SIDM Tech Update: HIT for Diagnosis

Stephen Martin samartin at POST.HARVARD.EDU
Mon Mar 6 01:53:04 UTC 2017


Another recent article on MD Anderson and technology, one with real-world
implications for its support staff:
http://www.modernhealthcare.com/article/20170106/NEWS/170109948


MD Anderson Cancer Center to cut 900 jobs due to losses from EHR rollout
By Maria Castellucci
<http://www.modernhealthcare.com/staff/maria-castellucci>  | January 6, 2017
The University of Texas MD Anderson Cancer Center will cut about 800 to 900
people from its payroll, or 5% of its workforce, as it tries to recover
from financial losses after implementing its electronic health record.

The Houston-based cancer center reported significant losses in fiscal 2016
partly because of a difficult adaptation of its new Epic Systems network, the
Wall Street Journal reported
<http://www.wsj.com/articles/md-anderson-cancer-center-to-lay-off-roughly-5-of-workforce-1483654693>
.

Dan Fontaine, chief financial officer of MD Anderson, said physician
productivity suffered last year as they struggled to adapt to the new EHR
system. MD Anderson went live on its massive Epic EHR implementation last
March.

Physicians and nurses won't be affected by the layoffs. Cuts will be among
administrative positions such as billing employees.

MD Anderson reported a $266 million operating loss on $4 billion in revenue
at the end of 2016.

In remarks to the media Thursday, Dr. Ronald DePinho, president of MD
Anderson, said that the system must further optimize the EHR network to
realize productivity gains. "We are seeing a recovery trend, but more time
is needed,” he added.

It's not the first time MD Anderson has reported losses as a result of the
Epic rollout. The center reported a 76.9% decrease, or $ 405 million loss,
in adjusted income for the 10 months ended June 30, 2016
<https://www.utsystem.edu/sites/utsfiles/offices/board-of-regents/board-meetings/agenda-book-full/8-2016ab.pdf>.
The system attributed the loss to “an increase in expenses combined with a
decrease in patient revenues as a result of implementation of the Epic
EHR.”

MD Anderson employs about 20,000 researchers and clinicians.

On Thu, Mar 2, 2017 at 10:36 AM, Jackson, Brian <brian.jackson at aruplab.com>
wrote:

> Most don’t.  MD Anderson may be a little different, though.  Do you
> remember Steven Brill’s article in Time a few years back about large
> nonprofit healthcare orgs overcharging their self-pay patients and sending
> them to collection agencies?  MD Anderson was prominently featured in the
> article.  http://time.com/198/bitter-pill-why-medical-bills-are-
> killing-us/ (subscription required, but you can find pdfs of the article
> posted elsewhere)
>
>
>
> --Brian
>
>
>
> *From:* Jason Maude [mailto:jason.maude at ISABELHEALTHCARE.COM]
> *Sent:* Thursday, March 02, 2017 3:51 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>
> *Subject:* Re: [IMPROVEDX] SIDM Tech Update: HIT for Diagnosis
>
>
>
> Further information about the progress of IBM Watson
>
> https://www.forbes.com/sites/matthewherper/2017/02/19/md-
> anderson-benches-ibm-watson-in-setback-for-artificial-
> intelligence-in-medicine/#2e4489a63774
>
>
>
> I didn’t realize institutions like this had $62mn to spend on experimental
> software!
>
>
>
> Regards
>
> Jason
>
>
>
>
>
> Jason Maude
>
> Founder and CEO Isabel Healthcare
> Tel: +44 1428 644886 <+44%201428%20644886>
> Tel: +1 703 879 1890 <(703)%20879-1890>
> www.isabelhealthcare.com
>
>
>
>
>
> *From: *Bob Swerlick <rswerli at GMAIL.COM>
> *Reply-To: *Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.
> IMPROVEDIAGNOSIS.ORG>, Bob Swerlick <rswerli at GMAIL.COM>
> *Date: *Sunday, 19 February 2017 21:51
> *To: *"IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <IMPROVEDX at LIST.
> IMPROVEDIAGNOSIS.ORG>
> *Subject: *Re: [IMPROVEDX] SIDM Tech Update: HIT for Diagnosis
>
>
>
> Part of how Watson works may also make it difficult to apply to diagnostic
> work. Watson works through an iterative process and it needs to learn when
> it gets a task to sort out whether it gets that task done right or wrong.
> Watson first is trained on a learning data set and learns from that data
> set.
>
>
>
> In my mind, the challenge for this is finding a data set that is not
> already riddled with diagnostic errors. Without this, Watson is useless.
>
>
>
> Bob Swerlick
>
>
>
> On Fri, Feb 17, 2017 at 9:54 AM, Berner, Eta S <eberner at uab.edu> wrote:
>
> I thought they had initially tried it for diagnosis and it did not perform
> as well as they hoped.  But diagnosis may also not be perceived as a big
> revenue generator for IBM.
>
>
>
> On February 16, 2017, at 3:56 PM, Edward Winslow <edbjwinslow at GMAIL.COM>
> wrote:
>
> Thanks Maureen,
> Several of us have explored IBM's Watson and have been told that, as of
> yet, IBM has not been interested in using Watson to help with diagnosis. We
> think that this should be a fascinating potential application, but there
> are others that are of higher strategic priorities for the time being.
>
>
>
> On Thu, Feb 16, 2017 at 3:34 PM, Maureen Cahill <MCahill at ncsbn.org> wrote:
>
>
>
>
>
> Ed, I wondered about IBM’s Watson [https://www.ibm.com/watson/health/]
> but maybe that is upstream from the tools.
>
> Maureen
>
>
>
> Maureen Cahill [Senior Policy Advisor] 312.525.3646 <(312)%20525-3646>
> (D) mcahill at ncsbn.org
>
> National Council of State Boards of Nursing (NCSBN) 111 E. Wacker Drive,
> Ste 2900, Chicago, IL 60601-4277 312.279.1032 <(312)%20279-1032> (F)
> www.ncsbn.org
>
> Our Mission – NCSBN, Leading in nursing regulation
>
>
>
>
>
> *From:* Edward Winslow [mailto:edbjwinslow at GMAIL.COM
> <edbjwinslow at GMAIL.COM>]
> *Sent:* Thursday, February 16, 2017 2:26 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* [IMPROVEDX] SIDM Tech Update: HIT for Diagnosis
>
>
>
> *Health Information Technology (HIT) Tools for Diagnosis:*
>
>
>
> In November, we posted a call for IT or ideas you have for improving
> diagnosis. These tools are often referred to as either:
>
> ·      Medical Diagnostic Decision Support Systems (MDDSSs)
>
> ·      Diagnostic Clinical Decision Support Tools (DCDSTs)
>
>
>
> Laura Zwaan in her article in our journal (Diagnosis; 2014, 1, 139-141
> <https://www.degruyter.com/view/j/dx.2014.1.issue-1/dx-2013-0018/dx-2013-0018.xml?format=INT>)
> suggested that, properly devised and used, health IT should help improve
> the diagnostic process and that information about such tools should be
> widely disseminated.
>
>
>
> Here are the 4 tools submitted in response; all are commercially
> available, and listed by date of introduction. Each of the submissions were
> from representatives of the organization that created the tools.
>
>
>
> *DXplain* (http://www.mghlcs.org/projects/dxplain) - Submitted by Edward
> P Hoffer, MD (ehoffer at gmail.com):
>
> DXplain, a MDDSS developed and supported by the Lab of Computer Science at
> the Massachusetts General Hospital, was first released in 1987, with 500
> diseases in the database (db). Over the ensuing decades it has evolved and
> expanded to its current database of over 2500 diseases and some 6000
> “findings,” which include symptoms, physical findings, demographics,
> laboratory test results and imaging findings. Its most common use allows
> the student or clinician to enter information about a patient and receive a
> rank-ordered list of diseases that can explain the findings entered.
> The system was designed to be transparent, and will explain why a disease
> is on the list. It can guide the user to enter additional findings that
> will refine the disease list. Uniquely, it allows the entry of negatives –
> ie, absence of findings, which often help exclude diseases that would
> otherwise be suggested. The user can interrogate the db to get disease
> descriptions and diseases associated with any finding. Each disease has a
> hand-selected set of good references and also facilitates PubMed and Google
> searches. Many of the findings have associated descriptive text to describe
> their meaning.
> DXplain is available world-wide over the Internet by annual subscription
> and is used by hospital, group practices and medical schools. Full details
> are available at dxplain.net
> Isabel (http://www.isabelhealthcare.com/ ) – Submitted by Jason Maude (
> Jason.maude at isabelhealthcare.com ):
>
> The *Isabel DDx Generator* is powered by statistical natural language
> processing software applied to a database of disease presentations. The
> system covers 10,000 conditions, all ages and all specialty areas of
> medicine. Besides clinical features, Isabel utilizes additional algorithms
> to only present those results relevant to the patient’s age, gender and
> geographic region.
> The *Isabel Symptom Checker* uses the medically validated Isabel system.
> This enables patients to enter multiple symptoms in everyday language.
> Suggested possible diagnoses are linked to further knowledge. A ‘Where
> now?’ (triage) feature is also provided to help patients decide where to
> seek care within a health system.
>
> We subsequently learned that any healthcare professional can take a 10-day
> free trial of the DDx Generator. There is also a “free patient version” – “Symptom
> Checker <http://symptomchecker.isabelhealthcare.com/home/main>” available
> VisualDx (https://www.visualdx.com/)– Submitted by Art Papier, MD (
> apapier at visualdx.com)
> In 2016, VisualDx transformed from a dermatology app to diagnostic support
> for general medicine.
> VisualDx is a web-based diagnostic decision support system improving
> diagnostic accuracy at the point of care. Through its medical image library
> and its search technology, health care professionals can build a custom
> differential. VisualDx introduced the “Sympticon,” a graphical method to
> communicate the pattern of symptoms. This process encourages a logical
> method of clinical reasoning and a visual approach to review, compare, and
> understand variations of disease.
> Available on the desktop, as a native IOS or Android mobile app, and
> through the electronic health record, VisualDx fits into the clinicians’
> workflow. VisualDx uses FHIR inside of Cerner Millennium EHR, and can
> integrate inside of Epic and other EHR’s.
> To understand the approach, please view sample differentials at the link
> above
> 30-day free trials are available to students, residents, and any
> healthcare professional. Xebra (https://www.physiciancognition.com/)
> Submitted by Vipindas Chengat, MD (syncopesystem at gmail.com)
> Physician Cognition’s decision-support and clinical education tools are
> driven by its core technology, Xebra™, an engine designed to mimic the
> cognitive strategies of a clinician. Xebra combines a variety of
> statistical and data analysis strategies to replicate the problem-solving
> approach taught by many medical schools. Xebra can process any number and
> combination of symptoms, signs, labs, medications, and past medical history
> and present a differential list in the order of probability, but its goal
> is not to offer a definitive diagnosis Rather it is to support the
> clinician’s decision-making process with a checklist approach. Part of
> Xebra’s core capability is its workup guide, which can help the clinician
> refine the diagnosis through an evidence-based step-wise process.
> Physician Cognition’s products are targeted toward clinician students,
> residents, nurse practitioners and physician assistants to facilitate
> further learning and critical thinking development. While all products
> provide pre-searched and direct access to relevant educational resources,
> XebraPro and XebraED also incorporate both public and private clinician
> social media platforms to facilitate the discussion of unique and
> challenging cases, as well as workup guides.
> The company also has ongoing R&D projects with various academic
> institutions to investigate integration of Xebra decision-support tools
> with EHRs.
>
>  On a Google and Pub Med search we were able to identify several other
> systems with potential for being used as a DCDST:
>
> 1.     The Open Clinical Website <http://www.openclinical.org> has links
> to some diagnostic tools
>
> 2.     LeXMED <http://www.openclinical.org/dm_lexmed.html> (*L*earning
> *EX*pert Systems for *ME*dical *D*iagnosis)
>
> a.     Primarily for Diagnosis of abdominal pain.
>
> 3.     AideDiag, <http://www.copal-sante.fr/aidediag/#/home> in French
>
> 4.     CACDDST <http://www.connan.jp/examples/en/syoujou1.jsp>
> (Computer-Aided Clinical Diagnostic Decision Support Tool)
>
> 5.     Up to Date: Available on most University Library Websites
>
>
>
> This is an evolving field. Some DDSS’s that were available in 2011[1]
> <#m_-4084084578514712337_m_-1377031865414199923_m_86957951924440> no
> longer have active websites.
>
>
>
> To date, it is not yet clear if any of these DCDSTs can be imbedded into
> existing EMRs/EHRs for seamless use by clinicians desiring an integrated
> DCDS.
>
>
>
> We welcome any comments on this topic, which will go through the usual
> SIDM ListServe review process.
>
>
> ------------------------------
>
> [1] <#m_-4084084578514712337_m_-1377031865414199923_m_86957951924440>
> Bond, WF, et al: Differential Diagnosis Generators: an Evaluation of
> Currently Available Computer Programs: J Gen Intern Med, 2011, 000027, 213-9
>
>
>
> --
>
> *Edward B, J. Winslow, MD, MBA*
> Home 847 256-2475 <(847)%20256-2475>; Mobile 847 508-1442
> <(847)%20508-1442>
> edbjwinslow at gmail.com
>
> winslowmedical.com
>
>
>
> "The only thing new in the world is the history that you don't know"
>        Harry S. Truman, 33rd President of US (1945-1953)
>
>
> "... it can be argued that underinvestment in assessing the past is likely
> to
> lead to faulty estimates and erroneous prescriptions for future action."
>         Eli Ginzberg, 1997
>
>
>
>
> ------------------------------
>
>
>
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>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
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>
> --
>
> *Edward B, J. Winslow, MD, MBA*
> Home 847 256-2475 <(847)%20256-2475>; Mobile 847 508-1442
> <(847)%20508-1442>
> edbjwinslow at gmail.com
>
> winslowmedical.com
>
>
>
> "The only thing new in the world is the history that you don't know"
>        Harry S. Truman, 33rd President of US (1945-1953)
>
>
> "... it can be argued that underinvestment in assessing the past is likely
> to
> lead to faulty estimates and erroneous prescriptions for future action."
>         Eli Ginzberg, 1997
>
>
>
>
> ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
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> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
>
> ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
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> SUBED1=IMPROVEDX&A=1 or send email to: IMPROVEDX-SIGNOFF-REQUEST@
> LIST.IMPROVEDIAGNOSIS.ORG
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
>
>
>
>
> --
>
> Bob Swerlick
>
>
> ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
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> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
>
> ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
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>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
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>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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