AI "Machine Learning" Approaches to the diagnosis of sepsis

Stephen Martin samartin at POST.HARVARD.EDU
Mon Mar 6 19:14:14 UTC 2017


Hi Folks,

I recall being struck by the human factor + algorithm approach (data
extracted automatically from any EHR and ED attending paged directly) from
a DEM presenter 2 years ago on sepsis.

https://www.dropbox.com/s/6ahf5p0t4abrrt8/DEM_Sepsis.pptx?dl=0

*Diagnostic Challenges of Sepsis*

*https://www.pocadvisor.com/ <https://www.pocadvisor.com/>*




*Stephen Claypool, MDMedical Director & Vice President ofClinical
Development & InformaticsWolters Kluwer*


Best,
Steve

On Mon, Mar 6, 2017 at 10:57 AM, Robert Bell <
0000000296e45ec4-dmarc-request at list.improvediagnosis.org> wrote:

> Thanks Michael and Jason,
>
> One thing that I have always felt is that the importance of time is not
> fully recognized by HCPs when managing sepsis. Do the algorithms focus on
> the importance of prompt treatment?
>
> Rob Bell
>
> Sent from my iPad
>
> On Mar 6, 2017, at 7:08 AM, "Bruno, Michael" <mbruno at PENNSTATEHEALTH.PSU.
> EDU> wrote:
>
> HI Jason,
>
>
>
> There is actually considerable work being done on the idea of using
> information technology, specifically on the use of AI “Machine-learning
> algorithms,” for improving the speed and accuracy of the diagnosis of
> Sepsis. I recently learned that the timely diagnosis of sepsis has been
> recognized as being a particularly challenging problem as long ago as the 16
> th Century—it was actually mentioned in the writings of Niccolò
> Machiavelli (1429-1527)!
>
>
>
> We have a group here at Hershey, led by Dr. Marco Huesch, Radiology’s Vice
> Chair for Research, working on the use of machine-learning algorithms for
> rapid detection of sepsis in ED patients.  Similar work is being undertaken
> at Johns Hopkins and elsewhere (see the attached manuscript).  The JHU
> group is focused on ICU patients.
>
>
>
> Mike
>
>
>
>
>
> *Michael A. Bruno, M.S., M.D., F.A.C.R.*
> Professor of Radiology & Medicine
>
> Vice Chair for Quality & Patient Safety
>
> Chief, Division of Emergency Radiology
>
> Department of Radiology, H-066
>
> Penn State Milton S. Hershey Medical Center
>
> 500 University Drive, Hershey PA 17033
> ( (717) 531-8703  |   6 (717) 531-5737
>
> *** mbruno at pennstatehealth.psu.edu
>
> <image001.png>
>
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>
> *From:* Phillip Benton [mailto:0000000697ec7b18-dmarc-request at LIST.
> IMPROVEDIAGNOSIS.ORG]
> *Sent:* Saturday, March 04, 2017 4:52 PM
> *To:* <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>IMPROVEDX at LIST.
> IMPROVEDIAGNOSIS.ORG
> *Subject:* [IMPROVEDX] Computer analysis of probable Root
> Cause/Contributing Cause(s) of preventable patient deaths using elecctronic
> medical records.
>
>
>
> Jason,
>
>
>
> As a physician-attorney now devoting all of my remaining time to improving
> medical quality by decreasing medical error, I applaud your great and
> continuing efforts.
>
>
>
> I am exploring the possibility of creating a system that reverse engineers
> from decisions on Dx and Rx and would like your thoughts: If we know the
> adverse event [patient death after 6 days illness with undiagnosed (until
> autopsy) septic peritonitis from diverticulitis with occult rupture] is
> there any computer program in existence or under development that can input
> the recorded clinical and pathologic facts to deduce a probability
> hierarchy of medical errors that would have led to this patients death? In
> effect, is there software to do probable
>
> 'root-cause analysis' based strictly upon the digitized medical record
> (H&P, imaging, labs, consultant opinions, path reports)?
>
>
>
> She was first misdiagnosed as "constipation" on the first ER visit for
> severe abdominal pain, then again misdiagnosed as "atypical cardiac pain"
> on ER visit 3 days later. Acute abdomen "signs" were present but
> not classic, not uncommon for a 72 YO with an aging immune system.  She was
> admitted and had negative cardiac consultation but no further diagnostic
> studies, then died 23 hours after admission with cardiovascular collapse
> from undiagnosed sepsis.
>
>
>
> If this type computer retro-analysis were possible, the next step would be
> to investigate to confirm and then to correct the human and systems errors.
> Of course an experienced physician(s) has to put it all into context at the
> end, but just trying to piece together an exact chronology is very
> difficult, even for top (Harvard & Yale) reviewing medical experts, with
> our new  electronic hospital records systems. Could 'Watson' or 'Isabel'
> not do it more quickly?
>
> Thanks,  PGB
>
>
>
> Phillip Benton, MD, JD
>
> Atlanta Medical Center
> <pgbentonmd at aol.com>pgbentonmd at aol.com
>
>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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