So you stayed at a Starwood hotel: Tips on data breach

If you stayed at one of Marriott’s Starwood hotels in recent years, hackers might have information on your address, credit card and even your passport. Some of this can be used for identity theft, as hackers create bank and other accounts under your name.

Marriott says the breach affected about 500 million guests, though it’s possible the records could include a single person who booked multiple stays. Marriott says the unauthorized access had been taking place since 2014 and was only recently discovered. It’s possible the data include hotel stays going further back.

How can you tell if you’ve been affected, and what can you do if you are?

Here are some things to know:

THE SCOPE

The breach affects only the hotel brands operated by Starwood before Marriott bought it in 2016. The brands include W Hotels, St. Regis, Sheraton, Westin, Element, Aloft, The Luxury Collection, Le Méridien and Four Points. Starwood-branded timeshare properties are also affected. Marriott-branded chains aren’t affected, as data on those stays are on a different network.

Marriott says the breach affected reservations at Starwood properties through Sept. 10, 2018. That could include reservations made for a future stay.

AM I AFFECTED?

Marriott says it began sending emails to affected guests on Friday. Be careful, though, when you receive an email about this breach, as hackers may be using the incident to dupe you into providing passwords or installing malicious software. If you get such an email, it’s best to go directly to a website Marriott has set up on this breach: answers.kroll.com. There, you can find phone numbers to call.

This May 19, 2014, file photo shows the master bathroom in the Abu Dhabi Suite at the St. Regis in Abu Dhabi, United Arab Emirates. The information of as many as 500 million guests at Starwood hotels has been compromised and Marriott said …more

WHAT SHOULD I DO?

Marriott is offering free one-year subscription to a monitoring service, WebWatcher. This service monitors websites where stolen information is shared. If your details are found, you’ll get an alert. It’s available only for guests from the U.S., Canada and the U.K. U.S. residents are also eligible for consultation with a fraud specialist and reimbursement for legal and other expenses related to identity theft.

Though Marriott doesn’t know yet whether hackers got all the keys to unlock encrypted credit card data, the company says it’s quite possible they did. You should review your credit card statements for unauthorized activities.

In the U.S., you can also request free credit reports from Equifax, Experian and TransUnion. These reports may reveal accounts opened under your name.

MY INFORMATION HAS ALREADY BEEN HACKED. WHY SHOULD I WORRY NOW?

This May 19, 2014, file photo shows the master bedroom in the Abu Dhabi Suite at the St. Regis in Abu Dhabi, United Arab Emirates. The information of as many as 500 million guests at Starwood hotels has been compromised and Marriott said …more

Hacks involving retailers and other businesses are usually limited to names, email and physical addresses and passwords. In some cases, payment cards are also stolen, meaning you need to replace your card and update all the services with auto payment enabled.

For about two-thirds of the 500 million Starwood guests affected, hackers may also have the date of birth and gender, which can contribute to identity theft.

Hackers also got passport numbers on this group of guests if the hotel had them. This might be the case with stays outside the U.S., where a U.S. driver’s license isn’t always accepted as identification. In the U.S., your passport number does change when you renew, but that might not be for years. The good news is that criminals often need the actual passport to do anything with your number.

The database may have details on future stays, including arrival and departure dates, along with your home address. Burglars could figure out when you’ll be away. Ask a friend or neighbor to check your home, or arrange a house sitter.

WHAT SHOULD I DO IN THE FUTURE?

In this Dec. 14, 2017, file photo a doorman stands at Le Meridien hotel, the venue of an international conference on security, in Chiang Mai, Thailand. The information of as many as 500 million guests at Starwood hotels has been compromised …more

There’s not much you can do to prevent such hacks, but you can mitigate the damage.

For starters, consider using a credit card rather than a debit card, as credit cards typically offer more protections against losses.

Even if you weren’t affected in this breach, request the free credit reports anyhow. After all, they are free. Details are at the Marriott website. Check the website haveibeenpwned.com to see if your information has been stolen in other breaches.

And think twice when businesses ask you for personal information. Does the hotel really need your date of birth? Perhaps the information is requested for loyalty programs that might give you free stays—but nothing’s really free, and your data has value to both the hotel and potential hackers.

https://phys.org/news/2018-11-starwood-hotel-breach.html

NYC hospitals selling companies at center of captive insurance scheme

Prominent New York City health systems are ridding themselves of an insurance company that engaged in hidden scheme to funnel hundreds of millions of dollars back to the hospitals, and pledge to use the sale proceeds to improve services.

Montefiore Health System, Maimonides Medical Center, Mount Sinai Health System and Beth Israel Medical Center, which is part of Mount Sinai, are selling the professional liability insurer Hospitals Insurance Company and its third-party administrator, FOJP Service Corporation, to The Doctors Company for $650 million.

The deal, which is subject to approval by New York's Division of Financial Services, is expected to close next year. The hospitals have used HIC and FOJP for medical malpractice insurance for 40 years, and will continue to use both companies for such services even under their new ownership.

DFS determined last year that HIC illegally kept secret the fact that its offshore captive insurance company soaked up more than $160 million in premium payments that yielded more than $200 million in investment income over a two-decade period, all while avoiding domestic regulation. The violations came to light in a 2017 settlement agreement.

 

According to the settlement agreement, HIC broke state insurance laws by hiding the existence of its captive insurance companies from state regulators, failing to get state approval to perform retrocession transactions among the insurers and working with an unlicensed adjuster—FOJP—for nearly 40 years. The company was fined $3 million.

Stephanie Reichin, a spokeswoman for FOJP and HIC, said the sale allows the hospitals to unlock capital HIC holds but which the providers do not currently have access to. The hospitals will receive 100% of the sale price, which she said they plan to reinvest into their operations. Under the deal, FOJP and HIC will become wholly owned subsidiaries of The Doctors Company, Reichin said.

Under the deal, Mount Sinai will receive half of the proceeds, which the system said will go toward its downtown transformation, including the construction of a new Mount Sinai Beth Israel Hospital, Reichin said.

Another 25% of the proceeds will go to Montefiore, which plans to will spend the money on IT platforms designed to reduce fixed costs and infrastructure to aid the transition to value-based care.

The remaining 25% will go to Maimonides, which plans to spend it on ambulatory facilities, modernization of its main campus and technology.

In a news release, FOJP and HIC said The Doctors Company shares their mission of protecting hospitals' and physicians' abilities to provide the best possible care to patients. They said deal also aligns with state policymakers' goal of expanding competition among medical malpractice insurers in the state, while remaining under the full authority of the DFS.

"The Doctors Company understands the needs of our member hospitals and physicians, and shares our mission of protecting their ability to provide the best possible care to all patients," Walter Harris, CEO of HIC and FOJP, said in a statement.
https://www.modernhealthcare.com/article/20181129/NEWS/181129910

Clinicians warn HIV prevention drug use can lead to risky behavior

Dr. Stephen Cambalik, a family medicine physician at Jorge Prieto Health Center on Chicago’s South Side sees about 13 patients who use pre-exposure prophylaxis to HIV, also known as PrEP.

Along with prescribing the medication, which if used as prescribed once a day is highly effective at staving off infection, Cambalik’s clinic also gives patients a complete risk assessment, sexual health education and regular screenings.

Even with those services, Cambalik admits he constantly has to correct patients who believe using PrEP means they don’t have to use condoms. And as a result, he worries those patients might be more susceptible to other sexually-transmitted diseases like gonorrhea, syphilis and hepatitis.

Cambalik’s concern is supported by studies. In March, the journal Clinical Infectious Diseases reported an increase of STDs among PrEP users who engaged in unprotected sex. While the number of PrEP users is relatively small now, new national guidelines for clinicians hope to change that. And the concern of properly educating patients about unprotected sex while using the medication is something providers must be conscious of now that the US Preventive Services Task Force has recommended expanded use of PrEP.

The panel’s draft guidance, if finalized, would for the first time call for clinicians to offer PrEP to patients at high risk for contracting HIV. The recommendation received the highest grade of “A,” which means the guidelines would require Affordable Care Act-compliant health plans to fully cover the cost of the daily medication, which has a list price of $1,300 a month.

“If this goes into clinical practice then it has to go with the whole package,” Cambalik warns, referring to regular follow-up care and sexual health counseling.

Dr. John Elping, professor of family and community medicine at the Virginia Tech Carilion School of Medicine in Roanoke, VA., also is a member of the task force that made the recommendation.

“We hope that this opens another door for additional prevention,” Elping said. “I think this does represent progress in how we look at HIV,.”

Despite the drug’s benefits, use of PrEP has remained low since it was first approved in 2012. Of the estimated 1.1 million Americans identified in 2015 as possibly benefitting from taking PrEP, only 90,000 prescriptions were filled that year, according to the Centers for Disease Control and Prevention. Most of those who could have benefited from PrEP that year were African-American and Latinx adults, who together accounted for 800,000 of the 1.1 million at risk but who had a combined total of only 14,000 PrEP prescriptions filled.

A University of California Santa Cruz survey of how a small group of gay and bisexual men perceived PrEP found that men who visited a clinic catering to LGBT patients were most likely to use PrEP, adding fuel to the debate that providers may stigmatize the drug or that it’s not being widely promoted. That’s despite drugmaker Gilead hosting regular informational dinners for providers like Cambalik who get invited two to three times a year.

Those dinners don’t appear to make much of a difference.

“For the average private practice that has maybe 1% of at-risk population, they will probably be oblivious to PrEP,” said Dr. David Zich, an internal and emergency medicine physician at Northwestern Medicine in Chicago.

Zich points to federal data to show the impact expanded PrEP use could have.

The CDC reports that PrEP, if taken consistently, can reduce the risk of HIV infection by up to 92%. Consistent use of condoms with the drug can reduce the risk of infection even further.

But Zich doubted the USPTF recommendation would have any impact toward reducing the 40,000 new HIV infections that occur in the U.S. each year.

“Unfortunately, many of the people who are at the highest risk are at the highest risk because they just don’t care,” said Zich, who added his assessment was based on interacting with a small subset of high-risk patients in the ED and did not speak for the majority of individual who could benefit from taking PrEP. “They have other issues in their life that predominate.”

According to the CDC, populations at highest risk for contracting HIV are among younger gay and bisexual men, who made up 61% of new infections in 2016. According to HHS, LGBT youth are two to three times more likely to attempt suicide and experience issues such as homelessness, violence, tobacco use, alcohol and substance use at greater rates than the general population.

One way to expand use of PrEP would be to educate providers on identifying the risk factors that would make a patient an eligible candidate.

The average primary care clinician shys away from asking those questions, said Wendee Wechsberg, director of substance abuse, gender and applied research for not-for-profit research institute RTI International’s Global Gender Center. “What general practitioner doctors really need to learn to do is better assessments.”

And vendors are responding to that need.

Patient platform software firm Healthvana, has a PrEP mobile app that helps facilitate the conversation and keep patients on track with their medication adherence and STD screening. The firm currently works with 200,000 PrEP users.

The comment period for the USPTF guidelines ends Dec. 26.

https://www.modernhealthcare.com/article/20181130/TRANSFORMATION01/181139992/clinicians-warn-hiv-prevention-drug-use-can-lead-to-risky-behavior

US Cancer Centers Accused of Misleading Advertising

Among US cancer centers, the vast majority of the top spenders in advertising in 2017 used deceptive marketing that conveyed a false sense of hope, according to the consumer watchdog group, Truth in Advertising (TINA.org).

The cancer centers include such prestigious institutions as MD Anderson in Houston, Memorial Sloan Kettering in New York City, Dana-Farber in Boston, and Moffitt in Tampa, Florida.

Truth in Advertising’s 1-year investigation into the direct-to-consumer television and digital marketing materials showed that 90% (43/48) featured positive patient testimonials about treatment outcomes in cancers with a 5-year survival of less than 50%.

None of the testimonials mentioned that the responses were not typical for that particular cancer type, as legally required by the Federal Trade Commission (FTC).

Almost half of the exceptional response testimonials involved patients with stage 4 cancer, and 17% attributed treatment success to participation in a clinical trial, without disclosing the inherent limitations or risks, the investigation revealed.

The investigative report, entitled “US Cancer Centers: Deceptive Marketing of Hope,” was published online October 22.

“Exploiting False Hope”

Cancer patients and their families face “devastating odds of survival and have a right to know the truth,” said Bonnie Patten, executive director of TINA.org, in a statement. “To sway this uniquely susceptible population’s decisions as to where they should seek treatment by exploiting false hope is simply not acceptable.”

While overall cancer mortality rates have declined, US cancer centers are spending record amounts on direct-to-consumer marketing. Annual spending on advertising has shot up by 320% over a 9-year period, from $54 million in 2005 to $173 million in 2014, according to the report. Today, the National Cancer Institute estimates that more than 1200 cancer centers compete for the $150 billion consumers spend on healthcare annually.

As a result of its findings, TINA.org has filed a misleading advertising complaint with the FTC against Cancer Treatment Centers of America (CTCA), based in Boca Raton, Florida. According to the watchdog group, CTCA ranked highest on its list of cancer centers that spent money on advertising in 2017, doling out $69 million of the $140 million spent that year by US cancer centers to produce more than 130 exceptional patient testimonials that were circulated in 2018.

In addition, TINA.org has put the 42 other cancer centers on notice with lettersseeking removal of “deceptive testimonials from its marketing materials.”

“TINA.org hopes that these cancer centers will do the right thing and either correct the deceptive ads or do away with them completely,” Patten told Medscape Medical News. In 2019, the organization will audit its findings to see how many cancer centers have voluntarily complied with truth in advertising laws by either remediating or removing testimonials.

“At that time, a determination will be made as to whether we will file a complaint against any of the cancer centers with the appropriate governmental authorities,” Patten explained.

She expects that the FTC will take action against CTCA since the for-profit center is “a repeat offender with the agency.” Although prior legal action brought by the FTC against CTCA was settled in 1996, the agreement to stop using deceptive testimonials in marketing materials ended in in 2016.

This is the first time that TINA.org has investigated marketing practices for US cancer centers, Patten noted, adding that “it won’t be our last…”

Cancer Centers Respond

Kim Polacek, spokesperson for strategic communications at Moffitt Cancer Center, told Medscape Medical News that their patient testimonials “provide an outlet for our patients and their loved ones to share their cancer journey in a transparent and authentic way, regardless of the outcome.”

Importantly, Polacek added that Moffitt treatment teams discuss personalized treatment options and a range of potential outcomes with all patients prior to the start of any plan.

At Memorial Sloan Kettering, Caitlin Hool, senior manager in the department of communications, said they “stand by the integrity of our communications and the importance of enabling our patients to share their experience.”

Hool pointed out that nearly half of the items flagged by TINA.org as “deceptive” were actually newsletter articles written by survivors who wanted to share “…stories of inspiration, hope and challenge.” The balance of the marketing materials called into question were made up of unscripted patient videos and educational articles, Hool said.

“Memorial Sloan Kettering holds itself to a high standard in communicating accurate and timely information about cancer and cancer treatment to the general public, patients and their families, and cancer survivors,” said Hool.

Laura Sussman, program director for communications in public relations at MD Anderson, said they are “committed to truthful advertising.” She added that “MD Anderson takes great care to ensure our messages are accurate, appropriate and responsible.”

Sussman noted that the TINA report suggests that editorial content, including information on MD Anderson’s website blog, is an example of advertising.

“This blog content focuses on the patients’ cancer journey,” she said. “It is often written by the patients themselves and includes information on side effects and loss of loved ones, in addition to stories about survivorship. Our blog also includes information from our doctors, nurses, and researchers and others involved in the patient experience.”

Ellen Berlin, director of media relations at Dana-Farber Cancer Institute, said they are committed to providing accurate and trustworthy advertising.

“Many patients appreciate the opportunity to share their individual journey and hear about the experiences of others. As with any medical treatment, every patient is unique and specific treatment options are developed and provided by clinicians working directly with patients and their families.”

In an NBC News story, big spender CTCA stated that “to ensure clinical accuracy and tell our story in an informative and responsible manner, all of our advertising undergoes meticulous review prior to publication.”

The organization noted that all of the patients volunteered to share their stories to help others who receive a similar diagnosis, and that they received no compensation.

2005 Study Shows the Problem Is Not New

The use of patient testimonials to help health care consumers decide where to get a second opinion or go for treatment is not new.

Results from a 2005 survey of the advertising used by 17 top US medical centers showed that consumers were more likely to trust first-person testimonials that came from a medical institution than another source. The survey also revealed that while the medical centers had a rigorous review process for the advertising they used to attract research subjects, none of them had anything comparable for reviewing the marketing materials aimed at patients.

“Many of the ads seemed to place the interests of the medical center before the interests of the patients,” write Robin J. Larson, MD, MPH, of the Department of Veterans Affairs Medical Center in White River Junction, Vermont, and colleagues in a report published in 2005 in the Archives of Internal Medicine.

The most commonly used marketing strategies appealed to the emotions (61.5%), promoted the prestige of the institution (60.7%), focused on a symptom or disease (53.3%), and advertised events and offers that would increase consumer contact (47.5%). Of the 21 ads for single interventions, 38% were unproved and 29% were cosmetic. None quantified positive claims and only one touched on potential harms.

More attention needs to be paid to the conflict of interest between public health and the need to generate revenue, the study authors wrote. They also suggested that a formal institutional preview of ads could be adapted from the US Food and Drug Administration’s guidelines for advertising to attract research participants, adding: “Why should patients get less protection than research subjects?”

In an accompanying editorial, Philip Greenland, MD, professor of cardiology at the Feinberg School of Medicine at Northwestern University, Chicago, Illinois, and a senior editor of JAMA, pointed out that each profession “is granted a monopoly over the use of a body of knowledge.” This power comes with the expectation that members will act with integrity to provide an altruistic service, he said.

“For physicians this means consistently placing the interests of individual patients and society above their own,” writes Greenland, then editor of the Archives of Internal Medicine.

“We must remember that we accepted the duty of caring for patients when we entered medicine, and we must continue to practice with professional attitudes and behaviors no matter what pressures we face. If we do not, the consequences will undoubtedly be a further erosion of confidence and additional loss of control over our own professional work.”

The persons referenced in this article have disclosed no relevant financial relationships.

The full report is available on the TINA.org website

https://www.medscape.com/viewarticle/905744#vp_1

When the Government Promotes Medical Marijuana Use for Pain

A new law in Illinois encourages patients to request marijuana as a substitute for prescribed opiates. A recent article on Medscape described the initiative and asked healthcare professionals for their opinions. The responses came quickly and ardently.

Many were completely in favor of the new idea. A physician’s assistant saw it as an issue of basic decency:

We have an epidemic of undertreated pain. This suffering is cruel and unnecessary. Just because a small percentage of people who use opioids end up abusing them isn’t justification for withholding pain management for the patients who need it.

An internist continued in this vein:

Cannabis has the safest therapeutic index of any scheduled drug. It is safer than acetaminophen and NSAIDs… As a physician who has seen the broad scourge of the opiate epidemic decimate towns all over the land, I find this therapeutic substitution not only timely but essential.

But more than a few were worried about how well-regulated marijuana would be. One primary care physician spoke for many:

I live in a state where marijuana use has been legalized, and I watch people using it on a daily basis in my community with less instruction than what you receive on a bottle of ibuprofen… Who is going to support my prescribing, or is this off-label and I’m naked here?

Another physician saw dark forces at work:

Use marijuana for chronic pain, and make the patient so brain-addled that even if he feels no pain, he’ll be useless as a member of society. Opiates, properly dosified, leave the patient’s mind clear to pursue his/her life normally. Once marijuana is legal all over, we’ll have a doped-up population easy to manipulate by the very few who make money out of that particular drug trade and are smart enough not to use it at all themselves.

An anesthesiologist relied on dramatic phrasing to hammer home the point:

What could possibly go wrong? Two words: opioid epidemic. Will this social experiment with cannabis be the same? The evidence is not there yet for prescribing cannabis for chronic pain…. This is madness.

A primary care physician added:

With the known or suspected dangers associated with marijuana use, such as increased risk for schizophrenia and cardiac conditions, it seems extraordinarily irresponsible to substitute one addictive substance for another with unproven benefit.

But a clinical nurse specialist was appalled by this view:

You are more worried about a potential risk for schizophrenia and cardiac conditions based on limited data [than you are about] leaving surgical patients with untreated pain. There are robust data available from other countries that haven’t done the over-the-top prohibition that we have in the United States. Opioid deaths are down in states with medical marijuana availability, such as Colorado and Oregon.

And an obstetrician put it succinctly: “It’s weed; it’s not killing people.”

A clinical nurse specialist shot back:

Tell that to the young woman’s family who was hit by a car and killed by someone stoned on pot.

Another professional found this unconvincing:

This is not an argument against cannabis use; it’s about being responsible! The facts are that cannabis has never killed anyone via overdose. The same can’t be said about opioids, sleeping medications, and even insulin.

A medical administrator thought a completely drug-free lifestyle was best:

My best pain management course is a healthy diet [and] a healthy weight. I exercise daily and take physical therapy once a week…. This is where we need to look to fight the opiate addiction. Stop thinking that the only pain management plan is a drug. Prescribing another drug in place of opioids is not the answer.

But quite a few found this reasoning a bit myopic. Another administrator shot back:

Well, lucky you…. My doctors are no longer comfortable prescribing opioids because of the present climate. So I get nothing. Well, at least I’m in no danger of becoming a 66-year-old addict. All I had to do was give up my quality of life. Thanks a lot.

A physician felt that marijuana was not quite ready for medical use:

There is a lack of research regarding which components [of marijuana] and what ratios provide the best therapeutic effects with the least side effects.

But another professional saw this as a strength rather than a weakness:

Part of the beauty of the increased flexibility here in Oregon is that growers can experiment with different strains to get different intended effects. The THC/CBD that is useful for daytime use without cognitive effects isn’t the same thing I’d recommend for someone whose pain wakes them up at night…. The variety of strains…allow patients to carefully titrate the intended effect without undue side effects.

The final word goes to a nurse who leaned into stoner stereotypes and pondered the effects marijuana could have on the ability to give a serious business presentation:

[I was addressing] people from China, San Francisco, Los Angeles, and San Diego. I have migraines and chronic pain. I cannot be wrong; I have to go into great detail, and I have to make everyone in the room understand. I can just see me on marijuana trying to accomplish this: “Hey, dude, what’s up?” Or, “Excuse me, I have to smoke a joint.”

The full article can be found on Medscape.

https://www.medscape.com/viewarticle/905403#vp_1

Amazon Introduces Cloud-Based Patient Data Mining Software

Amazon Web Services (AWS), the technology and e-commerce giant’s cloud subsidiary, has launched Amazon Comprehend Medical, a cloud-based software that information technology (IT) developers, healthcare providers, pharmaceutical companies, and others can use to mine structured data from the unstructured clinician notes in electronic health records (EHRs) and other clinical databases, according to a company release.

The extracted data can be used for clinical decision support, revenue cycle management, clinical trials management, and population health management, Amazon said. The company has previously sold similar text-analysis software to companies outside healthcare for purposes such as travel booking and customer support, according to the Wall Street Journal .

The Journal story quoted Amazon executive Taha Kass-Hout, MD, MS, the former chief health informatics officer for the US Food and Drug Administration, as saying that Amazon’s software, during the testing phase, performed as well or better than similar applications that have been studied. However, it doesn’t appear, according to Kass-Hout, that any breakthrough has been achieved.

A number of other companies, including IBM Watson Health, Optum, and smaller developers and EHR vendors, use natural language processing to identify the key clinical data in text notes and convert that information into structured data that analytic applications can then interpret. The challenge is that doctors use many different terms and abbreviations for the same concept. As a result, even the most advanced forms of natural language processing have limited accuracy and are prone to making obvious errors, such as misinterpreting an order for a test to rule out diabetes as evidence that a patient has diabetes.

Comprehend Medical, says Amazon, “allows developers to identify the key common types of medical information automatically, with high accuracy, and without the need for large numbers of custom rules. Comprehend Medical can identify medical conditions, anatomic terms, medications, details of medical tests, treatments, and procedures.”

Amazon’s data mining application is not paired with clinical analytic software. Instead, the results of the data mining are made available to analytic solutions that can access the data in the Amazon cloud. “Through the Comprehend Medical API [application programming interface], these new capabilities can be integrated with existing services and health systems easily,” Amazon said.

Providers and developers have to send the unstructured data to Comprehend Medical’s cloud server before it can be mined. Amazon says that its service protects patient confidentiality and that the company has no access to the patient data, which requires a viewer to have an encrypted key. Moreover, Amazon notes that “the service is also covered under AWS’s HIPAA eligibility and BAA [business associate agreement].”

Skeptical Responses 

It’s difficult to tell how much value the Amazon data mining software might have, Dean Sittig, PhD, professor of biomedical informatics at the University of Texas Health Science Center at Houston, told Medscape Medical News.

One reason, he said, is that Amazon has not released any data to verify the statement that the software is “highly accurate.” For the most part, he said, natural language processing applications are 75% to 80% accurate — far less than what would be required in clinical care, where even 95% accuracy isn’t considered good enough. But in areas such as screening patients for diseases and related medications, he said, the software might prove useful.

Greg Kuhnen, senior director and healthcare IT advisor for The Advisory Board Co, a healthcare consultancy firm, echoed that sentiment, saying that it would be difficult for any data mining application to be accurate and specific enough for clinical decision support.

“However, Amazon seems to have carefully selected the domains they want to target with the new software,” he told Medscape Medical News. “The domains they named — life sciences and clinical trials recruitment — are two of the easier areas to go after because they feed into a human review process that’s fairly tolerant of false positives.”

Building Care Pathways

Healthcare organizations clearly have an appetite for structured data, coupled with analytics, to support quality improvement and population health management. For example, Flagler Hospital, a community hospital in St. Augustine, Florida, uses an artificial-intelligence (AI) application to create optimal clinical pathways for patients with particular conditions and comorbidities, according to Healthcare IT News.

Flagler’s quality improvement team selected and applied the new pathways to order sets in the hospital’s EHR. In its pilot project on pneumonia, Flagler saved $1356 per patient in direct costs and lowered length of stay by 2 days. The hospital is now applying the same deep-learning software to other conditions and expects to save millions of dollars.

Similarly, Penn Medicine in Philadelphia has used deep learning to redesign its care pathways. Its first big success was in predicting which patients were likely to get sepsis in the hospital before they showed any signs of the often fatal illness. One challenge Penn had was that so much of its clinical data was unstructured.

Will data mining of the kind that Amazon is promoting significantly raise the accuracy of AI applications designed to improve the quality of care? Sittig was skeptical. While increasing the amount of structured data fed into AI algorithms might slightly improve the resultant care pathways, he said, it still wouldn’t address the challenge of human variability.

Nevertheless, if the majority of patients benefited, and physicians could alter the protocol to fit the individual patient, this approach would be valuable, he added.

https://www.medscape.com/viewarticle/905784#vp_1

Patients Often Withhold Information From Providers

Patients often do not disclose medically relevant information to their healthcare providers, according to results of a study published onlineNovember 30 in JAMA Network Open.

Withholding of information can interfere with the delivery of adequate care and perhaps even do harm. The reasons for not reporting all relevant facts during the taking of a medical history have not been well studied. Andrea Gurmankin Levy, PhD, MBe, Middlesex Community College, Connecticut, and colleagues assessed the frequency with which patients failed to disclose to their clinicians information relevant to their care, as well as the patients’ reasons for doing so, through an analysis of responses to an online survey.

Data were collected from two survey groups. Between March 16 and March 30, 2015, 2096 US adults responded to Amazon’s Mechanical Turk (MTurk) survey. Between November 6 and November 17, 2015, 3011 individuals responded to the Survey Sampling International (SSI) survey. After excluding respondents who did not meet age criteria (50-100 years) or who did not want their data included, 4510 remained.

The primary outcome measures were self-reported nondisclosure of seven types of information to the clinician and the reasons for wihholding this information. The researchers defined healthcare providers as “any medical caregiver, such as a doctor, physician’s assistant, or nurse.”

Well more than half of participants reported withholding information: 1630 from the MTurk cohort (81.1%), and 1535 from the SSI cohort (61.4%).

The most common situations in which information was withheld were not agreeing with the clinician’s recommendation (MTurk, 45.7%; SSI, 31.4%) and not understanding the clinician’s instructions (MTurk, 31.8%; SSI, 24.3%).

The five reasons most commonly indicated for participants not disclosing information were not wanting to be judged or lectured (MTurk, 81.8%; SSI, 64.1%), not wanting to hear how harmful their behavior is (MTurk, 75.7%; SSI, 61.1%), embarrassment (MTurk, 60.9%; SSI, 49.9%), not wanting the clinician to think they were difficult patients (MTurk, 50.8%; SSI, 38.1%), and not wanting to take up more of the clinician’s time (MTurk, 45.2%; SSI, 35.9%).

“If patients are withholding information from clinicians as frequently as this research suggests, then clinicians are routinely not receiving the information that they need to provide high quality care to patients, especially sicker patients,” the researchers conclude. They note that sicker patients were more likely to withhold information.

In an invited commentary, Arthur S. Elstein, PhD, from the Department of Medical Education, University of Illinois College of Medicine, Chicago, delved more deeply into the reasons for not fully disclosing information to a healthcare provider.

In his commentary, Elstein notes that “[p]erhaps the oldest question in the history of health care is, What brings you (the patient) to see me (the healer) today?’ ”

Elstein points out that the patient’s account of his or her illness “is only 1 possible account, and not necessarily the true state of affairs…. [T]he upshot is that, on the one hand, not all experiences can be retrieved on demand and, on the other, patients are sometimes reluctant to tell all they know. Both are threats to the validity of the clinical interview.”

Although the study authors found that race and education were not significant factors in whether or not patients failed to disclose information, Elstein indicates that both online surveys overrepresented college-educated white individuals and underrepresented other groups. The method of sampling selected individuals who like to take Internet surveys, Elstein writes.

Elstein also points out that nonwhite patients might be more concerned about disapproval and disrespect from the clinician, and he calls for further investigation of this “socioeconomic bias.”

The study may itself suggest an opportunity to correct the problem, Elstein says. “[T]he authors have implicitly suggested a remedy worth trying: to shift questions that are the most difficult to answer candidly in a face-to-face clinical interview to an impersonal survey instrument. The success of this study in eliciting data on the prevalence of nondisclosure suggests that this technology might be useful in solving the problem. A trial of this strategy would almost surely be less expensive than a sustained effort to change the clinical culture and the interviewing style of a generation of clinicians.”

Limitations of the study include self-reporting of memories online and the fact that if participants withheld information from healthcare providers, they might also do so on a survey. In addition, the survey did not capture the extent of nondisclosure — for example, one instance of withholding information would have counted as much as perpetual nondisclosure of drug use. In addition, the survey presented possible reasons for nondisclosure, from which the participants then chose, rather than having the participants volunteer their own reasons for withholding information.

The study was funded through faculty research funds provided by the Division of General Medicine of the University of Michigan. The researchers and Dr Elstein have disclosed no relevant financial relationships.

JAMA Network Open. Published online November 30, 2018. Full text, Commentary

https://www.medscape.com/viewarticle/905825