Monday, August 7, 2017

3 Doctors Over 60 Tell Us How Healthcare Has Changed

"It's not like it used to be"




How has medicine changed in the last 30 or 40 years?  

circa 1950

circa 2000



circa 2015

 Just in the last decade medicine has changed a lot. For instance, by the end of the year approximately 90% of office-based physicians nationwide will be using electronic health records (EHRs).

The doctors: Over 100 years of collective experience

  • Barbara Bergin, MD, is an orthopedic surgeon at Texas Orthopedics and has been a doctor for 31 years. I highly recommend you check out Bergin’s blog, where she offers tips on keeping your joints healthy using conversational language, humor, and personal anecdotes.
  • Damien Howell, PT, DPT, OCS, is a physical therapist at Damien Howell Physical Therapy, and has been practicing for more than 40 years. Howell also blogs. “I started that webpage in 2003 before blogs existed,” he says with a laugh.
  • John Errol Asher, MD, is a board-certified infectious disease physician and internist, who began practicing more than 40 years ago before retiring this year.

As a senior retired ophthalmologist I have witnessed most of these changes. In 1962 when I was a junior medical school student Medicare came into existence.

The reference article focuses on the electronic health care record, which is too narrow a focus on changes over the last 49 years.

Perhaps the most annoying aspects of change have been the growth and interference with doctor and patient choices for treatments requiring authorizations for payment of claims. This interference is perhaps the one greatest change in health care.  This is the result of increasing costs, yet health care costs continue to increase.

Recently increasing regulations and CMS rules have been found to increase costs offsetting any possible reductions in health care cost.

In an effort to decrease overhead, many physicians have created group medical practice business structure,   in an effort to build an organization with greater negotiating power,  and to reduce overhead.  The former may be valid, the latter is in doubt.

3 Doctors Over 60 Tell Us How Healthcare Has Changed

A new Partnership between Humans and Machines in Healthcare



GregorTobeitz, Editor The Healthcare Nerd & The Digital Strategist


Artificial intelligence is on the lips of computer scientists. Many computer scientists promise great things for it's use in health care and medicine. It will add to the growing number of digital systems to aid in care of patients.


Nearly on a monthly basis, research that documents how algorithms are over-performing on humans, have been published.
With the current pace of advancements in AI one can easily assume that in 10 years from now algorithms will over-perform humans on 80% of today’s classified diagnosis.
10 years is a long time, when you consider that during this period we will have access to new neurosynaptic processing power such as IBM’s TrueNorth or cloud based quantum computing. Ten years ago the iPhone got introduced which led to the development of 180.000 registered health apps, which equals 50 apps a day. Yes, a large part of them aren’t useful, but we can’t ignore the impact apps had on patients and clinicians. During the last 5 years we have seen error rates on speech and image recognition drop by over 20 percent to nearly human accuracy. So it is not a long shot to predict that, soon algorithms will over-perform humans on specific tasks such as diagnosing disease or selecting the best personalized treatment plan. We can’t ignore technology that, depending where you live, can deliver 10 to 100 times better results. We should discuss on how we will design our future healthcare systems and future work, and not question if this is going to happen, as at one point it might be too late to influence our future.



Harvard Medical School, showed that AI isn’t about Humans versus Machines. They trained a Deep Learning Algorithm for identifying Metastatic Breast Cancer, interpreting pathology images. Their algorithm reached an Algorithm Accuracy 92.5%, where Pathologists reached an Accuracy of 97%. But used in combination, the detection rate approached 100 percent (approximately 99.5 percent).
It is exactly this kind of collaboration between humans and machines that is going to play a vital role in the age of AI and we already have a blueprint of how a productive partnership could look like.
Chess was one of the first areas that was taken over and subsequently dominated by machines almost 20 years ago. After Garry Kasparov, the reigning world champion at the time, lost to the IBM Computer ‘Deep Blue’ in 1997, the head to head contest between humans and machines lost much of it’s appeal. Today no human, not even the grandest of all grand masters, can beat even a mid-tier chess program running on an iPhone. After this huge symbolic victory for the machines there was doubt that humans could contribute something meaningful to the world of chess ever again.

What helped the team win didn’t have anything to do with being the best chess players or having the most powerful chess computer but having the best process of collaborating with machines. It was all about the partnership and the complementary interplay between humans and machines. Humans still have a lot to offer to the game of chess if they are not racing against the machines but with the machines. To achieve the best results humans and machines have to collaborate — they have to become partners. But this requires a new set of skills and a new way of thinking on the part of humans.
Bart de Witte is keynote speaker, innovator, intrapreneur and healthcare nerd. Bart is involved in leading edge technologies leading the Digital Health Business for IBM DACH, he has been intimate involved as a mentor in the formation and growth of a dozen startups within the healthcare sector. He is passionate about technology and data-driven transformation of healthcare systems.



We also know that in our current healthcare systems we are lacking the human element. Recent studies have shown that our social determinants count for more as 50% to our health status. From a 7 minute consultation a a physician spent less then 20% for true human interaction, and is focussed on collecting clinical data, reasoning, documenting, administrating and coordinating. But one of the most important parts of care delivery, empathy and compassion have become neglected. This already starts at medical school.
A recent study done at Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School, showed that AI isn’t about Humans versus Machines. They trained a Deep Learning Algorithm for identifying Metastatic Breast Cancer, interpreting pathology images. Their algorithm reached an Algorithm Accuracy 92.5%, where Pathologists reached an Accuracy of 97%. But used in combination, the detection rate approached 100 percent (approximately 99.5 percent).
It is exactly this kind of collaboration between humans and machines that is going to play a vital role in the age of AI and we already have a blueprint of how a productive partnership could look like.
Chess was one of the first areas that was taken over and subsequently dominated by machines almost 20 years ago. After Garry Kasparov, the reigning world champion at the time, lost to the IBM Computer ‘Deep Blue’ in 1997, the head to head contest between humans and machines lost much of it’s appeal. Today no human, not even the grandest of all grand masters, can beat even a mid-tier chess program running on an iPhone. After this huge symbolic victory for the machines there was doubt that humans could contribute something meaningful to the world of chess ever again.
We now know that is not the case.







A new Partnership between Humans and Machines in Healthcare