NLP, meet NPE: the curious case of Robert Budzinski

Robert Lucius Budzinski, of 1106 Edgewood Drive, Richardson, TX 75081, patent infringement plaintiff asserting to be the "sole inventor" of the Natural Language Processing (NLP) technology alleged wrongfully used by a breadth of major tech corporations. He is reported to be suing a number of them, e.g., Nuance, Google, Apple, Microsoft, and Amazon.

"NLP, meet NPE"

"NPE" is intellectual property legalese for "Non-Practicing Entity."

Otherwise known as a "patent troll." Mr. Budzinski is the owner/"President"/"Director"/"Registered Agent" (and sole "employee") of "Word to Info, Inc.," a private corporation (operating out of his residence) that apparently produces no discernible products or services (a "NPE"). A "company" with no internet presence of any sort -- if you exclude Mr. Budzinski's LinkedIn page:

That's it in its entirety. No employment or education history, no accomplishments or interests, no connections, no nothing. Zip, zilch, nada, nyet.

I did find Plaintiff's Counsel info in one of the lawsuit filings:

Steven R. Daniels
Texas State Bar No. 24025318
FARNEY DANIELS PC
800 South Austin Ave., Suite 200
Georgetown, Texas 78626
Email: sdaniels@farneydaniels.com
Telephone: (512) 582-2828
Fax: (512) 582-2829

James R. Gourley
Texas Bar No. 24050679
CARSTENS & CAHOON, LLP
13760 Noel Road, Suite 900
Dallas, Texas 75240
Email: james@cclaw.com
Telephone: (972) 367-2001
Fax: (972) 367-2002
Attorneys for Plaintiff
Word to Info, Inc.

I routinely search Google news and other internet sources for anything new on "natural language processing" (NLP), looking in particular for stuff relating to the health care space. Recall my prior posts on the topic, here, here, and here.

I ran across this at AppleInsider.com:

Apple's Siri latest target in string of natural language patent lawsuits
By Mikey Campbell

One-man company Word to Info on Friday expanded a string of patent lawsuits over natural language processing technology — active cases involve Amazon, Google, Microsoft and Nuance — to include Apple, taking specific aim at the tech titan's Siri virtual assistant.

Filed in the patent holder-friendly Eastern Texas District Court, Word to Info's suit alleges infringement of seven patents detailing methods of natural language processing. The company asserted the same series of patents against a number of tech industry giants marketing their own voice recognition and virtual assistant solutions.

Specifically, Word to Info is leveraging U.S. Patent Nos. 5,715,468, 6,138,087, 6,609,091, 7,349,840, 7,873,509, 8,326,603 and 8,688,436 in its case against Apple. The IP string covering methods of interpreting natural language input dates back to 1998, when the U.S. Patent and Trademark Office granted the '468 property to inventor and Word to Info director Robert Budzinski...

I did a cursory review of all seven patent filings listed in the article. They total about 2,100 pdf printable pages of dense detail -- most of the content repetitiously redundant.

UPDATE: the most recent (08/18/17) TX court filing -- against Apple -- by this plaintiff here (49 pg pdf). The suit alleges seven "Claims for Action," each of them mapping to the Budzinski patents set forth and linked above.

The "abstracts" from all of the Budzinksi patents, from the oldest to the most recent:

Abstract
A memory system for storing and retrieving experience and knowledge with natural language. The primary components of this memory system include syntactic processes, function word processes, morphology processes, ellipsis processes, concrete and abstract noun word sense number processes, verb word sense number processes, adjective word sense number processes, purpose identification processes, plausibility and expectedness processes, communication processes, context storage processes, and text generation processes. The syntactic processes include word isolation, dictionary look up, and parsing. The function word processes select and evaluate functions associated with function words which are certain: adjectives, nouns, verbs, adverbs, pronouns, prepositions, conjunctions, and interjections. Morphology processes replace morphological words with phrases or clauses composed of function words arid state representation words. Certain nouns, verbs, and adjectives are state representation words. Selecting the word sense number of a state representation word selects the state representation of such a word. Experience and knowledge are stored as clause implying word sense numbers organized into paths in a directed graph.

Abstract
A memory system for storing and retrieving experience and knowledge with natural language through methods and apparatus is disclosed. The primary components of this memory system include syntactic processes, function word processes, ellipsis processes, morphology processes, meaning word sense number processes, purpose identification processes, plausibility and expectedness processes, communication processes, context storage processes, and text generation processes. The function word processes select and evaluate functions associated with function words which are certain words in each part of speech. Ellipsis processes replace unstated words. Morphology processes replace morphological words with phrases or clauses composed of function words and word sense numbers. A word sense number is an address to the meaning of a word. Certain nouns, verbs, and adjectives are meaning words. Word sense numbers are selected to be consistent with the context of the clause containing the words, the context, and stored experience and knowledge. Experience and knowledge are stored as nodes with associated clause implying word sense numbers organized into paths in a directed graph. Nodes in the directed graph have access conditions which determine if a node is accessible on a path. A path has an associated purpose relation which is any concept that labels the path. Purpose identification processes select: purpose relations, experience and knowledge, processes for setting a verb's result states or a state value, object classification paths, and activity selection paths. The communication processes coordinate incoming and outgoing natural language text. Text generation processes generate natural language text from word sense numbers.


Abstract
A memory system for storing and retrieving experience and knowledge with natural language through methods and apparatus is disclosed. The primary components of this memory system include syntactic processes, function word processes, ellipsis processes, morphology processes, meaning word sense number processes, purpose identification processes, plausibility and expectedness processes, communication processes, context storage processes, and text generation processes. The function word processes select and evaluate functions associated with function words which are certain words in each part of speech. Ellipsis processes replace unstated words. Morphology processes replace morphological words with phrases or clauses composed of function words and word sense numbers. A word sense number is an address to the meaning of a word. Certain nouns, verbs, and adjectives are meaning words. Word sense numbers are selected to be consistent with the context of the clause containing the words, the context, and stored experience and knowledge. Experience and knowledge are stored as nodes with associated clause implying word sense numbers organized into paths in a directed graph. Nodes in the directed graph have access conditions which determine if a node is accessible on a path. A path has an associated purpose relation which is any concept that labels the path. Purpose identification processes select: purpose relations, experience and knowledge, processes for setting a verb's result states or a state value, object classification paths, and activity selection paths. The communication processes coordinate incoming and outgoing natural language text. Text generation processes generate natural language text from word sense numbers.

Abstract
A memory system for storing and retrieving experience and knowledge with natural language through methods and apparatus is disclosed. The primary components of this memory system include syntactic processes, function word processes, ellipsis processes, morphology processes, meaning word sense number processes, purpose identification processes, plausibility and expectedness processes, communication processes, context storage processes, and text generation processes. The function word processes select and evaluate functions associated with function words which are certain words in each part of speech. Ellipsis processes replace unstated words. Morphology processes replace morphological words with phrases or clauses composed of function words and word sense numbers. A word sense number is an address to the meaning of a word. Certain nouns, verbs, and adjectives are meaning words. Word sense numbers are selected to be consistent with the context of the clause containing the words, the context, and stored experience and knowledge. Experience and knowledge are stored as nodes with associated clause implying word sense numbers organized into paths in a directed graph. Nodes in the directed graph have access conditions which determine if a node is accessible on a path. A path has an associated purpose relation which is any concept that labels the path. Purpose identification processes select: purpose relations, experience and knowledge, processes for setting a verb's result states or a state value, object classification paths, and activity selection paths. The communication processes coordinate incoming and outgoing natural language text. Text generation processes generate natural language text from word sense numbers.

Abstract
A memory system for storing and retrieving experience and knowledge with natural language through methods and apparatus is disclosed. The primary components of this memory system include syntactic processes, function word processes, ellipsis processes, morphology processes, meaning word sense number processes, purpose identification processes, plausibility and expectedness processes, communication processes, context storage processes, and text generation processes. The function word processes select and evaluate functions associated with function words which are certain words in each part of speech. Ellipsis processes replace unstated words. Morphology processes replace morphological words with phrases or clauses composed of function words and word sense numbers. A word sense number is an address to the meaning of a word. Certain nouns, verbs, and adjectives are meaning words. Word sense numbers are selected to be consistent with the context of the clause containing the words, the context, and stored experience and knowledge. Experience and knowledge are stored as nodes with associated clause implying word sense numbers organized into paths in a directed graph. Nodes in the directed graph have access conditions which determine if a node is accessible on a path. A path has an associated purpose relation which is any concept that labels the path. Purpose identification processes select: purpose relations, experience and knowledge, processes for setting a verb's result states or a state value, object classification paths, and activity selection paths. The communication processes coordinate incoming and outgoing natural language text. Text generation processes generate natural language text from word sense numbers.

Abstract
A memory system for storing and retrieving experience and knowledge with natural language through methods and apparatus is disclosed. The primary components of this memory system include syntactic processes, function word processes, ellipsis processes, morphology processes, meaning word sense number processes, purpose identification processes, plausibility and expectedness processes, communication processes, context storage processes, and text generation processes. The function word processes select and evaluate functions associated with function words which are certain words in each part of speech. Ellipsis processes replace unstated words. Morphology processes replace morphological words with phrases or clauses composed of function words and word sense numbers. A word sense number is an address to the meaning of a word. Certain nouns, verbs, and adjectives are meaning words. Word sense numbers are selected to be consistent with the context of the clause containing the words, the context, and stored experience and knowledge. Experience and knowledge are stored as nodes with associated clause implying word sense numbers organized into paths in a directed graph. Nodes in the directed graph have access conditions which determine if a node is accessible on a path. A path has an associated purpose relation which is any concept that labels the path. Purpose identification processes select: purpose relations, experience and knowledge, processes for setting a verb's result states or a state value, object classification paths, and activity selection paths. The communication processes coordinate incoming and outgoing natural language text. Text generation processes generate natural language text from word sense numbers.

Abstract
A memory system for storing and retrieving experience and knowledge with natural language through methods and apparatus is disclosed. The primary components of this memory system include syntactic processes, function word processes, ellipsis processes, morphology processes, meaning word sense number processes, purpose identification processes, plausibility and expectedness processes, communication processes, context storage processes, and text generation processes. The function word processes select and evaluate functions associated with function words. A word sense number is an address to the meaning of a word. Word sense numbers are selected to be consistent with the context and stored experience and knowledge. Experience and knowledge are stored as nodes with access conditions and with associated clause implying word sense numbers organized into paths in a directed graph. A path has an associated purpose relation which is any concept that labels the path. Text generation processes generate natural language text from word sense numbers.

Yeah, gave me MEGO as well. Beneath each abstract are dozens of equally dense enumerated "claims" ostensibly setting forth the putative (and obtuse) "operational details" of the "invention." The old jibe "if you can't dazzle 'em with brilliance, baffle 'em with bullshit" comes to mind.

BTW: I just asked Siri on my iPhone 6s (multiple times) "Is Robert L. Budzinski a patent troll?" "She" couldn't accurately process the query. All I got was repeated irrelevant gibberish.

Also of note: I never once encountered in these patent documents the phrase "computational linguistics" (or the word linguistics, for that matter).

Moreover, checking the body text and index of this authoritative reference book I have studied and heretofore cited, no mention of a "Budzinski." You would think that a guy purporting to be the "sole inventor" of a huge chunk of applied AI/NLP (worth potential billions) would have an academic and professional rap sheet a mile long, one that would show up in a boatload in scholarly citations.

Maybe I'm missing something. Not for lack of extensive searching.

UPDATE

You keep digging, using various name/word/phrase combinations and permutations, eventually you find something.

1981. Looks like he worked for T.I. Obviously some kind of microelectronics guy (engineer?). Link to the above paper here. I'd eventually run across an IEEE link citing him as as a co-author on three papers (including the above) around that time (the other two are firewalled in pdf at IEEE).

Still have yet to unearth a C.V. Still smells like "NPE," notwithstanding that his cred has to be up just a notch in my eyes, although technical cred is a separate issue from patent trolling.

There's a ton of reportage on patent trolling, (which has been recently asserted to "cost the economy" $80 billion a year), e.g.,

'THE ULTIMATE PATENT TROLL'
In the words of technology reporters.
MORGAN BASKIN & JACK DENTON

Founded in 2000, Intellectual Ventures "has earned a special brand of hatred in the business world as the ultimate patent troll. It doesn't delay your flight like United, buffer your movie stream like Comcast, or shellac your shrimp with oil like BP. Rather, it hoards ideas." It "goes around to companies and says: 'Hey, you want to protect yourself from lawsuits? We own tons of patents. Make a deal with us. Our patents will not only cover everything you're doing in your business, no one will dare sue you." "It then wields this intellectual-property portfolio—the world's largest—like a weapon. Companies can either pay up or face a lawsuit.”…

__

Back to Budzinski...

"PLAINTIFF DEMANDS A JURY TRIAL"

But of course he would.

In 1991 I took a gig as the Technical Editor (pdf)  for "CSI" ( Computational Systems, Inc., of West Knoxville TN). It was a small recent startup founded by two PhD industrial-electrical engineers who were alumni of a larger competitor (TEC). We designed, built, and marketed digital Fast Fourier Transform (FFT) industrial analyzers. We were staffed up with hardhat assembly and C language programmers writing tight code straight to the chip clocks.

A great, fun job. Heady stuff. Kind of an Appalachian "Silicon Valley" loosey-goosey culture producing then-state of the art portable industrial digital tech (we were just across the pike east of Oak Ridge, where I'd spent the prior five and a half years in a radiation lab writing code). My department was an "artsy" Mac shop, basically an in-house ad agency doing magazine-quality 4-color digital pre-press.

Well, our competitor sued us for patent infringement, based on asserted purloined IP (essentially a de facto "non-compete" "leave your brain at the door" case). We were killing them in sales (owing more to our assiduous customer service and support than to our technologies per se). They retaliated.

And they won. Jury trial. Crippling monetary judgment. Only one juror had beyond a high school education. [Technology For Energy Corporation v. Computational Systems, Inc., et al., (E.D. Tenn., Fed. Cir.) (Patent infringement litigation)]

I survived the ensuing layoffs.

Wasn't a patent troll thing, but I will never forget the turmoil. In July of 1992 I left to move to Las Vegas in the wake of my wife's transfer and promotion to manage QA at the Nevada Test Site nuke cleanup project.

I then took an analyst/LAN manager job with the Nevada Medicare QIO (HealthInsight, then known as Nevada Peer Review). I recall during my first stint (of three) with them a discussion one day concerning an ortho doc who did more than a quarter of all hip jobs in the state. Owing to the relatively high efficacy of his px, he sought to patent his surgical "method."

Lordy. The blowback was pretty severe. I don't think he ever went through with it.

BTW, a good, quick read on intellectual property fundamentals and issues:

"We all create intellectual property. We all use intellectual property. Intellectual property is the most pervasive yet least understood way we regulate expression. Despite its importance to so many aspects of the global economy and daily life, intellectual property policy remains a confusing and arcane subject. This engaging book clarifies both the basic terms and the major conflicts surrounding these fascinating areas of law, offering a layman's introduction to copyright, patents, trademarks, and other forms of knowledge falling under the purview of intellectual property rights..."

I finished this book in short order. Highly recommended survey look into the breadth of sub-topics of IP: patents, copyrights, trademarks, and trade secrets, as well as relatively minor tangentially overlapping areas such as fashion design, internet domain names, and celebrity exclusive use of "likeness." Good discussion of the evolved histories and global differences in IP scope and enforcement.

Recent item: General Mills just (rightfully) lost an IP lawsuit wherein they tried to obtain exclusive trademark rights to the color "yellow," on the grounds that market identification of Cheerios was/is inextricably bound up with it in the product's packaging. Consumers might otherwise be "confused."

The jokes just write themselves.

Jokes aside, we might ask, what is the proper scope of intellectual property ownership enforcement in the law?

If there were only one man in the world, he would have a lot of problems, but none of them would be legal ones. Add a second inhabitant, and we have the possibility of conflict. Both of us try to pick the same apple from the same branch. I track the deer I wounded only to find that you have killed it, butchered it, and are in the process of cooking and eating it.

The obvious solution is violence. It is not a very good solution; if we employ it, our little world may shrink back down to one person, or perhaps none. A better solution, one that all known human societies have found, is a system of legal rules explicit or implicit, some reasonably peaceful way of determining, when desires conflict, who gets to do what and what happens if he doesn’t…

Friedman, David D.. Law's Order: What Economics Has to Do with Law and Why It Matters (p. 3). Princeton University Press - A. Kindle Edition. 

I have not the slightest doubt that, were I to query Budzinski's patent attorneys, I'd be met with harrumphingly indignant, derisive (albeit utterly self-serving) paternalistic pushback lecturing down to me about the Altruistic Nobility of their tireless work in defense of "the little guy."

A planet populated by more than 7 billion contending people is a complicated place. Our technologies are complicated, ever-moreso. Necessarily, our laws are increasingly complicated. And, among the most complex among them are the laws going to IP. Nonetheless, to the extent that IP filings are woefully obtuse, dense documents riddled with verbose, redundant, vague, ambiguous, often internally inconsistent jargon-language, they seem to principally only serve the lawyers whom they mostly enrich.**

** A similar observation can be made in general about legislation and the regulations they authorize. Overcomplexity and lack of clarity in law inevitably beget legal challenges, where the courts have to try to clean up the messes.

For one thing, perhaps "Loser Pays" IP litigation reform might serve to mitigate the excesses in this area. (Ohhh... the poignant wailing that that notion produces in tortland!) I also have to wonder how IP litigation firms' expenses are covered prior to judgments or settlements? Is this stuff typically done on "spec?" And, are there the equivalent of "VC/investment funds" bankrolling these actions? I seriously doubt that our NLP boy Rob is paying out of pocket by the billable hour.

 THE NPE AT SILICON VALLEY HBO

LOL.

CODA

Pretty interesting read at The New Yorker:

Who Owns the Internet?
What Big Tech’s monopoly powers mean for our culture.
By Elizabeth Kolbert

...Thirty years ago, almost no one used the Internet for anything. Today, just about everybody uses it for everything. Even as the Web has grown, however, it has narrowed. Google now controls nearly ninety per cent of search advertising, Facebook almost eighty per cent of mobile social traffic, and Amazon about seventy-five per cent of e-book sales...

And Rob Budzinski wants him a piece of all that. "Rentier?"

Relatedly,

Google Just Proved That Monopolies Imperil Democracy, Not Just The Economy
Barry Lynn and his team of anti-monopoly researchers were fired by a think tank after criticizing the search giant.

WASHINGTON ― For the past decade, former business journalist Barry Lynn has used his perch at the New America Foundation to warn politicians and the public that a new era of corporate monopolies threatened not only American workers, but also democracy itself.

Lynn was just proven right: New America has fired him as head of its Open Markets program along with his team of about 10 researchers and journalists, after they called for an antitrust investigation of the think tank’s largest longtime donor, Google…

Naked Capitalism is also on the story: "New America Foundation Head Anne-Marie Slaughter Botches Laundering Google’s Money, Fires Anti-Trust Team at Eric Schmidt’s Behest."

OH, AND, ANOTHER THING,

apropos, read this in my AAAS Science Magazine:

Fostering reproducibility in industry-academia research
Science  25 Aug 2017:
Vol. 357, Issue 6353, pp. 759-761
DOI: 10.1126/science.aan4906

Many companies have proprietary resources and/or data that are indispensable for research, and academics provide the creative fuel for much early-stage research that leads to industrial innovation. It is essential to the health of the research enterprise that collaborations between industrial and university researchers flourish. This system of collaboration is under strain. Financial motivations driving product development have led to concerns that industry-sponsored research comes at the expense of transparency (1). Yet many industry researchers distrust quality control in academia (2) and question whether academics value reproducibility as much as rapid publication. Cultural differences between industry and academia can create or increase difficulties in reproducing research findings. We discuss key aspects of this problem that industry-academia collaborations must address and for which other stakeholders, from funding agencies to journals, can provide leadership and support…

Barriers to Sharing
Efforts to promote reproducible research have varied. One widely supported strategy is to increase the availability of data produced in studies, along with computer code written to clean and analyze data. Publishers and funders have instituted policies mandating data deposition or data management plans; however, success has not been uniform.

There are disincentives to open sharing of information. For academic research, rewards come from public presentations and publications that lead to recognition within the community, grants, and tenure. The emphasis on publications to reap academic rewards means that academic researchers can be reluctant to release information or even to fully describe their work. In industry, publishing is typically not a high priority; the goals are the provision of a product (whether goods or services) that will outstrip competitors and provide monetary rewards to investors. The need to obtain patents or maintain trade secrets to protect intellectual property (IP) can provide a strong financial incentive to not disclose or share information. Corporations see relatively little advantage to releasing data for research purposes, so any nonzero risk of consequences (even if only hypothetical) can be sufficient to shut down such efforts…

The Creative Commons license CC0 (which waives all rights of data authors) is attractive as it does not require data sets to have a “provenance” trail and can thus ease automated mining of data. However, lack of provenance tracking in CC0 creates challenges for data evaluation, interpretation of analyses, and accreditation of data generators, thus making CC-BY (in which author attribution is required) attractive. Both continue to be discussed as aspirational goals.

Irreproducible research wastes time, money, and resources. Academic researchers, universities, and other institutions, industry, funding agencies, and editors all have a role to play in raising research standards and creating an environment of trust between communities.

Hmmm... For one thing, I refer you to this book I cited a while back (scroll down):

____________

More to come...

Hurricane Harvey and its terrible continuing aftermath

Just wow. Been following developments on the news all weekend. I have friends there. I'd planned to next write about Natural Language Processing in the context of the latest Patent Troll lawsuit. It can wait a bit.

This eclipses Hurricane Katrina. It's mid-day Monday as I post this, and the torrential rain and flood emergency persists and worsens (and is probably going to impact New Orleans by week's end). I am reminded of my posts about Katrina a year ago, When does "practicing medicine" become "Playing God?" and Shards writ large. Health care fragmentation disaster response implications.

Everyone schlepping around in that sewage and chemical soup "water" might want to have hepatitis shots.

to wit,

Hurricane Harvey May Leave Behind Health Hazards in Water

UPDATE

The Houston Hospital Running Out of Food
Ben Taub Hospital is surrounded by water, and an evacuation attempt failed Sunday night.

__

TUESDAY MORNING 

Unreal. Below, downtown Houston underwater.

____________

More to come...

On deck, the 2017 Health 2.0 Conference, Oct 1-4

"This October 2,000 of the best and brightest will gather to discuss, witness, and share the leading cutting-edge innovations transforming today’s global health care system. Health 2.0’s flagship event connects thought leaders, providers, innovators, investors, and start-ups for four days packed full of curated discussions, demos, exhibits and networking…"

AGENDA    REGISTRATION    HOTEL

Conference block rate for the onsite Hyatt Regency hotel expires Sept 7th. Mercifully, the NFL 49ers play Arizona at Arizona on October 1st, so there won't be that huge traffic mess around Levi Stadium.

I booked my hotel rez starting on Saturday September 30th so I can hit the ground running Sunday morning. Joe Flower will keynote the Provider Symposium Sunday morning.

BTW, Sept 30th is the final day of federal FY 2017. President Trump is threatening a government shutdown to try to coerce congressional funding of his Mexico Wall (yeah, right). More seriously, the "Freedom Caucus" right wing Tea Party faction of the GOP wants another federal shutdown to try to get their way on the federal debt ceiling. My note on this now-hardy perennial a couple of years ago on another of my blogs:

Let's be very clear here: While "defunding" and transiently shutting down the government by failing to pass budget legislation is a political act within the bounds of tripartite government (notwithstanding its inanity), intentionally defaulting on the public debt is a separate and explicit Constitutional violation of legislative branch members' Oaths of office -- notwithstanding the GOP extremists' conflating attempt to glom it all together. to wit,

Section 4 of the 14th Amendment declares that "the validity of the public debt shall not be questioned." Section 5 subsequently states that the Congress has the sole responsibility over this question.

More broadly, as set forth in Article I, Sections 7 and 8, only Congress has the authority to appropriate funds and levy taxes. They can appropriate funds by raising taxes and/or borrowing from the private credit markets in the name of the nation. If they choose the latter, they are required to see to it that payment is always honored, even should that mean raising taxes or cutting other program expenditures. Neither the President not the Supreme Court has any Constitutional authority here. Should honoring the public debt require a presidential veto override, so be it. Muster the requisite votes. Should it require taking out "poison pill" provisions in order to pass debt service legislation, so be it. Those are among the legitimate mechanics of governance, in this case devolving to the Congress and no other entity...

During the 2013 Health 2.0 Conference we had a number of federal officials in attendance (e.g., ONC, CMS) to speak. Because of the 2013 federal shutdown they had to leave early and return to DC.

We'll see.

HIMSS

Interestingly, this will be the first Health 2.0 Conference under HIMSS ownership (should we call it "The 1st Annual HIMSS 2.0 Conference?")

I find it a bit curious that there is no prominent, static mention/link (as of today) regarding the 2017 Health 2.0 Conference on the HIMSS homepage. What's up with that? (Mention of the Conference does appear transiently amid a rotating group of small horizontal banner ads at the top of the page. Hit "Ctrl-R" repeatedly to see if you can get it to pull up.)

I went to the HIMSS Facebook page.

OK. Nyet. Nada. Zilch.

They do cite this on the HIMSS homepage at the right side "top of the fold":

Interesting timing overlap. I just searched through the agenda. Maybe I've missed something, but I see no mention of "Health IT Week." (Neither do repeated spelling-variant searches on the health2con.com site turn up any mention.) Wonder if they'll have an exhibit hall booth presence?

Now that HIMSS owns the Health 2.0 Conferences, I hope I don't get any photography grief, like I encountered at the HIMSS16 closing Keynote.

BTW, loves my New Yorker...

NLP on the agenda?

Searching the conference agenda also fails to turn up any mention of the acronym "NLP" or its referent phrase "Natural Language Processing," on which I've previously ruminated here and here.

I continue to study and follow the topic. Ran across this the other day (which I've excerpted below):

FDA, UCSF-Stanford CERSI, and San Francisco State University Collaborative WorkshopJune 15, 2017

Goals and Objectives:
The objective of this workshop was to identify current and emerging natural language processing (NLP) efforts being applied to unstructured text such as clinical notes or narratives in electronic health records (EHRs). The workshop provided insights into utility and challenges in designing and implementing NLP systems to capture relevant or missing information from clinical notes or text for conducting postmarketing safety surveillance and informing the design and execution of clinical trials for medical products, which include drugs, biologics, and devices. The workshop included panel discussion sessions to provide stakeholders with a forum to discuss natural language processing with experts in the field.

The workshop focused on whether NLP can be applied to unstructured text in clinical notes to:

• Identify indication or reason for medical product use, adverse outcomes or events associated with use of these products, and confounders or personal behaviors that may modify risks associated with use of these products
• Support protocol design, feasibility, recruitment efforts and execution of clinical trials

Use of Natural Language Processing to Extract Information from Clinical Text: Summary of the FDA Workshop
 
A public workshop organized by the U.S. Food and Drug Administration (FDA), the UCSF-Stanford Center of Excellence in Regulatory Science and Innovation (UCSF-Stanford CERSI), and San Francisco State University was held at the FDA White Oak Campus on June 15, 2017. The objective of the workshop was to identify current and emerging natural language processing (NLP) efforts being applied to unstructured text such as clinical notes or narratives in electronic health records (EHRs)…

While this workshop focused on NLP, it was noted by several speakers that it is only one part of the solution pipeline (sequence of software tools) – it is most often preceded by complex data acquisition and pre-processing, and followed up with some combination of machine learning or rule-based systems to produce desired decisions or interpretations. In many cases, NLP is in fact performed as a set of rules, or has been replaced with text mining and statistical methods with good success in specific areas especially when a large number of records are available. 

Classical NLP technology, designed for regular text, encounters significant challenges in processing information from clinical text in medical records such as EHRs. The challenges come from two key areas: a) NLP was not originally designed to process data in this format and with the “noise” inherent in EHRs, and b) most NLP algorithms require large gold standard databases for training ground truth data, which are hard to come by. It was also noted that for NLP to be successful in these areas, it will need to adequately handle negative statements (negations) and medical context. 

In spite of the above challenges, a literature review presented by one of the speakers showed that NLP and related methods were successful for some specific applications (e.g., radiology diagnosis, filling in certain EHRs, extraction of specific medical terms, etc.). Since each of these applications were developed separately, the issue of generalization remains.

To move forward, several possible approaches and directions were identified by one or more speakers/panelists:

• Given that NLP is only part of the analysis pipeline that may include (deep) machine learning, it is important to optimize the whole pipeline, from data capture to final data/decision representation.
• Leveraging new analytics methods that reduce dependence on large training databases (e.g., deep learning, CNN, text mining etc.) would be beneficial.
• Developing general solutions using a single generalizable NLP/analytics method is difficult, so it may be worthwhile to work on solving specific problems first, then analyzing commonalities among successful solutions, leading to possible generalizations…

DATA
Electronic Health Records (EHRs) and other structured clinical documents were originally designed for very different purposes (patient care, billing, reporting). The clinical notes or text contained in these documents may contain additional information and context about the medical encounter but the clinical information it contains is non-standardized, has errors, typos, omissions and often miss key information necessary for envisioned FDA applications (e.g., confounders, prescriber and patient intent or behavior). This poses significant challenges for classical NLP tools designed to work on regular text. Further complicating the situation, the applications of NLP addressed at the workshop are many, and often require information and context not originally coded or missing in EHRs and related documents (e.g., confounders, temporal components, state of instrumentations)…

Leveraging a variety of complementary data sources (including other patient records, observations during the exam etc.) in addition to EHRs would help to provide missing information, redundancy, as well as context, all of which are important for making the correct decisions…

TOOLS AND RESOURCES
The following ideas were suggested by one or more speakers/panelists as possibilities to help develop tools…


• Using and leveraging best practices of open source software.
• Developing software environments in the form of interactive workbench where one can easily create and test analytic pipelines (aggregate of software tools used) by integrating available tools, as has been done for other areas.
• Provide and disseminate open source NLP and machine learning tools with adequate distribution, licensing and documentation.

Availability of accessible, easy to share gold standard databases remains critical. The positive experience of other areas on machine learning where such databases have helped to make significant advances needs to be leveraged. This remains, however, a technical/cost issue as well as a policy and legal issue due to data privacy considerations…

Recall from my earlier posts, there are two materially differing subtopics: [1] NLG, Natural Language Generation (expressing "structured" numerical data and informatics codes in narrative form -- relatively old news), and [2] NLU, Natural Language Understanding, the far more difficult area (and the focus of my abiding dubiety).

Hope I find some good NLP stuff at the Conference (amid my myriad other topics of KHIT interest).

UPDATE: NLP NEWS ITEM

Apple's Siri latest target in string of natural language patent lawsuits
One-man company Word to Info on Friday expanded a string of patent lawsuits over natural language processing technology — active cases involve Amazon, Google, Microsoft and Nuance — to include Apple, taking specific aim at the tech titan's Siri virtual assistant.

Interesting. A "patent troll?" At first blush, looks like one to me. Bears watching.

ON THE VENTURE CAPITAL COMMUNITY

A staple of Health 2.0 events involves panels of Silicon Valley VCs. Below, an interesting read (particularly in the wake of the persistent troubles at Uber, and the misfortunes of bro'grammer #GoogleManifesto Man):

In December 2010, Sheryl Sandberg gave a talk about women’s leadership in which she mentioned “sitting at the table.” Women, she said, have to pull up a chair and sit at the conference-room table rather than clinging to the edges of the room, “because no one gets to the corner office by sitting on the side.”

Less than a year later, I would take those words to heart. I had been working for six years at the Silicon Valley firm Kleiner Perkins Caufield & Byers as a junior partner and chief of staff for managing partner John Doerr. Kleiner was then one of the three most powerful venture-­capital firms in the world. One day, I was part of a small group flying from San Francisco to New York on the private jet of another managing partner, Ted Schlein. I was the first to arrive at Hayward Airport. The main cabin of the plane was set up with four chairs in pairs facing each other. Usually the most powerful seat faces forward, looking at the TV screen, with the second most powerful next to it. Then came the seats facing backward. I was sure the white men booked on the flight (Ted, senior partner Matt Murphy, a tech CEO, and a tech investor) would be taking those four seats and I would end up on the couch in back. But Sheryl’s words echoed in my mind, and I moved to one of the power seats — the fourth, backward-facing seat, but at the table nonetheless. The rest of the folks filed in one by one. Ted sat across from me, the CEO next to him, and the tech investor next to me on my right. Matt ended up with what would have been my original seat on the couch.

Once we were airborne, the CEO, who’d brought along a few bottles of wine, started bragging about meeting Jenna Jameson, talking about her career as the world’s greatest porn star and how he had taken a photo with her at the Playboy Mansion. He asked if I knew who she was and then proceeded to describe her pay-per-view series (Jenna’s American Sex Star), on which women competed for porn-movie contracts by performing sex acts before a live audience.

“Nope,” I said. “Not a show I’m familiar with.”

Then the CEO switched topics. To sex workers. He asked Ted what kind of “girls” he liked. Ted said that he preferred white girls — Eastern European, to be specific.

Eventually we all moved to the couch for a working session to help the tech CEO; he was trying to recruit a woman to his all-male board. I suggested Marissa Mayer, but the CEO looked at me and dismissively said, “Nah, too controversial.” Then he grinned at Ted and added, “Though I would let her join the board because she’s hot.”

Somehow, I got the distinct vibe that the group couldn’t wait to ditch me. And once we landed at Teterboro, the guys made plans to go to a club, while I headed into Manhattan alone. Taking your seat at the table doesn’t work so well, I thought, when no one wants you there. (When Sandberg’s book Lean In came out, that same Jenna Jameson–obsessed CEO became a vocal spokesperson for it.)

Seven months later, I would sue Kleiner Perkins for sexual harassment and discrimination in a widely publicized case in which I was often cast as the villain — incompetent, greedy, aggressive, and cold. My husband and I were both dragged through the mud, our privacy destroyed. For a long time I didn’t challenge those stories, because I wasn’t ready to talk about my experience in detail. Now I am…

Yikes. Read all of it. (a fairly long read). I ran into it here. Just an excerpt from her forthcoming book Reset.

Interesting, accomplished, scary-smart woman. Same age as my younger daughter.
____________

More to come...

The "opioid epidemic" and the EHR

From The New Yorker (my new hardcopy arrived in the snailmail today):

"...the President pointed out, again, that once a person starts using drugs it is “awfully tough” to get him off, but suggested that the problem might be avoided by telling young people that drugs are “no good, really bad for you in every way.” His wife, Melania, sat beside him, as if to echo Nancy Reagan’s support of the “Just say no” campaign during her husband’s Administration. But that message seems particularly inappropriate, given the epidemiology of this drug crisis: the first person many addicts would have to say no to is a health-care provider…"

Certainly getting a ton of media coverage across the last year or so. I can't claim to have done any deep study here going to the prevalence and incidence trends of late with respect to opioid class Rx adversity. But, particularly in light of the President's (typically) confused assertion above, I do worry about (ulterior motive?) "conflation" -- "the first person many addicts would have to say no to is a health care provider" -- i.e., illegal street drugs vs. inappropriately, overused nominally legit Rx. As I reported in 2015,

I've had my own issues with proper "pain management" Rx obstruction:

...Tramadol 50 mg. I have some bulging disks and pinched nerves ("cervical and lumbar spondylosis with myelopathy"), in part the upshot of too many years of getting the crap knocked out of me while pursuing my absurd decades-long full-court Hoop Dreams, (I have the attestational eyebrow suture scars, and torn meniscal and MCL vestiges), followed by too many recent years of too much sitting, reading, and blogging for hours and days on end.

I usually took one Tramadol a day, in the early morning upon arising (even though the scrip said 'one every 4-6 hours as needed'). On bad days, I'd drop a 2nd one mid-day. They helped. Materially.

Given that DEA recently "rescheduled" Tramadol, I can't help but wonder whether my young doc wants to keep his fingerprints off the Rx. I'd given him my entire longitudinal Hx from my Vegas Primary, dumped from the EHR. I fail to see the point of doing an expensive encounter with yet another physician -- one who doesn't know me, and who will have to redundantly (and expensively) read the chart, listen to (or blow off) my CC Subjective, and either bless or deny the simple Rx request...

My current Muir Primary writes me for Meloxicam. 1x/day.

Works acceptably (if not quite as well). It's a NSAID, not an opioid. I'm largely over my irascible Tramadol snit.

More from The New Yorker piece:

During the 2016 Presidential campaign, when Donald Trump was asked about the opioid crisis he often mentioned that he first learned about the severity of the situation in New Hampshire, which he visited several times ahead of that state’s primary. In 2014, after West Virginia, New Hampshire had the second-highest rate of death from opioid and heroin overdoses, at twenty-two out of every hundred thousand residents. (In 2015, there were more than thirty thousand such deaths nationwide, and the rate is projected to rise.)

As Trump heard more about addiction, he began speaking about it at rallies and, sometimes, in personal terms. Five days before the New Hampshire primary, at an event in Manchester, Trump talked about his older brother, Fred, who died in 1981, following a long battle with alcoholism. “He had everything,” Trump said. “I mean, the most handsome guy. And then he got hooked and there was nothing—and by the way, nothing you could do about it.” A woman sitting behind him nodded in agreement, as others in the room listened, rapt. Yet, as much as people empathized with Trump’s conclusion that he was, on an individual level, powerless in the face of his brother’s addiction, some of them voted for him because he also claimed, with increasingly sweeping rhetoric, that he, and perhaps only he, could “solve” the national crisis.

Last Tuesday, the President attended a “major briefing” on the epidemic with the Secretary of Health and Human Services, Tom Price, and other aides, at his golf club in Bedminster, New Jersey. They had with them a draft report that had been prepared by a special commission chaired by Governor Chris Christie, of New Jersey. The draft is rich in recommendations for channelling additional resources to the crisis. One is that naloxone, an anti-overdose drug known commercially as Narcan, be provided to first responders at a lower cost. Another would expand the definition of the kinds of in-patient facilities that are eligible for reimbursement under Medicaid, which the authors say is the quickest way to get help to a large number of people. In fact, the report demonstrates the crucial role that Medicaid plays in addressing the crisis, and the program’s still greater potential for combatting it. (The report also helps explain why Senator Mitch McConnell had a hard time getting colleagues from states hit hard by opioids to sign on to an Obamacare repeal that called for gutting Medicaid.)

Trump, however, gave no sign of rethinking his approach to funding these public-health initiatives. Instead, before he upended the briefing with his threat to consume North Korea with “fire and fury,” he had focussed his remarks on finger-pointing and punitive measures. The opioid crisis, he said, is the fault of the Mexicans and the Chinese, who allow drugs to be sent from their nations to ours. The metric that he offered for success in handling the problem domestically was the number of federal drug prosecutions brought and the average length of prison terms they produced. Both have dropped since 2011, which the President sees as evidence not of a bipartisan consensus on the need for sentencing reform but as proof of the laxity and the bad faith of members of the Obama Administration, who, he said, had “looked at this scourge, and they let it go by.”

Attorney General Jeff Sessions has already instructed federal prosecutors to pursue charges yielding the maximum possible prison terms, and revoked earlier guidelines designed to avoid harsh mandatory minimum sentences in cases involving nonviolent drug offenders. This promises to expand the practice of mass incarceration, with people cycling in and out of prison without receiving treatment, and further generations of children being exposed to disruption, broken families, and, potentially, their own susceptibility to what painkillers seem to offer.

At the briefing, the President pointed out, again, that once a person starts using drugs it is “awfully tough” to get him off, but suggested that the problem might be avoided by telling young people that drugs are “no good, really bad for you in every way.” His wife, Melania, sat beside him, as if to echo Nancy Reagan’s support of the “Just say no” campaign during her husband’s Administration. But that message seems particularly inappropriate, given the epidemiology of this drug crisis: the first person many addicts would have to say no to is a health-care provider…

U.S. ATTORNEY GENERAL JEFFERSON BEAUREGARD SESSIONS III

"Marijuana is an extremely dangerous drug ... Good people don't smoke marijuana."

This ignorant cracker never fails to raise my BP. To him, potentially dangerous overmedication problems are likely simply seen as law enforcement problems. For which, perhaps for-profit private prisons might be of assistance.

apropos, I have some distant tangential scholarly history on this topic. From my 1998 graduate thesis (on coercive mass drug testing):

...our government “finds,” on the basis of myriad reports—derived principally from news stories and social science investigative methods of wildly variant quality—that the use of illicit drugs, particularly in the workplace, is a sufficiently adverse social and economic phenomenon to justify the coerced participation of millions of asymptomatic citizens as “donors” of bioassay specimens for chemical metabolite analysis to uncover the presence of forbidden psychoactive recreational toxins. Willing, even eager submission to non-cause drug testing is coming to be seen as the latest variant of the Loyalty Oath, with aspersions cast upon the motives and character of dissenters. Legions of survey researchers provide an endless outpouring of statistics purporting to demonstrate the alarming prevalence and horrific economic and epidemiological costs of drug abuse. Vendors of laboratory services assure us that their technologies are utterly reliable, that only the “guilty” need be concerned. It’s For Our Own Good, we are soothingly told.
 
Is any of this so? Are the enabling laws and policies ethical and wise, grounded in coherent history and viable scientific data? Are such measures critical to public health and safety? Are the analytical procedures and technologies truly effective, and fail-safe to the point of negating reasonable concerns over the possibility of false accusation? Can the nation’s laboratory infrastructure deal competently with the already huge and rapidly increasing sample workload? Is such a forcible deterrence strategy the only feasible option available to us for promoting the health and welfare of both individuals and society as a whole?
 
The questions are timely ones. A spate of expansive and harsh new drug testing legislative proposals is under consideration by the 105th Congress and state legislatures around the nation, and commercial vendors of analytical technologies are rushing to market patented (and, as such, potentially enormously lucrative) alternatives to the conventional urine and blood tests traditionally used in drug bioassay. There now exist methods that use hair and saliva samples, as well as a recently introduced “patch” that, when worn on the skin, ostensibly reveals the presence of illicit compounds. Also recently in the news were reports on the commercial availability of a $20 drug testing “smear kit” called DrugAlert™ that parents are being encouraged to use on their childrens’ clothing, furniture, and possessions if they suspect their kids of drug use. The kits are returned to the vendor for analysis, after which a “confidential” report of findings is mailed back to the parents.
 
How did we arrive at such a state of alarm? The path leading to proposals for a panoptic metabolite surveillance state is a perplexing one...

We have learned nothing.

 
Welcome to Trump's "Just Say No" v2.0.

Trump Declares National Opioid Emergency (August 12th)

President Trump declared the opioid crisis a "national emergency" on Thursday, after declining to do so during a press briefing two days prior.

An advisory panel had urged the president to declare an emergency in an interim report last week.

"The opioid crisis is an emergency, and I'm saying officially right now it is an emergency. It's a national emergency. We're going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis," he told USA Today and other reporters during a press briefing.

Asked whether Trump needed "emergency powers" to make such a declaration, the president responded, "We're going to draw it up and we're going to make it a national emergency. It is a serious problem, the likes of which we have never had."

Physicians, policy experts, and health consultants reacted positively to the news of the Trump administration's decision to declare the opioid epidemic a national emergency. But what the President does next will determine how successful his efforts are, they suggested…

No details thus far on what will comprise an actual constructive, effective action plan.

So, looking down in the eRx data tables of every doc's EHR documentation, can we expect DOJ subpoenas? Or, short of that, Big Brother HHS gumshoeing of eRx transactions via online PBM intermediaries such as SureScripts?

To the extent that the escalated opioid Rx abuse incidence represents an exigent "national emergency," we will not arrest and prosecute our way out of it.

AUG 25TH UPDATE

apropos of my last assertion, I saw an interview with this Stanford addiction med physician on MSNBC last night.

"Three out of four people addicted to heroin probably started on a prescription opioid, according to the director of the Centers for Disease Control and Prevention. In the United States alone, 16,000 people die each year as a result of prescription opioid overdose. But perhaps the most frightening aspect of the prescription drug epidemic is that it’s built on well-meaning doctors treating patients with real problems.

In  Drug Dealer, MD, Dr. Anna Lembke uncovers the unseen forces driving opioid addiction nationwide. Combining case studies from her own practice with vital statistics drawn from public policy, cultural anthropology, and neuroscience, she explores the complex relationship between doctors and patients, the science of addiction, and the barriers to successfully addressing drug dependence and addiction. Even when addiction is recognized by doctors and their patients, she argues, many doctors don’t know how to treat it, connections to treatment are lacking, and insurance companies won’t pay for rehab..."

She proffered my very same point. (Disclosure; I've not bought and read this book. I may.)

BTW, recall my post of several years ago, on the book "Overdo$ed?"

Oh, uh, tangentially, from Naked Capitalism:

How Alfred McCoy Stalked the CIA From Its Heroin Trail to the Surveillance State
Posted on August 25, 2017 by Yves Smith

UPDATE

Some People Still Need Opioids
The crackdown on pain medication prescribing is intended to help the addiction crisis—but it’s leaving chronic pain patients in untenable situations.

On July 26, Todd Graham, 56, a well-respected rehabilitation specialist in Mishawaka, Indiana, lost his life. Earlier that day, a woman complaining of chronic pain had come to Graham’s office in hope of receiving an opioid such as Percocet, Vicodin, or long-acting OxyContin. He reportedly told her that opioids were not an appropriate first-line treatment for long-term pain—a view now shared by professionals—and she, reportedly, accepted his opinion. Her husband, however, became irate. Later, he tracked down the doctor and shot him twice in the head.

This horrific story has been showcased to confirm that physicians who specialize in chronic pain confront real threats from patients or their loved ones, particularly regarding opioid prescriptions. But Graham’s death also draws attention to another fraught development: In the face of an ever-worsening opioid crisis, physicians concerned about fueling the epidemic are increasingly heeding warnings and feeling pressured to constrain prescribing in the name of public health. As they do so, abruptly ending treatment regimens on which many chronic pain patients have come to rely, they end up leaving some patients in agonizing pain or worse…

My gravely ill daughter would be in abject, unbearable misery but for the morphine and MScontin she takes daily.

STATNEWS UPDATE

A doctor’s murder over an opioid prescription leaves an Indiana city with no easy answers

MISHAWAKA, Ind. — Dr. Todd Graham wasn’t yet halfway through his workday at South Bend Orthopaedics when a new patient came into his office here complaining of chronic pain.
Heeding the many warnings of health officials, he told her opioids weren’t the appropriate treatment.

But she was accompanied by her husband, who insisted on a prescription. Graham held his ground. The husband grew irate. The argument escalated to the point that Graham pulled out his phone and started recording audio until the couple left.

Two hours later, the husband would return, armed.

Graham didn’t know that the shouting in his office wasn’t the end of the confrontation. It was frightening, he told his colleagues. But the incident two weeks ago wasn’t out of the ordinary — physicians here and across the country have grown increasingly accustomed to disputes over opioids. So Graham didn’t call the police. He didn’t file a report. He just kept seeing patients.

Many of his peers say they would’ve done the same thing. Many of them have.

Now, they’re not so sure.

That’s what they whispered to one another at the funeral five days later — the funeral for Dr. Graham…

As a tangential aside, I'm reminded of an Ann Neumann's obervation on a nexus involving law enforcement and pain mangement.

Pain management in a facility where drug use is rampant— and, indeed, a major cause of incarceration— is problematic. Doctors and nurses can find it hard to believe a patient who tells them he’s in pain. “A culture of suspicion emerged concerning the illicit drug trafficking of narcotics intended for pain relief,” the Palliative Medicine report states. The “macho” prison culture also prevented many in pain from admitting what they felt. But a larger issue, one difficult to measure, exists: “prison healthcare staff may believe that prisoners deserve their suffering.” In other words, pain is punishment. Staff members tend to default on the side of pain when prescribing narcotics to hospice patients. If anyone deserves to be in pain, the thinking goes, don’t thieves, murderers, drug users, rapists? In church parlance and even in broader society, the belief that pain makes us better people is commonplace. In prison, suffering is part of the centuries-old plan.

Neumann, Ann. The Good Death: An Exploration of Dying in America (p. 170). Beacon Press. Kindle Edition.

AUG 24 UPDATE

From STATnews:

New tool helps physicians learn if their opioid prescribing is appropriate
By BRUCE HAMORY

Addiction is a powerful, complicated disease. Genetic, environmental, and psychosocial characteristics all factor into a person’s risk for dependency. When it comes to opioid addiction, who your doctor is also influences whether or not you will become addicted to these powerful pain medications.

That’s because some doctors write opioid prescriptions more often, and for longer, than other doctors. Taking opioids for just five days — days, mind you, not weeks or months — can lead to long-term use and addiction. So when a doctor writes an initial prescription for nine days instead of three, that doctor is increasing his or her patient’s risk of opioid addiction.

Of course, there are many people who need opioids for pain management and for whom opioids are a legitimate treatment option. But easy availability and a lack of appreciation for the true risk of addiction have contributed to the opioid epidemic. We need to curb overprescribing to loosen opioids’ grip on America. But when it comes to opioids, many physicians don’t have a good sense of what constitutes appropriate use. Helping physicians navigate this minefield is an important next step in controlling the nation’s opioid epidemic…

Our initiative is focused on bringing transparency to opioid prescribing behavior in a way that does not threaten the doctor-patient relationship. Instead, we are giving physicians the data they crave to understand their own and their peers’ practice patterns. This approach of holding a mirror into physicians’ own practicing patterns has been shown to spark meaningful behavior change without bringing a physician’s clinical judgment into question.

This effort to develop appropriateness measures is an entirely doctor-developed, home-grown solution, one that uses the wisdom of clinicians to put actionable and relevant data into the hands of physicians. Doctors may have contributed — however unknowingly — to the current opioid crisis. And doctors can help bring us back from it.

____________

More to come...