trust.

Think of a cross between ChatGPT and Siri, let’s call them “Service Agents”. As Service Agents mature, they will augment or automate many of the activities of our current customer service workforce; directly translating into productivity gains.

But, as enticing as productivity gains are, and as the use of AI matures, we begin to ask questions such as “How can executives be certain that the AI’s responses align with how the organisation has chosen to engage with its customers?” and “How do businesses know the AI is operating within the guardrails that also govern the human workforce?”

As AI progresses, these questions move from simple questions to complex requirements of governance and risk management. Issues that board directors need to be across, that the C-Suite needs to understand and that the executive teams need to manage.

We have seen it before with cyber-security. Technology issues in businesses can be hard to grasp. The longer a company takes to get on top of issues, the more exposed it is.

AI can be even more difficult for executives to grasp. We typically observe a vast underestimation of the size and materiality of the business risks created by AI.

Not only is AI fast-changing but its self-learning and dynamically responsive nature – and what this means to business – is something that business has never had to deal with.

Self-learning. Think of that for a moment. How do executives and board members know that the self-learning capabilities of the AI technology that an inhouse data scientist has created continues to remain on track to deliver the objectives for which it was intended?

AI is so categorically different in the way it works that businesses must manage it as a “socio-technology” as opposed to a traditional software technology that is well understood. The “socio” refers to the impact it has on humans, the way it is developed, and the need for humans to interact and manage AI for productive engagement. All of this suggests a need for proactive risk management. Executives should consider a lens they are familiar with; portfolio risk management, balancing an integrated pool of potential benefits with a broad set of drivers for potential loss. Despite the familiarity of risk management practices, the breadth of AI risks far exceeds traditional business risk measures.

DSG.ai, an AI specialist firm, has assembled more than 100 distinct dimensions of AI risk (The AI Risk Ontology) for active governance, risk and compliance (GRC) management if AI is to be scaled sustainably. When adopted, it provides executive visibility across the full AI risk landscape with the adaptability to allow for continuous change as other forms of AI technology (for example Generative AI and Agents) mature.

Those who see the significance of these issues recognise they cannot wait for regulation and are beginning to stand up AI internal audit teams and implement specialised AI governance systems to constantly monitor AI risks and performance. Counterintuitively, AI risk management done well actually improves productivity and momentum, as opposed to slowing down innovation.

One company in the ASX 20 recently undertook a deeply specialised AI audit and uncovered a high degree of inherent risk but did not have the capability to manage and remediate in ways that meet recognised global standards.

This prevented the organisation from effectively identifying sudden shifts in performance and found that their risk exposure was actually far greater than what was understood. The lack of ability to monitor for incidents also meant that any AI errors are most likely to go undetected until an irreversible and visible impact on customers is recorded.

Board directors, the C-Suite and executives need to understand that effective AI risk management must not be left as the sole responsibility of technologists and those enamoured with the technology.

Just as we have seen the far-reaching impacts of cyber risk, AI needs to be addressed today instead of kicking the risk-shaped can down the road.

Dr Elan Sasson is CEO of DSG, a global AI company operating in Europe and APAC helping enterprise businesses manage AI at scale through a range of risk management solutions.

Here is the link:

https://www.theaustralian.com.au/business/technology/ensure-the-advantages-of-ai-outweigh-the-risks/news-story/39a93fc14726a54da496228de2f4b792

While there is more than a tinge of the sale motive about this, there are some reasonable points made tat are worth noting!

With so much hype around AI at present it is worth taking in a range of views to get a feel for what is actually going on.

Certainly caution is warranted at this point!

David.

 

I Am Not Sure I Am All That Reassured By This From Microsoft!

This appeared last week:

Microsoft president says no chance of super-intelligent AI soon

By Muvija M and Martin Coulter

Dec 1 2023 6:36AM

Downplays so-called "dangerous discovery" by OpenAI.

The president of Microsoft said there is no chance of super-intelligent artificial intelligence being created within the next 12 months, and cautioned that the technology could be decades away.

OpenAI cofounder Sam Altman earlier this month was removed as CEO by the company’s board of directors, but was swiftly reinstated after a weekend of outcry from employees and shareholders.

Reuters last week exclusively reported that the ouster came shortly after researchers had contacted the board, warning of a dangerous discovery they feared could have unintended consequences.

The internal project named Q* (pronounced Q-Star) could be a breakthrough in the startup's search for what's known as artificial general intelligence (AGI), one source told Reuters.

OpenAI defines AGI as autonomous systems that surpass humans in most economically valuable tasks.

However, Microsoft president Brad Smith, speaking to reporters in Britain, rejected claims of a dangerous breakthrough.

"There's absolutely no probability that you're going to see this so-called AGI, where computers are more powerful than people, in the next 12 months. It's going to take years, if not many decades, but I still think the time to focus on safety is now," he said.

Sources told Reuters that the warning to OpenAI's board was one factor among a longer list of grievances that led to Altman's firing, as well as concerns over commercializing advances before assessing their risks.

More here:

https://www.itnews.com.au/news/microsoft-president-says-no-chance-of-super-intelligent-ai-soon-602991

I am not sure the assurance that nothing will happen ‘soon’ is all that useful!

While I am sure we are all good for tomorrow, I am also pretty sure that in my nipper’s lifetime we will have seen the emergence of Artificial General Intelligence (AGI) with all that my lead to.

There is no doubt the world could do with a good deal of help with a range of tricky problems in pretty much all domains from the geo-political to the environmental and so on! Just how this will come about I have no idea but I am pretty sure the need is there.

I am also not sure where the start of the queue is to ask for particular problems to be solved.

What I can also be sure of is that there is plenty of need for problems to be solved!

I am less sure about just how we humans are going to co-exist with AGI entities but there are certainly many books in the DF domain offering views as to how it might all work out!

Being a simple soul I would certainly counsel moving carefully and slowly into what may be a pretty trickly future!

Anyone have additional thoughts?

David.

 

It Really Is The Same Old Story We Have Seen Many Times Before I Believe!

It really is amazing how many of these stories I have read over the years. Why do they recur?

Bendigo Health staff survey reveals safety concerns over electronic patient records

ABC Central Victoria / By Anna Chisholm

29-11-2023

"Massive safety risk", "threat to patient safety", and "moral distress" are phrases used by unidentified Bendigo Health workers responding to an "experience survey" about the service's Electronic Patient Record (ePR) system.

Key points:

• The ABC has obtained a copy of a report on the results of a staff "experience survey" understood to have been shared internally
• The report includes unidentified Bendigo Health workers' comments, with some staff sharing concerns about patient safety
• It found more than 50 per cent of clinicians surveyed had plans to leave Bendigo in the next two years

The ABC has obtained a copy of the survey report prepared by KLAS research, which was shared with some staff internally last Thursday. 

It included comments from staff that the system was putting patients at risk and exhausting workers.

According to the document, more than 50 per cent of clinicians reported plans to leave Bendigo in the next two years with nurses and allied health professionals reporting high levels of burnout.

"The ePR, as it stands now, is a threat to patient safety, which is increasing mortality and morbidity in this hospital," a consultant staff specialist commented.

Bendigo Health's website states the ePR was introduced in late November 2020.

"Using an ePR improves patient safety, improves medication safety, and allows decisions to be made about your care with up-to-date information available to care teams," the service stated on its website.

'Death from a thousand cuts' 

The comments from staff included in the report repeatedly referenced stress and exhaustion.

"Since the introduction of this system during the first wave of COVID-19, my work stress, mental fatigue, and general displeasure of coming to work and having to troubleshoot this system every time have significantly increased," one nurse stated.

A consultant staff specialist commented: "The difficulty accessing information in an efficient manner for even minor things feels like death from a thousand cuts."

"There are potential risks imposed by the incomplete or difficult-to-access information, but the difficulty getting solutions makes me give up trying to do anything about it," they wrote.

"This causes moral distress on a near daily basis."

The report was circulated internally and includes a number of comments from staff.(Supplied)

A staff member in nursing and midwifery said: "I have reduced my hours at Bendigo Health and am seriously considering my future here."

"I used to believe I was a good nurse and provided excellent care to my patients, but I no longer feel that way," they said.

'Just don't click it'

The report stated using the system to record medications was a repeated concern for doctors and nurses.

"The drug chart is significantly difficult to read and interpret, often misleading the nursing staff to actual dosages prescribed, leading to many and multiple drug errors that have significantly affected patients," a survey response from a nurse read.

"Nurses have access to change the dosage and medications prescribed, which isn't safe, but we have been told, 'just don't click it'," the nurse continued.

"I can't think how this system passes national regulations since nurses could change prescriptions on a whim or with a mis-click."

Another nurse said they were in a group that tested the system initially and brought up concerns around its "usability".

They said "on many occasions" staff in the surgical services department "cannot see medications given in other departments, let alone give medications chartered by doctors".

Another nurse commented the ePR was complicated for doctors to prescribe medications, and "increases the likelihood of drug errors".

"We spend a lot of time interrupting [doctors] to amend orders," they said.

'Not easy to use, learn or maintain'

A worker in nursing and midwifery said in their survey response the system was difficult to "orient new staff to, particularly if they are also new to the ICU environment".

"In some respects, the program is a barrier to safe documentation," they said.

A consultant commented: "It is not easy to use, learn, or to maintain, and it does nothing to enhance the clinical experience."

"This is especially detrimental for our rotational doctors who are only with us for a short period of time and have little motivation to learn the system," they said.

The report also noted a number of responses in the section for other comments or concerns "mentioned patient safety issues", which it said was "atypical". 

"This underscores the need for reliable functionality, excellent training, and strong communication, and shared ownership," it continued.

Some positive responses

A consultant staff specialist — who also described the system as a threat to patient safety — said they "feel like a guinea pig being constantly and systematically bullied and harassed by a computer".

"We should move back to a paper-based system and then move to one of the programs which are proven to actually work," they said. 

An allied health worker commented: "The ePR seems to be an alternative system that does not provide improved efficiency or safety when compared to paper."

The report also included positive comments from staff members. 

"As someone who is tech savvy, it has helped me greatly with efficiency," an allied health professional commented.

A nurse said integrated information was "helpful and they do improve patient safety and care outcomes". 

A registrar or fellow also noted that "overall it is a pretty good system once you are familiar with it".

Staff concerns taken 'very seriously'

In the following statement, a spokesperson for Bendigo Health said it was taking concerns about the ePR system "very seriously".

"The survey was proactively initiated by Bendigo Health's leadership team to ensure staff had an opportunity to speak up and provide feedback as part of our commitment to continuous improvement for our ePR program.

"The ePR program involves a combination of hardware and software components and like any major digital transformation initiative it entails significant change management. Our core clinical system is purpose built and successfully deployed across Australia and 26 other countries.

"We would like to reassure our staff and our community that upon receipt of the survey results we met with the clinical system provider to work together to coordinate an action plan to address issues identified. We are working through this action plan now to ensure patient safety is at the heart of how this system operates.

"We acknowledge all major software implementation projects require enormous change management, time and continued support so any and all risks are appropriately managed and mitigated. We have advertised for more senior positions to provide this increased level of support to our staff. Some of the issues raised in the survey have already been solved; others will be resolved by initiatives underway, including replacing our existing Patient Administration System. We would like to assure that the action plan to address the issues is being constantly monitored by the CEO and the Board of Directors."

Here is the link:

https://www.abc.net.au/news/2023-11-29/bendigo-health-internal-survey-staffing-issues-epr-records/103159344

Here is a link to the system page:

https://www.bendigohealth.org.au/ePR/

The system was provided by TrakCare who have seen all this many time before:

Here is a link to a press release.

https://www.hhmglobal.com/industry-updates/press-releases/bendigo-health-implementing-intersystems-trakcare-as-electronic-medical-record

What can I say other than that I have seen all of this zillions of time before and we can all be confident that in a year or so it will all have settled down and that most will be totally relaxed with using the new system.

There is always a struggle in the middle of this processes but at the end of the day the vast majority are a success!

All that is needed is for time to pass I reckon, and the edges to be smoothed.

David.

 

I Have A Strong Feeling Believing In The Promise Of AI As A Way To Get Value From The myHR May Be An Dangerous Illusion.

I don’t claim to be an expert but I can confidently assert that there are many, many spruikers for the advantages and possibilities of AI in the health sector.

This from the Harvard Business Review provides a flavour:

GenAI Could Transform How Health Care Works

by  Ron Adner and Dr. James N. Weinstein

November 27, 2023

Summary.   

Consider how Napster, the networked file sharing system, upended the music industry. The emergence of generative AI language models like ChatGPT, has much in common with this Napster-initiated inflection point: a breakthrough technology with breathtakingly fast adoption, appropriation of other people’s data (OPD), and predictions of doom and obsolescence. Similarly, the generative AI revolution that ChatGPT has catalyzed is not going to be reversed. Leaders should look to three touchstones to calibrate their strategies and prepare for the transition: First, distinguishing between the role of AI in driving technology substitution and its role in ecosystem transformation. Second, preparing for the new organizational design challenges that will arise because of this ecosystem transformation. And third, crafting strategies that take advantage of new asymmetries that arise from new combinations inside and outside your own organization.

------

The word “disruption” is usually associated with technology substitution that offers a better way of accomplishing a given task. But its more profound realization is in ecosystem transformation that rewires and resets the boundaries across the old silos. This distinction is crucial in confronting the impact of generative AI.

Consider Napster. The networked file sharing system upended the music industry. Before Napster, music companies wrangled for years over how to engage with the digitization of music. And then Napster took the decision out of their hands — it broke the logjam. Initially, music industry leaders sounded alarms about rampant theft of intellectual property. But ultimately music-as-data led to a new golden age of profits as individual songs were re-aggregated into personalized streams by new actors like Spotify and Apple Music. The model shifted from album sales to predictable monthly subscriptions. Today more music is heard, by more people, in more places, with more profit to the music companies than ever before. Ecosystem transformation unlocks value.

The present moment, so full of debate about the impact and implication of generative AI language models like ChatGPT, has much in common with this Napster-initiated inflection point: a breakthrough technology with breathtakingly fast adoption, appropriation of other people’s data (OPD), and predictions of doom and obsolescence. And while OpenAI and ChatGPT, like Napster, may themselves be eclipsed by subsequent organizations and platforms, the generative AI revolution that they have catalyzed is not going to be reversed.

(Where Napster’s enabling of the appropriation and distribution of other people’s music was core to its value, ChatGPT’s appropriation of other people’s data for training its large language models is now the subject of numerous lawsuits. We fully expect the question of intellectual property will loom large in AI’s future. Our focus here, however, will be not on the original training data but on the new and proprietary data to which these learning models will be applied.)

How will the advent of large language models and other new AI approaches reset your sector, and how should leaders prepare? Our discussion focuses on the impact of AI on the U.S. health care context, but our broad points apply to every complex ecosystem wrestling with this new stage of digital revolution. From our positions as a technology executive and former health system CEO (Weinstein) and a strategy researcher and advisor (Adner), we present these ideas in the hopes that leaders might conceptualize new ways of strategizing and interacting.

Three touchstones will help leaders calibrate their strategies and prepare for the transition: First, distinguishing between the role of AI in driving technology substitution and its role in ecosystem transformation. Second, preparing for the new organizational design challenges that will be required for this ecosystem transformation to deliver its value. And third, crafting strategies that take advantage of new asymmetries that arise from new combinations inside and outside your own organization.

Technology Substitution vs. Ecosystem Transformation

ChatGPT broke the record for technology adoption, gaining 100 million users in two months. Most discussions have focused on the question of what tasks it will improve and what jobs it will replace. In other words: technology substitution and how to respond to it. But it is disruption at the ecosystem level that transforms the game and raises the biggest opportunities for change. By combining and analyzing data across previously disconnected silos, generative AI creates the opportunity to raise the bar on efficiency and effectiveness across the spectrum of health care delivery. Consider just three examples:

Billing and Claims

Administrative expenditure accounts for 15–30% of health care spending in the U.S., of which about half is consumed by hospitals’ management of billing- and insurance-related expenses. And even these estimates are unfairly low as they ignore non-dollar indirect cost, borne by patients and their families — the time spent fighting for insurance coverage and clarification on billing. Allowing artificial intelligence to break the silos between insurers, hospitals, and consumers would automate claims management, prior authorization, and even payment planning and collections, helping to eliminate a massive drag on system efficiency.

Resource Management

Health systems are plagued by long cycles of oversupply (buffers held in case of emergencies) punctuated by sudden shortages (when emergencies turn out bigger than expected) of equipment, medicine, rooms, beds, and staff. Poor management of patient flow causes unnecessarily long hospital stays and delays in admissions for those who in serious need. Lack of coordination with extended care and rehabilitation facilities increases time spent at the most expensive place for care, and puts patients at increased risk for hospital acquired complications. AI will enable cross-platform coordination across hospitals, systems, partners, and vendors to create higher resilience and better patient placement, lowering risk, shorten recovery times while improving outcomes and lowering cost.

Redefining Quality

A positive outcome from an avoidable surgery? Accurate results from an unnecessary test? These contradictions highlight the need for quality and performance measures that consider the patient and the patient journey more holistically. By incorporating the latest advances in medical science and real-world evidence into treatment recommendations and measures, AI stands to improve patient outcomes and raise standards in ways that reduce burden on both the patients and the system.

As you set your vision for an AI-enabled future, consider the balance of aspiration between inside-the-box substitution and cross-silo transformation. How is this balance reflected in your investment priorities: capital expenditures, operating expenditures, and capability development?

Ecosystem Transformation Requires Organizational Transformation

Change is held back by an inability among the actors who succeed in the current system to find their way towards a new equilibrium. High cost on one income statement shows up as high revenue on another. These income statements, literal and figurative, are determined by organizational boundaries, routines, and records. The AI-enabled transformations in billing, resource management, and quality described above all hinge on sharing data in novel ways. This novelty, however, gives rise to a new set of emergent organizational challenges.

Changing data access changes authority

Historically, the decision hierarchy that guides the reporting structure in an organizations was matched by a parallel information hierarchy — incomplete views across silos that may lead to suboptimal decisions, but that allow for clear decision-making paths and more efficient execution. This is true inside organizations (e.g., nurses do not have access to HR records) and across organizations (e.g., hospitals don’t have access to insurers’ financial records). But the promised benefits of transformational AI rely on crossing these silos. This means that, beyond concerns of privacy and security, true transformation will require organizations to rethink the informational foundations of authority. Once released across data pools, AI eliminates organizational information censors. This is a huge ecosystem transformation, shifting the focus from insuring the accuracy of content (“Is the data correct?”) to controlling the breadth of questions (“Who is allowed to ask what?”). This shift from censoring data to censoring questions implies a radical change in fundamental principles administration and management.

New information demands new metrics

New visibility into new data combinations open debates on relevant and appropriate metrics which, in turn, impact goals and incentives. The core questions of what is the definition of success, and who gets to define it, moves to the forefront. Consider surgeon productivity in a world where data can be viewed across silos. Do you measure the number of procedures they manage in a month? The revenue they generate? What weights do you assign? In a world of merged data pools and open inquiry, anyone with access can create their own new measures, and the system needs to find a way of settling on a new equilibrium.

Transparency creates new responsibility

A corollary to visibility across data silos is the expectation of more holistic decisions that take the broader landscape into consideration. Historically, a doctor’s recommendation of the “best” treatment was based on optimizing medical outcomes. But with an AI-facilitated view of a patient’s broader circumstances outside of the medical visit – the specifics of their insurance coverage; their work situation; their homelife situation – the notion of “best” can change dramatically. How to incorporate economic and social lenses into a medical recommendation, and to do so in an ethically and legally defensible way, will become a critical new requirement for both providers and insurers.

As AI enables more visibility across silos what parts of your org chart and your governance need to be revisited. You must be proactive in making sure that the upside of giving more people more access to information is not overwhelmed by the unintended downside of new sources of conflict. For every organization in the ecosystem this will lead to a redefinition of rules and roles. For successful organizations, this will be handled with forethought, not as afterthought.

Lots more here:

https://hbr.org/2023/11/genai-could-transform-how-health-care-works

So, while we can see the added value in general the specifics of just how this way work clinically are a little hard to be sure of.

When you contemplate typical health data which is often disjointed, incomplete, full of abbreviations and hardly clearly formatted (or even legible) just how clear value is to be obtained can be a little less than obvious!

It is probably these attributes that provide the scope for an effective AI to add the most value and to obtain the most clarity, reliability, accuracy and utility!

Just having these attributes in records would surely improve patient safety and confidence in decision making!

What more arcane transformations of a record are fascinating possibilities as are the representational possibilities that might be engaged! A ‘meta’ record what adds value to the original is a fascinating possibility and clearly conceivable!

Clearly we can move well beyond just ‘tidying’ a record up – but how far might be useful I will leave to the reader’s imagination. However, I sure do not think the decrepit myHR is a place to start from!!!!

I am very interested in what others might add, and just what sort of record tool(s) might be ideal going forward!

David.

AusHealthIT Poll Number 725 – Results – 03 December, 2023.

Here are the results of the poll.

Is It Time To Give Up On The myHealthRecord?

Yes                                                                                36 (95%)

No                                                                                   2 (5%)

I Have no Idea                                                               0 (0%)

Total No. Of Votes: 38

A clear outcome with a huge majority feeling the time has come to drop it totally.

Any insights on the poll are welcome, as a comment, as usual!

A good number of votes. But also a very clear outcome! 

0 of 38 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many thanks to all those very few who voted! 

David.

Even The College Is Worried About The Damage Possible By Uncrated Results!

This also on the topic of the week:

22 November 2023

Real-time diagnostics may prompt patient panic: RACGP

Diagnosis pathology Political RACGP

By Laura Woodrow

The college is worried that providing real-time results to patients on My Health Record will prompt a barrage of concerned calls to GPs and lead to misinterpretation.

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While the RACGP supports pushing providers to upload pathology and diagnostic test results to My Health Record by default, it has stressed the importance of a seven-day delay to ensure patients aren’t going it alone.

In September, the Department of Health and Aged Care launched consultation on its plans to modernise My Health Record following recommendations made by the Strengthening Medicare Taskforce Report.

The federal government has since promised two years of funding dedicated to modernising My Health Record, including requiring providers to upload diagnostic imaging and pathology results to the platform.

“If a patient gets a diagnostic scan or pathology test, then those results should be uploaded. At the moment, this happens by exception. It is not the rule. I intend to make it the rule,” said Health Minister Mark Butler in May.

In its response to the consultation, the RACGP supported the proposal that would require providers to share pathology and diagnostic imaging by default.

But the college stressed that this shouldn’t replace communication between providers or a patient’s relationship their general practitioner.

As such, the college recommended that the seven-day delay rule – which dictates that pathology and diagnostic imaging results should only be available to patients after a week-long buffer period – should remain in place.

“Maintaining the seven-day rule allows consumers to have access to their health information, albeit with a small delay that allows their GP or other clinician to discuss their results with them,” said the college.

“We do not consider the benefit of real time access to results outweighs the potential harm of consumers misinterpreting results or receiving fortunate results with no immediate clinical support.”

According to a survey conducted by the AMA, 65% of patients agreed that they would want to speak to a clinician before receiving life changing results, noted the submission.

“While most patients will usually receive normal results, many will not, and receiving possibly life changing news via My Health Record with no support or context from the clinician who ordered the test is not appropriate,” read the submission.

The college raised concerns that real time access for consumers may cause distress and prompt patients to contact their GP to inquire about their results.

“Before viewing results, patients should see a message reminding them that their results need to be interpreted by a clinician and to not take action until they have spoken with clinician who requested the tests,” the college said.

“It should be emphasised that the clinician will be in contact with them, which is current standard practice for the follow up of test results.”

Results that are already available in real time such as influenza and HbA1c should be an exception to the seven-day rule, added the college.

If their advice isn’t heeded, the RACGP has called for a post-implementation evaluation into whether the change affected patient health outcomes.

The college added that a “thorough and wide-ranging communication campaign” was vital to ensure consumers are aware of the availability of their results on My Health Record and the burden is not on GPs to explain.

“GPs should not be expected to explain the changes to patients during consultations, so consumer resources available through practices (such as posters or flyers) that GPs can refer their patients to would be helpful,” the submission said.

The RACGP also noted that it was important for healthcare providers to be in the know well in advance of the rollout of any changes.

Beyond changes to availability of documents, the group said the “clunky, hard to navigate and slow” interface could do with a facelift.

The system will need to be responsive, efficient, consistent in terminology and have data input in a way that is easy to integrate into general practice clinical systems and allows large volumes of data to be sifted through with ease, added the college.

The consultation is now closed to submissions.

More here:

https://www.medicalrepublic.com.au/real-time-diagnostics-may-prompt-patient-panic-racgp/102960

It will be interesting to see what is finally done in this area! I think the College warning is a bit over the top!

David.