Alesandro Larrazabal, M.D.

Introducing DeepCura's most ambitious feature so far. DeepCura Detective: A State-of-the-Art Tool for Physician-Validated Differential Diagnoses and Optimized Reimbursements. Underlying Clinical Architecture DeepCura generates four hypotheses with 20 differential diagnoses from analyzing more than 20,000 data points extracted from the EHR and other proprietary sources. A second agent then gathers clinical consensus among all theories, selecting five final theories based on statistical significance. This method, inspired by Microsoft’s Medprompt technique, aims to increase a model’s clinical accuracy, supporting evidence below: https://lnkd.in/d4yPedDD These five finalist theories are forwarded to our DeepCura Detective Agent to gather the required physician-validated evidence. These are then presented to the physician-in-charge to scrutinize, reject, or approve. Here's a real-life example of how DeepCura Detective can identify missed reimbursement opportunities and improvement in clinical documentation accuracy and diagnosis: Scenario: Diagnosis of Heart Failure Initial Situation: A patient comes to the hospital with symptoms like shortness of breath and fatigue. The attending physician, under time constraints, initially notes these symptoms and orders a basic set of tests, diagnosing the patient with respiratory infection based on the most apparent symptoms and initial test results. The patient is treated for the respiratory infection and sent home. Use of DeepCura: Later, a review of the patient's complete medical chart is conducted and extracted from the EHR using DeepCura, which analyzes not just the notes but also lab results, patient history, and other diagnostics more comprehensively. DeepCura identifies several additional data points: Elevated levels of certain enzymes in the blood that were slightly above normal but not initially highlighted. A history of hypertension and mild kidney issues that were not fully considered in the context of the patient's presenting symptoms. Identification of Missed Opportunities: DeepCura, through its proprietary clinical architecture, suggests that these symptoms and lab results, when combined with the patient's medical history, could also indicate the possibility of heart failure, a condition that shares symptoms with respiratory issues but requires different management. Action Taken: The tool prompts a reevaluation of the patient's diagnosis. The physician revisits the patient’s records, orders additional tests such as an echocardiogram, and consults with a cardiologist. These further investigations confirm that the patient indeed has early-stage heart failure, which was initially missed. Outcome: (Continue reading on comments section due to length limit.)

4

2 Comments

Researchers at Columbia University have unveiled #BeatProfiler, a groundbreaking tool using machine learning to assess heart function and medication response. This innovation promises to revolutionize cardiac research in several ways. 🎯 #Accuracy: BeatProfiler demonstrates exceptional precision in analyzing heart cell health and categorizing the effects of various medications. ⏱️ #Speed: Thanks to machine learning, the analysis process is significantly accelerated compared to traditional methods, saving valuable time in research and drug development. 🔍 #Transparency: With its open-source nature, BeatProfiler fosters collaboration and knowledge sharing among researchers, potentially catalyzing advancements in cardiac research. Reference : https://lnkd.in/ggPt-7-y

13

How can we improve patient experience in primary care in the midst of immense constraints? Recent conversations highlight the extreme need to transform our primary care model, which is a critical pathway to enable better experiences and outcomes for primary care patients, families, and providers. For example see: 💡 Zeev Neuwirth, MD https://lnkd.in/eBiZ6Ewm and a featured editorial posted by 💡💡Barbra Rabson https://lnkd.in/ehD-iKCE While the immense constraints in primary care delivery models are far from "simple", the featured article below offers "14 Simple Tips" on Patient Experience (published by The Journal of The American Academy of Family Physicians ). Article Highlights: 👉 A positive patient experience is the result of multiple factors and interactions throughout the patient journey. 👉Physicians and their teams can improve the patient experience through practical steps, such as expanding visit options, using pre-visit planning to keep visits organized, and involving patients in their care decisions. 👉To improve visits, try simple strategies such as sitting down, avoiding medical jargon, providing visit summaries, and using the “teachback” technique. Morcomb EF, Schlecht KA, Malone E 3rd. Improving the Patient Experience: 14 Tips. Fam Pract Manag. 2022 Mar-Apr;29(2):27-31. PMID: 35290007. **** The Patient Experience Symposium will feature a robust #PrimaryCare track in Boston Sept 16-18, 2024. www.PatientSymposium.com Learn from Susan Edgman-Levitan , Zeev Neuwirth, MD and Barbra Rabson and many other primary care experts advocating for improved primary care experiences for all. See the lastest post about the track here: https://lnkd.in/etb7rk8M The Journal of Patient Experience is a proud partner of the event. #PatientExperience #PrimaryCare #HealthcareExperience #ValueBasedHealthCare

65

5 Comments

Takeaways from week two Stanford Med216: Generative AI and Medicine - “Be part of the wave of innovation, don’t let it crash on you” with Dr. John Hennessy - Alphabet Chairman and former President Stanford University. Pulling out a key thread from Dr. Hennessy’s session was his take on technology coming in waves of innovation: • We are in the AI wave of innovation - we have seen previous waves of innovation with the internet and with mobile. This is the wave to learn about, contribute to, and be a part of. • What’s different with AI innovation? - The speed of adoption and rate of change in this wave is unprecedented. Previously, we have seen technology take years for adoption and for its impact to be seen. We are going to see changes much faster with AI and need to react specifically around impacts to education and jobs.  • Role of education - Undergrad Education – Focusing on creating lifelong learners - Graduate Education - learning enough to be fearless to push forward when a new area comes along. These goals are not different in the AI wave of innovation - now we just have more people studying linear algebra.   • Regulatory environment is very tricky - the technology can be used for good or bad, and just because it can be used for bad does not mean we outright ban it. There are no easy answers to the copyright/usage of content. If we over-regulate we will push innovation elsewhere.  • What’s coming down the pipe?  We aren’t close to AGI. The improvements seen in the past few years have certainly shifted the timeline closer than most thought, but we are still years away. The Transformer architecture was a big step forward, but this isn't the end of innovation, we will continue to improve how we are building AI. What’s exciting in healthcare? • Patient interfacing - explaining medical concepts and treatments in ways that patients can fully understand. • Diagnostic error reduction – AI should be able to reduce errors in diagnosis and reduce the time it takes to reach the correct diagnosis. • Research and drug discovery will be made much more efficient with AI. • Overall with AI patients will take a larger role in their own healthcare journey. Quick hit questions: •Contrarian truth - "Individuals can change the world." •Key advice - "Remain intellectually curious for your entire life." Thanks to Longsha Liu and Bryant Lin my co-instructors for making this course possible. #genai #lifelonglearning #futureofhealth #AI (image created with Dalle)

79

4 Comments

⚜️I had the honor of being an invited speaker at this week’s MedAxiom - An ACC Company #CVTransforum meeting in Atlanta, where I was invited to talk about my biggest passion: use of #artificialintelligence to optimize quality and delivery of clinical care. ❗️The AI healthcare market's projected growth from $20 billion presently to as much as $200-$400 billion by 2032 underscores the urgency of our understanding and strategic adoption of this transformative technology. 🔹Cardiovascular 🫀imaging is the subfield of Cardiology with the broadest embracing of #ai and for good reasons: ✅ automated image analysis ✅ automated detection of abnormalities ✅ automated prognosis and planning of next steps in treatment. 🔸AI-enabled cardiovascular interventions are already here and they hold the promise to optimize procedural planning and execution. 🔹The rise of #telehealth and "hospital at home" models, catalyzed by AI-driven remote monitoring and virtual care, promises to redefine access and convenience for our patients, much like Amazon did for retail. 🔸Large language models #llm and their potential to streamline clinical documentation and decision support through seamless human-AI dialogue is truly awe-inspiring. 🔹AI-based clinical decision support algorithms are already in clinical use in a number of hospitals and could profoundly elevate diagnostic accuracy, treatment selection, and risk stratification by synthesizing multidimensional data and evidence-based guidelines. While extremely promising, I also highlighted some key caveats and limitations of AI in healthcare. ⚠️ Data quality, bias, privacy concerns, regulatory hurdles, and the need for robust validation. 💚 AI should be viewed as a powerful tool to augment human expertise rather than replace clinicians entirely. 🙏🏻 Grateful to ACC MedAxiom for hosting this exceptional meeting and look forward to continued dialogue on advancing the adoption of AI for the betterment of cardiovascular health globally. #innovation #healthcare #healthcareinnovation #healthcarequality #medicine #cardiology American College of Cardiology Ami Bhatt, MD Jerry Blackwell, MD, MBA, FACC Guy David Lori Walsh Aashima Gupta Fatima Paruk, MD, MPH Jennifer Joe, MD Jennifer N. Avari Silva Mpirik (Acquired by Tempus AI) Tempus AI Asif Ali, M.D. Lisa Crymes Pierre Elias, MD Ashley Beecy MD, FACC Shilpa Patel Aidoc University of Washington University of Alabama at Birmingham Harvard University John Michael Maier Pat Lara Ana Mercurio-Pinto

56

3 Comments

Private equity has a role, but too often, it's exploiting healthcare. The WSJ highlights how these firms inflate costs, impacting patients and providers alike. In anesthesia, we witness this daily. We must champion investments that prioritize patient care over profit margins. It's time for leadership that demands ethical practices and safeguards our profession from those looking to make a quick buck. https://lnkd.in/e_akBuWV #Leadership #Anesthesia #Healthcare #PrivateEquity #EthicalInvesting

17

1 Comment

Like the blind men attempting to describe an elephant based on the part they are touching, to a large extent, we are still blind when it comes to the issues at stake in deploying AI in healthcare. We can sense the potential but are still too wary about the downside of this technology. No one has enough inputs to describe the beast in its entirety, as yet. ➡️ Please subscribe to my LinkedIn weekly newsletter on healthcare, wellness a productivity. https://lnkd.in/gvr5kfEM

2

Single center EHR study of 5 064 pts w/ pre-diabetes compared those starting metformin (1154) vs 13 877 non-users w/ ~4 yrs F/U. Incidence of future gout was lower w/ metformin use (7.1 vs 9.5/1000PYs; HR 0.68); with no change in SUA or CRP https://buff.ly/3wDAERR

2

Healthcare in America has many great aspects: new diagnostic tests, amazing treatments, and a front-line work force of dedicated professionals and support staff. But though the US far outspends every other nation per capita, we don’t come close to having the best health care system in the world. In fact, we rank 69th overall in healthcare per Statista: https://lnkd.in/g_-t7AA6). That's why I hope you will listen to this podcast from “Defining Health Equity: From the People on the Frontlines.” Is Out of Control Capitalism Killing our Healthcare System?  https://lnkd.in/ghzEffxW

10

1 Comment

Wes Cronkite, Chief Technology and Innovation Officer at TruBridge, stresses the importance of including rural voices in AI healthcare initiatives like the Trustworthy & Responsible AI Network (TRAIN). With millions in rural areas, their needs are often overlooked, making it crucial to ensure equitable, bias-free AI tools in healthcare. TruBridge, with 45 years of backing community healthcare, joined TRAIN to elevate rural communities and ensure AI solutions consider diverse patient data. Cronkite emphasizes the need for rural and community healthcare facilities to prepare for AI integration by upskilling staff and prioritizing patient privacy. He foresees AI's responsible use streamlining operations and improving care delivery, benefitting both providers and patients. TruBridge collaborates with rural healthcare providers through initiatives like the Dream Factory, focusing on AI solutions to address staffing shortages and training lapses, ultimately enhancing patient-clinician interactions and care delivery efficiency. #aiinhealthcare #train #ruralhealthcare With the Specialist combines artificial intelligence with a board certified neurologist to enhance neurological care in the primary care setting, bringing the neurology consult to you. #withthespecialist #neurology #innovation https://lnkd.in/euXUYdTD https://lnkd.in/gExrwg2P

1

Excellent, if controversial for some, post from Tom Blomfield. He is the partner responsible for most of my YC investments in w24 so clearly we have some similar influences. I very much agree with the observations here as well. When I was first thinking about the LUNR Venture Studio I thought about looking at this arbitrage opportunity presented by the fact that the UK has outstanding technical and creative talent but an economy that is roughly 20x smaller than the US. It is not easy to cross the pond and there is significant extra support needed beyond the usual VC stuff and in a way that spray and pray investing does not really incentivise. I decided not to do it and instead focused on building companies with my friends and neighbors here in the Harvard and MIT communities and the AI R&D stuff but someone should do it as there remains a significant opportunity therein I think. Met some really great UK founders in the last few years who are making it work themselves but there are many more. You can't change the culture but you can find and accelerate the outliers. https://lnkd.in/eZz5D84R

14

2 Comments

" Hippocratic AI says its Constellation model outperformed real nurses 79% to 63% in identifying a medication's impact on lab values; 88% to 45% in identifying condition-specific disallowed over-the-counter medications; 96% to 93% in correctly comparing a lab value to a reference range; and 81% to 57% in detecting toxic dosages of over-the-counter drugs." The integration of AI in healthcare is poised to revolutionize patient safety and the overall quality of care. Medtech companies specializing in AI are forging collaborations with technology giants such as NVIDIA, Google, Microsoft, and OpenAI, ushering in a new era of medical innovation. These partnerships, coupled with the accessibility of open-source platforms, empower smaller medtech startups to drive innovation and develop groundbreaking products that continuously raise the bar in healthcare. https://lnkd.in/ene4w3Gi

3

2 Comments

The Sequence for the week of 4/29-5/5 talks about a previously unreported repeat expansion founder mutation causing Spinocerebellar ataxia type 4 (SCA4). SCA4 is a rare subtype of SCA characterized by ataxia and nerve pain and numbness that has never before been associated with repeat expansions. This could mean an entirely new way to utilize testing and treatments for SCA4! #genetics, #publicpolicy, #geneticcounseling, #precisionmedicine, #translationalmedicine, #genetictesting, #geneticresearch, #genomesequencing, #spinocerebellarataxia, #SCA, #SCA4

4

Like an unfazed young quarterback who keeps firing it downfield despite a spate of interceptions, CMMI keeps tossing around VBC models hoping something will connect. Contrary to its intent, CMMI's programs increased spending by $5.4 billion from 2011-2020 with another increase in net spending of $1.3 billion by 2030. Of the more than 50 models the Center has implemented, only 6 have generated "statistically significant" savings. Only 4 (Home Health Value-Based Purchasing, Prior Auth Model for Non-Emergent Ambulance Transport, Diabetes Prevention Program, and Pioneer ACO) were certified for expansion. CMMI points to the voluntary nature of the programs as a challenge to achieving cost savings. However, CMS hasn't done itself any favors here by aggressively ratcheting down payments and making downside risk >>> upside risk. (Notably, two upcoming programs -- TEAM and Inpatient THA/TKA PROMs are mandatory). Finding the VBC sweet spot was always going to require some trial and error. Perhaps CMMI has learned from the programs that failed or weren't chosen for expansion. TEAM doesn't seem to be all that different from CJR. Making Care Primary aims to closely integrate primary and specialty care (or, more likely, incentivize PCPs to take on more of this work). Not surprisingly, one of the criticisms is lack of provider input. The programs are too complex, too expensive to administer, and aren't transparent. CMMI should take note of several studies demonstrating the success of physician-led VBC efforts. Here are some other thoughts: - Offer financial grants in 5- or 10-year terms for any organization that designs its own VBC program and presents a reasonable and viable clinical/business model. CMMI would do itself a favor by partnering with or at least listening to innovators. - Medicare Advantage complexity and risk adjustment handwaving shouldn't be the only mechanisms by which advanced providers can profitably care for beneficiaries. That program isn't saving money either, but it's the only way many of these approaches can generate meaningful revenue (and most still aren't profitable). - Have regular meetings with those building VBC models, particularly those with strong physician leadership. Those meetings should be transparent and productive of action plans and iterative changes that increase model viability. - Be more open about what your goals and targets are. No one should be a victim of their own success, and if you keep moving the goalposts, you shouldn't be surprised when people get frustrated and drop out. I'm certain that, given fair incentives, a meaningful voice, and an equal seat at the table, healthcare innovators can design sustainable VBC programs. But there needs to be more collaboration and a willingness to listen and engage. Otherwise, you're just slowly adding to the alphabet soup of also-ran programs. #medicine #healthcare #health #vbc #healthcareinnovation #valuebasedcare

50

17 Comments

AI meets Rheumatology: ChatGPT and patient response optimization Large language models like ChatGPT, trained on vast text data, are revolutionizing healthcare by understanding and generating human-like language.

1

Cutting through the red tape can improve healthcare delivery and patient outcomes But we know that already There is currently a lack of a clear and predictable reimbursement pathway for AI/ML-enabled medical devices which is a significant barrier to widespread adoption and integration into clinical practice By establishing a formalized payment policy, CMS can provide the necessary certainty and incentives for manufacturers to invest in developing these technologies and for providers to adopt them, ultimately improving patient care and outcomes However, tailoring the payment requirements to the unique aspects of ABHS (algorithm-based healthcare services) will be crucial to ensure the policy is effective and encourages innovation in this rapidly evolving field #healthcare #AI #ML #ABHS #reimbursement ------------------------------------------------------------------------------------------ PS: Hey there! I'm Jess, a market research consultant specializing in the healthcare and animal health industries. I help clients navigate market complexities and capitalize on growth opportunities through customized research and analysis. If you're interested in discussing how current and emerging trends could impact your business or strategy, let's connect! https://lnkd.in/e_cwDwTw

3

Incorporating the patient voice in HTA https://lnkd.in/g39FJYsN

20

1 Comment