We had a brief ramble a couple of weeks ago about the potential and the dangers that emerging AI like ChatGPT-4 poses for healthcare. Amid stories of AI being able to pass medical exams with ease and the reality that Dr Google may take over from real doctors in real life, we did think the hype was all a bit overblown.
That was before we had a chat to to Simon Kos, health industry executive at Microsoft and a familiar face to everyone in health IT in Australia and NZ. Simon is speaking at the MedInfo conference on July 10 in a session titled ‘A role for AI’, mainly talking about the great stuff that Microsoft has worked on with Nuance in embedding conversational AI and voice recognition into electronic medical records to improve productivity.
We’ve been impressed with this technology for some time. Nuance first touted the benefits a few years ago at the HIC conference in Melbourne in 2019 and has since expanded its capabilities. Nuance and Microsoft then worked together on developing so-called ambient clinical intelligence through the Dragon Ambient eXperience (DAX) AI-powered voice-enabled solution, and then in 2021 Microsoft bought Nuance in a massive deal worth about $25 billion.
Nuance and Microsoft have since integrated the technology into the Cerner EMR – Mackay Base Hospital emergency department director Pieter Nel will be speaking about this project in the “Implementation successes” theme at MedInfo on Wednesday, July 12 – but the technology has since moved ahead at an extraordinary pace, with DAX now being combined with OpenAI’s ChatGPT-4 model in the Microsoft Azure OpenAI Service.
We really didn’t have a clue as to what this actually meant until Simon Kos decided to have a bit of fun with us and show how easily, quickly and accurately ChatGPT-4 could be used to convert obscure medical shorthand from an examination into not just a good quality clinical note but also a referral letter to a specialist, a summary in empathetic language for the patient, clinical decision support with prompts for tests that should be done based on current guidelines (with full references from the literature), and all of the data in the note clinically coded using SNOMED for the EMR and billing.
This was all created from shorthand notes, in a matter of seconds, using voice commands, including typos. It was stunning in its ability and potential. This technology is truly game changing and the hype is worth it for once. If you are at MedInfo the week after next, track down Simon and ask for a demo. He’ll love it. Mind blowing may be a cliché but this time it’s for real.
Meanwhile, back in the real world, we are still dealing with the more mundane but still essential matter of getting electronic referrals finally rolled out in this country and living up to the axe the fax mantra. Three of our most popular stories were about the roll out of a statewide eReferral system in Tasmania, the start of a similar system in South Australia, and the expected decision to shut down faxed referrals to My Aged Care by the Department of Health and Aged Care.
Tasmania has been working on its statewide system for a couple of years, using HealthLink SmartForms integrated into GP and specialist software for the referrals and a referral management solution developed by HealthCare Software for the four public hospitals. Reports from Primary Health Tasmania, which has led the implementation and has done a sterling job, is that the system has had good take up. This is not surprising as the PHN and the state government are paying for it, but the solution is a good one and it makes a lot of sense for such a small population.
SA Health is now also getting underway after a few years of faffing about. It has already implement HealthLink’s standards-compliant system – which uses a federated directory that allows all secure messaging systems to search it – for sending discharge summaries and other clinical correspondence out to GPs. It is now using the same system as well as Salesforce technology for its statewide referral management system in what is another coup for Salesforce’s health division.
SA is joining NSW in implementing statewide – NSW is using a mixture of technologies including HealthLink, SeNT referrals from BPAC and newcomer Consultmed – and Queensland is slowly but surely rolling out its more convoluted system using SeNT and a few other bits and bobs. Victoria of course is doing its own thing on a health service-by-health service basis so who knows where it’s at, but statewide referral criteria have been developed. We expect to hear very shortly what WA is choosing to use, and this may come as a bit of a surprise, we hear.
It has been a big year for HealthLink (the NZ-headquartered secure messaging provider and Pulse+IT are both owned by Clanwilliam Group). Another big win recently has been the announcement, long expected, that faxed referrals to My Aged Care will turned off at the end of July, and GPs are being encouraged to use HealthLink’s SmartForm-based eReferral direct to My Aged Care, or by phone or web referral. This has all been greeted with great joy by most – despite having been on the cards since My Aged Care was first introduced a good number of years ago now.
However, as the RACGP’s practice technology and management expert committee chair Rob Hosking very drily points out, while the fax has been axed for GPs referring to My Aged Care, aged care assessment teams and providers still insist on sending assessments back to GPs by fax, so the dreaded machine will be in play for some time yet.
We think the only way to get rid of it is to pay providers on all sides to give it the boot, or the baseball bat. GPs are incentivised to use secure messaging through the ePIP and public hospitals are finally getting on board, but if everyone else still insists on the fax then there’s little hope of axing it.
What do you think?
Should state and federal health departments pay to axe the fax?
Vote here or leave your comments below.
In last week’s poll, we asked: is the disruption of healthcare through IT overhyped? Two-thirds of readers said yes. We also asked: if you vote yes, are you too cynical? If you say no, give us some examples of real disruption. Here’s what you said.
This was a great advertisement for healthlink
My letterhead asks correspondents to write to me about patients only by secure messaging. It shows no fax number, but for those who can’t use HealthLink, it shows my email address. I am trying to persuade colleagues where I practise to disconnect the fax devices completely.
The RACGP recommend using email. Why don’t we just start using the tech that we all use everyday?
Provided you understand the risks and take steps to mitigate them before using email. The RACGP has actually long been a strong advocate for the use of secure electronic communications. No or low risk means using password-protected or encrypted emails or not using email at all. Sending everyday unencrypted and unsecured email increases risk. GPs have a responsibility (=reasonable steps must be taken) to ensure patient information is sent safely and securely.
if health decided to really join the 21st century, technology deployed well could make all the low value care and unwarranted referrals all disappear pretty quickly. Risk-based scoring algorithms could be used to guide referrals, triage and management advice to free up time for complex care…. But our Federal-State health funding split disincentivises a coordinated approach!
Interesting article. With AI, especially in assisted decision making tools there continues to be algorithmic biases because of the lack of access to granular and diverse data. NLP and LLM which seems to be the “go to” at present doesn’t really address the issue. As regulators tighten requirements for AI tools validation of data will be critical. There is a real need for access to robust diverse RWE. The usefulness of RWE in AI tools is heavily dependent on the homogeneity of collection and reporting of the data. There should be equal focus on this in R&D funding
Should state and federal health departments pay to axe the fax? Two-thirds of our readers said yes (65:35). We also asked: If yes, does this include private specialists? If no, is there any other incentive? Here’s what you said:
– All inclusive
– Yes
– More than 90% of medical specialists in private practice already have HealthLink
– There is a definite productivity incentive – so all providers would benefit from it anyway. No point in double dipping.
– Yes
– Yes
– No. But after public hospital have moved on, then the small private specialist will start doing the same due to losing competitive advantage when a good amount of private specialist have moved to electronic referrals too
– Many private providers would have ditched the fax already, if Government agencies didn’t insist on it.
– Yes
Pay 2nd care and specialists:
Start with hospitals being audited on their digital correspondence rate to primary care: set a minimum % received in primary care: ie reward / pay hospitals according to their digital delivery rate. GP clinics have digital (encrypted fax) plus multiple secure messaging options but there is little incentive for secondary health care or medical specialists to use secure messaging.
GP’s got small financial incentives to go to digital prescriptions in late 1990’ and update was amazing in just a few yrs. Hospitals and secondary care lack any incentives or penalties for not doing it ….. GPs did it quickly 25 yrs ago!
Fax (digital) is a single digital (encrypted address) for a multi Drs clinic.
Drs move clinics a lot and its hard for systems to be updated regularly to keep track of these movements and their chsnge in secure messaging address.
Just get 2nd care to send correspondence to a single digital fax and then GPs reception/admin make sure that digital correspondence is filed digitally into the EMR (a particular receiving GPs electronic inbox) who is currently working within clinic and reception know can review and electronically file correspondence within 3 days.
My EMR has a digital fax integrated within EMR: both for send and receive (as well as secure messahing)
Large GP clinics have been using this for 25+ yrs.
Hospitals are 25 yrs behind GPs: and their only incentive to go digital seems each each to develop a different online portal where GPs have to double entry data: ie GPs are becoming hospitals admin staff!
A safe system for acting on and filing into EMR (all done digitally and in a timely manner.
– private specialists’ is very hard – assumes that they would use software
– What’s wrong with email?
– Yes if they provide financial support to private specialists
– Yes, we should be funded to use secure messaging
– Yes
– Yes. hospitals need to lose funding if they are blocking the ability for our systems holding our patient data to not be interoperable. There should be a legislation that says by 2026 all hospitals must have less than 20% paper. All the interoperability investments are a waste of money if the hospital transacts data in paper.
– Yes includes prvte specialists , as govt privacy regulations
– Yes, should cover specialist and AHP
– The incentive needs to be at the clinical level. Faxes remain because the customer wants faxing, although the healthcare provider wants to move to a more digital model. Constantly shifting cost to Government is not the solution. The business has been absorbing no increase in the MBS reimbursement rate for years and moving to digital models is not without its associated cost. Perhaps like the replacement of cheques we need to find alternative ways to incentivise people to use other service delivery models.
– If more organisations and practitioners said no to accepting faxed referrals, and patients stated that they did not provide consent for their information to be transmitted by fax – the practise would stop instantly.
When recently asked by a health provider to send my personal health information to them via fax…. I stated clearly that they did not have my consent to send any of my information by fax due to privacy risks….. a business email was promptly provided….
This does not need money – it needs people to say no – no more faxes…..
– no
– Yes and include private specialists
– Unless we really want to keep Back To The Future 2 memories alive, the fax should go. If paying the software service providers to remove it completely does not work.
Perhaps charging a FEE to all end users continuing to function via fax could be adopted, and then the fee can go towards the software providers to implement the change.
If the software providers already have the means to operate without fax, well, the fee could still be the right incentive.
– Yes, include private. The answer has to be secured email; a separate messaging system will never be properly adopted