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EHR & Artificial Intelligence Can Reduce Medical Errors
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Ariella
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Ariella,
User Rank: Author
12/1/2014 | 9:36:00 AM
Re: First Step
@Alison Yes! I noticed the same thing when my son was in the hospital. I spent one night there and go maybe 3 hours of sleep because of the constant noise that the nurses seem to easily tune out. I do have an idea for a solution for that -- not to get them to respond if they choose to ignore the alert but getting it to be quieter for patients -- that I've included in a blog I wrote on adapting technology for a better patient experience. 
Alison_Diana
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Alison_Diana,
User Rank: Author
12/1/2014 | 9:33:04 AM
Re: First Step
Alert fatigue is a HUGE deal. When we were at the hospital with a family member, we were overwhelmed by the buzzers and lights going off -- and that was just for ONE patient, in ONE room, and it did not include the EHR (although I admit, I peeked at the computer screen!). I cannot imagine how clinicians deal with the endless cacophony of lights, buzzers, bells, vibrations, and other devices trying to capture their attention -- most of which are valid and important. 
Ariella
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Ariella,
User Rank: Author
11/19/2014 | 12:08:01 PM
Re: First Step
"
@Ariella: That could be solved by clever software designing. Software diagnosis and drug prescriptions can be made fairly accurate if there are numerous design steps involved. What you are talking about are human/software errors. While the human error cannot be minimized (because someone or the other would always click the wrong drug) it can be made limited using clever software  design that makes the doctor review his decisions."

It's not quite that simple. What you refer to does exist, but it leads to alert fatigue. If  at least half the time, one gets such an alert, one learns to ignore the alerts. That is a real and documented effect. That's why the system has to be much more sophisticated. It also has to look beyond the obvious errors to spot prescriptions that would have been given just due to similarity in name, say fertility drugs to a man, and such, which has occurred.
SachinEE
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SachinEE,
User Rank: Ninja
11/19/2014 | 11:13:48 AM
Re: First Step
"On the number of deaths: As reported in "Medical Errors: a Report by the Staff of U.S. Senator Barbara Boxer"  there 210,000 to 440,000 deaths in America each year that result from "medical errors and other preventable harm at hospitals."  EHR does not really eliminate the danger. I interviewed a doctor behind the company that designed a better prescription alert system, for such errors are a big factor in those preventable deaths.  Dr. Gidi Stein explained, doctors can feel "drowned by the numbers and figures on each and every patient," and so may end up overlooking some small item that is, in fact, critical -- a blood test result, a particular condition, or a drug. The pull-down menu in EMR systems can be problematic, too. A doctor might inadvertently click on the wrong drug in an alphabetical list or select the patient in Room 9 instead of Room 10."

@Ariella: That could be solved by clever software designing. Software diagnosis and drug prescriptions can be made fairly accurate if there are numerous design steps involved. What you are talking about are human/software errors. While the human error cannot be minimized (because someone or the other would always click the wrong drug) it can be made limited using clever software  design that makes the doctor review his decisions.
SachinEE
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SachinEE,
User Rank: Ninja
11/19/2014 | 11:10:42 AM
Re: Documentation side
"The world we live in today has people confusing the real world with virtual values which was what the article did and I don't mean that in a bad way at all but rather it only saw one side and not how the software works in the "real" world with people using it so again models are important and don't confused virtual world values with the real world as they need to work together and people need to know the difference an today with steroid marketing and flat out lies, it's a challenge."

@MedicalQuack: The reason why people want documentation with software supervision is because they want the best of both worlds where margin for error would be low. However in software diagnosis alone, the ER MD wouldn't have to have documentation because that is drastically accurate, and people fail to recognize this.
MedicalQuack
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MedicalQuack,
User Rank: Moderator
11/12/2014 | 12:54:22 PM
Documentation side
Now we come to the part to where we talk about how decisin making software is actually used in the field and what other areas of a hospital or doctor's practices touches this...ok so let's talk models now as healthcare likes to avoid a lot of model talk but we should do more of it.

Hospitalist I know is responsible for the hand off from the ER room to admit patient for his group or make another decision.  You do have to remember it's a different group of doctors in the ER than the group the hospitalist is in, keep that in check here.  This is real and a hospitalist I know.  Patient is in the ER and has issues and they use decision making software.  I think it's a good thing but again look at the whole model which consumers don't even think about at all but the folks that use the software sure do in addition to caring for the patient.

ER room examines patient and uses software to ensure they didn't miss any possible diagnosis and remember they have contracts with the hospital and malpractice insurance to pay.  Ok so ER MD to cover everything picks and loads up every single diagnosis it could possibly be, again they want to be covered.  This ends up being a quite a bit list of things that could be wrong, and it's exaggerated too as nobody wants to miss that diagnosis so even if it is related, the ER MD checks it "on" the list for the hospitalist to review with the hand off.

Hospitalist gets the medical record information in the hand off and again this is a different group of MDs from the ER and says "what a mess" "now I have to go through and remove tons of these as it clogs up the chart and most of its is not relative as the ER has done a CYA, so before hospitalist begins the job, clean up the chart and document the removal of all the non needed remote diagnosis codes added by the ER doctors.


This is the way it works in the "real" world of medicine with documentation.  There needs to be documentation as such for legal cases so while the software is a good thing for look up, you can see how other elements enter the picture and they do all the time.  It's always good to look at both sides and see how your model works as like this above, you're in for some surprises and this why models are important. 

The world we live in today has people confusing the real world with virtual values which was what the article did and I don't mean that in a bad way at all but rather it only saw one side and not how the software works in the "real" world with people using it so again models are important and don't confused virtual world values with the real world as they need to work together and people need to know the difference an today with steroid marketing and flat out lies, it's a challenge.

http://ducknetweb.blogspot.fr/2014/03/virtual-worlds-real-world-we-have.html

Larry Ellison made a very good point about artificial intelligence a while back and said to be careful as you do get fooled, if you don't think about what's really real and what's virtual. 

http://ducknetweb.blogspot.fr/2014/02/larry-ellison-ceo-oracle-hcm.html

 
Ariella
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Ariella,
User Rank: Author
11/12/2014 | 12:27:58 PM
Re: First Step
 On the number of deaths: As reported in "Medical Errors: a Report by the Staff of U.S. Senator Barbara Boxer"  there 210,000 to 440,000 deaths in America each year that result from "medical errors and other preventable harm at hospitals."  EHR does not really eliminate the danger. I interviewed a doctor behind the company that designed a better prescription alert system, for such errors are a big factor in those preventable deaths.  Dr. Gidi Stein explained, doctors can feel "drowned by the numbers and figures on each and every patient," and so may end up overlooking some small item that is, in fact, critical -- a blood test result, a particular condition, or a drug. The pull-down menu in EMR systems can be problematic, too. A doctor might inadvertently click on the wrong drug in an alphabetical list or select the patient in Room 9 instead of Room 10.
Ariella
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50%
Ariella,
User Rank: Author
11/12/2014 | 12:26:29 PM
Re: First Step
@Gary_EL yes, that's true. I was rather shocked when a doctor told us to bring him the CD of the X-Ray image from a lab. He explained that the systems used don't readily share information. So much for the efficiency of EHR with everything accessible in one point. 
Gary_EL
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Gary_EL,
User Rank: Ninja
11/12/2014 | 12:05:39 PM
First Step
Before EHR's can help make decisions collaboratively, they need to be able to communicate with each other. EHR's, as they exist now, are "Islands of Automation", to borrow a term from yesteryear. One hospital's system can rarely communicate with that of another. There needs to be a requirement that each new system support some kind of portal, or API, that makes communication with other EHR system possible.
PedroGonzales
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PedroGonzales,
User Rank: Ninja
11/11/2014 | 6:45:15 PM
Re: errors
@ Thomas.  You are absolutely right.  As the saying goes, garbage in, garbage out.  I would think that health care institutions would place greater emphasis on methods to make sure data entry into the EHR is accurate.  I think EHRs would become more complex if AI is integrated into them. 
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