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Wednesday, December 12, 2018

The Amazon Health IT play

Recall that I recently posted on Amazon's AWS machine learning open boot camp initiative.

OK, check this out:
Amazon will reportedly sell software that reads medical records
Electronic records are a famously contentious area

Amazon reportedly plans to start selling software that can read medical records and make suggestions for improving treatment or saving money, according to The Wall Street Journal.

The program scans medical files to pick out relevant information such as the medical condition and patient’s procedures and prescriptions. While other algorithms that try to do the same thing have been stymied by doctors’ abbreviations, Amazon claims to have trained its system to recognize the idiosyncrasies in how doctors take notes, sources told the WSJ. The company had already developed and sold this same software to other businesses, including ones focused on travel booking and customer service. For Amazon, this is another move into the health care market on the heels of the retailer buying the online pharmacy PillPack in June…

Given that Amazon already had the text-analysis technology, expanding into the health care market makes sense for the corporate giant. But the area of electronic health records is famously contentious. Though there has been a push to digitize medical records, the tangled evolution of e-health technology has, for many patients, led to a fragmented paper trail filled with gaps. In the recent, evocatively titled New Yorker article “Why Doctors Hate Their Computers,” physician Atul Gawande writes about how doctors are frustrated with the entire process, and observes that the various software systems for health records seem to have helped lead to burnout…
This certainly warrants watching. Could be good, providing de facto actual "interoperability." Could also present a host of vexing ethical conflict of interest problems. Think about it.
"The program scans medical files to pick out relevant information such as the medical condition and patient’s procedures and prescriptions..."
OK, any time electronic patient-identifiable information is created, viewed, edited/updated, deleted, or transmitted by a CE or BA (Covered Entity or its Business Associate), HIPAA (at 45.CFR.164.312 et al) requires that there be an audit trail log documenting date/time, which data, by whom, about whom. Will Amazon be a BA? Or will their software provide such functionality to licensees?

From CNBC:

BTW, also noteworthy here more broadly,
"In the recent, evocatively titled New Yorker article “Why Doctors Hate Their Computers,” physician Atul Gawande writes about how doctors are frustrated with the entire process, and observes that the various software systems for health records seem to have helped lead to burnout."
Yeah, already reported on that. See my post "Epic fail: Atul Gawande on the EHR."

A tangential note of caution for "Amazon HIT":
12 State AGs Sue Electronic Medical Records Company Under HIPAA for Data Breach, a First
A dozen state attorneys general have united to bring the first multistate lawsuit under federal health care privacy law, in connection with a medical records company data breach that put millions of patient records at risk. The lawsuit is part of a growing trend of state enforcement of consumer and data privacy laws, and the first such AG suit under HIPAA.

A dozen state attorneys general have united to bring the first multistate lawsuit under  federal health care privacy law, in connection with a medical records company data breach that put millions of patient records at risk.

The lawsuit is part of a growing trend of state enforcement of consumer and data privacy laws, and the first such AG suit under HIPAA—the federal Health Insurance Portability and Accountability Act of 1996, which requires companies to protect the privacy of patient information. The U.S. Department of Health and Human Services usually enforces HIPAA and the Federal Trade Commission usually enforces consumer data breach violations…
I was our HIPAA staff Lead at my last gig. This stuff still interests me.

How traditional pharmacies can survive the Amazon threat

Are traditional pharmacies doomed to the same fate as Borders, Blockbuster, and Sears? The threat is real.

Companies like Capsule and PillPack are redesigning the pharmacy for the digital age. In addition to making it effortless to get prescription medications, these disruptors are bent on cutting out the physical store. This summer, Amazon bought PillPack, bringing heft, customer-service expertise, and gargantuan corporate ambition to the fight…
Hmmm... Any correlation with the Amazon HIT play?


I "graduate" (discharged) early from cardiac rehab PT next Tuesday. I'm doing quite well, way better than I'd expected. No more need for my BP meds.

Major props to the entire Muir team. Grateful to be alive.

CrossFit is amassing an army of doctors trying to disrupt health care
CEO Greg Glassman believes his program could end chronic disease — and he wants doctors to help him.
By Julia Belluz @juliaoftoronto Dec 13, 2018
Oh, boy... More Disruption, Please...

Excellent article. Read it closely.

ERRATUM: MORE ON CLIMATE CHANGE (and other tech topics)

Nice podcast from Wired:

See my prior climate change posts.


More to come...

Thursday, December 6, 2018

More on climate change and health impacts

From Scientific American:

Also, nice piece at The Atlantic by Vann R. Newkirk II:

Climate change can seem almost too big to fathom. Reports such as the recent National Climate Assessment and the United Nations Intergovernmental Panel on Climate Change’s recent release have made waves by portraying the dire threats of a warming world, making the case that the fundamental fabric of humanity will be degraded without immediate action. But the scenarios—the biblical floods and droughts, the mass migrations of dispossessed people, the creeping seas and the retreating glaciers—have a way of short-circuiting the brain. It’s almost easier to despair or to will oneself into ignorance than to begin to grapple with the future. What are human lives when measured against the coming tempest?

Efforts to assess the exact human costs of climate change, however, have provided new tools for understanding the ways in which those lives will be impacted. A major report published November 28 in the public-health journal The Lancet provides predictions of how climate change is degrading human health, and how it will alter health-care systems in the future. The findings are reliably grim. But in focusing on the health-care implications and the potential damage done to people and their descendants, the report provides a firm backing to the call to climate action. The experts behind the report hope to marry the urgency of climate science with the muscle of America’s most successful and most trusted policy experiment—its public-health system…
Read all of it (including the linked resources therein). The Lancet work can be found here [pdf].
From page 21 of the Report:

Training the Next Generation and Educating the Public on the Health Impacts of Climate Change
Correlates with Lancet Working Group 5: Public and Political Engagement

Healthcare professionals need to be educated about the ways climate change is harming Americans’ health and well-being.These professionals include physicians, nurses, public health workers, and professionals in other health sciences. 

The International Federation of Medical Students Association (IFMSA) has created a 2020 Vision for Climate-Health in Medical Curricula as a call to action to include an element of climate-health in every medical school curriculum by 2020.67 The Global Consortium on Climate and Health Education (GCCHE), hosted at the Columbia University Mailman School of Public Health, has developed Climate and Health Core Competencies for health professional students which can act as an institutional guide.

Recent polls show that nearly half of Americans (49%) are “extremely or very sure” that climate change is happening versus only 7% who are “very sure” climate change is not occuring. Given that the bedrock of public health is education about threats to health, it is critical that health providers inform their patients, communities, and policy makers about the health harms of climate change. 

Evidence shows that primary care providers are among the most trusted voices to deliver this message (Figure 15), while nurses are the most trusted profession in the country across all sectors. It has been shown that educating Americans about the health impacts of climate change can increase public engagement and decrease political polarization.

I keep coming back to the climate change thing because if we don't get a handle on it soon, a lot of other tech topics in the health care space are going to be increasingly moot, as increasing financial resources diverted to exigent disaster relief and recovery crowd out funds for tech R&D and other economic needs.

See some of my prior climate related posts here. And, don't forget Mr. Best Words.

Look closely at the left side vertical descending bars of the Scientific American graphic above. The costs associated with adverse health impacts are projected to significantly outstrip other categories. Our time for continued denial is running out.
“The way I think about it is: Somebody was made sick yesterday from climate change, someone is being made sick today as we speak, and someone is going to be made sick from climate change tomorrow.” - Georges Benjamin, APHA


New post at Naked Capitalism:

The Inconvenient Truth about Climate Change and the Economy

Define the human right to science
Jessica M. Wyndham, Margaret Weigers Vitullo

The adoption of the Universal Declaration of Human Rights (UDHR) by the United Nations (UN) General Assembly will mark its 70th anniversary on 10 December. One right enshrined in the UDHR is the right of everyone to “share in scientific advancement and its benefits.” In 1966, this right was incorporated into the International Covenant on Economic, Social and Cultural Rights, a treaty to which 169 countries have voluntarily agreed to be bound. Unlike most other human rights, however, the right to science has never been legally defined and is often ignored in practice by the governments bound to implement it. An essential first step toward giving life to the right to science is for the UN to legally define it…

The scientific community has contributed three key insights to the ongoing UN process. One is that the right to science is not only a right to benefit from material products of science and technology. It is also a right to benefit from the scientific method and scientific knowledge, whether to empower personal decision-making or to inform evidence-based policy. In addition, access to science needs to be understood as nuanced and multifaceted. People must be able to access scientific information, translated and actionable by a nonspecialist audience. Scientists must have access to the materials necessary to conduct their research, and access to the global scientific community. Essential tools for ensuring access include science education for all, adequate funding, and an information technology infrastructure that serves as a tool of science and a conduit for the diffusion of scientific knowledge. Also, scientific freedom is not absolute but is linked to and must be exercised in a manner consistent with scientific responsibility…

In October 2018, the UN Committee on Economic, Social and Cultural Rights released a list of 29 questions related to defining the right to science [pdf]. Three of the most important questions were: What should be the relationship between the right to benefit from science and intellectual property rights? How should government obligations under the right differ based on the available national resources? What is scientific knowledge and how should it be differentiated, if at all, from traditional knowledge?…

The power and potential of the right to science for empowering individuals, strengthening communities, and improving the quality of life can hardly be overstated. It is time for the UN process to reach a responsible and productive end and for the right to science to be put into practice as was intended when it was first recognized by the United Nations in 1948.
Better late than never, I guess, when it comes to precisely pinning down core conceptual phrases.

Beyond international legal definitions, this goes to issues of "Ethics," no?

apropos of one specific science-technology area and ethics, "Artificial Intelligence," I call your attention here:

From their 2018 Report:
University AI programs should expand beyond computer science and engineering disciplines.
AI began as an interdisciplinary field, but over the decades has narrowed to become a technical discipline. With the increasing application of AI systems to social domains, it needs to expand its disciplinary orientation. That means centering forms of expertise from the social and humanistic disciplines. AI efforts that genuinely wish to address social implications cannot stay solely within computer science and engineering departments, where faculty and students are not trained to research the social world. Expanding the disciplinary orientation of AI research will ensure deeper attention to social contexts, and more focus on potential hazards when these systems are applied to human populations.
That's interesting. I am reminded of my cite of Dr. Rachel Pearson's book (MD, PhD) and her scholarship in the "Medical Humanities." Interdisciplinary synergy.


Saw an MSNBC Ali Velshi interview with this Jacob Ward fellow, and was rather impressed. Glad to now be aware of him.

Warrants following.
Could not agree more with that statement. Easier said than done. One of my favorite "Futurists," Ian Morrison, joked during a Health 2.0 Conference that "the benefit of being a Futurist is that you never have to change your slides."

Good writer, Jake Ward. Check this out:

In 1999, a trio of economists emerged from a conference at the University of California, Los Angeles, squinting without sunglasses in the unfamiliar sun, and began a slow walk through the hills overlooking the city. The three of them — a Harvard economist-in-training, Daniel Benjamin, and the Harvard economists Edward Glaeser and David Laibson — were reeling. They had just learned about a new field, neuroeconomics, which applies economic analysis to brain science in an effort to understand human choices. Now they were strolling through the taxonomy of midday joggers and dog-walkers in Los Angeles, talking all the while about how people become what they are. Benjamin recalls feeling very out of place. “Everyone was so beautiful,” he says.

The economists spent the walk discussing what else they could measure across such a wide variety of human beings. By the time the sun began to set, the conversation landed on the very building blocks of life. “If economists are studying the brain,” Laibson asked, “what about studying genes?”

At that time, the standard method for connecting genes to human outcomes was to look for connections between specific DNA clusters and specific conditions in the lives of people who share those genes. B.R.C.A., perhaps the best-known gene sequence in medical science, is associated with a high risk of breast cancer. The A.P.O.E. sequence seems to have a connection to your chances of developing Alzheimer’s. “We thought we were going to find a few candidate genes that were the critical genes for impulse control or risk taking or cognitive ability,” Benjamin says. But when Benjamin, Glaeser and Laibson began writing to the keepers of DNA databases, asking to partner up, they found the geneticists reluctant to join forces. And matching D.N.A. to social outcomes, like educational attainment or wealth, wasn’t just ethically questionable, it was practically impossible…

…researchers themselves acknowledge that it’s hard to think about oneself clearly when subjected to this new [DNA] tool. Benjamin, Conley and several others in the study went ahead and got their own polygenic scores measured. It was for fun, mostly, and no one was unhappy with their results. “But at the moment I did it, I regretted doing it,” Conley says. “It’s a cognitive trap. I immediately realized that at an individual level, it doesn’t predict anything, but it’s human nature to want to know more about yourself. I don’t know …” He pauses for several seconds. “People parse meaningless distinctions.

Benjamin is less conflicted. “I don’t regret doing it,” he says. “But I’m an economist, so I’m trained to always think more information is better.”
Ahhh... more "Omics" stuff. "Geno-economics?" "Neuroeconomics?" What could possibly go wrong with that kind of stuff? The hell with your GPA and GMAT. The hell with your FICO score (some people would end up in the "subprime DNA" demographic). The hell with your VC Startup Seed Round Pitch Deck. Just give us your whole genome assay result. GINA et al be damned.
I know: I should do a startup called™ 'eh? Get me some of that Silicon Valley money. Hmmm.. relatedly, how about™?
Read Jacob's entire NY Times Magazine article. Very thoughtful, analytical take on the issue. He's on Twitter here.
_____________ AnthropoceneDenial


Imagine my surprise.

More to come...

Tuesday, December 4, 2018

Health information, research biases

We are all prone to be afflicted by cognitive biases episodically -- even the "subject matter experts" among us. In health care, biasing ensues way before dx/px/tx efforts take place during patient encounters.

Nive Healthcare Triage video at The Incidental Economist:

Whether unintentional (bad methodology and/or sampling) or deliberate ("spin" to outright fraud), it's a significant problem.


More to come...

Sunday, December 2, 2018

Brief off-topic post on social and "spiritual" healing: the "One Voice" documentary

Our dear friend Mary Ford invited us to attend the Oakland Interfaith Gospel Choir Holiday Concert at the Paramount in Oakland last night. I'd only been dimly aware of them.

My Bad.

iPhone photo from my seat. I ended up lamenting not having brought my big Sony DSLR guns.

It was stunning, inspiring. As an old washed-up guitar player, I've been around a lot of A-list music and performers my whole adult life. This was every bit the equal. World-class. "Twenty Feet From Stardom?" "Muscle Shoals?" "3 Still Standing?" Add another.

And, the band -- sheesh.
I first came to the Bay Area in 1967. The lead singer in our North Beach bar band, Rick Stevens, went on to be the original lead singer for Oakland's eminent Tower of Power band. I still have friendships from those days. I have great affinity for Oakland.
They've produced a finely-crafted, compelling documentary, which has now begun film festival vetting. They sold a limited pre-release stash of DVDs. Of course, I bought one. Watched it today. Brought us to tears. Mostly tears of humbling joy.

"One Voice delves into the lives of four Oakland Interfaith Gospel Choir members and artistic director Terrance Kelly. This film illuminates a group of people from diverse faiths, races, genders, socioeconomic backgrounds, and lifestyles, all with a common goal: to bring joy and inspiration to the stage through black gospel music. By coming from a place of inclusion and acceptance, choir members are able to bridge their differences, embracing the celebrations and challenges that arise along the way.

Gospel music is a rich tradition born from the African-American spiritual during America's slavery period and the civil rights movement. Slaves used gospel to cope through the misery of bondage and civil rights activists sang gospel music to urge action and find courage. In the midst of a country that again finds itself grappling with issues of race, gender equality, and intolerance, a group in Oakland, California, continues the rich historical tradition of using music to promote peace, love, and acceptance.

With a rich history that spans three decades, OIGC has inspired audiences all over the world. The choir delivers its world-class music across the globe, thrilling concert attendees at renowned venues such as the Montreux Jazz Festival and the Molde International Jazz Festival. Yet it stays true to its Oakland roots, lifting the spirits of the homeless, elderly, and inmates throughout the San Francisco Bay Area. From its humble beginning to OIGC’s 30th anniversary celebration on the historic Paramount Theatre stage, this choir continues to circulate musical excellence through the manifestation of One Voice."
The tagline for my friends' band in Las Vegas is "Let the Healing Begin." I got some serious healing last night. Lordy, Mercy!