| Pretext: My wife is a psychiatrist. Via her, I'm am close friends with many doctors. Also, I know it's super easy to be critical, but I'm going to save you an insane amount of effort and heartache. This is actually a solved problem in medicine, already. Maybe not solved, but absolutely "good enough". M-Modal, Dragon, and Telephone services (yes, call someone and have them translate) all exist. They all translate notes well enough. For most doctors, it's a huge improvement over typing. The problem is primarily access. Most institutions simply do not want to pay for this. They don't view it as necessary. Further complicating the issue. Unless a physician is in private practice, they have little to no control over their ability to use a tool like this. HIPAA is far too high of a barrier. You're trying to implement a technical solution to what's ultimately a politics/human problem. ---- I've spent a bunch of time in the space, both as a MedSpouse and the CTO of a HealthTech company. I wish you the best of luck as I'd love to see life be easier for my wife, but this is _extremely_ far from being MVP viable. * HIPAA - You absolutely, 100%, without a doubt need to be HIPAA compliant. You likely want to be HITRUST compliant as well. You're very, very clearly a Business Associate (HIPAA term) and processing PHI. Without that, you're dead in the water. * Chrome extension - This is not going to cut it. At baseline, it requires copy and pasting between Chrome and the EHR system. Bad UX. * More tactically, most EHR access occurs via remote access, like Citrix. Often from a thin-terminal on the hospital floor or at a med station. These are locked down environments that have a high likely hood of not having Chrome installed _and_ not being allow to install _any_ software (including Chrome extensions).
* Doctors need real-time feedback and the ability to correct. Real-time feedback is critical because carrying a patient takes mental load. Part of the purpose of notes is to create a written record that "closes" a patient for the time being. An async service isn't really helpful since it generates an interrupt after the physician has already moved on.* Accuracy is important. Accuracy is even more important with _extremely_ similar and _extremely_ uncommon words. For example, can this system differential between prednisone and prednilisone? In fact, can it even identify those words? Can it do it with an accent? * FHIR is only as much of a standard as tables are to relational databases. The hard part is the thousands of custom fields that are different between health systems. * Structured data really isn't used or useful in medicine. You might have a medication list that can be structured as data, but actual notes include a lot of prose. I believe part of this is necessary to capture the nuance/minutiae of some healthcare. Part of it stems from the lack of any standard. * Again, this is all possible already. Tele-notes have been done since the introduction of EHR systems. * Nobody is going to use a Chrome extension. |
> HIPAA - You absolutely, 100%, without a doubt need to be HIPAA compliant
This is incorrect: kindly reminder that HIPAA is a specific law applicable only to a single particular country. The vast majority of the world does not need to be compliant to it. Although similar laws exists elsewhere, they are not at all insurmountable.
> More tactically, most EHR access occurs via remote access
I have never seen a system where EHR access is used via remote desktop. (Although I admit that would be a good security measure). But then again, I'm not in the US.
> can this system differential between prednisone and prednilisone
Whisper is nothing short of magic in this regard. Yes it can - out of the box. Even more: it can easily differentiate lots of medical terms in languages other than english. Even more: it can easily parse compound terms like "hypothalamic–pituitary–gonadal axis" in other languages where first two words sounds very very similar.
I reckon that differentiating prednisone and prednisolone in doctor's writing is a harder problem than differentiating those from voice.
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Having said that, your concerns and remarks are very valid. This is why we are not focusing on replacing written records/EHR fill out. There are other ways AI and large language models could deliver help for psych practice and the patient. And safer.