Dr. Glaucomflecken’s graduation speech to University of Colorado School of Medicine 2022

Of course the entire 90 minutes is worth watching, AND Dr. Glaucomflecken starts at minute 24. His speech is only about 13 minutes long. You won’t regret hearing what he has to say. He has survived 2 cancers, and a cardiac arrest (really? wow)

I’m so grateful to amazing folks like Dr. Will Flannery (Glaucomflecken’s real name), his humility, his insight, his humor, his TikTok channel. He’s a shining example of what a humanist physician aspires to be.

A.I. Is Mastering Language. Should We Trust What It Says? (nytimes)

GPT-3 can write text that astounds, based on its Large Language Model. Things are happening, people. Are we paying attention? #hcldr #hitsm #whyinformatics

I’m always on the looking for developments in computing outside of healthcare. This is a longer read, but so thought provoking:

  • What is a Large Language Model and why is it only recently important?
  • What is GPT-3 and what are all these magical things it supposedly does?
  • Can GPT-3 digest 1000 progress notes of a patient chart, say, and write a cogent 1-page summary for a clinician to digest rapidly? I’d pay for THAT.

‘‘The underlying idea of GPT-3 is a way of linking an intuitive notion of understanding to something that can be measured and understood mechanistically,’’ he finally said, ‘‘and that is the task of predicting the next word in text.’’ 

Prompt the algorithm with a sentence like ‘‘The writer has omitted the very last word of the first . . . ’’ and the guesses will be a kind of stream of nonsense: ‘‘satellite,’’ ‘‘puppy,’’ ‘‘Seattle,’’ ‘‘therefore.’’ But somewhere down the list — perhaps thousands of words down the list — the correct missing word appears: ‘‘paragraph.’’ The software then strengthens whatever random neural connections generated that particular suggestion and weakens all the connections that generated incorrect guesses. And then it moves on to the next prompt. Over time, with enough iterations, the software learns.

Ilya Sutskever

There is all this discussion of “is this a sophisticated parrot” or “truly an artificial intelligence capable of generating new ideas.” Well, in our Electronic Health Record world, just the first item would be transformative, if we can get an AI to digest a hyperobject large set of data into an executive brief. Just that.

CMIO’s take? This is an important article by Steven Johnson in the New York Times Magazine. Watch this space; the development of GPT-3 heralds a qualitative improvement in AI language models; so much so that we feel compelled to teach it values and culture lest it start spewing hatred it learns on the internet. This is a worthwhile long read.

Virtual Reality: reliving the past for seniors? (nytimes)

Interesting that one of our innovation partners, Rendever, has developed a way for family members to record and annotate video to be viewed by seniors, so that they can see their hometown, where they grew up, where they worked, to reawaken pleasant memories of times past. An interesting, unanticipated way of using virtual reality.

Steven Pinker Thinks Your Sense of Imminent Doom Is Wrong – The New York Times

Steven Pinker image from wired.com

“It is irrational to interpret a number of crises occurring at the same time as signs that we’re doomed.”
— Read on www.nytimes.com/interactive/2021/09/06/magazine/steven-pinker-interview.html

The Xenobot Future Is Coming—Start Planning Now (wired.com)

“…the ability to recode cells, de-extinct species, and create new life forms will come with ethical, philosophical, and political challenges”

https://www.wired.com/story/synthetic-biology-plan/

With CRISPR, the molecular scissors technology ,we are gaining not only read, but WRITE access to our genetic data. Writing code will no longer be limited to computers (and electronic health records), but into living organisms. Are we ready? The technology is racing ahead of our ability to think about and deploy it for the good of all.

Can Learning Machines Unlearn? (wired.com)

https://www.wired.com/story/machines-can-learn-can-they-unlearn/

How much data?

I’ve been thinking about this a lot. In our recent work designing predictive algorithms using linear regressions and neural networks, and similar approaches, we’ve discussed the use of EHR (electronic health record) data, and have had some success using such algorithms to reduce deaths from sepsis (blog post from 10/6/2021).

One of many problems, is “how much data?” And it has been interesting to work with our data science colleagues on creating a model, and then carefully slimming it down so that our models can run on smaller data sets, more efficiently, more quickly, with less computing power.

Forgetting?

A related problem is “when do we need to forget?” EHR data ages, the way clinicians record findings can change. Our understanding of diseases change. The diseases themselves change. (Delta variant, anyone?)

Will our models perform worse if we use data that is too old? Will they perform better because we gave them more history? Do our models have an “expiration date?”

The Wired.com article above talks about having to remove data that was perhaps illegally acquired, or perhaps after a lawsuit, MUST be removed from a database that powers an algorithm.

Humans need to forget. What about algorithms?

Isn’t human memory about selective attention, selective use of memory? Wouldn’t a human’s perfect memory be the enemy of efficient and effective thinking? I’ve read that recalling a memory slightly changes the memory. Why do we work this way? Is that better for us?

Is there a lesson here for what we are building in silico?

CMIO’s take? As we build predictive analytics, working toward a “thinking machine”, consider: what DON’T we know about memory and forgetting? Are we missing something fundamental in how our minds work as we build silicon images of ourselves? What are you doing in this area? Let me know.

My newest ukulele EHR parody song: Inbasket Dynamite

Has anyone ever written a K-pop anthem into an EHR parody? Is it possible to set an hyperobject to music? Regrettably, someone has tried.

CT’s at it again: doesn’t he ever learn?

It is great to be back together among our tribe of informaticists at Epic’s XGM (eXpert Group Meeting) in Verona, Wisconsin, where the best and the brightest share our work, our leadership and change management lessons, and celebrate our successes.

Inbasket Dynamite refers to the Hyperobject that is the EHR inbasket, the nerve center of communications that, like the post office, can grow to unmanageable size and could contribute to physician and provider burnout. Time to “light it up” and redesign it.

I’m on stage at the Epic Physician Advisory Council (PAC) reception, grateful to receive the 2021 PACademy Award (physician of the year) from the voting of our international physician informatics community, along with Heidi Twedt (2020 awardee) and Joel Buchanan (2022 awardee). Due to the pandemic, we have missed the last 2 years of the PAC meeting in person, so this is our catch-up. I’m honored to be in such company.

If you’re not a BTS fanatic, like we are at our house, here are a couple of videos to whet your appetite:

My son Avery covering BTS’s dance moves in Dynamite, for the pure joy of it:

And, one of the official BTS music videos on Dynamite. Many of their videos have been viewed over a billion times (ahem, a Billion):

A Woman’s guide to Toxic Trolls (wired.com)

I have lost the ability to even … #hcldr #whyinformatics #hitsm

Image from Getty, via Wired.com

https://www.wired.com/story/womans-guide-toxic-trolls-internet/

Sometimes a well-written piece allows one to step outside of one’s identity and perceive what it is like to be someone else. This is one.

This is a “wow” read, in support of my colleagues out there using social media for good, and how about 50% of our colleagues suffer through nearly unimaginable interactions in a largely unregulated space. AND one way to fight back.

Patients View their Own Radiology Images Online: first published experience (UCHealth)

What uses did they find for these images? Does UCHealth recommend this practice? Did CT Lin get fired as a result of these actions? #hcldr #whyinformatics #hitsm #hotoffthepress

From freepixel via JMIR

https://formative.jmir.org/2022/4/e29496

We surveyed patients who had access to view NOT ONLY their radiology reports BUT ALSO their radiology images (including plain film, CT, MRI, PET, etc) online via the EHR patient portal.

What did they think? Were they worried? Did they post the images online? Who did they share with? (hint, 4% shared on social media)

These questions, and more, are answered in the article. Click the link above, dear Reader, and press on.

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