By MATTHEW HOLT
It was not so way back that you would create a kind of maps of well being care IT or digital well being and be roughly proper. I did it myself again within the Well being 2.0 days, together with the previous sub classes of the “Insurgent Alliance of New Supplier Applied sciences” and the “Frontier of Affected person Empowerment Applied sciences”
However these straightforward days of matching a SaaS product to the meant consumer, and differentiating it from others are gone. The map has been upended by the hurricane that’s generative AI, and it has thrown the business right into a state of confusion.
For the previous a number of months I’ve been making an attempt to determine who’s going to do what in AI well being tech. I’ve had a lot of formal and casual conversations, learn a ton and been to 3 conferences previously few months all targeted lifeless on this subject. And it’s clear nobody has reply.
In fact this hasn’t stopped folks making an attempt to attract maps like this one from Protege. As you possibly can inform there are tons of of firms constructing AI first merchandise for each side of the well being care worth (or lack of it!) chain.
However this time it’s completely different. It’s by no means clear that AI will cease on the border of a consumer or also have a clearly outlined perform. It’s not even clear that there shall be an “AI for Well being Tech” sector.
This can be a multi-dimensional situation.
The principle AI LLMs–ChatGPT (OpenAI/Microsoft), Gemini (Google/Alphabet) Claude (Anthropic/Amazon), Grok (X/Twitter), Lama (Meta/Fb)–are all able to unimaginable work inside well being care and naturally exterior it. They’ll now write in any language you want, code, create films, music, pictures and are all getting higher and higher.
And they’re improbable at interpretation and summarization. I actually dumped a fairly incomprehensible 26 page dense CMS RFI document into ChatGPT the opposite day and in just a few seconds it told me what they asked for and what they were actually looking for (that unwritten subtext). The CMS official who authored it was very impressed and was just a little upset they weren’t allowed to make use of it. If I had wished to assist CMS, it will have written the response for me too.
The massive LLMs are additionally growing “agentic” capabilities. In different phrases, they can conduct multistep enterprise and human processes.
Proper now they’re getting used immediately by well being care professionals and sufferers for each summaries, communication and companionship. More and more they’re getting used for diagnostics, teaching and remedy. And naturally many well being care organizations are utilizing them immediately for course of redesign.
In the meantime, the core workhorses of well being care are the EMRs utilized by suppliers, and the most important kahuna of all of them is Epic. Epic has a relationship with Microsoft which has its personal AI play and likewise has its personal robust relationship with OpenAI – or at the least as robust as investing $13bn in a non-profit will make your relationship. Epic is now utilizing Microsoft’s AI each in word summaries, affected person communications et al, and likewise utilizing DAX, the ambient AI scribe from Microsoft’s subsidiary Nuance. Epic additionally has a relationship with DAX rival Abridge
However that’s not essentially sufficient and Epic is clearly constructing its personal AI capabilities. In a wonderful overview over at Well being IT Immediately John Lee breaks down Epic’s non-trivial use of Ai in its clincal workflow:
- The platform now provides instruments to reorganize textual content for readability, generate succinct, patient-friendly summaries, hospital course summaries, discharge directions, and even translating discrete medical information into narrative directions.
- We can routinely destigmatize language in notes (e.g., altering “narcotic abuser” to “affected person has opiate use dysfunction”),
- Whilst a doctor, I typically have a tough time deciphering the shorthand that my colleagues so continuously use. Epic confirmed how AI can translate obtuse medical shorthand-like “POD 1 sp CABG. HD secure. Amb w asst.”-into plain language: “Put up op day 1 standing submit coronary bypass graft surgical procedure. Hemodynamically secure. Affected person is ready to ambulate with help.”
- For nurses, ambient documentation and AI-generated shift notes shall be out there, decreasing handbook entry and liberating up time for affected person care.
And naturally Epic isn’t the one EHR (truthfully!). Its rivals aren’t standing nonetheless. Meditech’s COO Helen Waters gave a wide-ranging interview to HISTalk. I paid specific consideration to her dialogue of their work with Google in AI and I’m quoting virtually all of it:
This preliminary product was constructed off of the BERT language mannequin. It wasn’t essentially generative AI, nevertheless it was certainly one of their first massive language fashions. The function in that was known as Situations Explorer, and that performance was actually a leap ahead. It was intelligently organizing the affected person info immediately from throughout the chart, and because the doctor was working within the chart workflow, providing each a longitudinal view of the affected person’s well being by particular situations and categorizing that info in a way that clinicians may shortly entry related info to specific well being points, correlated info, making it extra environment friendly in knowledgeable determination making. <snip>
Past that, with the Vertex AI platform and positively a number of iterations of Gemini, we’ve walked ahead to supply further AI choices within the class of gen AI, and that features each a doctor hospital course-of-stay narrative on the finish of a affected person’s time within the hospital to be discharged. We really generate the course-of-stay, which has been normally useful for docs to not need to begin to construct that on their very own.
We additionally do the identical for nurses as they change shifts. We give a nurse shift abstract, which mainly categorizes the related info from the earlier shift and saves them fairly a little bit of time. We’re utilizing the Vertex AI platform to do this. And along with everybody else underneath the solar, now we have clearly delivered and introduced stay ambient scribe capabilities with AI platforms from a mess of distributors, which has been profitable for the corporate as nicely.
The idea of Google and the partnership stays robust. The outcomes are clear with the imaginative and prescient that we had for Expanse Navigator. The progress continues across the LLMs, and what we’re seeing is nice promise for the way forward for these applied sciences serving to with administrative burdens and duties, but additionally continued knowledgeable capacities to have clinicians really feel robust and assured within the selections they’re making.
The voice capabilities within the idea of agentic AI will clearly go far past ambient scribing, which is each thrilling and ironic when you concentrate on how the business began with a pen method again when, we took them to keyboards, after which we took them to cellular units, the place they might faucet and swipe with tablets and telephones. Now we’re proper again to voice, which I feel shall be pleasing supplied it really works effectively and successfully for clinicians.
So in the event you learn–not even between the traces however simply what they’re saying–Epic, which dominates AMCs and large non-profit well being programs, and Meditech, the EMR for many large for-profit programs like HCA, are each constructing AI into their platforms for nearly the entire workflow that almost all clinicians and directors use.
I raised this situation numerous alternative ways at a gathering hosted by Commure, the Normal Catalyst-backed provider-focused AI firm. Commure has been via numerous iterations in its 8 yr life however it’s now an AI platform on which it’s constructing a number of merchandise or capabilities. (For extra right here’s my interview with CEO Tannay Tandon). These embrace (to this point!) administration, income cycle, stock and workers monitoring, ambient listening/scribing, medical workflow, and medical summarization. You’ll be able to guess there’s extra to return by way of growth or acquisition. As well as Commure is doing this not solely with the deep pocketed backing of Normal Catalyst but additionally with partial possession from HCA–by the way Meditech’s greatest shopper. Which means HCA has to determine what Commure is doing in comparison with Meditech.
Lastly there’s additionally a ton of AI exercise utilizing the large LLMs internally inside AMCs and in suppliers, plans and payers typically. Don’t overlook that every one these gamers have closely personalized lots of the instruments (like Epic) which exterior distributors have offered them. They’re additionally making their AI distributors “ahead deploy” engineers to customise their AI instruments to the purchasers’ workflow. However they’re additionally constructing stuff themselves. As an illustration Stanford simply launched a homegrown product that uses AI to communicate lab results to patients. Not purchased from a vendor, however developed internally utilizing Anthropic’s Claude LLM. There are dozens and dozens of those homegrown tasks taking place in each main well being care enterprise. All these information scientists need to preserve busy in some way!
So what does that say concerning the position of AI?
First it’s clear that the present platforms of report in well being care–the EHRs–are viewing themselves as large information shops and predict that the AI instruments that they and their companions develop will take over a lot of the workflow at present executed by their human customers.
Second, the legislation of tech has normally been that water flows downhill. An increasing number of firms and merchandise find yourself turning into options on different merchandise and platforms. You might recall that there was once a separate set of software program for writing (Wordperfect), presentation (Persuasion), spreadsheets (Lotus123) and now there’s MS Workplace and Google Suite. Final month an organization known as Brellium raised $16m from presumably very intelligent VCs to summarize clinical notes and analyze them for compliance. Now watch them show me flawed, however doesn’t it appear that everybody and their canine has already constructed AI to summarize and analyze medical notes? Can’t another evaluation for compliance be added on simply? It’s a fairly good guess that this performance shall be a part of some larger product very quickly.
(By the best way, one space that could be distinct is voice dialog, which proper now does appear to have a separate set of abilities and firms working in it as a result of decoding human speech and conversing with people is difficult. In fact that could be a short lived “moat” that these firms have which can find yourself again in the principle LLM quickly sufficient).
In the meantime, Vine Kuraitis, Girish Muralidharan & the late Jody Ranck simply wrote a 3 half collection on how the EMR is shifting anyway in direction of turning into a bigger unified digital health platform which means that the medical a part of the EMR shall be built-in with all the opposite course of stuff occurring in well being programs. Suppose staffing, provides, finance, advertising, and so forth. And naturally there’s nonetheless the continuing integration between EMRs and medical units and sensors throughout the hospital and finally the broader well being ecosystem.
So this integration of information units may shortly result in an AI dominated tremendous system through which a lot of selections are made routinely (e.g. AI monitoring care protocols as Robbie Pearl suggested on THCB a while back), whereas some selections are operationally made by people (ordering labs or meds, or setting staffing schedules) and at last just a few selections are extra strategic. The progress in direction of deep analysis and agentic AI being made by the large LLMs has precipitated many (probably together with Satya Nadella) to recommend that SaaS is dead. It’s not onerous to think about a brand new future the place all the pieces is scraped by the AI and brokers run all the pieces globally in a well being system.
This results in an actual drawback for each participant within the well being care ecosystem.
In case you are shopping for an AI system, you don’t know if the applying or resolution you might be shopping for goes to be cannibalized by your personal EHR, or by one thing that’s already being constructed inside your group.
In case you are promoting an AI system, you don’t know in case your product is a function of another person’s AI, or if the talent is within the prompts your clients need to develop fairly than in your software. And worse, there’s little penalty in your potential purchasers ready to see if one thing higher and cheaper comes alongside.
And that is taking place in a world through which there are new and higher LLM and different AI fashions each few months.
I feel for now the problem is that, till we get a clearer understanding of how all this performs out, there shall be a lot of false begins, funding rounds that don’t go anyplace, and AI implementations that don’t obtain a lot. Experiences just like the one from Sofia Guerra and Steve Kraus at Bessmer could assist, giving 59 “jobs to be done”. I’m simply involved that nobody shall be too positive what the best software for the job is.
In fact I await my robotic overlords telling me the proper reply.
Matthew Holt is the Writer of THCB
