Mastodawn

2xfo 3d ago

@bich
Does this build a system that lets someone do something like, say, find all the people of a particular race?

I do not trust that the data is untraceable, too many demonstrations have shown you can just add qualifiers until you get to one person in the set, and we're talking about AI here; the most stealing-est and least deterministic thing to ever exist.

Plus it's the Trump administration and i just expect anything they want must be pushing us towards the jaws of hell, but maybe I'm just prejudiced by *gestures at world*

Bich Nguyen 2d ago

@RnDanger

I don't think that's what the AI is being used for. Usually, electronic medical records will have a certain spot in the chart to indicate race/ethnicity which depending on the system may or may not be based on self-report. Someone could export the demographic data and identify a specific population.

This could be a good thing like when a clinic is working on a quality improvement project and identifying health disparities.

2xfo 2d ago

@bich
I know access to information is required to do studies but i don't trust AI to compile or interpret that data, and i simply don't trust the knowledge or motivations of people trying to do it that way given all the evidence so far

nackmack 3d ago

@bich I genuinely wonder, as someone who used to have to take IT calls from physicians still charting at 11p-1a their time, if a real solution to get these care providers to bed on time is ever going to present itself

Bich Nguyen 2d ago

https://www.annfammed.org/content/11/3/272

I remember an article that explored high-performing clinic practices. One physician had two nurses. One would room the patient, get the initial history, then step out to discuss the patient with the physician. They would return, the nurse would scribe as the physician assessed the patient and provided a plan. The physician would step out to check in with the 2nd nurse/patient while the 1st nurse provided after visit instructions. This seemed great.

@bich having a live scribe is indeed great! Unfortunately the only practices the company I worked for served that could afford live scribes had very low Medicaid populations and mostly served highly affluent patients themselves.

@bich like having so much nursing staff to be able to have two per provider is incredible. And that they can take on charting/scribing. The practices I worked with didn't have enough staff to do that, if a nurse called out then their colleagues would have to handle multiple providers each day. The providers themselves barely have enough time during a visit to offer care to patients, which frustrates everyone. And then everyone ends up effectively pulling a second workday with all the charting to catch up on and upcoming appointments to prep for after hours. Idk maybe my problem is with the problems with solvently operating a medical practice in the current times

@circuitsunfish
I wonder if a lot of it isn't the insurance industry. If they're challenging everything, then it seems to me that the notes have to be more detailed.

@bich

@vervain @bich that's a part of it, also if providers prescribe too many controlled substances (ADHD medications, steroids, pain medications, just to name a few) they may get audited and have to attest that their patients genuinely need the care.

Sometimes if they order too many tests they get flagged for unnecessary billing (because they just have to make extra money that way via fraud apparently?)

But if they order too few tests that's also not good and they can get flagged

If they keep vaccines on site they have to attest to the storage conditions and they need to use them by the time they would expire

If their patients have a lot of x condition then there could be questions like why are they all so y (the answer is usually poverty and institutional barriers to health)

It just sucks on every side, every rock you lift has the worst kind of anaerobic scum and no fun isopods

noodle 2d ago

@circuitsunfish @vervain @bich
"It just sucks on every side, every rock you lift has the worst kind of anaerobic scum and no fun isopods"
I am ded

@noodle @vervain @bich i'm here all week

Nobody ناچیز नास्ति (he/him)2d ago

@circuitsunfish @bich
More doctors getting trained, a lot more doctors, more than that too.

@tadbithuman @bich I have such dreams of maybe scribing could be something that is part of medical training and also a path for people to have more remote work opportunities

I have an OT friend, also autistic, and notes are eating their life.

@bich

@vervain @bich please tell them that I respect their grind and if they would like to use any tool to make their life easier it's better in the long term to work with their IT department. The more staff asking for Tool That Does Thing the higher priority that will be.

If it sucks to work with their IT department,
first, my condolences,
second, that's a problem worth solving.

The IT department is there to support the medical business and should be best utilized matching technology solutions to the business they support. A good working relationship where IT understands the business processes and concerns and business values IT expertise and brings them into strategic planning is the ideal state and everyone gets so much more done every day.

Omgs, this is so kind. Thank you very much! Their partner is graduating as a nurse in a month or so and might appreciate this too.

@bich

@vervain @bich ofc ofc and congrats to the partner also!

in a lot of ways i miss healthcare IT so this is nice :))))

I'm glad! I'm guessing you are very good at it because it seems like your ground it in the people who need help. 💜
@bich

@vervain @bich I loved the work while I was there, didn't love the understaffing and on call. If there was a way for me to get back into it and maintain my health I would be there in a heartbeat

We need a sea change, my friend.
@bich

@vervain @bich so true. Maybe it will even happen lol

Jennifer Hamilton MD PhD 2d ago

@bich My office got new computers about 3 weeks ago, including in the exam rooms. Yesterday when I was seeing patients I discovered that the computers in both the exam rooms I was using had the cord to the keyboard wrapped up tightly, keeping me from moving it even two inches closer towards me. Eventually I got the wires unwrapped and gave a solid YANK so that I could once again sit down facing the patient and touch-type, keyboard on my lap.

I guess everyone else using the room was using AI.