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Monday, October 30, 2017

6 weekly online sessions, $2,600, and you're a "Transformational #AI Leader"?

I'm on a lot of email lists. This just came in the other day.

Okeee-dokeee, then. In very short order, you'll acquire
  1. "A practical grounding in artificial intelligence (AI) and its business applications, equipping you with the knowledge and confidence you need to help you transform your organization into an innovative, efficient, and sustainable company of the future."
  2. "The ability to lead informed, strategic decision making and augment business performance by integrating key AI management and leadership insights into the way your organization operates."
  3. "Recognition of your understanding of AI in the form of a certificate of completion from the MIT Sloan School of Management - one of the world’s leading business schools."
To "GET COURSE BROCHURE," you have to give up an email address and phone number, and agree to this:
I consent to MIT and GetSmarter contacting me using the details given above, including by automated means, even if I am on a corporate, state or national Do Not Call Registry, subject to GetSmarter's Privacy Policy.
I gave them one of my KHIT email aliases (it maps to my ISP default), and my POS Xfinity hard line that I never use (it came with my Comcast package; incoming calls are probably 99% endless marketing robocalls, and wrong numbers. I just ignore it).

I am reminded of my March 2017 post "12 weeks, 1,200 hours, and $12,000, and you're a "Software Engineer"? See also my last post "Future jobs: robots, nerds, and nurses?"

The brochure notes that this course will principally dwell on 3 topical "AI" sub-areas: [1] Machine Learning; [2] Natural Language Processing (NLP), and; [3] robotics.

For my NLP takes, see "Assuming / Despite / If / Then / Therefore / Else..." Could AI do "argument analysis?" and Continuing with NLP, a $4,200 "study."

You might also find my 2015 "AI vs IA: at the cutting edge of IT R&D" of interest and utility.

More broadly, as I've noted before, there's a thriving market in these myriad "professional certificate" online courses these days. See, e.g., my post going to "Certified Genetic Counselors." (Scroll down.)

Whatever. Get their brochure and make up your own mind.

Pardon my dubiety.

"The term “AI” is thrown around casually every day. You hear aspiring developers saying they want to learn AI. You also hear executives saying they want to implement AI in their services. But quite often, many of these people don’t understand what AI is." -- Radu Raicea


One of my daily web surfing stops is The Incidental Economist. Aaron Carroll, MD is a regular contributor there. He has a new book coming out.

From the Amazon blurb:
Physician and popular New York Times Upshot contributor Aaron Carroll mines the latest evidence to show that many “bad” ingredients actually aren’t unhealthy, and in some cases are essential to our well-being.
Advice about food can be confusing. There's usually only one thing experts can agree on: some ingredients—often the most enjoyable ones—are bad for you, full stop. But as Aaron Carroll explains, these oversimplifications are both wrong and dangerous: if we stop consuming some of our most demonized ingredients altogether, it may actually hurt us…
Looks interesting.

More to come...

Friday, October 27, 2017

Future jobs: robots, nerds, and nurses?

LOL. My New Yorker.

New also from The Atlantic:
Why Nerds and Nurses Are Taking Over the U.S. Economy
A blockbuster report from government economists forecasts the workforce of 2026—a world of robot cashiers, well-paid math nerds, and so (so, so, so) many healthcare workers.

Manufacturing will fall. Retail will wobble. Automation will inch along but stay off the roads, for now. The rich will keep getting richer. And more and more of the country will be paid to take care of old people. That is the future of the labor market, according to the latest 10-year forecast from the Bureau of Labor Statistics.

These 10-year forecasts—the products of two years’ work from about 25 economists at the BLS —document the government’s best assessment of the fastest and slowest growing jobs of the future. On the decline are automatable work, like typists, and occupations threatened by changing consumer behavior, like clothing store cashiers, as more people shop online.

The fastest-growing jobs through 2026 belong to what one might call the Three Cs: care, computers, and clean energy. No occupation is projected to add more workers than personal-care aides, who perform non-medical duties for older Americans, such as bathing and cooking. Along with home-health aides, these two occupations are projected to create 1.1 million new jobs in the next decade. Remarkably, that’s 10 percent of the total 11.5 million jobs that the BLS expects the economy to add. Clean-energy workers, like solar-panel installers and wind-turbine technicians, are the only occupations that are expected to double by 2026. Mathematicians and statisticians round out the top-10 list…
 Another interesting article:
The Real Story of Automation Beginning with One Simple Chart
Robots are hiding in plain sight. It’s time we stop ignoring them.

There’s a chart I came across earlier this year, and not only does it tell an extremely important story about automation, but it also tells a story about the state of the automation discussion itself. It even reveals how we can expect both automation and the discussion around automation to continue unfolding in the years ahead. The chart is a plot of oil rigs in the United States compared to the number of workers the oil industry employs, and it’s an important part of a puzzle that needs to be pieced together before it’s too late.

What should be immediately apparent is that as the number of oil rigs declined due to falling oil prices, so did the number of workers the oil industry employed. But when the number of oil rigs began to rebound, the number of workers employed didn’t. That observation itself should be extremely interesting to anyone debating whether technological unemployment exists or not…
Sleeping Through a Wake Up Call
This is a story of technological unemployment that is crystal clear, and yet people are still arguing about it like it’s something that may or may not happen in the future. It’s actually a very similar situation to climate change, where the effects are right in our faces, but it’s still considered a debate. Automation is real, folks. Companies are actively investing in automation because it means they can produce more at a lower cost. That’s good for business. Wages, salaries, and benefits are all just overhead that can be eliminated by use of machines.

But hey, don’t worry, right? Because everyone unemployed by machines will find better jobs elsewhere that pay even more… Well, about that, that’s not at all what the history of automation in the computer age over the past 40 years shows. Yes, some with highly valued skills go on to get better jobs, but they are very much the minority. Most people end up finding new paid work that requires less skill, and thus pays less. The job market is steadily polarizing…
But, wait! There's more...

Robot Overlords or Robot Colleagues?
The endless debate over whether the future of work will actually include humans.

“In a bet against college, WeWork acquires a coding bootcamp”
A slew of pieces over the past few days only add to the debate over the future of work. First, let’s tackle the WeWork news above. I’ll believe this when I see it actually happen, but WeWork promises it will roll out a coding curriculum across its entire base of hundreds of locations worldwide. I’m skeptical because I’m not convinced the world needs millions of vocationally trained coders — I’m more convinced the world needs all of us to be minimally literate in how digital computing works, and the jobs of the future will more likely require us to understand how to work with computers, rather than how to code them. It’s a bit like writing a century or so ago — we should all learn how to read and write, but only a small fraction of us became professional writers of one kind or another. The rest of us got very good at reading the code of writing — the output…
I'm reminded of my prior post "12 weeks, 1,200 hours, and $12,000, and you're a "Software Engineer"?

See also "The future of health care? "Flawlessly run by AI-enabled robots, and 'essentially' free?" And, my post "Aye, Robot."

See as well my earlier "AI vs IA: At the cutting edge of IT R&D."


From Wired:

SOONER OR LATER, the US will face mounting job losses due to advances in automation, artificial intelligence, and robotics. Automation has emerged as a bigger threat to American jobs than globalization or immigration combined. A 2015 report from Ball State University attributed 87 percent of recent manufacturing job losses to automation. Soon enough, the number of truck and taxi drivers, postal workers, and warehouse clerks will shrink. What will the 60 percent of the population that lacks a college degree do? How will this vulnerable part of the workforce find both an income and the sense of purpose that work provides?...
Below: some disturbing news here specific to the health care space:
Robot-surgery firm from Sunnyvale facing lawsuits, reports of death and injury
SUNNYVALE — When Teresa Hershey was told she needed a hysterectomy, her doctor recommended a novel approach: an operation performed by a robot, guided by the surgeon.
“She was just very persuasive,” said Hershey, 45. “I’d never heard of it.”

The doctor’s assertion that less invasive, robot-assisted surgery would mean seven to 10 days of recovery instead of six to eight weeks for a conventional operation convinced her, along with the prospect of less scarring: The da Vinci robots from Sunnyvale’s Intuitive Surgical need only small holes for inserting surgical equipment.

Now, seven years and 10 corrective surgeries later, Hershey is gearing up to fight Intuitive in Santa Clara County Superior Court. She says she has refused the firm’s offers to settle.
“I want to go all the way,” said Hershey, whose case would be only the third to go to trial amid a torrent of legal claims. “There’s just been too much with this company, and too many people hurt. I just want the world to know what they’ve done. I don’t want them to get away with it, to be swept under a rug.”

Since the da Vinci surgical robot received FDA approval in 2000, Intuitive’s devices — which are operated by a surgeon using joysticks, foot pedals and a 3-D viewer — have propelled the firm to a $35 billion valuation and world dominance in robot-aided surgery. But the legal claims that have come with Intuitive’s success showcase the serious risks that accompany the rewards new medical technology can bring…
I'm not sure it's entirely accurate to call the da Vinci technology "robotic." But, whatever.

I recall being enthusiastically offered a "robotic prostatectomy" option back in 2015 during my stint with the disease. I declined.

apropos of all this,

Link here.

More to come...

Monday, October 23, 2017

The unhappy intersection of health care data and clinical quality oversight policy

Kip Sullivan, JD has a doozy of a post up at THCB:
MedPAC Sinks Deeper Into the MACRA Tar Pit

The Medicare Payment Advisory Commission (MedPAC) has done it again. At their October 4, 2017 meeting they agreed to repeal the Merit-based Incentive Payment System (MIPS), an insanely complex and evidence-free pay-for-performance scheme within the larger program known as MACRA. Instead of examining how they made such a serious mistake in the first place (MedPAC has long supported turning fee-for-service Medicare into a giant pay-for-performance scheme), they repeated their original mistake –- they adopted yet another vague, complex, evidence-free proposal to replace MIPS.

MedPAC’s history gives us every reason to believe that when they discuss their “repeal and replace MIPS” proposal at their December 2017 and January 2018 meetings, they will refuse to discuss their “replace” proposal in any detail; they will not ask for evidence indicating their proposal is safe and effective; and in their March 2018 report to Congress they will foist upon CMS the dirty work of figuring out how to make their lead balloon fly. CMS will dutifully write up a gazillion pages of gibberish describing how the new program is supposed to work, it won’t work, MedPAC will return to the scene of the crime years later and, pretending they had no part in creating it, propose yet another evidence-free tweak. And so on.

MedPAC is caught in a trap of their own making. They endorse health policy fads without any evidence and without thinking through the details; then when the fads don’t work, rather than review their defective thought process, they endorse other iterations of the fads, again without evidence and without thinking through the details. The tweaked version of the fad fails, and MedPAC starts the cycle all over again. Two analogies for this trap or vicious cycle occur to me. One is the tar pit where mastodons got stuck and died; struggle only caused the dimwitted creatures to sink faster. The other is the hedge fund that gradually becomes a Ponzi scheme. Investors like Bernie Madoff make bad investments, and when the investments go south, instead of admitting their mistakes, they induce their investors to throw good money after bad…
Read all of it. Link in the title. Docs have been complaining angrily about "quality reporting measures" since I worked in the Meaningful Use program. MACRA is merely the successor to this data burden, with some new twists going to payment reforms. Some of the comments illustrate the problem nicely:
Kip, can we be BFFs? You have a knack for putting into words exactly my feelings about all this mess of buzzword care and puffery language to assuage the politicos to feel that they are getting “Value” for their healthcare dollar. CMS and ONC and MEDPAC and all the others have made such a mess, it truly should be flushed. Attribution, There is no possible way to attribute costs to my part of the care for a fractured hip, when the patient has kidney disease, heart disease, GI problems, diabetes, etc. What part of the readmission within 90 days is “my” fault if I fixed the hip perfectly, but the patient suffered a hypoglycemic episode at 67 days? And how many click boxes, data entry points do I need to do? Do you really think that my reporting of preop antibiotics is anything but 100%? It always is. Yet somehow, MACRA MIPS values this, yet I have to report it ? Stupid. And its self reporting…no chance for inflation of “Value” by admins, right? All this counting of numerators and denominators and attesting has led to what, exactly? Nothing but burned out MDs that are distracted from real care. Worse, it drive MANY away from caring for the more fragile. less healthy, socially isolated, etc as it will make MY NUMBERS look worse if they have complications or higher resource use, like they are admitted to a skilled facility after a total hip, as they have no one to care for them at home, and they are anxious about going home. Is that my fault? Some articles in this blog has shown that public reporting of these “values” “Complications” etc are definitely driving MDs from caring for those that will ruin my numbers, even with 1 or 2 complicated patients. Think bundled care here. Why would I EVER operate on anyone that could kill my bundle and cost me money, punish me, report nasty numbers on me. Its just the nature of the beast. You punish me for caring for complicated patients both health and social, forget getting any kind of care. Thats EXACTLY what ACOs and BUNDLES do. MIPS MACRA are just the main stage of that mess. I found it extremely disheartening that MEDPAC is grasping at ANY buzzword straw to get themselves out of the MIPS MACRA mess and they initial thought was to just PUNISH providers for FFS no matter what, as FFS is obviously the devil to MEDPAC, so they are dying for a new set of abbreviations, mantras that can be the solution to the scourge that is FFS. What a nightmare, and they are in charge. They should be forced to read your blog. I love your work Kip, please keep it coming.
William Palmer, MD
It seems pretty clear that defining and measuring quality in healthcare has long been an enormous challenge and remains one. We also don’t want to create disincentives for doctors to be willing to care for the highest risk, most complex patients. It’s also pretty clear that the fee for service payment model provides incentives to provide too much care and HMO’s provide incentives to provide too little care. We also have too much defensive medicine because our society is inherently more litigious than others.
At the same time, healthcare costs rose from around 5% of GDP in 1960 to between 17% and 18% of GDP today partly because of huge advances in what modern medicine can do for us patients and partly because of high prices, especially for drugs, devices and, to some extent, imaging. Moreover, most patients can’t afford to pay for the expensive procedures without health insurance. Balance billing, if we had it, would be an additional cost burden that wouldn’t count toward insurance deductibles and OOP limits. That would be a big problem for most people as well.

At the end of the day, what I want as a patient is good care, from both primary care doctors and specialists at a cost that won’t bankrupt me or the country. What those of us who invest in healthcare and health insurance companies want is for them to be sufficiently profitable to produce an adequate risk-adjusted return on our capital relative to other investment alternatives, again without bankrupting the country.

So what’s the answer to the cost conundrum? My own preferences include price transparency to allow both patients and referring doctors to identify the most cost-effective, good quality providers in real time, comprehensive tort reform to reduce defensive medicine, more use of data analytics to go after fraud, especially in the Medicare and Medicaid programs, and a lot less futile care and the end of life much of which patients don’t even want.

While doctors claim that they only account for 10% of healthcare costs after deducting practice expenses, their decisions to order tests, prescribe drugs, admit patients to the hospital, consult with patients and perform procedures themselves drive virtually all healthcare spending.

The docs are in a position to have the best ideas to bring healthcare costs under control relative to GDP but their preference is to be left alone to take care of patients. As Steve2 noted in a recent blog post, nobody cared about healthcare costs when they were 5% of GDP. At 18%, we have to care. Where’s the physician leadership on this issue?
Recommend you peruse all of the comments below the post as well.

One of my long-time wisecracks:
Just as no amount of calling point-to-point interfaced data exchange "interoperability" will make it so, neither will calling Process Indicators "CQMs" (Clinical Quality Measures) make them so.
Process indicators are, in the aggregate, very loosely-coupled proxies for "quality of care." Whether they are uniformly efficacious, or a precious-time-wasting check-box click burden continues to be a matter of heated dispute.

Kip Sullivan concludes:
...In my next comment I will explore the history of this habitual failure. I will focus on the commission’s endorsement of pay-for-performance in 2003 and how that endorsement led the commission into the MACRA tar pit.
I look forward to reading it.

Other THCB posts tagged "Kip Sullivan."


Speaking of "science" and "wellness" quackery. Timothy Caulfield:

Wellness Brands Like Gwyneth Paltrow's GOOP Wage War on Science
Despite the best efforts of journalists and doctors, debunkers are not winning the wellness war.

Gwyneth Paltrow's wellness obsession has become one of the more reliable punchlines in Hollywood, but she may very well have the last laugh. The actress-turned-wellness-guru is now known as much for her acting as for her scientifically dubious lifestyle brand, Goop. In 2016, the company raised tens of millions of dollars in venture capital, all despite unrelenting mockery in the press. The marketing for some products is so ridiculous I sometimes wonder if Goop is really just a form of clever satire aimed at the dangers of pseudoscience. (If this is true, mission accomplished.)

But assuming this isn’t performance art, the increasing popularity of companies like Goop is a cause for legitimate concern. Despite the best efforts of journalists and doctors, the debunkers are not winning the wellness war. Indeed, there is evidence that the trust people place in traditional sources of science is eroding.

And it’s not just science — global trust in institutions everywhere is plummeting. While these are socially complex phenomena, I believe there are several powerful — and, ultimately, tremendously harmful — rhetorical devices deployed by the multibillion-dollar wellness industrial complex that have facilitated its cultural ascendency. By examining these devices, perhaps we can make people think twice before they try being voluntarily stung by bees as a cure for inflammation…
Another good read. I was struck by how little has changed on this front across the 19 years since my elder daughter died. I wrote on my 1998 essay:
Is science the enemy? To the extremist "alternative healing" advocate, the answer is a resounding 'yes'! A disturbing refrain common to much of the radical "alternative" camp is that medical science is "just another belief system," one beholden to the economic and political powers of establishment institutions that dole out the research grants and control careers, one that actively suppresses simpler healing truths in the pursuit of profit, one committed to the belittlement and ostracism of any discerning practitioner willing to venture "outside the box" of orthodox medical and scientific paradigms...
Different day, same bullshit.

Recall also my prior post "I am not a scientist?"

More to come...

Wednesday, October 18, 2017

Omics update

My latest Science Magazine arrived the other day.

"Special Issue: Single-Cell Genomics?" Interesting.

A Fantastic Voyage in Genomics

Laura M. Zahn

Imagine being able to shrink down to a small enough size to peer into the human body at the single-cell level. Now take a deep breath and plunge into that cell to see all of the ongoing biological processes, including the full complement of molecules and their locations within the cell. This has long been the realm of science fiction, but not for much longer. Recent technological advances now allow us to identify and visualize RNA transcripts, proteins, and other cellular components at the single-cell level. This has led to discoveries about the immune system, brain, and developmental processes and is poised to revolutionize our understanding of the entire human body.

We anticipate breakthroughs with an increased ability to confidently examine the components of a single cell, including in identifying and treating disease at the cellular or even molecular level. Advancing our understanding of pathology will allow us to predict how genes predispose individuals to a disease and aid in prevention and treatment. This will be especially important for diseases such as cancer, which can often have extremely variable genetic compositions resulting in different gene expression profiles within a single tumor. Although the technology to shrink oneself remains fiction, our ability to visualize how genes act at the single-cell level is not, and we look forward to enlarging our knowledge of the human body.

The immune system varies in cell types, states, and locations. The complex networks, interactions, and responses of immune cells produce diverse cellular ecosystems composed of multiple cell types, accompanied by genetic diversity in antigen receptors. Within this ecosystem, innate and adaptive immune cells maintain and protect tissue function, integrity, and homeostasis upon changes in functional demands and diverse insults. Characterizing this inherent complexity requires studies at single-cell resolution. Recent advances such as massively parallel single-cell RNA sequencing and sophisticated computational methods are catalyzing a revolution in our understanding of immunology. Here we provide an overview of the state of single-cell genomics methods and an outlook on the use of single-cell techniques to decipher the adaptive and innate components of immunity.

The stereotyped spatial architecture of the brain is both beautiful and fundamentally related to its function, extending from gross morphology to individual neuron types, where soma position, dendritic architecture, and axonal projections determine their roles in functional circuitry. Our understanding of the cell types that make up the brain is rapidly accelerating, driven in particular by recent advances in single-cell transcriptomics. However, understanding brain function, development, and disease will require linking molecular cell types to morphological, physiological, and behavioral correlates. Emerging spatially resolved transcriptomic methods promise to fill this gap by localizing molecularly defined cell types in tissues, with simultaneous detection of morphology, activity, or connectivity. Here, we review the requirements for spatial transcriptomic methods toward these goals, consider the challenges ahead, and describe promising applications.

Single-cell multi-omics has recently emerged as a powerful technology by which different layers of genomic output—and hence cell identity and function—can be recorded simultaneously. Integrating various components of the epigenome into multi-omics measurements allows for studying cellular heterogeneity at different time scales and for discovering new layers of molecular connectivity between the genome and its functional output. Measurements that are increasingly available range from those that identify transcription factor occupancy and initiation of transcription to long-lasting and heritable epigenetic marks such as DNA methylation. Together with techniques in which cell lineage is recorded, this multilayered information will provide insights into a cell’s past history and its future potential. This will allow new levels of understanding of cell fate decisions, identity, and function in normal development, physiology, and disease.
Firewalled, AAAS members only. Or, you can buy the hardcopy at a newsstand or read it at a library.

Lots of detail, mostly over my head, but important stuff. I have to wonder how far away these research developments are from widespread applied clinical tx practice?

Some reporting on the topic from H&HN:
Genomic Medicine Has Entered the Building
With game-changing promises starting to pay off, hospitals need to start preparing now for the changes genomics will bring

After years of fanfare and a few false starts, the era of genomic medicine has finally arrived.

Across the country, thousands of patients are being treated, or having their treatment changed, based on information gleaned from their genome. It’s a revolution that has been promised since the human genome was first published in 2001. But making it real required advances in information technology infrastructure and a precipitous drop in price.

Today, the cost of whole exome sequencing, which reveals the entire protein-coding portion of DNA, is roughly equivalent to an MRI exam in many parts of the country, says Louanne Hudgins, M.D., president of the American College of Medical Genetics and Genomics and director of perinatal genetics at Lucile Packard Children's Hospital Stanford, Palo Alto, Calif.

“Genomic sequencing is a tool like any other tool in medicine, and it’s a noninvasive tool that continues to provide useful information for years after it is performed,” she says…
"Treating genes, not organs"
Let's hope. Read all of it.

I've had a recurrent go at "Omics" topics before, e.g., here, and here. See also my post on "Personalized Medicine."

Below, apropos?


How Technology Development and Big Data are Affecting the Transformation of Health Care
Precision Medicine has come a long way in the last 10+ years thanks to advances in diagnostics, computing, and consumer tools. The ongoing quest to better understand disease predisposition and prevention through genomic and environmental factors is key to increasing the quality and length of life. Technology for Precision Health will explore how technology can help.

How can we think differently about gathering, analyzing and sharing information? Which incentives can be offered to structurally change the system toward longer term care of patients? Which mechanisms will empower patients with their data and create virtuous partnerships with providers to truly drive value? Conference delegates will learn about the latest tools in Precision Medicine and Health as well as be part of the discussion on new ontologies and policy changes needed to bring these technologies to patients...
Click here (or the above headline) for the site link.

Also of pertinence, from the NEJM:
Lost in Thought — The Limits of the Human Mind and the Future of Medicine
Ziad Obermeyer, M.D., and Thomas H. Lee, M.D.

In the good old days, clinicians thought in groups; “rounding,” whether on the wards or in the radiology reading room, was a chance for colleagues to work together on problems too difficult for any single mind to solve.
Today, thinking looks very different: we do it alone, bathed in the blue light of computer screens.

Our knee-jerk reaction is to blame the computer, but the roots of this shift run far deeper. Medical thinking has become vastly more complex, mirroring changes in our patients, our health care system, and medical science. The complexity of medicine now exceeds the capacity of the human mind.

Computers, far from being the problem, are the solution. But using them to manage the complexity of 21st-century medicine will require fundamental changes in the way we think about thinking and in the structure of medical education and research.

It’s ironic that just when clinicians feel that there’s no time in their daily routines for thinking, the need for deep thinking is more urgent than ever. Medical knowledge is expanding rapidly, with a widening array of therapies and diagnostics fueled by advances in immunology, genetics, and systems biology. Patients are older, with more coexisting illnesses and more medications. They see more specialists and undergo more diagnostic testing, which leads to exponential accumulation of electronic health record (EHR) data. Every patient is now a “big data” challenge, with vast amounts of information on past trajectories and current states.

All this information strains our collective ability to think. Medical decision making has become maddeningly complex. Patients and clinicians want simple answers, but we know little about whom to refer for BRCA testing or whom to treat with PCSK9 inhibitors. Common processes that were once straightforward — ruling out pulmonary embolism or managing new atrial fibrillation — now require numerous decisions.

So, it’s not surprising that we get many of these decisions wrong…
Open access. Read all of it.
"Computers, far from being the problem, are the solution. But using them to manage the complexity of 21st-century medicine will require fundamental changes in the way we think about thinking and in the structure of medical education and research."
Also of note, our hardy perennial, EHR lamentation. From THCB:
EHR-Driven Medical Error: The Unknown and the Unknowable

Politico’s Arthur Allen has written a useful report on recent findings about EHR-related errors. We must keep in mind, however, that almost all EHR-related errors are unknown, and often unknowable. Why?...
Interesting post. I'd like to have Dr. Jerome Carter's reaction. See also my prior post "Are structured data now the enemy..."


"Machine Learning" looks to be partially a bit remedial for me (e.g., regression models and decision trees), but looks like a good quick tutorial. "The Influential Mind" goes to my abiding interest in cognitive/neuroscience topics. Stay tuned.


Seattle's AI entrepreneur Matt Bencke has died, losing his fight against stage IV metatstatic pancreatic cancer. He was only 45. Very sad. I have followed developments closely, given that my 47 yr old daughter has a very similar dx.

Rachel Lerman of The Seattle Times has a fine story on Matt. My heart goes out to his family and friends.

More to come...

Monday, October 16, 2017

What a week! California on fire.

The scope of the Napa-Sonoma-Santa Rosa area fires is breathtaking and disheartening. I know people who have lost everything except their lives. Last Wednesday as I was taking my daughter to her chemo session at Kaiser, the air was thick with the acrid smell of fire, and you could not even see the nearby foothills below Mt. Diablo (we live in Antioch close by Brentwood).

I don't even want to think about the tonnage of toxins in those smoke plumes, given the thousands of structures and vehicles destroyed in addition to the grasslands and woodlands.

Unreal. And, while firefights have made significant gains, it's not over yet. I hope the forecast for rain by Thursday is accurate.

More to come...

Thursday, October 5, 2017

2017 Health 2.0 Conference photo gallery recap

Running way behind this year. First, the Las Vegas mass shooting took the air out of my soul, given my long connection there (none of my many friend were hit, but everyone I know there is traumatized). Then, I encountered WiFi hassles in my Hyatt room, which kept me offline Tuesday night. Turns out they'd taken down their login interface and replaced it with a new one. No more "last name + room number." The new login page, which asks for your full name and email address, finally came up yesterday morning. Too late. Whatever. I'll catch up from home.

My Sunday pre-conference Provider Symposium post is here.

So, I'm home. Left the Convention Center at 1:32 and beat the 680 crush. Home by 3, too tired to do anything.

Gonna now triage my myriad shots and begin uploading them. Then I'll review my copious notes and post my conference takeaways. Lots of great stuff.
Indu set the "looking ahead" agenda at the outset, citing "Five Drivers" going forward:
  1. FHIR and Blockchain;
  2. New modalities and analytics;
  3. New entrants into healthcare, large and small;
  4. Incumbents adopting new stripes;
  5. New environments for health care.
In the interim, before I riff on more detail, I recommend to everyone this poignant THCB post. Reminds me of this one. I totally personally relate to the latter one, given my daughter's Stage IV pancreatic cancer dx.

Stay tuned. Hundreds of shots to review.

But, first, a divergence apropos of HIT, breaking news from STAT:
IBM to Congress: Watson will transform health care, so keep your hands off our supercomputer

To the public, IBM trumpets its Watson supercomputer as the next big thing in medicine, a new kind of machine that melds human expertise with digital speed to give patients personalized treatment advice.

Meanwhile, in the halls of Congress, company executives have been delivering a blunter message: We will revolutionize patient care, so please get out of the way.

Like any new technology, Watson poses unknown risks; for example, what if its advice is wrong and harms a patient? But IBM argues that its machine doesn’t need to be regulated because it’s different from other medical devices. It’s not like a pacemaker or a CT scanner, so the company shouldn’t have to prove to the government that it’s safe and effective.

Now, as federal regulators prepare to weigh in on that issue, a STAT examination shows the lengths to which IBM has gone to shield its prized machine from government scrutiny.

The company’s fingerprints are all over legislation passed last year that exempted several types of health software from FDA jurisdiction…
See my prior post "Watson and cancer." FierceHealthIT is also on the story.


HIMSS in the House, Hal Wolf and Stephen Lieber.
HLA Global in the House, Jon Patrick and son.

Triple threat opening Keynotes: Bruce Greenstein, Aneesh Chopra, and David Brailer.

More pics...

Gil Addo, CEO, RubiconMD
Amy Abernethy, MD PhD, CMO, Flatiron
Sandra Hernandez, MD, President & CEO, California Health Care Foundation
BTW, no, I don't have names for everyone I've shot. Stuff goes by too fast, and there's no way to consistently link up names in my notes to shots in the camera, given the volume of shots. More photos on the way...


Major Underachiever
Indu interviews RWJF's Dr. Michael Painter
I got invited to the Tuesday evening Aetna private reception. Nice. Thanks.

A long day. A ton to assimilate. More shots below coming shortly.


The shutter clicks continue.

I have more, LOL, but you get the idea. Yet another great Health 2.0 Conference. Gotta now spend some time pondering my notes.


MobiHealthNews has excellent comprehensive coverage up.
In-Depth: News and views from Health 2.0 2017

This year was the 11th anniversary of Health 2.0, a yearly health tech conference that explores the newest in digital health with eyes for what’s still to come. This year marked the first Health 2.0 conference since the show was acquired by HIMSS, MobiHealthNews's parent company.

With the four-day event come and gone, MobiHealthNews has collected all of its coverage from the Santa Clara Convention Center below, along with extra conference announcements and speaker discussions that might not have made it to the front page…
I can't top that. Read all of it. Kudos.

See also:
Health 2.0 Fall Conference Startup Pitch Competition: Meet the Companies

This week, healthcare technology innovators, thought leaders, and business owners convene in Santa Clara, California for Health 2.0’s 11th Annual Fall Conference. While this year’s event runs from October 2-4, Medgadget was able to participate in the Sunday pre-conference and the annual Startup Pitch Competition.

Evaluating eight “Series A ready” companies, organized into professional solution (B2B) and consumer solution (B2C) tracks, were six judges…
Be up with some of my own conclusions shortly. Of particular interest to me were "Interoperability," 'Big Data & Analytics," "NLP," health care "policy," and "workflow."


Another fine recap, from the PoV of one of the Provider Symposium Day panelists:
Key Takeaways from Another Great Health 2.0
Rasu Shrestha MD MBA

The Health 2.0 Conference gets better every year. I’m so grateful to have engaged with so many industry leaders – both familiar faces and new friends. What a wonderful opportunity to speak on the “Innovation to Implementation to Transformation” panel on Sunday and connect with people behind some of the most up-and-coming health care technology companies at MarketConnect Live. I also really enjoyed engaging with a ballroom full of enthusiastic attendees leading a lunch and learn discussion with my colleagues where we discussed best practices in marrying the competencies of a digital health company with the realities of patient care.

Sunday night’s Traction 2017 pitch competition was a highlight. I saw some promising startups that are using technology to solve long-standing health care problems. From skin cancer detection to new uses for 3D-printers, I saw innovations that reinforce UPMC Enterprises’ belief that technology can be an enabler of better, more efficient, and more affordable care.

While at Health 2.0, I thought a lot about where our industry is going and what each person’s role is in redefining the health care trajectory. I left the conference with three key takeaways I’d like to share with you…
Below, cool, someone had a fish-eye lense. Click the pic to enlarge,

Hmmm... I may need to buy one of those.

Also of note, from Joe Flower's opening Keynote:
"Six Assertions on Knowing the Unknowable Future of Healthcare"

I've been mostly offline for a week, under the weather and dealing with my ailing daughter while my wife was in Florida on business. I don't have a lot to add the the assessments of the Conference, except to say that my irascible dubiety toward "interoperability" has been attenuated. I retain some misgivings, but it seems that the FHIR crowd is indeed making significant headway. Beyond that, my skeptical view of "NLP" pretty much remains intact, and I continue to view warily all the exuberant hype around the putative panacea of "big data."

More to come...