e-Patient Dave

Power to the Patient!

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Governing wildfires: What we can learn about AI from our history with cars

I asked GPT-4o for an image representing AI as a powerful wild horse pulling a Roman chariot with five people in it. Here’s what I got. Impressive, but not quite right: not a chariot, and not five people(! … how hard is THAT to get right??)

An analogy came up last month that I think bears discussion, and I wonder what you think. Everyone knows we have to watch out for AI’s dangers, but the same was true when cars were new. And electricity. And machinery. How do we learn to move forward – to enjoy new power – without horrible risks??

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Include patient users in co-creation of AI and related policy. The need is urgent! #PatientsUseAI

There’s something important in this, so I hope you’ll give it some thought. Patients are being overlooked as users of artificial intelligence (ChatGPT etc), and we need to fix that.

On March 22 I spoke in Boston as the consumer (aka patient) voice on an important panel. The event was the annual AMIA Informatics Summit, and the panel was the latest in an ongoing project on how to be responsible yet effective about AI’s immense potential to improve healthcare. (More on the project below.)

Most of the 90 minute session was reserved for audience Q&A, so for opening statements, each of us five panelists was only given 7 minutes. Yikes! So I did what any empowered person would do: did my best in 7 minutes, then came home and recorded what I wanted to say … which took 20 minutes. :-) For the impatient, the video is above, or you can read the discussion below first.

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Is Beth Israel lying, denying, or complying?

I am really irritated. My hospital has told me they’re not supporting the federally required FHIR standard (a “FHIR endpoint”) to let me access my health data. Is this legal??

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Important update: a robust Twitter thread is drawing lots of answers on whether this is legal. Some of it is “gray area” but among other things:

  • At present, even if their behavior is a violation, there’s no penalty!
  • But by end of 2023, if they don’t have this, they might not get any more payments from CMS!
    • That’s Medicare and Medicaid, which are about 40% of all US hospital revenue
  • There are three separate requirements.
    • System vendors are required (today) to offer a FHIR endpoint to their buyers (hospitals).
      • Well-known large vendors like Epic and Cerner offer it.
      • But Beth Israel Deaconess is its own system developer, and they haven’t created one.
    • Care providers (hospitals etc) aren’t required to buy them and offer them to patients (yet)
    • But by end of 2023, providers will have to offer this to patients, if they want to get paid by CMS (Medicare).

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Resuming the original post:

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Ethics and barriers: BMJ webinars on patient access to medical records

The BMJ (formerly the British Medical Journal) continues to lead the world in patient & public partnership with clinicians, including more coverage of patient empowerment topics than anyone else I know in medical publishing. Some of the issues are unique to Britain but many are global cultural issues – not least being the balance of power between clinicians and the patients they serve.

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The problem with “herd immunity” as a COVID-19 strategy

Caution: This post is not a prediction. It’s just a tutorial about the concept of herd immunity, with an eye to why it’s probably not an approach the US wants to take in solving the complex problems we’ve gotten ourselves into with COVID-19.

Click this graphic to go see a six second animation of these images, created in 2017 by Reddit user TheOtherEdmund. You many need to watch a few times. Get a feel for the differences in what happens in the different blocks, and come back to discuss:

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