The KHIT Blog: The Amazon Health IT play

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:

"Amazon Comprehend Medical"

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.

UPDATE FROM STATNEWS

How traditional pharmacies can survive the Amazon threat
By VIK PANDA DECEMBER 13, 2018

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?

PERSONAL ERRATUM

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.

UPDATE: ON DECK

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 julia.belluz@voxmedia.com 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...

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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
___

"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
___

"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
___

"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
___

"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
___

"'Solutions' exist only in mathematics."

- Karen Martin
___

"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
___

"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Wednesday, December 12, 2018

The Amazon Health IT play

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