
Amazon Starts Selling Software to Mine Patient Health Records - dcgudeman
https://www.wsj.com/articles/amazon-starts-selling-software-to-mine-patient-health-records-1543352136
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markolschesky
If you want to play with this and you're looking for a decent sample exam
note, I grabbed some pieces of standard looking notes (Physical, ROS, Hand
exam) and tossed them into a gist here:
[https://gist.github.com/molsches/32fcec2499e95b5b23bc268800e...](https://gist.github.com/molsches/32fcec2499e95b5b23bc268800e22780)

Mostly impressive in how it parses the data and can find conditions and tests
in the unstructured data. Handles a few things strangely, but I imagine that
gets better over time as it continues to be trained.

I think for it to truly be useful it needs some layer of semantic data mapping
to something to standards like IMO/SNOMED/LOINC/RxNorm etc but I could see
that being where other companies build their "products" on top of AWS vs. AWS
competing with other Healthcare ML vendors in the space.

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carbocation
Did you grab several pieces from several notes? This looks like a garbled mess
to me, but if I understood how you had transformed it to get it into this
state, it might make more sense.

~~~
nkrumm
The posted text is actually a series of "dot phrases" or "smart texts" (aka
templates in EHR speak), _not_ actual notes. Mostly these are inserted into
clinical notes to achieve a certain level of documentation; typically they are
saved in a "all negative" format, and the relevant parts are edited to reflect
the patient history and physical. These seem to have been derived from the
Univ of Washington Emergency Medicine residency.

These might make OK material for some initial testing but they don't reflect a
real clinical note. A good source of those might be the MIMIC database [1]

[1] [https://mimic.physionet.org/](https://mimic.physionet.org/)

~~~
markolschesky
Of course. I mostly wanted to get something out quickly. Those are all a bunch
of small snippets of ROS and Physical Exams which demonstrate many of the
things which the article discussed, notably finding Dx, Medications and
whether or not they were negative or not.

I didn't know that there was a database of notes like MIMIC! I'll have to
check it out.

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bkuehl
I work in the tech healthcare industry. I wonder why they only went with (or
focused on?) ML/NLP text analysis to analyze data. There is a wealth of
discrete data available in EMRs (pharmacy, lab, eMAR, etc.). Yes, there is
plenty of diagnosis text but that is almost always associated with ICD10
codes. The only area where I believe text analysis would be useful is
documentation and microbiology data, and in many cases micro is discrete as
well.

~~~
d12345m
Ex-healthcare IT data person weighing in with a probably ridculous idea:

The focus on NLP is because in 20-30 years, discrete data won't be entered
into EMRs by providers at all.

Here's the pitch: Providers hate EMRs. They begrudge the time they spend
working in EMRs instead of focusing on patient care. They loathe spending
their office hours working on documentation. They hate spending their time in
meetings with IT staff talking about EMR workflows and form-building. They
hate getting lectured by accounting staff about how their documentation
affects billing. They couldn't care less about this stuff and in an ideal (or
even just a slightly more efficient) world, they wouldn't have to.

Every EMR that depends on webform-like inputs that map to database fields is
going to be seen as a roadblock to patient care, which is what providers see
as their primary concern.

I think the focus on NLP makes a ton of sense if you frame the problem with
EMRs that way. EMR software will continue to be the bane of providers'
existence right up to the day that providers can simply talk to their EMR in
whatever way they want and have the computer interpret their speech and
reliably spit out the discrete data that the accountants and number-crunchers
want.

Obviously, I'm talking about a monumentally complicated undertaking and it's a
bit on the ridiculous side. But I honestly believe we're going to go there, if
only because providers won't be happy until we do.

~~~
kayadx83
As someone who works in healthcare clinically and also is a product designer,
I agree with some certain parts of your idea. It would certainly help
providers. While you are right that providers might not like documentation and
filling out forms, other staffs like nursing hates typing reports. Getting rid
of forms would lengthen nursing documentation which would directly delay
patient care more than providers having to fill out forms. Delaying nursing
care would stagnate patient flow which directly impacts hospital's bottom
line. Furthermore, there are quality metrics and other stats hospitals measure
that the cost of getting wrong would be more than the cost of spending a
little extra to get it right since it affects ratings etc. Hospitals are too
risk averse so how widely they depend on NLP would be questionable. What we
need is better designers to design the EHRs better to actually fit the reality
of operations. A lot of times you have hospital admins making decisions on
form designs without understanding usability so you end up with horrible
forms.

I don't think EHRs are going away anytime soon because of their strong
integration and impact on hospital operations. I would love for Amazon to
partner with existing EHR companies but those companies tend not to be very
open with their applications. If anything, Amazon can use this as a way to get
into the EHR business and slowly take away the operational control EHRs have
over hospitals.

~~~
rficcaglia
Operational control EHRs have over hospitals is because of executive level
dysfunction. I have personally seen large Epic sites where the CxOs had never
actually used Epic hands on before forcing it upon the staff and spending well
over $100M on implementing it. Later when they saw the 40 clicks it took just
to create an encounter and heard disgruntled providers complaints, they were
stunned (too late).

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rhacker
This is the beginning of the final chapter in the story about the last kind of
private data becoming owned by advertising companies. The final stroke of pen
writing away our privacy to another institution in the name of a better
future.

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neonate
[https://outline.com/sAaAKf](https://outline.com/sAaAKf)

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wmab
Read it outside the WSJ paywall (normally need to Incognito it):
[https://www.facebook.com/flx/warn/?u=https%3A%2F%2Fwww.wsj.c...](https://www.facebook.com/flx/warn/?u=https%3A%2F%2Fwww.wsj.com%2Farticles%2Famazon-
starts-selling-software-to-mine-patient-health-
records-1543352136&h=AT1MqUWOSdF4oojXXfuXTOxtB0eaP4Bh8e2Z8E6QFuT6XqRlwyj05mLQHdldYS_Tn1xEfdsZlKGYU310Cr66ZB38GX2qe0MJj08PlJvXs_yMsj7Gw9_xJYrD8OoE)

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_archon_
Who owns a patient's medical records?

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prolikewh0a
Amazon will soon. HIPAA will be ignored, broken, spit on. There will be no opt
out or privacy. I guarantee it.

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anfilt
As long as none of the data goes to amazon, sure sell their software.
Otherwise WTF no....

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dwighttk
"It could also be an economic benefit to the Seattle-based center, Mr.
Trunnell said. The center has employed about 60 people to scan and pull
essential data from records on about 500,000 cancer patients. As automation
does more of the work, some employees could do other tasks."

or be fired

