When Doctors Need Advice, It May Not Come From a Fellow Human

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June 3 2014 12:57 PM

A.I., M.D.

When doctors need advice, it may not come from a fellow human.

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“That’s a decent idea you've got there, but the computer says ... ”

Photo by Dragon Images/Shutterstock

Long Island dermatologist Kavita Mariwalla knows well how to treat acne, burns, and rashes. But when a patient came in with a potentially disfiguring case of bullous pemphigoid—a rare skin condition that causes large, watery blisters—she was stumped. 

The medication doctors usually prescribe for the autoimmune disorder wasn’t available. So she logged in to Modernizing Medicine, a Web-based repository of medical information and insights, for help. Within seconds she had the name of another drug that had worked in comparable cases.

“It gives you access to data, and data is king,” she said of Modernizing Medicine. “It’s been very helpful, especially in clinically challenging situations.”  

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The system, one of a growing number of similar tools around the country, lets Mariwalla tap into the collective knowledge of 4,000 providers and 13 million patients. Then it spits out recommendations.  

Tech titans like Google, Facebook, Microsoft, and Apple have already made huge investments in artificial intelligence to deliver tailored search results and build virtual personal assistants. That approach is starting to trickle down into health care too, thanks in part to the push under the health reform law to leverage new technologies to improve outcomes and reduce costs. 

Computers can’t replace doctors at the bedside, but they are capable of crunching vast amounts of data and identifying patterns humans can’t. AI can be a tool to take full advantage of electronic medical records, transforming them from mere e-filing cabinets into full-fledged doctors’ aides that can deliver clinically relevant, high-quality data in real time. 

“Electronic health records are like large quarries where there’s lots of gold, and we’re just beginning to mine them,” said Dr. Eric Horvitz, who is the managing director of Microsoft Research and specializes in applying AI in health care settings.

Increasingly, physician practices and hospitals around the country are using supercomputers and homegrown systems to identify patients who might be at risk for kidney failure, cardiac disease, or postoperative infections and to prevent hospital readmissions, another key focus of health reform. 

And they’re starting to combine patients’ individual health data—including genetic information—with the wealth of material available in public databases, textbooks, and journals to help come up with more personalized treatments.  

For now the recommendations from Modernizing Medicine are largely based on what is most popular among fellow professionalssay, how often doctors on the platform prescribe a given drug or order a particular lab test. But next month the system will display data on patient outcomes that the company has collected from its subscribers over the past year. Doctors will also be able to double-check the information against the latest clinical research by querying Watson, IBM’s AI supercomputer. 

“What happens in the real world should be informed by what’s happening in the medical journals,” said Daniel Cane, CEO of Florida-based Modernizing Medicine. “That information needs to get to the provider at the point of care.” 

“Quick and Seamless”

Using homegrown systems, doctors at Vanderbilt University Medical Center in Nashville and St. Jude Children’s Research Hospital in Memphis are getting pop-up notifications—not unlike those on an iPhone—within individual patients’ electronic medical records. The alerts tell them, for instance, when a drug might not work for a patient with certain genetic traits.

“With a single click, the doctor can prescribe another medication. It’s a very quick and seamless process,” said Vanderbilt’s Dr. Joshua Denny, one of the researchers who developed the system. 

Take the anti-blood-clot medication Plavix. Some people can’t break it down. The Vanderbilt system warns doctors to give patients a genetic test to see whether they can; if not, it gives physicians suggestions on alternative drugs.

Doctors heed the computer’s advice about two-thirds of the time, figuring in, for example, the risks associated with alternative medication.

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