Headspace CEO Russ Glass on AI in healthcare.

Artificial Intelligence

GPT-4 Capable of Diagnosing Complex Cases

The New England Journal of Medicine is adding to its library of top tier publications with the launch of a new journal focused on artificial intelligence – NEJM AI – and it’s gearing up for the January debut with a sneak peek at a few early-release articles.

Use of GPT-4 to Diagnose Complex Clinical Cases was a standout study from the preview, finding that GPT-4 correctly diagnosed over half of complex clinical cases.

Researchers asked GPT-4 to provide a diagnosis for 38 clinical case challenges that each included a medical history along with six multiple choice options. The most common diagnoses included 15 cases related to infectious disease (39.5%), five cases in endocrinology (13.1%), and four cases in rheumatology (10.5%).

• GPT-4 was given the plain unedited text from each case, and solved each one five times to evaluate reproducibility.

• Those answers were compared to over 248k answers from online medical-journal readers, which were used to simulate 10k complete sets of human answers.

GPT-4 correctly diagnosed an average of 21.8 cases (57%), while the medical-journal readers correctly diagnosed an average of 13.7 cases (36%). Not too shabby considering the LLM could only leverage the case text and not the included graphics.

• Based on the simulation, GPT-4 also performed better than 99.98% of all medical-journal readers, with high reproducibility across all five tests (lowest score was 55.3%).

A couple caveats to consider are that medical-journal readers aren’t licensed physicians, and that real-world medicine doesn’t provide convenient multiple choice options. That said, a separate study found that GPT-4 performed well even without answer options (44% accuracy), and these models will only grow more precise as multimodal data gets incorporated.

The Takeaway

The race to bring AI to healthcare is on, and it’s generating a stampede of new research investigating the boundaries of the tech’s potential. As the hype of the first lap starts to give way to more measured progress, NEJM AI will most likely be one of the best places to keep up with the latest advances.

Patient-Centered Design for Diabetes Care

Glooko’s recently overhauled Mobile App makes it easier than ever for diabetes patients to organize, log, visualize, and share their data. Head over to this conversation with Glooko’s product and design team for a behind-the-scenes look at how patient-centered design is improving diabetes outcomes.

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The Wire

• Optum Employs 10% of US Physicians: The number that drew the most attention at UnitedHealth Group’s investor day was 90,000, which is the number of physicians now employed by or affiliated with Optum. That means that Optum now controls nearly 10% of all physicians in the US, and has acquired upwards of 20k doctors in the past year alone. The growth further extends Optum’s massive lead as the nation’s largest physician employer, which is put in perspective by the fact that the next two largest – Ascension and HCA Healthcare – combine for a similar total.

• Hospitals Continue to Stabilize: Kaufman Hall’s latest National Hospital Flash Report showed that median hospital operating margins stood at 1.2% through October, marking the third consecutive month at that level and signaling continued stabilization. Although year-to-date hospital operating revenue per calendar day was up 6% (vs. expenses per calendar day up 4%), the story that those numbers miss is that the gap between the top- and bottom-performers is widening, and the hospitals with the strongest provider and outpatient networks are coming out on top.

• BJC and Saint Luke’s Close Merger: Missouri-based BJC HealthCare and Saint Luke’s Health System are moving forward with their proposed merger, which is now expected to close on January 1st after receiving the go-ahead from regulators. The merger will establish a 28-hospital system with $10B in revenue across Missouri, Kansas, and Illinois, with both BJC and Saint Luke’s planning to keep their respective brands and headquarters in St. Louis and Kansas City.

• St. Luke’s + TytoCare:  Idaho-based St. Luke’s Health System (not to be confused with soon-to-be-merged Saint Luke’s in MO), announced an exclusive partnership with TytoCare to provide virtual care to its employees and health plan members. Starting in 2024, participating employees will be able to conduct high-quality remote physical exams courtesy of TytoCare’s Home Smart Clinic and included On-Demand Virtual Visits. St. Luke’s is Idaho’s largest self-insured employer as well as its biggest provider, so TytoCare could soon be adding more momentum if the service is expanded to patients.

• Should “Asian” Be One Demographic? About 25M US adults are Asian, but health disparities between subgroups are getting obscured by a federal government that combines them into one demographic. A great piece in STAT explains how Asian Americans have roots in over 50 countries with vastly different cultural and genetic backgrounds, yet orgs like the CDC and NIH continue to overlook important health drivers by using a single racial category in studies that inform policy decisions.

• Forbes 30 Under 30 in Healthcare: Forbes released its annual 30 Under 30 in Healthcare list, and it’s a great spot to check out a few of healthcare’s rising stars, or at least some very well-connected young individuals. The final roster includes up-and-comers from nearly every corner of the industry, and was selected by a panel that included AbCellera CEO Dr. Carl Hansen, Acme Capital Partner Aike Ho, and Gameto Co-Founder Dr. Dina Radenkovic.

• Nabla Powers NextGen EHR: Nabla Copilot was selected to power NextGen’s new Ambient Assist feature within its EHR, which automatically generates subjective, objective, assessment, and plan (SOAP) notes from patient-provider conversations. In a blog post discussing the launch, NextGen CMO Dr. Robert Murray touted benefits of Ambient Assist including that it never hallucinates, makes medical judgements, or stores the audio/transcription for any reason other than creating the note in real-time.

• AI Not a Priority for Group Practices: A Medical Group Management Association survey of 423 group practice leaders found that they have more pressing concerns than obsessing over AI. When asked to list their top tech priorities, fine-tuning their EHRs was the top response (35%), followed by improving patient communications (26%) and upgrading rev cycle systems (21%). Only then does AI make an appearance at rank four (13%), which the MGMA attributed to AI remaining “nascent” at 90% of group practices, while cumbersome manual workloads are ubiquitous.

• Mayo Clinic Campus Transformation: Mayo Clinic announced a $5 billion expansion of its flagship campus in Rochester, Minnesota, designed to “blur the line between physical and digital.” Clinical floors will incorporate predictive AI to help reimagine inpatient care, support hospital operations, and identify risks before they escalate. The five new buildings total a whopping 2.4M square feet are expected to be completed over the next six years, so it’ll be interesting to see what new tech makes the final cut.

• New Docs Shun Geriatrics: The US population isn’t getting any younger, but this year’s National Resident Matching Program data shows that new doctors still aren’t flocking to geriatric medicine. Only 44.5% of post-residency fellowships for geriatric internal medicine were filled in 2023, compared to almost every fellowship finding a match across interventional pulmonology, cardiovascular disease, and gastroenterology. The NRMP points to a lack of exposure to geriatric care during training as a key driver, but poor reimbursement compared to other specialties probably doesn’t help with the popularity.

• Don’t Skip Leg Day: A study presented at last week’s RSNA 2023 meeting showed that stronger muscles help stave off knee replacements. Researchers used 3T MRI to evaluate the thigh muscles of 134 people in an osteoarthritis study, half of whom underwent single total knee replacements. Those with a higher ratio of quadriceps muscle to hamstring volume had lower odds of total knee replacement, leading the researchers to conclude that a balance between the muscle groups is likely a better health indicator than pure muscle volume.

Wrangling the Right Amount of Data

Optimizing treatment decisions starts with wrangling the right amount of data. Join Synapse Medicine and Health Gorilla on December 4th at 1pm ET for an expert discussion on the tech and challenges making the biggest impact on clinical decision making, including the latest AI / data policy advances, the information gaps in EHRs, and the risks of data overwhelm.

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